Safety of systemic therapy for noninfectious uveitis

ABSTRACT

Introduction: The treatment strategies for noninfectious uveitis (NIU) aim to achieve disease remission, prevention of recurrences, and preserving vision, while minimizing the side effects associated with the therapies used.

Areas covered: The index review aims to provide a detailed overview of the adverse events and safety parameters associated with the systemic therapies for the management of the NIU.

Expert opinion: Despite being the cornerstone of management of acute cases of NIU, long-term corticosteroid use is associated with multi-system side effects, requiring the use of steroid-sparing agents. Adalimumab was recently approved by the FDA for the management of NIU based on the results of VISUAL studies. Similarly, newer drugs targeting various aspects of the inflammatory cascade are being developed. However, until we completely understand the molecular pathways of the inflammatory diseases, the therapeutic profile of these newer agents needs to be broad enough to suppress inflammatory cascade and narrow enough to spare normal cellular processes. Another strategy that has shown some potential in decreasing the systemic side effects is to provide local drug delivery. Therefore, the future of management of NIU is very bright with many novel therapeutic agents and strategies of drug delivery on the horizon.

KEYWORDS:

• Noninfectious uveitis
• systemic therapies
• safety
• immunomodulatory agents
• expert opinion

Article highlights

• The main aim in the management of uveitis is to achieve quiescence, prevent the disease from recurring, and preserve the visual function, while minimizing the adverse effects associated with the available treatment.

• The long-term management of NIU is a therapeutic challenge and follows a step-wise approach. As we climb the ladder, treatment efficacy increases; however, the therapeutic window also narrows down and side effect profile becomes broad, limiting the use of highly potent drugs such as alkylating agents to refractory cases.

• The choice of agent is dependent upon a variety of factors, such as severity of the ocular condition, underlying disease etiology, and association with a systemic disease entity.

• Apart from corticosteroids, adalimumab is currently the only FDA approved agent for the long-term management of NIU.

• An important aspect of management of uveitis is its control during pregnancy as autoimmune disease commonly affect females of reproductive ages. Additionally, the management of uveitis during pregnancy is also not well established because of the absence of data from controlled clinical trials due to ethical considerations.

This box summarizes key points contained in the article.

Declaration of interest

QD Nguyen serves on the Scientific Advisory Board for AbbVie, Bayer, EyePoint, Genentech, Regeneron, and Santen, among others. QDN also chaired the Steering Committee for the VISUAL, SAVE and SAVE-2, and STOP-Uveitis studies and was on the Steering Committee for other studies sponsored by Genentech and Regeneron. The Byers Eye Institute at Stanford University receives research funding from Research to Prevent Blindness. 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. 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.