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    Future of uveitis therapy takes shape with new treatments

    Several promising compounds in clinical trials; numerous agents with potential for off-label use


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    Potentially effective new drugs are in the pipeline for treating uveitis, in addition to several promising formulations in clinical trials.

    Dr. Van Gelder

    Seattle—Uveitis therapy seems to have a promising future, with many potentially effective new drugs in the pipeline. To date efficacious local and systemic modalities are currently available to treat non-infectious uveitis, several promising formulations are being evaluated in clinical trials, and numerous agents have potential for off-label use.

    This is especially noteworthy, because there has been little change over the past decade with regard to uveitis treatment options. Most patients are treated initially with oral or topical corticosteroids. The steroid-sparing immunomodulating drugs, such as methotrexate, are well established and widely used.

    Steroid-sparing drugs are efficacious, according to Russell Van Gelder, MD, PhD. Methotrexate, azathioprine, mycophenolate mofetil, and cyclosporine were all evaluated in the Systemic Immunosuppression Therapy for Eye Disease Study.

    “All of the drugs show roughly the same efficacy—about 60% to 70%—for the achieving steroid-sparing dose of less than 10 mg prednisone daily,” said Dr. Van Gelder, the Boyd K. Bucey Memorial Chair, Department of Ophthalmology, University of Washington, Seattle.

    Though all of these drugs may have serious adverse effects, they may not be as frequent as many believe, Dr. Van Gelder said.

    A new development in uveitis treatment during the past few years is the increased use of tumor necrosis alpha (TNF-α) inhibitors, specifically infliximab (Remicade, Janssen Biotech Inc.) and adalimumab (Humira, Abbott Laboratories). The expert panel review of the American Uveitis Society published in Ophthalmology (2014;121:785-796) recommended these drugs as first-line therapies and as steroid-sparing therapies in patients with Behçet’s disease and that they be used early in the treatment of juvenile idiopathic arthritis in patients for whom methotrexate was not successful, he said.

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