Nonsteroidal drugs for the treatment of noninfectious posterior and intermediate uveitis

Abstract

There are an increasing number of treatment options. As the vast majority of published studies in uveitis are case series or nonrandomized trials, there remains a lack of level 1 evidence to guide the choice and duration of therapy. Standard initial treatment for steroid-resistant disease is to add a single immunosuppressant to the regime, with additional agents being substituted or added as required. Combination of two immunosuppressants in addition to steroids may be indicated especially in chronic uveitis. High cost and limited long-term experience with biologic agents have restricted their use to uveitis refractory to immunosuppressants, but evidence suggests a potential therapeutic role earlier in Bechet's disease.

Fingolimod (FTY720) as an Acute Rescue Therapy for Intraocular Inflammatory Disease

“…Our data support the plausible translation of fingolimod into the management of noninfectious uveitis, as it may prove to be a highly effective rescue therapy for patients with acute or relapsing disease, precluding the need for high-dose corticosteroid therapy or prolonged biologic therapy as currently used. 38,39 Previous studies of fingolimod have not examined this role; instead, therapeutic approaches have focused on the longterm use of fingolimod. 22,23 In particular, a previous preclinical in vivo study of the use of fingolimod to treat EAU disease progression was monitored only for a short pe- Retinal cell infiltrate and structural damage in mice with experimental autoimmune uveoretinitis.…”

Current concepts and future directions in the pathogenesis and treatment of non-infectious intraocular inflammation

“…Despite which around 35% remain visually disabled, 3 often after a protracted chronic relapsing and debilitating disease course. However, published evidence and investigations of use and outcomes of immunosuppressive medications continues to accrue, emphasising the need and requirement to treat appropriately, [4][5][6][7] especially as ours and others data demonstrate that poor vision secondary to uveitis impacts the general quality-of-life. [8][9][10][11] Until recently its prevalence within the ageing population has also been grossly underestimated.…”

Uveitic macular edema

“…55 In particular, Daclizumab, an anti-IL-2 antibody, has been used in BRC patients refractory to traditional immunomodulatory therapies. Eight patients reviewed retrospectively have been initially treated with 1 mg/kg of intravenous Daclizumab at 2-week intervals.…”