The Efficacy and Safety of Infliximab in Refractory Noninfectious Uveitis: A Meta-Analysis of Observational Studies

Egyptian Consensus Guidance for Treatment of Adults with Non-Infectious Uveitis

PURPOSE

Developing and setting up an Egyptian consensus for the management of NIU.

METHODS

A two-phase survey was implemented to obtain expert opinions from Egyptian specialists in the management of non-infectious uveitis. A core team of specialists in management of NIU formulated 21 clinical questions that were structured according to the PICO format (population, intervention, comparison, and the outcome). The literature review team conducted a systemic literature review to address the PICO questions. Based on literature search, a set of 21 sectioned recommendation statements were developed.

RESULTS

The differences in ethnicity and socioeconomic standards of the Egyptian population raised the need to develop an Egyptian consensus guidance for management of NIU. The management statements developed in this work were based on a thorough review of the literature and consensus agreement of a national expert panel. Systemic immunosuppression should be initiated during steroid tapering and should be used as first line along with steroids in case of underlying systemic disease. The panel recommended that maintenance dose of steroids should not exceed 7.5 mg daily. A major limitation facing the Egyptian health system is the socioeconomic status and limited insurance coverage. Hence, the use of conventional immunosuppression is usually exhausted before considering biologic therapy, and the role of biosimilars is emphasized to their relatively lower cost, similar efficacy, and safety in comparison to the original molecule.

CONCLUSION

This guideline provides direction for rheumatologists and ophthalmologists making decisions on management of adults with non-infectious uveitis. Putting into consideration that clinical practice varies based on local pharmaceutical availability and patient demographics.

Uveitis in the Pediatric Population and Therapeutic Management: A Current Literature Review

Uveitis is an inflammatory disease that can lead to severe complications, including vision loss. The pediatric population is particularly at risk of developing complications, as uveitis in this age group often has idiopathic origins or is associated with systemic diseases that follow a severe course. This, coupled with unfavorable treatment outcomes, continues to be a challenge in pediatric ophthalmology. The cornerstone of uveitis treatment involves a therapeutic strategy that depends on the etiology, severity, and localization of the inflammation, as well as the patient's response to treatment and the presence of ocular complications. Patients who do not receive timely treatment face a significantly increased risk of experiencing a severe disease course. Understanding potential therapeutic options and their side effects is crucial in managing children with uveitis. Equally important is the continuous monitoring of the child's condition throughout the treatment process, due to the chronic and recurrent nature of uveitis in this demographic. The authors conducted a review of the current literature from 2018 to 2023 on the management and introduction of new therapeutic approaches for children with uveitis.

The efficacy and safety of TNF inhibitor (golimumab) as salvage treatment in patients with refractory noninfectious uveitis

BACKGROUND

Tumor necrosis factor inhibitor (TNFi) is recently reported to treat noninfectious uveitis (NIU) effectively. However, as a new kind of TNFi, golimumab is just on the market in China for several years, and its administration for NIU treatment lacks sufficient evidence. Therefore, the current study aimed to investigate the efficacy and safety of golimumab in refractory NIU patients.

METHODS

Thirty NIU patients with 49 affected eyes refractory to conventional treatments (corticosteroids and immunosuppressive agents) were consecutively enrolled. They received treatment of TNFi (50 mg golimumab every 4 weeks) for at least 6 months. The anterior chamber cell grade, vitreous haziness grade, central macular thickness, and visual acuity were evaluated at baseline, month (M) 1, M3, and M6.

RESULTS

After treatment, the anterior chamber cell grade declined from baseline (0.6 ± 0.7) to M6 (0.3 ± 0.5) (P < 0.001); the vitreous haziness grade decreased from baseline (1.2 ± 1.2) to M6 (0.4 ± 0.5) (P < 0.001); meanwhile, the central macular thickness also reduced from baseline (351.4 ± 90.8 μm) to M6 (271.8 ± 54.4 μm) (P < 0.001). In terms of visual acuity (LogMAR), it showed a declined trend from baseline (0.5 ± 0.3) to M6 (0.4 ± 0.2), but without statistical significance (P = 0.096). Subgroup analyses revealed that TNFi history related to decreased golimumab efficacy. In addition, 13.3% of patients had adverse events, including elevated liver enzymes (6.7%), fatigue (3.3%), and rash (3.3%).

CONCLUSION

Golimumab is effective and safe for refractory NIU treatment, while a large-scale trial is still needed for verification.