Safety and efficacy of rituximab in refractory noninfectious uveitis and scleritis

To investigate the safety and efficacy of rituximab in patients with refractory noninfectious uveitis and scleritis.

A retrospective review of 24 patients (47 eyes) treated with rituximab for refractory noninfectious uveitis and scleritis in the period between January 2018 and December 2024. The diagnosis of these patients included chronic recurrent uveitis associated with Vogt-Koyanagi-Harada disease (n = 16), idiopathic granulomatous uveitis (n = 3), multiple sclerosis-associated uveitis (n = 2), progressive subretinal fibrosis (n = 1) and scleritis (n = 2). The primary outcomes were disease quiescence and improvement in best-corrected visual acuity (BCVA). Secondary outcomes included reduction in corticosteroid and immunosuppressive therapy and adverse events.

Rituximab was successful in inducing and maintaining disease quiescence and significantly improved visual acuity in patients presenting with uveitis and scleritis. After starting rituximab therapy, BCVA improved at 1 year from 0.93 ± 0.67 logMAR (Snellen: 20/160) to 0.63 ± 0.83 logMAR (Snellen: 20/80) (p < 0.001). Follow-up period ranged from 12 to 80 months (mean 41 ± SD 20.5). At the last follow-up, BCVA continued to improve to 0.46 ± 0.73 logMAR (Snellen: 20/60) (p < 0.001). Nine of twenty-four patients (37.5%) required more than 3 rituximab doses for disease control. Rituximab successfully reduced corticosteroid use, allowing 87.5% (21/24) of patients to discontinue steroids completely, with the remaining needing ≤ 7.5 mg/day. Mycophenolate mofetil dosage significantly decreased from a mean of 1840 ± SD 323 mg to 1045 ± SD 688 mg daily (p < 0.001), with two patients discontinuing all medications. All patients were flare-free at last follow-up.

Rituximab is an effective and safe treatment for refractory noninfectious uveitis and scleritis. It offers significant visual improvement, disease quiescence which potentially reduces reliance on corticosteroids and immunomodulatory therapy.