Long-Term Outcomes of Rituximab Therapy in Patients With Noninfectious Posterior Uveitis Refractory to Conventional Immunosuppressive Therapy

Lasave, Andrés F.; You, Caiyun; Ma, Lina; Abusamra, Khawla; Lamba, Neerav; Navarro, Manuel; Meese, Halea; Foster, C. Stephen

doi:10.1097/iae.0000000000001563

Cited by 38 publications

(30 citation statements)

References 27 publications

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“…Rituximab was well tolerated, and the risk of infection reduced with reduction in concomitant immunosuppressive therapy. In the most recent retrospective case series on patients with recalcitrant posterior uveitis treated with rituximab, 81.8% of patients achieved control of ocular inflammation maintained at 2 years follow up, with no significant side effects requiring discontinuation …”

Section: Other Targeted Biologic Therapymentioning

confidence: 99%

The use of biologic agents in the management of uveitis

Trivedi

Katelaris

2019

Internal Medicine Journal

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The uveitides are a heterogenous group of ocular inflammatory disorders that account for the third highest cause of blindness worldwide, responsible for 5–10% of visual impairment globally. Up to 35% of patients with uveitis can suffer significant vision loss. To prevent irreversible structural damage and blindness, it is important that the diagnosis and commencement of appropriate therapy occurs promptly. Management includes topical and systemic corticosteroid therapy and conventional immunomodulatory agents, including methotrexate, azathioprine, mycophenolate mofetil and cyclosporin. Significant progress has been made in the past decade in our understanding of the immunopathological pathways that drive intraocular inflammation, allowing the development of targeted therapy with biologic agents. These include TNF‐α inhibitors, such as infliximab, adalimumab and etanercept; interleukin blockers, such as tocilizumab and daclizumab; and other targeted therapies, such as rituximab and abatacept. The efficacy of these agents has been studied in cases of severe uveitis that are refractory to conventional immunomodulatory agents and provide exciting results that have revolutionised uveitis management. Though the biologic era has provided a large armamentarium to treat uveitis, ongoing challenges and cases of recalcitrant uveitis remain, posing a challenge to internal medicine physicians. This comprehensive review aims to construct an updated summary on the existing evidence pertaining to the use of biologic agents in the treatment of uveitis. Methods include a systematic search for studies between 2000 and 2018 using PubMed, EMBASE, Ovid MEDLINE and Cochrane libraries.

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Section: Other Targeted Biologic Therapymentioning

confidence: 99%

The use of biologic agents in the management of uveitis

Trivedi

Katelaris

2019

Internal Medicine Journal

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“…Therefore, it is not clear if mCRP is truly a specific antigen involved in ocular and renal disease, or if these findings represent an auto-antibody that develops to this acute phase reactant as a results of chronic inflammation as has been reported previously in lupus nephritis [47]. Understanding the role of humoral immunity in uveitis has become more important as we try to explain the success of rituximab, a B-cell depleting biologic therapy, on certain forms of recalcitrant uveitis [48,49]. A more thorough understanding of TINU pathogenesis may also uncover an important role for humoral immunity in other forms of uveitis.…”

Section: Pathogenesismentioning

confidence: 99%

Tubulointerstitial nephritis and uveitis

Pakzad-Vaezi

Pepple

2017

Current Opinion in Ophthalmology

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Purpose of review Tubulointerstitial nephritis and uveitis (TINU) is an important yet under-recognized ocular inflammatory syndrome. This review summarizes key historical publications that identified and defined the syndrome, and more recent literature that reveal the importance of urinary beta-2 microglobulin testing and kidney biopsy in the diagnostic evaluation of patients with TINU. Additionally, research studies providing new insights into disease pathogenesis are highlighted. Recent findings In contrast with initial reports of TINU manifesting exclusively as an anterior uveitis in pediatric patients, more recent reports have identified TINU in patients of all ages with a wide range of ocular manifestations. Urinary beta-2 microglobulin has emerged as a sensitive and specific laboratory screening test, and the role of kidney biopsy in differentiating TINU from sarcoidosis continues to evolve. Genetic studies have identified HLA-DQA1*01, HLA-DQB1*05, and HLA-DRB1*01 as high risk alleles and the identification of anti-mCRP antibodies suggests a role for humoral immunity in disease pathogenesis. Management strategies have evolved to include systemic anti-inflammatory treatment as a result of important outcome studies in patients with significant renal and ocular disease. Summary With greater recognition, understanding, and treatment of this syndrome, both ocular inflammation and renal disease can be better addressed.

