Long-term outcomes of noninfectious uveitis treated with systemic immunomodulatory therapy: a retrospective case series

Tina Felfeli; Michael Balas; Felicia Tai; Arshia Eshtiaghi; Jess Rhee; Alexander J Kaplan; Panos G Christakis; Efrem D Mandelcorn; Nupura K Bakshi; Laurence A Rubin; Larissa A Derzko-Dzulynsky

doi:10.1016/j.jcjo.2024.05.005

Long-term outcomes of noninfectious uveitis treated with systemic immunomodulatory therapy: a retrospective case series

Can J Ophthalmol. 2024 Jun 15:S0008-4182(24)00141-8. doi: 10.1016/j.jcjo.2024.05.005. Online ahead of print.

Authors

Affiliations

¹ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, ON; Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, ON. Electronic address: [email protected].
² Temerty Faculty of Medicine, University of Toronto, Toronto, ON.
³ Division of Ophthalmology, McMaster University, Hamilton, ON.
⁴ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON.
⁵ Faculty of Medicine, Schulich School of Medicine and Dentistry, London, ON.
⁶ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Department of Ophthalmology, Toronto Western Hospital, University Health Network, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON.
⁷ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON.
⁸ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON; Department of Ophthalmology, Mount Sinai Hospital, Toronto, ON.
⁹ Temerty Faculty of Medicine, University of Toronto, Toronto, ON; Division of Rheumatology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON.
¹⁰ Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Kensington Vision and Research Centre, Kensington Health Institute, Toronto, ON; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON.

PMID: 38889882
DOI: 10.1016/j.jcjo.2024.05.005

Abstract

Objective: To study the clinical characteristics and long-term outcomes of patients with noninfectious uveitis (NIU) who are treated with systemic immunomodulatory therapy (IMT).

Design: Retrospective case series.

Participants: All consecutive cases of adults with NIU under the care of 5 uveitis subspecialty tertiary care clinics between 2010 to 2021 were included.

Methods: Patient outcomes were assessed at initial presentation and at the latest available follow-up.

Results: A total of 418 NIU patients receiving IMT therapy with a median age of 46.0 years and 59.3% female were identified. Each patient required an average of 1.4 agents until achieving an optimal response. Following initial treatment with prednisone, patients were most commonly initiated on methotrexate. The top 3 treatments with the highest proportion of optimal treatment response when taken alone or in combination with other agents were infliximab (79.3%), cyclosporine (75%), and adalimumab (70%). The strongest predictors for requiring a greater number of IMTs trialed were younger age, panuveitis, and a chronic or recurrent disease course. Multivariable linear regression analysis suggested that baseline visual acuity at diagnosis was the only significant predictor of final visual acuity (p < 0.001).

Conclusions: NIU patients on IMT are often trialed on multiple therapeutic agents before achieving an optimal treatment response. Visual acuity at diagnosis is a predictor of final visual outcomes, whereas chronic or recurrent disease course, younger age, and panuveitis are predictors of requiring multiagent treatment regimens.