Novel therapies in the treatment of noninfectious uveitis

Introduction: Uveitis is a major cause of vision loss worldwide, and noninfectious uveitis (NIU) constitutes the majority of uveitis cases in the developed world. While corticosteroids were long the mainstays of uveitis therapy, there are now many steroid-sparing options, both systemic and local, to treat NIU. Areas covered: Herein we review the safety, efficacy, and potential clinical roles of emerging treatments for NIU beyond conventional immunosuppressive therapy and local steroid injections. These include systemic tocilizumab, an Il-6 antagonist, and new evidence regarding the anti-TNF agents adalimumab and infliximab. New local therapies to be reviewed include intravitreal methotrexate, sirolimus, and infliximab, and the dexamethasone intravitreal implant (ozurdex). A PUBMED literature review of all the agents plus the word "uveitis" was performed and all English-language articles were reviewed for the use of these agents and their mode of administration in treating noninfectious uveitis. Expert commentary: Tremendous progress has taken place in treating uveitis. The anti-TNF alpha agents have good efficacy with a reasonable safety profile. Data for intravitreal methotrexate is limited but intriguing because of its extended duration of action and limited side effects. The role of other agents is still unclear.