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  • Guidance for managing noninfectious uveitis with immunomodulatory therapy during the COVID-19 pandemic

    Comprehensive Ophthalmology, Uveitis

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    Review of: Evolving consensus for immunomodulatory therapy in non-infectious uveitis during the COVID-19 pandemic

    Agrawal R, Testi I, Lee C, et al. British Journal of Ophthalmology, June 2020

    This paper provides consensus guidelines to steer the treatment of patients with noninfectious uveitis during the COVID-19 pandemic

    Study design

    The authors conducted a cross-sectional survey of international uveitis experts. A steering committee first identified clinical questions relating to the use of immunomodulatory therapy (IMT) in patients with noninfectious uveitis during the COVID-19 pandemic. They surveyed 139 global uveitis experts, 59 (42.4%) with more than 15 years of experience and 34 (24.5%) practicing in North America. Consensus statements were achieved if there was 75% agreement among experts.

    In total, they developed 216 statements on when to initiate, continue, decrease, and stop systemic and local corticosteroids, conventional immunosuppressive agents and biologics in patients with noninfectious uveitis. Thirty-one additional questions relating to general recommendations, use of non-steroidal anti-inflammatory drugs (NSAIDs) and hydroxychloroquine were also added.

    Outcomes

    There was a high consensus for not initiating IMT in patients who have suspected or confirmed COVID-19. Clinicians are urged to consider using local over systemic corticosteroid therapy in high-risk or very high-risk patients for severe or fatal COVID-19 infection.

    There was a consensus in starting or initiating NSAIDs for the treatment of scleritis in healthy patients. There was no consensus in starting hydroxychloroquine for any risk groups.

    Limitations

    These guidelines were based on expert opinion rather than evidence-based trials.

    Clinical significance

    This is the first survey of uveitis experts worldwide, resulting in consensus guidelines based on global expert opinion and practical experience that helps bridge the gap between clinical needs and the absence of evidence. During the pandemic, clinicians should consider the patient’s potential COVID-19 infection status and baseline systemic risk factors when deciding on a treatment course for noninfectious uveitis.