Biological and Targeted Therapy in Non-Infectious Uveitis: Current Evidence and Future Perspectives

Non-infectious uveitis (NIU) comprises a group of immune-mediated inflammatory diseases of the uvea that frequently affect people of working age. If inflammation is not controlled promptly, it may lead to permanent structural damage and visual loss. Prolonged corticosteroid use increases the risk of adverse effects. Contemporary treatment aims not only to control inflammation, but also to minimise dependence on corticosteroids. This narrative review examines the efficacy, safety, and place of biological and targeted therapies in the treatment of NIU. Adalimumab is the best-studied biological agent for intermediate, posterior, and panuveitis, as well as for uveitis associated with juvenile idiopathic arthritis. Infliximab has an important role in severe Behçet-associated uveitis and occlusive retinal vasculitis. Among the biological therapies with mechanisms of action other than TNF-α inhibition, tocilizumab is the best studied, particularly in refractory uveitic macular oedema. Janus kinase inhibitors (JAK inhibitors) are a rapidly developing class of targeted synthetic disease-modifying antirheumatic drugs (DMARDs). Clinical studies in NIU have shown variable efficacy and indicate their potential as a future therapeutic option. Treatment selection should be individualised and should take into account the anatomical form and severity of uveitis, the presence of systemic disease, macular oedema or occlusive retinal vasculitis, age and comorbidities, and the response to previous therapy. Therapeutic drug monitoring, biomarkers, and quantitative imaging parameters represent promising approaches to treatment personalisation; however, their clinical utility requires validation in prospective studies, and they are not currently part of routine clinical practice in non-infectious uveitis.