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“…A retrospective analysis done on eight patients with refractory uveitis secondary to JIA demonstrated good control of uveitis while under treatment . In another retrospective case series, long‐term effects of rituximab therapy were studied in 11 patients with uveitis refractory to multiple immunomodulatory agents . Four patients received rituximab as a primary therapy while seven patients took rituximab as an adjunct agent.…”

Section: Emerging and Adopted Therapiesmentioning

confidence: 99%

“…The use of rituximab has also been reported in uveitis secondary to Vogt‐Koyanagi‐Harada disease, Bechet disease, and is able to induce remission in scleritis refractory to other therapy . Even though there have been reports of side effects such as infusion reactions, macular oedema and malignancies, the use of rituximab in the setting of uveitis has not been sufficiently extensive at this time to adequately assess the side‐effect profile of the drug in the setting of uveitic diseases …”

Section: Emerging and Adopted Therapiesmentioning

confidence: 99%

“…202 In another retrospective case series, long-term effects of rituximab therapy were studied in 11 patients with uveitis refractory to multiple immunomodulatory agents. 203 Four patients received rituximab as a primary therapy while seven patients took rituximab as an adjunct agent. The study demonstrated a statistically significant reduction in the mean best-corrected visual acuity (BCVA) logMAR from 0.6 ± 0.4 to 0.3 ± 0.5.…”

Section: Rituximabmentioning

confidence: 99%

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New therapies in development for the management of non‐infectious uveitis: A review

Hassan

Karkhur

Bae

et al. 2019

Clinical Exper Ophthalmology

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Uveitis is a spectrum of inflammatory disorders characterized by ocular inflammation and is one of the leading causes of preventable visual loss. The main aim of the treatment of uveitis is to control the inflammation, prevent recurrences of the disease and preserve vision while minimizing the adverse effects associated with the therapeutic agents. Initial management of uveitis relies heavily on the use of corticosteroids. However, monotherapy with high‐dose corticosteroids is associated with side effects and cannot be maintained long term. Therefore, steroid‐sparing agents are needed to decrease the burden of steroid therapy. Currently, the therapeutic approach for non‐infectious uveitis (NIU) consists of a step‐ladder strategy with the first‐line option being corticosteroids in various formulations followed by the use of first‐, second‐ and third‐line agents in cases with suboptimal steroid response. Unfortunately, the agents currently at our disposal have limitations such as having a narrow therapeutic window along with their own individual potential side‐effect profiles. Therefore, research has been targeted to identify newer drugs as well as new uses for older drugs that target specific pathways in the inflammatory response. Such efforts are made in order to provide targeted and safer therapy with reduced side effects and greater efficacy. Several specially designed molecular antibodies are currently in various phases of investigations that can potentially halt the inflammation in patients with NIU. In the review, we have provided a comprehensive overview of the current and upcoming therapeutic options for patients with NIU.

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Long-Term Outcomes of Rituximab Therapy in Patients With Noninfectious Posterior Uveitis Refractory to Conventional Immunosuppressive Therapy

Abstract: Rituximab therapy was associated with stability and remission of recalcitrant noninfectious posterior uveitis in patients who did not tolerate or did not respond to other therapies.

Cited by 38 publications

References 27 publications

The use of biologic agents in the management of uveitis

The use of biologic agents in the management of uveitis

Tubulointerstitial nephritis and uveitis

New therapies in development for the management of non‐infectious uveitis: A review

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