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Biologics for the treatment of noninfectious uveitis

current concepts and emerging therapeutics

Thomas, Akshay S.

Current Opinion in Ophthalmology: May 2019 - Volume 30 - Issue 3 - p 138–150
doi: 10.1097/ICU.0000000000000562
RETINAL, VITREOUS AND MACULAR DISORDERS: Edited by Brandon G. Busbee and John W. Kitchens
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Purpose of review There is mounting evidence supporting the use of biologic therapeutics for the management of noninfectious uveitis (NIU). This review highlights: biologics with documented efficacy in NIU; agents with ongoing evaluation for efficacy in uveitis; and therapeutics for which investigation for efficacy in NIU is warranted.

Recent findings The tumor necrosis factor-alpha (TNF-α) inhibitor adalimumab has recently gained approval by the Food and Drug Administration for the treatment of noninfectious intermediate, posterior, and panuveitis. There is mounting evidence supporting the use of tocilizumab and rituximab in NIU. There is developing interest in evaluating the interleukin (IL)-23 inhibitors for efficacy in NIU.

Summary The TNF-α inhibitors adalimumab and infliximab have the greatest body of data supporting their use in NIU. These agents are considered second-line therapy for most forms of NIU but may be considered first-line therapy for uveitis associated with Behçet's disease and juvenile idiopathic arthritis. The B-cell inhibitor rituximab and the IL-6 inhibitor tocilizumab also have documented efficacy in NIU. Tocilizumab and interferon therapy may be particularly efficacious in the management of uveitic macular edema. The IL-23 inhibitors and janus kinase inhibitors are agents whose efficacy in NIU will likely be determined in the near future.

Tennessee Retina, Nashville, USA

Correspondence to Akshay S. Thomas, MD, MS, Tennessee Retina, 345 23rd Avenue N., Suite 350, Nashville, TN 37203, USA. Tel: +1 615 983 6000; fax: +1 615 983 6010; e-mail: akshaysthomas@gmail.com

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