Emerging treatments

Intravitreal sirolimus

Combined analysis of two phase 3, randomised, double-blind trials indicates that intravitreal sirolimus improves ocular inflammation (compared with low-dose active control) in patients with non-infectious uveitis.[94] Corticosteroid tapering was reported in approximately 70% of patients receiving the higher dose. Mean changes from baseline intra-ocular pressure were minimal.[94]

Tocilizumab

In one small phase 2 multicentre randomised clinical trial, the majority of patients (>77%) receiving tocilizumab (an interleukin-6 antagonist monoclonal antibody) experienced a positive clinical response (ascertained using a composite end point scoring system to assess the inflammatory outcomes in patients with non-infectious uveitis).[95] Tocilizumab may be considered in cases of non-infectious uveitis refractory to tumour necrosis factor (TNF)-alpha inhibitors.[59]

Janus kinase (JAK) inhibitors

Baricitinib, an oral JAK inhibitor, is undergoing phase 3 trials in patients with chronic anterior antinuclear antibody-positive uveitis.[96] Brepocitinib, an investigational oral JAK1 and tyrosine kinase 2 (TYK2) inhibitor, is being evaluated in a phase 2 trial of patients with active non-infectious intermediate, posterior, and panuveitis.[97]

Suprachoroidal triamcinolone

Triamcinolone suprachoroidal injection has been approved by the US Food and Drug Administration (FDA) for the treatment of macular oedema associated with uveitis.[98]​  

Ixekizumab

A phase 4 study to evaluate the efficacy of ixekizumab (an interleukin-17A antagonist monoclonal antibody) for the treatment of non-infectious intermediate, posterior, or panuveitis (or chronic corticosteroid-dependent anterior uveitis that has been resistant to treatment with a classic synthetic disease-modifying anti-rheumatic drug [DMARD]) is currently recruiting.[99]

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