Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis
Authors: Andrew D. Dick, James T. Rosenbaum, Hassan A. Al-Dhibi, Rubens Belfort, Antoine P. Brézin, Soon Phaik Chee, Janet L. Davis, Athimalaipet V. Ramanan, Koh-Hei Sonoda, Ester Carreño, Heloisa Nascimento, Sawsen Salah, Sherveen Salek, Jay Siak, Laura Steeples, Massimo Accorinti, Nisha Acharya, Alfredo Adan, Rupesh Agrawal, Nurullah Akkoc, Saed Al Ghamdi, Turki Al Ghamdi, Anood Al Saati, Nasser Alsabaani, Mohamed Al-Shamarani, Artur Bachta, Talin Barisani-Asenbauer, Nicholas Beare, Fernanda Belga Ottoni Porto, Ricardo Blanco, Anita Chan Sook Yee, Vinod Chandran, Christophe Chiquet, Hiok Hee Chng, Andrius Cimbalas, Luca Cimino, Miguel Cordero-Coma, Couto Cristobal, Miguel Cuevas, João Eurico da Fonseca, Joke de Boer, Alejandra de la Torre, Ilse De Schryver, Larissa Derzko-Dzulynsky, David Diaz-Valle, Claudia Eugenia Duran Merino, Andrea Facsko, Luis Figueira, Alejandro Fonollosa, Eric Fortin, Richard Gale, Mauro Galeazzi, Sandra Garcia, Jose Maria Garcia Ruiz de Morales, Nataša Gašperšič, Debra Goldstein, Marta Guedes, Yan Guex-Crosier, Ahmet Gul, Rola Hamam, Muhammad Haroon, Kenichi Hasegawa, Arnd Heiligenhaus, Claire Hooper, Yih-Shiou Hwang, De-Kuang Hwang, Xavier Juanola, Toshikatsu Kaburaki, Sibel Kadayifcilar, John Kempen, Takeshi Kezuka, Amin Kherani, Maarja Kirsimäe, Kaisu Kotaniemi, Aleksandra Kraut, Agnieszka Kubicka-Trząska, Lucia Kuffova, Susan Lightman, Lyndell Lim, Wee Kiak Lim, Peter McCluskey, Mairide McGuire, Pierfrancesco Mirabelli, Elisabetta Miserocchi, Marta Misiuk-Hojło, Cristina Muccioli, Santiago Muñoz, Conor Murphy, Philip I. Murray, Zoltan Nagy, Kenichi Namba, Piergiorgio Neri, Quan Nguyen, Donncha O'Gradaigh, Mohammed Omair, Kati Otsa, Yilmaz Ozyazgan, Franco Pablo, Maria Pia Paroli, Uwe Pleyer, Gyula Poór, Rui Proença, Theodore Rabinovitch, Russell Read, Margarita Rebrov, Claudia Recillas-Gispert, Aniki Rothova, Sergio Schwartzman, Pascal Seve, Srilakshmi Sharma, Joanne Sims, Nicolette Sohár, Eric Suhler, Sándor Szántó, Zsuzsanna Szepessy, Christoph Tappeiner, Jennifer Thorne, Ilknur Tugal Tutkun, Anna Turno-Kręcicka, Joachim Van Calster, Irene van der Horst-Bruinsma, Nataša Vidovič Valentinčič, Albert Vitale, Stephanie Voorduin Ramos, Nenad Vukojevic, Denis Wakefield, François Willermain, Nilufer Yalcindag, Joyce Hisae Yamamoto, Stephen Yeh, Reda Zemaitiene, Olga Ziouzina
Journal: Ophthalmology (2018)

An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics.The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents.An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence.In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed.Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents.