Update on the use of systemic biologic agents in the treatment of noninfectious uveitis

Sirichai Pasadhika, James (Jim) Rosenbaum

Research output: Contribution to journalArticle

69 Citations (Scopus)

Abstract

Uveitis is one of the leading causes of blindness worldwide. Noninfectious uveitis may be associated with other systemic conditions, such as human leukocyte antigen B27-related spondyloarthropathies, inflammatory bowel disease, juvenile idiopathic arthritis, Behçet's disease, and sarcoidosis. Conventional therapy with corticosteroids and immunosuppressive agents (such as methotrexate, azathioprine, mycophenolate mofetil, and cyclosporine) may not be sufficient to control ocular inflammation or prevent non-ophthalmic complications in refractory patients. Off-label use of biologic response modifiers has been studied as primary and secondary therapeutic agents. They are very useful when conventional immunosuppressive therapy has failed or has been poorly tolerated, or to treat concomitant ophthalmic and systemic inflammation that might benefit from these medications. Biologic therapy, primarily infliximab, and adalimumab, have been shown to be rapidly effective for the treatment of various subtypes of refractory uveitis and retinal vasculitis, especially Behçet's disease-related eye conditions and the uveitis associated with juvenile idiopathic arthritis. Other agents such as golimumab, abatacept, canakinumab, gevokizumab, tocilizumab, and alemtuzumab may have great future promise for the treatment of uveitis. It has been shown that with proper monitoring, biologic therapy can significantly improve quality of life in patients with uveitis, particularly those with concurrent systemic symptoms. However, given high cost as well as the limited long-term safety data, we do not routinely recommend biologics as first-line therapy for noninfectious uveitis in most patients. These agents should be used with caution by experienced clinicians. The present work aims to provide a broad and updated review of the current and in-development systemic biologic agents for the treatment of noninfectious uveitis.

Original languageEnglish (US)
Pages (from-to)67-81
Number of pages15
JournalBiologics: Targets and Therapy
Volume8
DOIs
StatePublished - Feb 15 2014
Externally publishedYes

Fingerprint

Uveitis
Biological Factors
Biological Therapy
Juvenile Arthritis
Therapeutics
Immunosuppressive Agents
Retinal Vasculitis
Mycophenolic Acid
Off-Label Use
Inflammation
Spondylarthropathies
Eye Diseases
Azathioprine
Blindness
Sarcoidosis
HLA Antigens
Biological Products
Inflammatory Bowel Diseases
Methotrexate
Cyclosporine

Keywords

  • Biologics
  • Eye
  • Monoclonal antibody

ASJC Scopus subject areas

  • Oncology
  • Immunology and Allergy
  • Pharmacology (medical)
  • Gastroenterology
  • Rheumatology

Cite this

Update on the use of systemic biologic agents in the treatment of noninfectious uveitis. / Pasadhika, Sirichai; Rosenbaum, James (Jim).

In: Biologics: Targets and Therapy, Vol. 8, 15.02.2014, p. 67-81.

Research output: Contribution to journalArticle

@article{e4029a06c49c493ea9a22f4c57663c14,
title = "Update on the use of systemic biologic agents in the treatment of noninfectious uveitis",
abstract = "Uveitis is one of the leading causes of blindness worldwide. Noninfectious uveitis may be associated with other systemic conditions, such as human leukocyte antigen B27-related spondyloarthropathies, inflammatory bowel disease, juvenile idiopathic arthritis, Beh{\cc}et's disease, and sarcoidosis. Conventional therapy with corticosteroids and immunosuppressive agents (such as methotrexate, azathioprine, mycophenolate mofetil, and cyclosporine) may not be sufficient to control ocular inflammation or prevent non-ophthalmic complications in refractory patients. Off-label use of biologic response modifiers has been studied as primary and secondary therapeutic agents. They are very useful when conventional immunosuppressive therapy has failed or has been poorly tolerated, or to treat concomitant ophthalmic and systemic inflammation that might benefit from these medications. Biologic therapy, primarily infliximab, and adalimumab, have been shown to be rapidly effective for the treatment of various subtypes of refractory uveitis and retinal vasculitis, especially Beh{\cc}et's disease-related eye conditions and the uveitis associated with juvenile idiopathic arthritis. Other agents such as golimumab, abatacept, canakinumab, gevokizumab, tocilizumab, and alemtuzumab may have great future promise for the treatment of uveitis. It has been shown that with proper monitoring, biologic therapy can significantly improve quality of life in patients with uveitis, particularly those with concurrent systemic symptoms. However, given high cost as well as the limited long-term safety data, we do not routinely recommend biologics as first-line therapy for noninfectious uveitis in most patients. These agents should be used with caution by experienced clinicians. The present work aims to provide a broad and updated review of the current and in-development systemic biologic agents for the treatment of noninfectious uveitis.",
keywords = "Biologics, Eye, Monoclonal antibody",
author = "Sirichai Pasadhika and Rosenbaum, {James (Jim)}",
year = "2014",
month = "2",
day = "15",
doi = "10.2147/BTT.S41477",
language = "English (US)",
volume = "8",
pages = "67--81",
journal = "Biologics: Targets and Therapy",
issn = "1177-5475",
publisher = "Dove Medical Press Ltd.",

