Topics:
Rheumatology • Spondyloarthritis • Uveitis • Inflammatory eye disorders • Ophthalmology • TNF inhibitor
What do you use to treat uveitis refractory to conventional synthetic DMARDs and TNF inhibitors?
Are IL-17 or IL-23 inhibitors helpful?
Answer from: at Academic Institution
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...
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Answer from: at Academic Institution
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...
Comments
at Massachusetts Eye Research and Surgery Institution (MERSI)
In our experience, tocilizumab, when given intrave...
In our experience, tocilizumab, when given intrave...
Answer from: at Community Practice
I agree with @Vikas Majithia -- 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 he...
Answer from: at Academic Institution
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...
Answer from: at Academic Institution
Rituxan.