Non-anti TNFα biologic agents for noninfectious uveitis associated with systemic inflammatory diseases: a systematic review

ABSTRACT

Introduction

Noninfectious uveitis related to systemic inflammatory diseases represents a leading cause of blindness. Anti-TNFα agents are the first-line biologic therapy after traditional immunosuppressants, for ocular and systemic involvement. However, some patients fails anti-TNFα agents, due to primary inefficacy, loss of efficacy or adverse events.

Areas covered

This systematic review summarizes evidence on the efficacy and safety of non-anti-TNFα biologics in adult patients with noninfectious uveitis associated with systemic inflammatory diseases. The systematic review of PubMed and Embase yielded 3663 records, from which 16 studies were included (13 non-controlled, 3 controlled trials). Most studies focused on Behçet’s syndrome (BS) and juvenile idiopathic arthritis (JIA) and assessed the efficacy of tocilizumab (n = 11), rituximab (n = 3), secukinumab (n = 1), or anakinra/canakinumab (n = 1). A body of evidence supports the use of tocilizumab BS and JIA-associated uveitis, for improving visual acuity, reducing central macular thickness, inducing ocular remission, and sparing corticosteroids. Preliminary data suggest that rituximab may represent a valid alternative, particularly in JIA, while anakinra/canakinumab might play a role in BS-associated uveitis. The role of secukinumab appears limited.

Expert opinion

Current evidence encourages investigations on the efficacy and safety of non-anti-TNFα agents in noninfectious non-idiopathic uveitis.

KEYWORDS:

• Biologics
• noninfectious uveitis
• rituximab
• systematic review
• tocilizumab

Article highlights

• Anti-TNFα agents are the first-line biologic therapy for noninfectious uveitis related to systemic inflammatory diseases. However, a subgroup of patients fails them, due to primary inefficacy, loss of efficacy or adverse events.

• This systematic review summarizes current evidence on non-anti-TNFα biologics in adult patients with noninfectious uveitis associated with systemic inflammatory diseases.

• Sixteen studies were included, mostly focusing on the efficacy and safety of tocilizumab or rituximab for patients with Behçet’s syndrome (BS) or juvenile idiopathic arthritis (JIA)-associated uveitis.

• A body of evidence supports the use of tocilizumab BS and JIA-associated uveitis.

• Preliminary data suggest that rituximab may represent a valid alternative, particularly in JIA, although safety issues need to be considered.

Acknowledgments

We acknowledge Prof. Domenico Prisco and Dr. Giacomo Emmi who contributed in conceiving this study.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/1744666X.2023.2193687

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

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

Additional information

Funding

This paper was not funded.