Biologic drugs in noninfectious uveitis: an update

Abstract

Noninfectious uveitis is a potentially sight-threatening ocular disorder and variable therapeutic strategies have been proposed. Over the last two decades, advances in the understanding of the pathogenesis of autoimmune disease, as well as improved biotechnology, have enabled the development of a new class of drugs called biologics, which provide selective targeting of the immune mediators of the inflammation cascade. Biologic therapies were introduced as a new option for patients with uveitis refractory to the conventional therapy using corticosteroids and immunosuppressive agents. These drugs may potentially provide more effective and less toxic treatment than conventional therapy. Biologic therapies include a wide variety of drugs with different mechanisms of action, including monoclonal antibodies against cell surface markers, cytokines and their receptors or recombinant forms of natural inhibitory molecules. Although some results are based on investigations with insufficient clinical trials, especially in biologics, the majority of biologics indicate preferable outcomes on refractory uveitis, with remarkable promise to increase the possibility of long-term remission. The development of these new drugs is one of the most revolutionary advances in recent years, and the promise of shifting paradigms makes it an exciting time for uveitis specialists worldwide.

Keywords::

• biologics
• cytokines
• immunomodulation
• inflammation
• uveitis

Financial & competing interests disclosure

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 material discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • Over the past decade, the off-label use of biologic agents such as TNF-α antagonists has improved the treatment armamentarium for refractory immune-mediated uveitis.

• • To date, the efficacy has not been directly compared to other anti-TNF agents for the management of any systemic disease.

• • Prior to the onset of biological therapies, it is essential to rule out the presence of pathologies such as latent tuberculosis, neoplasms or demyelinating diseases that may worsen with the use of these treatments.

• • Future treatment will require a better understanding of the mechanisms involved in autoimmune diseases and better delivery systems in order to provide targeted treatment with minimal side effects.