This multicenter, prospective case series evaluated changes in ongoing immunomodulatory and biologic therapies used for noninfectious uveitis during the COVID-19 pandemic.
Study design
Conducted at tertiary eye care centers in India, researchers collected data from 176 patients (284 eyes) with noninfectious anterior uveitis, intermediate uveitis, posterior uveitis or panuveitis. Enrolled patients were receiving immunomodulatory and/or biological therapies before the pandemic and were assessed for follow-up between March and June 2020. Main outcome measures included change in the ongoing treatments with corticosteroids, immunomodulatory and biological agents, use of alternative therapies and rates of uveitis relapse.
Outcomes
At the time of enrollment, 90 patients (121 eyes) had active noninfectious uveitis; the remaining patients were quiescent on maintenance therapy. Among patients with active disease, 7 did not receive intravenous methylprednisolone despite an indication for treatment. Thirty-five patients received a rapid tapering of oral corticosteroids despite having active disease. Most patients (161) were receiving systemic immunomodulatory and 25 were on biological therapies at baseline.
Overall, immunomodulatory therapies were altered in 18% of patients (29/161). Twenty-two eyes received intravitreal therapies during the study period. Among eyes with inactive disease, 53 relapsed; 25 of these were due to altered therapies. None of the patients developed COVID-19-related symptoms during the study period.
Limitations
This was an observational study and no interventions were performed. Since the study was not a clinical trial, it cannot determine the therapeutic value or clinical utility of certain anti-inflammatory therapies. When this study was initiated in March 2020, the guidelines for the use of corticosteroids and immunomodulatory therapies for uveitis were either not available or were preliminary and is still evolving. Thus, none of the study sites followed any particular protocol for reducing systemic corticosteroids and immunomodulatory treatment in their patients. Additionally, there is no distinction made between patients who had stable disease on long-term immunosuppression versus patients who have been more recently diagnosed with uveitis and might have had a more variable response to treatment.
Clinical significance
Altering immunomodulatory and biologic therapies or maximizing immunosuppression in patients with ocular inflammation can lead to permanent vision loss. It is important to consider the patient’s risk factors for contracting COVID-19 against their need for systemic immunosuppression.