Uveitis treatment strategies include local, systemic approaches
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A local approach for the treatment of unilateral or asymmetric uveitis and systemic therapy for bilateral uveitis are effective guidelines, but they can be interchangeable for certain patients, according to a speaker.
“Many times it is possible to combine treatments, and this may result in a good alternative for the management of some conditions and reducing the burden of each approach for the individual,” Carlos Pavesio, MD, said at the virtual Euretina meeting.
Treatment choices for noninfectious intermediate uveitis and posterior uveitis can be pared down by considering clinical factors of each patient, such as the location, severity and duration of the inflammation, the laterality of the disease, and the evaluation of visual acuity and if any vision loss is reversible. Ophthalmologists must also determine if a concurrent systemic disease is present and requires treatment, Pavesio said.
The patient’s general health, adverse events of drugs, secondary effects of treatment on comorbid conditions and compliance are significant issues when determining a therapy, he said.
Several therapies are available to treat inflammation. Corticosteroids are typically used as the first line of therapy, topically as periocular or intraocular injections or systemically as oral or intravenous therapy. T-cell inhibitors, alkylating agents and antimetabolites can also be used, he said.
“We move on to the new-generational drugs, which are the biologics. The No. 1 used drug is anti-TNF agents, especially adalimumab, which is being licensed for the indication of treatment in uveitis,” Pavesio said.
A stepwise approach to treat patients is standard, which typically starts with periocular corticosteroid injections and then intraocular steroids or injections/devices. Systemic corticosteroids and immunosuppressive drugs are usually used next, and biologics are used when everything else fails.
“Clearly, this approach is a dynamic process. The likelihood is that the more we understand the role of biologics, the more likely it is they will move further down the ladder,” he said.
The specific ocular diagnosis must be considered when choosing a therapy. Intermediate uveitis, for example, benefits from either a systemic or local approach, but Behçet’s disease and Vogt-Koyanagi-Harada disease are examples of diseases that do not do well with local therapy and require systemic therapy, he said.
Patient age, the presence of active systemic disease and any choroidal involvement must also be considered.
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Pavesio C. Local and/or systemic strategies: What is the best option for each patient? Presented at: Euretina 2020 meeting; Oct. 2-4, 2020 (virtual meeting).
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