Long-term outcomes of noninfectious uveitis treated with systemic immunomodulatory therapy: a retrospective case series

• Published in: Canadian journal of ophthalmology 2024-06
• Main Authors: Felfeli, Tina, Balas, Michael, Tai, Felicia, Eshtiaghi, Arshia, Rhee, Jess, Kaplan, Alexander J., Christakis, Panos G., Mandelcorn, Efrem D., Bakshi, Nupura K., Rubin, Laurence A., Derzko-Dzulynsky, Larissa A.
• Format: Article
• Language: English
• ISSN: 0008-4182; 1715-3360; 1715-3360
• DOI: 10.1016/j.jcjo.2024.05.005

To study the clinical characteristics and long-term outcomes of patients with noninfectious uveitis (NIU) who are treated with systemic immunomodulatory therapy (IMT). Retrospective case series. All consecutive cases of adults with NIU under the care of 5 uveitis subspecialty tertiary care clinics between 2010 to 2021 were included. Patient outcomes were assessed at initial presentation and at the latest available follow-up. A total of 418 NIU patients receiving IMT therapy with a median age of 46.0 years and 59.3% female were identified. Each patient required an average of 1.4 agents until achieving an optimal response. Following initial treatment with prednisone, patients were most commonly initiated on methotrexate. The top 3 treatments with the highest proportion of optimal treatment response when taken alone or in combination with other agents were infliximab (79.3%), cyclosporine (75%), and adalimumab (70%). The strongest predictors for requiring a greater number of IMTs trialed were younger age, panuveitis, and a chronic or recurrent disease course. Multivariable linear regression analysis suggested that baseline visual acuity at diagnosis was the only significant predictor of final visual acuity (p < 0.001). NIU patients on IMT are often trialed on multiple therapeutic agents before achieving an optimal treatment response. Visual acuity at diagnosis is a predictor of final visual outcomes, whereas chronic or recurrent disease course, younger age, and panuveitis are predictors of requiring multiagent treatment regimens.