Current standardized therapeutic approach for uveitis in Japan

Abstract

Uveitis is an ocular disease associated with systemic immune-mediated diseases such as rheumatoid arthritis, inflammatory bowel disease and ankylosing spondylitis; and infectious diseases. Infectious uveitis occasionally shows symptoms similar to those of non-infectious uveitis. Therefore, distinguishing between non-infectious and infectious uveitis is critical for definitive diagnosis and appropriate choice of treatment. Once the cause of infection is known, treatment can be promptly initiated. However, in contrast to infectious uveitis, noninfectious uveitis is more difficult to diagnose clinically. Eliminating the possibility of infectious uveitis is important because unlike the infectious type, non-infectious uveitis is treated with immunosuppressive drugs such as corticosteroids and biological agents. Compared to other countries, the drugs available in Japan are limited. Cyclosporin A is the only immunosuppressive drug available for treating uveitis in Japan, and infliximab and adalimumab are the only biological drugs that have been approved for use in the treatment of uveitis in Japan. In this review, I describe the characteristics of typical non-infectious uveitis in Japan and its treatment methods.

Resuming anti-TNF therapy after development of miliary tuberculosis in Behcet’s disease-related uveitis: a case report

“…Bechet’s disease is a multisystemic inflammatory disorder characterized by diverse manifestations including recurrent oral and genital ulcers, ocular inflammation, and skin lesions. TNF inhibitors have emerged as a therapeutic option for refractory BD, providing symptom relief and reducing disease activity [ 2 – 7 ]. Despite the benefits of TNF inhibitors in BD, the risk of TB is a most significant concern, especially in endemic country including Japan.…”

“…The advent of tumour necrosis factor (TNF)-α inhibitors such as infliximab (IFX) and adalimumab (ADA) has significantly improved visual acuity in non-infectious uveitis including BD [ 2 – 6 ]. In Japan, IFX has been approved since 2007 for the treatment of refractory uveitis in BD, and ADA has been approved since 2016 for the treatment of refractory non-infectious uveitis including BD [ 7 ]. While TNF inhibitors have been evaluated for their efficacy in the treatment of BD, many adverse events such as infections, infusion reactions and malignancy have also been reported [ 3 , 8 , 9 ].…”

The impact of aqueous humor polymerase chain reaction and serological test results for establishing infectious uveitis diagnosis: An Indonesian experience

“…One of the most important factors to consider when treating uveitis is determining whether the underlying cause is infectious or non-infectious [ 18 ]. In developing countries, including Indonesia, where ancillary testings are not easily accessible in all centers, implementing a diagnostic approach based on clinical pattern recognition is essential in managing uveitis cases [ 6 , 7 , 8 ].…”

Sarcoidosis-Related Uveitis: A Review

“…The comparison of first-line treatments showed superiority of MTX over MMF in terms of risk of relapse and adverse events [146]. Data on cyclosporine are anecdotal, even though it is used in Japan [147,148]. Leflunomide has also been reported as an alternative to methotrexate in cases of intolerance.…”