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Updated: Sep 20, 2025
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Experimental Autoimmune Uveitis: An Intraocular Inflammatory Mouse Model
Published on: January 12, 2022
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Failure of primary immunosuppressive agents in uveitis
Ankush Kawali1, Sara Rizvi1, Sai Bhakti Mishra1
1Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India.
Indian Journal of Ophthalmology
|May 28, 2025
Summary
Managing refractory non-infectious uveitis (NIU) often requires combination immunomodulatory therapy (IMT). Methotrexate (MTx) plus mycophenolate mofetil (MMF) is common, with biologics like tofacitinib (Tofa) showing promise, especially for Vogt-Koyanagi-Harada (VKH) disease.
Area of Science:
- Ophthalmology
- Immunology
- Rheumatology
Background:
- Non-infectious uveitis (NIU) presents significant management challenges, particularly in refractory cases.
- Primary immunomodulatory therapy (IMT) failure necessitates exploring alternative and combination treatment strategies.
- Understanding treatment patterns and effectiveness in patients requiring IMT revisions is crucial for optimizing care.
Purpose of the Study:
- To evaluate the effectiveness of various immunomodulatory therapy (IMT) regimens for non-infectious uveitis (NIU).
- To identify optimal treatment strategies for refractory NIU cases that have failed primary IMT.
- To analyze treatment patterns and outcomes in patients requiring IMT revisions due to uncontrolled inflammation or relapses.
Main Methods:
- Retrospective study analyzing data from December 2023 to November 2024.
- Inclusion criteria: patients with NIU, scleritis, or episcleritis who failed primary IMT.
- Analysis of primary IMT regimens and subsequent revisions, including combination therapies and biologics.
Main Results:
- The cohort included 54 patients; panuveitis was the most common diagnosis (44.4%).
- Methotrexate (MTx) was the predominant primary IMT (83.3%).
- First IMT revisions frequently involved combination therapy (MTx + mycophenolate mofetil [MMF] in 24.1%). Subsequent revisions showed increased use of biologics (Adalimumab [ADA], tofacitinib [Tofa]). Vogt-Koyanagi-Harada (VKH) disease was common among those with primary IMT failure, with increased Tofa use in later revisions.
Conclusions:
- Refractory NIU management is challenging, often requiring combination IMT.
- Combination therapy with MMF and MTx is frequently employed.
- Biologics like Tofa represent a valuable option, particularly for VKH disease, warranting further investigation in prospective studies.
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