Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

2018

OPHTHALMOLOGY

Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

01 Pubblicazione su rivista

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

DOI: 10.1016/j.ophtha.2017.11.017

ISSN: 0161-6420

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics.
Clinical Relevance: 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.
Methods: 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 reviewof the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE,CINAHL,SCOPUS,BIOSIS, andWeb 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.Atotal of 44 globally representativegroupmembersmet in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence.
Results: 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.
Conclusions: 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.

biologic agents immunomodulatory treatment uveitis