Perspectives for immunotherapy in noninfectious immune mediated uveitis

ABSTRACT

Introduction: Noninfectious uveitis (NIU) is one of the leading causes of blindness worldwide. In adult patients, anterior NIU is usually managed with topical corticosteroids. In intermediate, posterior uveitis. and panuveitis, systemic corticosteroids are used especially in case of bilaterality or association with systemic disease. Biotherapies are recommended in case of inefficacy or intolerance to corticosteroids or conventional immunosuppressive drugs. Anti-TNF-α agents are by far the most widely used biotherapies. In case of failure or poor tolerance to anti-TNF-α, new targeted therapies can be proposed.

Areas covered: We present and discuss an updated overview on biologics and biotherapies in NIU.

Expert opinion: In case of dependency to systemic or intravitreal steroids, sight-threatening disease, and/or failure of conventional immunosuppressive drugs, anti-TNF-α are used as first-line biologics to achieve quiescence of inflammation. Anti-interleukin-6 is another option that may be proposed as first-line biologic or in case of poor efficacy of anti-TNF-α. Interferon can be directly proposed in specific indications (e.g. refractory macular edema, sight-threatening Behçet’s uveitis). In the rare cases that remain unresponsive to traditional biotherapies, novel molecules, such as Janus-associated-kinase and anti-phosphodiesterase-4-inhibitors can be used. Therapeutic response must always be evaluated by clinical and appropriate ancillary investigations.

KEYWORDS:

• Biologic
• biotherapy
• anti-TNF-α
• anti-interleukin-6
• noninfectious uveitis
• Janus-associated kinase (JAK) inhibitors

Article highlights

• In noninfectious uveitis, systemic corticosteroids are usually proposed in case of bilateral disease, association with systemic disease and/or failure of local corticosteroids.

• In case of cortico-dependence and/or failure of conventional immunosuppressive drugs, biologics are used.

• Anti-TNF-α (especially infliximab and adalimumab) are the first-line biologics in the majority of cases.

• Anti-TNF-α are efficient in both adulthood and childhood noninfectious uveitis, including juvenile idiopathic arthritis (JIA)-uveitis and uveitis in the context of juvenile Behçet’s disease.

• Anti-interleukin-6 (especially tocilizumab) is the second option.

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

• In severe non-infectious uveitis cases that are refractory to the aforementioned conventional biologics, a new generation of targeted therapies (anti JAK, anti PDE4) can be proposed.

• Interferon-alpha is highly efficient in uveitic macular edema.

• Close collaboration with internal medicine specialists is highly recommended when biologics and targeted therapies are considered in noninfectious uveitis.

Declaration of interest

S Touhami declares travel grants, lecture and board fees from Bayer, Novartis, Allergan/Abbvie. B Bodaghi declares their role as a consultant for AbbVie, Allergan, Alimera, Horus Pharma, Novartis, Bayer, Thea. D Saadoun declares consultant fees and research grants from Abbvie, Roche Chu gai, Mylan, Amgen. J Gueudry reports travel grants and lecture fees from Bayer, Allergan/Abbvie. 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.