Emerging drugs for the treatment of noninfectious uveitis

ABSTRACT

Introduction: Uveitis is a leading cause of visual impairment and a significant burden of blindness. Although corticosteroids and conventional immunosuppressive agents have been successfully used, these are non-specific, and their long-term use may induce significant adverse effects.

Areas covered: This article discusses existing local and systemic applied treatments for ocular inflammation including corticosteroids, non-biologic, and biologic disease-modifying anti-rheumatic drugs (DMARD). Potential drugs being studied in clinical trials are introduced for both local and systemic use.

Expert opinion: Treatment options for uveitis continue to expand. Still, more efforts and research are needed to better understand the mechanisms potentially leading to clinical trials.

KEYWORDS:

• Autoimmunity
• biological
• cytokine
• corticosteroid
• kinase inhibitor
• small-molecular-weight-inhibitor
• uveitis

Article highlights

1. Uveitis accounts for ~10–15% of preventable blindness especially in relatively young patients and remains a treatment challenge, since only few agents are currently approved by regulatory agencies (EMA, PMDA, FDA).

2. Current treatment strategies are characterized by an increasing spectrum of local, intravitreal applied substances. On the other hand, the potential of biologicals has been insufficiently tested for uveitis and may offer multiple more treatment options.

3. In addition, ‘small molecules’ became a focus of interest because of their highly targeted molecular effects, their favorable bioavailability, and oral administration.

4. Limitations in testing of therapies in uveitis refer to the fact that the underlying immune pathology of different clinical entities is often not taken into account. As a result, surprising (negative) results have repeatedly appeared even in advanced stages of clinical studies. Therefore, an even more closer and careful cooperation of all parties involved in clinical studies is a prerequisite to serve our often severely affected patients.

This box summarizes key points contained in the article.

Declaration of interest

U Pleyer has served as principal investigator or consultant for: Abbvie, Alcon, Allergan, Dompé, Novartis, Santen, Shire and Thea. Dr. Pohlmann has received grant/research support from Allergan and Bayer. D Poddubnyy has received grant/research support from AbbVie, Merck Sharp & Dohme, and Novartis, has been a speaker/consultant for AbbVie, Celgene, Bristol-Myers Squibb, Boehringer Ingelheim, Janssen, Lilly, Merck Sharp & Dohme, Novartis, Pfizer, Roche and UCB Pharma. J Rademacher has received grant/research support from AbbVie, and has been a speaker and consultant for Novartis. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.