Progress in the pharmacotherapy of uveitis: the art of personalized care

ABSTRACT

Introduction

Uveitis is a heterogeneous group of inflammatory intraocular disorders that can lead to blindness, but prompt diagnosis and management can improve visual outcomes and reduce treatment burden.

Areas Covered

In this review, the authors provide an overview of commonly used treatments for the management of noninfectious uveitis.

Expert Opinion

Initially, the treatment of noninfectious uveitis was limited to corticosteroids, which have a broad range of adverse ocular and systemic effects. Now new delivery and therapeutic options, such as biological response modulators, represent novel yet exciting additions to this armory and have the potential to alter the course of treatment as well as prognostic outcomes for uveitis patients. Further research is needed to evaluate the efficacy of this novel class of immunomodulators in uveitis therapy.

KEYWORDS:

• Alkylating agents antimetabolites
• biologic response modulators
• corticosteroids
• pharmacotherapy
• uveitis

Article highlights

• Uveitis is heterogeneous group of inflammatory intraocular disorders involving the uveal tract and is a leading cause of preventable blindness in the developed world.

• First-line treatment of NIU includes topical, oral, intraocular and periocular corticosteroids. Recently, XIPERE™ (triamcinolone acetonide injectable suspension), for suprachoroidal use, was FDA-approved for the treatment of uveitic macular edema, the most common cause of vision loss in uveitis.

• A step-wise approach is then used for refractory cases, progressing after corticosteroids to include antimetabolites, non-biologic inhibitors of T-lymphocyte signaling, alkylating agents, then biologic response modulators.

• Humira® (adalimumab) injection, for subcutaneous use, is the first and only FDA approved biologic response modulator used for the treatment of NIU intermediate, posterior, and panuveitis in adults and pediatric patients 2 years of age and older.

• Novel investigational gene therapy is currently in development for the treatment of NIU.

This box summarizes key points contained in the article.

Declaration of interest

T A Ciulla is an employee of Clearside Biomedical in which he holds equity. However, this manuscript was written during his work as a Volunteer Clinical Professor of Ophthalmology at Indiana University School of Medicine, and none of the work herein represents any official position or opinion of Clearside or its management. 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 of this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.