SAT0598 Systematic literature review on the efficacy and safety of immunomodulatory drugs in patients with nonifectious intermediate and posterior uveitis, panuveitis and macular oedema

Abstract

Background: Posterior segment uveitis (PSU) is a sight-threatening condition Objectives: To perform a systematic review of the literature on the use of immunomodulatory drugs in adult patients with non-infectious and non-malignant PSU including intermediate (IU) and posterior uveitis (PU), panuveitis (PanU) and macular oedema (ME). Methods: Search strategies were designed for Medline, Embase, and Cochrane Library for articles with clinical, safety or cost-effectivity data up to, Jan 2017 followed by secondary search from their bibliography. Quality was assessed (Jadad/ Oxford) Results: From 1103 articles, 31 moderate quality clinical trials (CT) were selected, prospective/retrospective, with variability in mean duration, No. and patients'characteristics. PSU was treated with synthetic DMARDs methotrexate (MTX), azathioprine (AZA), cyclosporine A (CsA), cyclopshosphamide (CyC), tacrolimus, sirolimus, micophenolate (MMF) and interferon b, and biologic DMARDs ranibizumab, daclizumab, rituximab (RTX), secukinumab, adalimumab (ADA), bevacizumab and infliximab (IFX) at usual dosages. Most common measures: visual acuity (VA), macular thickness and vitreous haze. MTX vs. MMF, was effective in IU, PU and PanU, with no differences in efficacy and adverse events (AEs), neither in Vogt-Koyanagi-Harada. MTX was effective with RTX, and SC was inferior to IFNβ with lower rate of AEs in IU with cistoid ME (CME). CsA did not show efficacy vs. placebo (pbo), with more neurological AEs. Tacrolimus vs. CsA was safer with similar efficacy, and CsA was useful with no differences vs. prednisone (pred) or vs. CsG, and similar vs. CYC at 2 y in Behçet PSU. CsA +pred + ketoconazole combined showed additional benefits. CYC+AZA were effective in PU, except for VA and retinal vasculitis, with no differences vs. RTX +MTX. CYC was useful in serpiginoid choroiditis ±dexamethasone. ADA was useful in IU, PU and PanU vs. pbo. IFX in Behçet PSU, was more effective vs. prednisolone +CsA + AZA/MTX. Intravitreal ADA and IFX did not show any benefit. Secukinumab vs. pbo did not prevent recurrences. In another RCT, IV route showed a higher response rate vs. SC for 30 mg/kg, with similar rate of EAs. Intravitreal bevacizumab was effective in multifocal choroiditis and CME. Intravitreal ranibizumab was useful in pigmentary retinitis +CME. Daclizumab in Behçet PSU did not show benefit vs. pbo. Tacrolimus as 2nd line in PU was effective ±pred. Intravitreal and subconjunctival sirolimus were effective in IU, PU and PanU in vitreal haze but not VA and ME, improving functional scores Conclusions: 1 Moderate quality of evidence 2 Variability in patients, definitions and outcomes 3 Systemic DMARDs MTX, MMF, CsA, CyC, tacrolimus, sirolimus, MMF and IFNβ were useful in PSU;AZA in combination 4 Biologic DMARDs ADA, IFX (systemic), ranibizumab, bevacizumab (intravitreal) were useful, daclizumab did not show efficacy. Possible efficacy of secukinumab 5 Intravitreal anti-TNF (ADA,IFX) were not useful. (Figure Presented).