Uveitis is one of the leading causes of
blindness worldwide. Noninfectious
uveitis may be associated with other systemic conditions, such as
human leukocyte antigen B27-related
spondyloarthropathies,
inflammatory bowel disease,
juvenile idiopathic arthritis, Behçet's disease, and
sarcoidosis. Conventional
therapy with
corticosteroids and
immunosuppressive agents (such as
methotrexate,
azathioprine,
mycophenolate mofetil, and
cyclosporine) may not be sufficient to control ocular
inflammation or prevent non-ophthalmic complications in refractory patients.
Off-label use of
biologic response modifiers has been studied as primary and secondary therapeutic agents. They are very useful when conventional immunosuppressive therapy has failed or has been poorly tolerated, or to treat concomitant ophthalmic and systemic
inflammation that might benefit from these medications.
Biologic therapy, primarily
infliximab, and
adalimumab, have been shown to be rapidly effective for the treatment of various subtypes of refractory
uveitis and
retinal vasculitis, especially Behçet's disease-related eye conditions and the
uveitis associated with
juvenile idiopathic arthritis. Other agents such as
golimumab,
abatacept,
canakinumab,
gevokizumab,
tocilizumab, and
alemtuzumab may have great future promise for the treatment of
uveitis. It has been shown that with proper monitoring, biologic
therapy can significantly improve quality of life in patients with
uveitis, particularly those with concurrent systemic symptoms. However, given high cost as well as the limited long-term safety data, we do not routinely recommend biologics as first-line
therapy for noninfectious
uveitis in most patients. These agents should be used with caution by experienced clinicians. The present work aims to provide a broad and updated review of the current and in-development systemic
biologic agents for the treatment of noninfectious
uveitis.