What do you use to treat uveitis refractory to conventional synthetic DMARDs and TNF inhibitors?

I would add support to a trial of intravenous tocilizumab, particularly if macular edema is a feature of the uveitis. The STOP-Uveitis trial demonstrated reasonable efficacy in intermediate, posterior, and panuveitis (STOP-Uveitis) and I have used this within my own practice with success in patients...

Refractory uveitis is a difficult condition to treat after failure of conventional DMARDs and monoclonal TNF inhibitors. Approaches include the use of a combination of conventional DMARDs, switching to a different TNF monoclonal inhibitors, or intraocular glucocorticoid implant. IL-17 inhibition has...

I agree with @Dr. First Last -- tocilizumab seems to have the best and most consistent data. I have had some success with golimumab in a couple Blau panuveitis patients, and with secukinumab in a psoriatic arthritis-related chronic uveitis patient. A lot is trial and error with the wonderful help of...

The next step would be to escalate to Rituximab - there is data in ophthalmic literature to support this - dosing regimens vary from using the RA protocol to using the lymphoma protocol for treating the uveitis. The approach may seem aggressive, however, uveitis is one of the leading causes of preve...

Rituxan.