Expert opinion on the use of biological therapy in non-infectious uveitis

ABSTRACT

Introduction: Conventional immunosuppressive drugs, anti-TNF alpha treatments and biotherapies are increasingly being used in non-infectious uveitis.

Areas covered: The present work was led by a multidisciplinary panel of experts, including internal medicine specialists, rheumatologists and ophthalmologists, and proposes an extensive review on the use of biological agents in non-infectious uveitis.

Expert opinion: In case of dependency to steroids or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or biological therapies such as anti-TNF alpha treatments (adalimumab, infliximab) can be used to achieve and maintain disease quiescence. Interferon is an efficient immunomodulatory drug that can be proposed as second-line therapy in specific indications (eg. refractory macular edema, sight-threatening Behçet’s uveitis). Other biologics, especially tocilizumab, are showing promising results.

Local treatments (steroids, sirolimus etc.) can be used as adjuvant therapies in case of unilateral relapse. Therapeutic response must always be evaluated by clinical examination and appropriate ancillary investigations.

KEYWORDS:

• Anti-TNF alpha
• biotherapy
• immunosuppressive treatment
• uveitis

Article highlights

• Non-infectious uveitis is a generic term that includes different entities.

• Systemic therapy may be used in bilateral and severe cases and in specific uveitis entities.

• Adalimumab has demonstrated efficacy and safety in non-infectious non-anterior uveitis. Other biotherapies are also potentially useful in refractory cases.

• Biologics can be considered immediately in case of disease severity or threat for visual function.

• Anti TNF alpha agents and Tocilizumab are the preferred biological therapies in non-infectious non-anterior uveitis.

• Close collaboration with internal medicine specialists is highly recommended when biologics are considered in non-infectious uveitis.

• Infection and masquerade syndromes should be ruled out in case of poor response to therapy.

This box summarizes key points contained in the article.

Declaration of interest

L Kodjikian: Principal Investigator for trials sponsored by Novartis, Bausch&Lomb, Théa, Alcon; has sat on advisory boards for Abbvie, Alcon, Allergan, Bayer, Novartis, Théa; lecture fees from Alcon, Allergan, Bayer, Horus, Novartis. A Brézin: Abbvie consultant. P Quartier: Principal Investigator for trials sponsored by Abbvie, BMS, Chugai-Roche, Novartis, Pfizer, Sanofi, advisory boards for Abbvie, Lily, Novimmune, Novartis, Pfizer, SOBI, Lecture fees from Abbvie, Chugai-Roche, Novartis, Pfizer, Sobi; Data monitoring committee member for SANOFI. J Sellam: Consultant for Roche, Chugai, Pfizer, BMS, MSD, Abbvie, Servier, Expanscience, Ménarini, Sandoz, Hospira, Janssen, Medac, Nordic Pharma. Research funded by Roche, Pfizer, TRB Chemedica. B Bodaghi: advisory boards for Abbvie, Allergan, Santen. D Saadoun: advisory boards for Abbvie. G Kaplanski: lecture fees from Abbvie and SOBI. Investigator for trials sponsored by Roche-Chugai. C Chiquet: advisory boards for Abbvie, lecture fees from Thea and Horus .P Sève received honoraria: advisory boards for Abbvie and Novartis and lectures fees from LFB, Roche, SOBI, Abbvie, Pfizer. 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 relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.