}

TY - JOUR

T1 - Update on the use of systemic biologic agents in the treatment of noninfectious uveitis

AU - Pasadhika, Sirichai

AU - Rosenbaum, James (Jim)

PY - 2014/2/15

Y1 - 2014/2/15

N2 - Uveitis is one of the leading causes of blindness worldwide. Noninfectious uveitis may be associated with other systemic conditions, such as human leukocyte antigen B27-related spondyloarthropathies, inflammatory bowel disease, juvenile idiopathic arthritis, Behçet's disease, and sarcoidosis. Conventional therapy with corticosteroids and immunosuppressive agents (such as methotrexate, azathioprine, mycophenolate mofetil, and cyclosporine) may not be sufficient to control ocular inflammation or prevent non-ophthalmic complications in refractory patients. Off-label use of biologic response modifiers has been studied as primary and secondary therapeutic agents. They are very useful when conventional immunosuppressive therapy has failed or has been poorly tolerated, or to treat concomitant ophthalmic and systemic inflammation that might benefit from these medications. Biologic therapy, primarily infliximab, and adalimumab, have been shown to be rapidly effective for the treatment of various subtypes of refractory uveitis and retinal vasculitis, especially Behçet's disease-related eye conditions and the uveitis associated with juvenile idiopathic arthritis. Other agents such as golimumab, abatacept, canakinumab, gevokizumab, tocilizumab, and alemtuzumab may have great future promise for the treatment of uveitis. It has been shown that with proper monitoring, biologic therapy can significantly improve quality of life in patients with uveitis, particularly those with concurrent systemic symptoms. However, given high cost as well as the limited long-term safety data, we do not routinely recommend biologics as first-line therapy for noninfectious uveitis in most patients. These agents should be used with caution by experienced clinicians. The present work aims to provide a broad and updated review of the current and in-development systemic biologic agents for the treatment of noninfectious uveitis.

AB - Uveitis is one of the leading causes of blindness worldwide. Noninfectious uveitis may be associated with other systemic conditions, such as human leukocyte antigen B27-related spondyloarthropathies, inflammatory bowel disease, juvenile idiopathic arthritis, Behçet's disease, and sarcoidosis. Conventional therapy with corticosteroids and immunosuppressive agents (such as methotrexate, azathioprine, mycophenolate mofetil, and cyclosporine) may not be sufficient to control ocular inflammation or prevent non-ophthalmic complications in refractory patients. Off-label use of biologic response modifiers has been studied as primary and secondary therapeutic agents. They are very useful when conventional immunosuppressive therapy has failed or has been poorly tolerated, or to treat concomitant ophthalmic and systemic inflammation that might benefit from these medications. Biologic therapy, primarily infliximab, and adalimumab, have been shown to be rapidly effective for the treatment of various subtypes of refractory uveitis and retinal vasculitis, especially Behçet's disease-related eye conditions and the uveitis associated with juvenile idiopathic arthritis. Other agents such as golimumab, abatacept, canakinumab, gevokizumab, tocilizumab, and alemtuzumab may have great future promise for the treatment of uveitis. It has been shown that with proper monitoring, biologic therapy can significantly improve quality of life in patients with uveitis, particularly those with concurrent systemic symptoms. However, given high cost as well as the limited long-term safety data, we do not routinely recommend biologics as first-line therapy for noninfectious uveitis in most patients. These agents should be used with caution by experienced clinicians. The present work aims to provide a broad and updated review of the current and in-development systemic biologic agents for the treatment of noninfectious uveitis.

KW - Biologics

KW - Eye

KW - Monoclonal antibody

UR - http://www.scopus.com/inward/record.url?scp=84896806271&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896806271&partnerID=8YFLogxK

U2 - 10.2147/BTT.S41477

DO - 10.2147/BTT.S41477

M3 - Article

AN - SCOPUS:84896806271

VL - 8

SP - 67

EP - 81

JO - Biologics: Targets and Therapy

JF - Biologics: Targets and Therapy

SN - 1177-5475

ER -