DeCure for Uveitis

In a retrospective study of 83 patients presenting with intermediate uveitis between 1970 and 1991, evidence of systemic disorders was found in 26 patients (31.3%). Among those 26, 10 had presumed sarcoidosis, 6 had multiple sclerosis, 2 had isolated optic neuritis, 2 had inflammatory bowel disease, 4 had isolated thyroid abnormalities, and 2 had histories suggestive of Epstein-Barr virus infection. Associated ocular findings included cystoid macular edema, peripheral retinal perivascular sheathing, cataracts, posterior vitreous detachment, fine keratic precipitates, preretinal macular fibrosis, retinal tears, retinal detachment, and optic disc edema. The authors concluded that patients with intermediate uveitis may have associated systemic diseases and should have careful follow-up with regular systemic evaluation.

A 2004 review of immunosuppressive drug therapy in uveitis noted that uveitis is an important cause of functional visual loss and blindness in the developed world. The review stated that immunosuppressive drugs may be required to treat severe noninfectious uveitis successfully, but that the efficacy and safety of such treatments are often limited by the small numbers of patients enrolled in clinical trials or studied retrospectively, the absence of control participants, and the variable natural course of some types of uveitis. The review highlighted that a persistent limitation of the published literature remains the general lack of randomised, controlled clinical trials, and that the long-term risks of most immunosuppressive drugs and the risk of relapse after discontinuation of therapy are also not well established. It noted that tumour necrosis factor-alpha antagonists are promising but extremely expensive, and that they may be more effective for rheumatologic and nonocular autoimmune disorders than for uveitis.

A 2012 review of biological agents for the treatment of uveitis stated that conventional treatment includes corticosteroids and immunosuppressive agents, which are highly efficacious but can be associated with serious systemic side effects. The review reported that over the previous two decades, advances in understanding the pathogenesis of inflammatory diseases and improved biotechnology had enabled selective targeting of chemical mediators of disease. It concluded that there are a wide variety of new and emerging biological agents currently being used in the treatment of uveitis, which has expanded the therapeutic horizons far beyond previous limitations. A 2016 review noted that the treatment of uveitis is undergoing significant change as a result of the development of new therapeutic approaches, of which the biologic agents form a major part, and that some of these targeted therapies have now undergone systematic evaluation through prospective clinical trials, unlike many of their predecessor drugs.

A 2023 review of recent advances in uveitis therapy highlighted that posterior segment noninfectious uveitis remains a significant challenge to treat due to its severity, chronicity, and high recurrence rates. The review stated that available evidence suggests that newer biologic options may be superior to conventional immunosuppressive therapies in terms of efficacy and side effect profiles, but that further high-quality research and additional clinical trials will be needed to clarify their roles in the stepladder treatment approach of noninfectious uveitis. A 2005 review of emerging approaches to the treatment of uveitis noted that the use of traditional forms of treatment is restricted by limited effectiveness and considerable side effects. Across all these reviews, what is still missing are adequately powered, randomised, controlled clinical trials with long-term follow-up, particularly for newer biologic agents, and a clear understanding of which patient subgroups might benefit most from specific treatments.