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Systemic immunotherapy becoming more popular in ophthalmology

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Nisha Acharya

WASHINGTON — Immunosuppression therapies are becoming more popular in ophthalmology and can be used to treat common conditions such as scleritis and peripheral ulcerative keratitis, according to a speaker here.

“The important thing with these conditions is that 50% of the time there is an associated systemic autoimmune disease, usually a vasculitic condition, and so for that reason I think systemic therapy has a critical role. We know that in these conditions there are a number of infiltrating cells in the blood vessels and in the ocular tissues. Those include lymphocytes, plasma cells, macrophages and some others. So, systemic immunosuppression therapy can really help to mitigate this,” Nisha Acharya, MD, said during Cornea Day at the American Society of Cataract and Refractive Surgery annual meeting.

Conventional immunomodulatory therapies have several classes, including antimetabolites, T-cell inhibitors and alkylating agents. Antimetabolites are usually used when corticosteroid-sparing therapy is needed, she said.

The use of biologics is becoming more popular in ophthalmology. Biologics are designed to block to the activity of bioactive mediators of the immune response and are typically used to treat ocular inflammatory conditions, but these are off-label uses, Acharya said.

“There is significant progress in the field of immunosuppression. We have a lot of new recombinant technologies. There are not trials, per se, for ocular inflammation, but we’re getting experience through our own personal experience. It is not clear if these should be used earlier or late, but I think my preference is to start using biologics earlier. Cost and side effects are a concern, but I think that this whole field is very exciting. We need to be cautious, but we’re moving into a new era,” she said. – by Robert Linnehan

Reference:

Acharya N. New and old approaches to immunosuppression of the ocular surface. Presented at: American Society of Cataract and Refractive Surgery annual meeting; April 13-17, 2018; Washington.

Disclosure: Acharya reports no relevant financial disclosures.