Biologic therapy for refractory scleritis: a new treatment perspective

Area of Science:

• Ophthalmology
• Rheumatology
• Immunology

Background:

• Scleritis is a serious eye inflammation often linked to systemic autoimmune diseases.
• Refractory cases require advanced treatment beyond corticosteroids and traditional immunosuppressants.

Purpose of the Study:

• To review existing literature on the efficacy of biologic drugs for treating difficult cases of scleritis.
• To evaluate different biologic agents based on available clinical evidence.

Main Methods:

• Comprehensive literature search of MEDLINE, Embase, and LILACS databases.
• Hand-searching reference lists of relevant articles.
• Inclusion of case reports and retrospective studies due to lack of randomized trials.

Main Results:

• No randomized controlled trials were identified for biologic therapy in scleritis.
• Monoclonal antibodies (infliximab, adalimumab) appear more effective than etanercept for corticosteroid-refractory scleritis.
• Rituximab shows potential as a primary treatment for scleritis associated with vasculitis.

Conclusions:

• Biologic therapies, particularly monoclonal antibodies, offer a viable treatment option for refractory scleritis.
• Further research, including randomized trials, is needed to establish definitive treatment guidelines for biologic use in scleritis.