Review of immunosuppressive drug therapy in uveitis

Purpose of review: Uveitis is an important cause of functional visual loss and blindness in the developed world. Immunosuppressive drugs may be required to treat severe noninfectious uveitis successfully, but 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. This review was undertaken to highlight recent clinical advances in the treatment of severe noninfectious uveitis. Recent findings: A literature search emphasizing the research published since 2001 was undertaken. The role of previously available immunosuppressives such as antimetabolites, calcineurin inhibitors, and alkylating agents continues to develop. In recent years, more specific drugs, collectively known as biologics, have been used in the treatment of uveitis. A persistent limitation of the published literature remains the general lack of randomized, controlled clinical trials. The long-term risks of most immunosuppressive drugs and the risk of relapse after discontinuation of therapy are also not well established. Tumor necrosis factor-α antagonists are promising but extremely expensive, and they may be more effective for rheumatologic and nonocular autoimmune disorders than for uveitis. Summary: The number of options available for the treatment of severe noninfectious uveitis has expanded in the past few years. While promising, the new drugs are expensive, and their long-term efficacy and safety are not known; consequently, older immunosuppressive drugs still play an important role in the treatment of uveitis.