Defined protocols are needed to optimize biologic therapy for noninfectious uveitis

Data from a systematic literature review were used to determine the efficacy and safety of optimizing biologic therapy in patients with noninfectious uveitis (NIU) in remission after treatment.

Study design

Eleven studies published before March 2021, enrolling a total of 513 patients, were included in the literature review. All of the studies were of tumor necrosis factor (TNF) inhibitors.

Outcomes

There was no set criterion of when to begin optimization of therapy, though it is recommended to allow for at least 3–6 months of disease inactivity. Optimization of therapy allowed for overall decreased costs, but relapse rates ranged from 25%–50%, with variable time frames of when relapse occurred. However, relapse could be controlled with either dose escalation or switching to a different TNF inhibitor.

Limitations

Many of the included studies had a moderate-to-high risk for bias. Additionally, there was no standard protocol for how to optimize a patient's regimen. The studies enrolled small numbers of patients with various types of uveitis.

Clinical significance

Results of this literature review demonstrate that optimization is important for patients with NIU who achieve remission and can lead to significant cost savings. However, without a standard protocol on when or how to optimize patients and with significant relapse rates seen, optimization is still something to discuss individually with a patient, and it is important to monitor their clinical course while undergoing optimization due to the variable rate of relapse.