Next-Generation Treatments for Uveitis Secondary to Rheumatological Disease

Ashvini K. Reddy, MD, presented a look at new and emerging treatments for managing the ocular inflammation associated with systemic rheumatological diseases on Sunday at AAO 2016.

Humira (adalimumab, Abbvie) is a human monoclonal immunoglobulin tumor necrosis factor alpha (TNF-α) antibody recently approved by the FDA for noninfectious uveitis in adults. Dr. Reddy said that in recent evaluations, adalimumab demonstrated an impressive remission rate and durability of effect, and it was able to resolve cystoid macular edema in a subset of patients who presented with the complication at baseline.

Adalimumab may also lead to better long-term systemic health outcomes by reducing reliance on immunosupressants; one study showed that 84.7% of subjects were able to decrease their use by 50% from baseline after 6 months. Dr. Reddy noted that although adalimumab is not yet approved for pediatric use, much of the early evidence for its utility came from investigations of juvenile idiopathic arthritis (JIA), during which it outperformed the older-generation biologics infliximab and etanercept. “Some studies have suggested that it may ultimately be superior to established drugs like methotrexate,” said Dr. Reddy.

Iluvien (Alimera Sciences) is a nonbiodegradable vitreous implant that releases 0.19 mg of fluocinolone acetonide over 3 years. Although this implant is currently approved only for diabetic retinopathy, research from Wilmer Eye Institute indicates that it holds promise for uveitis. Iluvien is also significantly less expensive than the Retisert implant and has an excellent safety profile, said Dr. Reddy.

Medidur (pSivida) is a 0.18-mg fluocinolone-releasing implant that is currently in clinical trials in the United States. In a phase 3 trial, it met its primary endpoint of preventing recurrence of posterior uveitis disease at a significance level of p < .00000001. The ongoing study will follow patients for 3 years.—Aliyah Kovner

Financial disclosures. Dr. Reddy: None.