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Ophthalmology. 2018 May;125(5):757-773. doi: 10.1016/j.ophtha.2017.11.017. Epub 2018 Jan 6.

Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative.

Author information

1
Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom; Institute of Ophthalmology, University College London, London, United Kingdom; National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and Institute of Ophthalmology, University College London, London, United Kingdom. Electronic address: opadd@bristol.ac.uk.
2
Legacy Devers Eye Institute, Portland, Oregon; Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; Departments of Medicine and Cell Biology, Oregon Health & Science University, Portland, Oregon.
3
Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia.
4
Department of Ophthalmology and Visual Sciences, Paulista School of Medicine, Federal University of São Paulo and Vision Institute, São Paulo, Brazil.
5
Service d'ophtalmologie, Université Paris Descartes, Hôpital Cochin, Paris, France.
6
Ocular Inflammation and Immunology Service, Singapore National Eye Centre, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore, Republic of Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Duke-National University of Singapore Medical School, Ophthalmology & Visual Sciences Academic Clinical Program, Singapore, Republic of Singapore.
7
Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida.
8
Ophthalmology, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom; Pediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
9
Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
10
Ophthalmology, Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
11
Uveitis Service, Federal University of São Paulo, São Paulo, Brazil.
12
Department of Ophthalmology, Oregon Health & Science University, Portland, Oregon; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
13
Ophthalmology, Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; Manchester Royal Eye Hospital, Central Manchester University Hospitals, and University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.

Abstract

TOPIC:

An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics.

CLINICAL RELEVANCE:

The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents.

METHODS:

An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence.

RESULTS:

In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed.

CONCLUSIONS:

Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents.

PMID:
29310963
DOI:
10.1016/j.ophtha.2017.11.017
[Indexed for MEDLINE]
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