Other Biologic Agents
Rituximab, a chimeric monoclonal antibody directed against CD20+ cells (mainly B lymphocytes) given as an intravenous infusion, may be useful in the treatment of Behçet retinal vasculitis, granulomatosis with polyangiitis-associated necrotizing scleritis or other scleritis, and mucous membrane pemphigoid. Case series have reported success in refractory JIA-associated uveitis.
Interferon alfa-2a/2b (IFN-α2a/2b), administered subcutaneously, has been reported to be beneficial in some patients with uveitis. IFN-α2a has antiviral, immunomodulatory, and antiangiogenic effects. Reports in the European literature indicate that IFN-α2a is efficacious and well tolerated in patients with Behçet uveitis, controlling inflammation in almost 90%; it is somewhat less effective in non-Behçet uveitis, with inflammation control in 60%. There are also reports of IFN-α2b successfully treating uveitic macular edema. Prior to initiation of IFN-α2a therapy, patients discontinue any other immunomodulatory drugs. A flu-like syndrome has been observed, most frequently during the first weeks of therapy; however, symptoms may be reduced through prophylactic administration of acetaminophen. Despite the use of low interferon doses, leukopenia or thrombocytopenia may occur. Depression is another important adverse effect of interferon therapy.
Abatacept, a T-cell costimulation inhibitor given as an intravenous infusion, has been used in JIA uveitis with mixed results, including one small study suggesting only 14% sustained inflammation control; another study suggested a 49% success rate at 1 year.
Gueudry J, Wechsler B, Terrada C, et al. Long-term efficacy and safety of low-dose interferon alpha2a therapy in severe uveitis associated with Behçet disease. Am J Ophthalmol. 2008;146(6):837–844.
Kötter I, Zierhut M, Eckstein AK, et al. Human recombinant interferon alfa-2a for the treatment of Behçet’s disease with sight threatening posterior or panuveitis. Br J Ophthalmol. 2003;87(4):423–431.
Excerpted from BCSC 2020-2021 series: Section 9 - Uveitis and Ocular Inflammation. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.