Biologic Therapy For Ocular Inflammatory Diseases: An Update

Uveitis comprehends a wide and heterogeneous group of intraocular inflammatory conditions potentially sight-threatening and variable therapeutic strategies have been proposed. Classical treatment with steroids and conventional immunosuppressive agents is often used as first-step. However, a number of patients may not respond properly or tolerate these medications with well-known side effects. Over the last two decades, advances in the understanding of the pathogenesis of autoimmune uveitis, as well as improved biotechnology, have enabled the development of a new class of drugs called biologics, which provide selective targeting of the immune mediators of the inflammation cascade. Biologic therapies were introduced as a new option for patients with autoimmune rheumatic conditions refractory to conventional therapy and due to their success have posteriorly been used in ophthalmology to treat ocular inflammatory disorders. These new agents may potentially provide more effective and less toxic treatment than conventional therapy. Biologic therapies include a wide variety of drugs with different mechanisms of action, including monoclonal antibodies against cell surface markers, cytokines and their receptors, or recombinant forms of natural inhibitory molecules. Although some results are based on investigations with insufficient clinical trials, the majority of biologics indicate preferable outcomes on refractory uveitis, with remarkable promise to increase the possibility of long-term remission. The development of these new drugs is one of the most revolutionary advances in recent years, and the promise of shifting paradigms makes it an exciting time for uveitis specialists worldwide.