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

Abstract

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.

Ocular sarcoidosis: clinical experience and recent pathogenetic and therapeutic advancements

“…5), plays a central role in the initiation and amplification of the inflammatory response. In addition to TNF-a inhibitors, a steadily growing list of other biologic agents, such as lymphocyte inhibitors and specific receptor antagonists, are being tested in patients with non-infectious uveitis, including sarcoidosis, both in observational case series and in non-randomized off-label studies [16,50].…”

A Review of Clinical Applications and Side Effects of Methotrexate in Ophthalmology

“…Low-dose MTX has anti-inflammatory and immunomodulatory properties by increasing levels of intracellular and extracellular adenosine [ 124 ], which is the foundation of ophthalmic MTX treatment. The standardized and recommended administration of ophthalmic MTX treatment is once a week, starting with a dose of 7.5 mg and escalating every 4 to 8 weeks up to 25–30 mg/week when necessary [ 125 , 126 ]. In patients with insufficient response to MTX alone, cyclosporin with or without azathioprine was added [ 127 ].…”

Recent Potential Treatment Approaches for the Management of Uveitis

“…The fi rst-line treatment of uveitis includes Corticosteroids that are effective in treating the infl ammation in acute conditions. However, in unrestrained conditions, immunosuppressant therapy is adopted including therapeutic agents like antimetabolites-methotrexate, azathioprine, mycophenolate; calcineurin inhibitors-cyclosporine, tacrolimus, and alkylating agents like cyclophosphamide and chlorambucil [11][12][13].…”

“…Factor- agents have also emerged as a potential therapeutic approach for treating uveitis in children and adults targeting the immunological pathway involved in the disease [11,12,14].…”