Immunosuppressive and biologic agents in the treatment of uveitis due to systemic disease

Abstract

Purpose: To determine treatment strategy, visual outcome, adverse effects and therapeutic response to immunomodulation in non-infectious posterior uveitis (PU). Design: Retrospective study on 125 patients over 3 years with minimum follow up of 3 years. Materials and Methods: Retrospective study on 125 patients with Non infective PU over 3 years in a tertiary centre in Chennai, India were analysed. Slit lamp bio-microscopy, best corrected visual acuity, tonometry and indirect ophthalmoscopy, tailored laboratory investigations on blood, aqueous or vitreous samples, and ancillary investigations were done. All patients had active posterior uveitis in at least one eye. Immunosuppressives or/and biologics with or without corticosteroids were administered. Results: Autoimmune PU occurred in 39% males and 61% females. Median age was 47years (21 to 65 years). Immunomodulators were used in 32%, biologics in 18% and combination treatment in 50%. Sixty three percent discontinued medications after a period of 30 to 36 months. Immunosuppressive treatment was continued in 7 patients at maintenance dose for 4 years. Vision improved in 53% and deteriorated in 22% cases. Recurrence occurred in VKH and recalcitrant disease in Behcet’s uveitis. Good response, resolution and visual improvement were noted with serpiginous choroiditis. Conclusion: Immediate corticosteroids combined with immunomodulation over long term reduced inflammation, prolonged remission and preserved vision. Biologics were found to be more commonly associated with adverse effects than immunosuppressives. However serious side effects were observed with methotrexate TB is the commonest complication of treatment in Behcet’s uveitis. Serpiginous choroiditis responds favourably to immunosuppression and tapering steroids with ATT for 9 months is required.