Non-anti TNFa biologic agents for noninfectious uveitis associated with systemic inflammatory diseases: a systematic review

Introduction: Noninfectious uveitis related to systemic inflammatory diseases represents a leading cause of blindness. Anti-TNFa agents are the first-line biologic therapy after traditional immunosup-pressants, for ocular and systemic involvement. However, some patients fails anti-TNFa agents, due to primary inefficacy, loss of efficacy or adverse events.Areas covered: This systematic review summarizes evidence on the efficacy and safety of non-anti-TNFa biologics in adult patients with noninfectious uveitis associated with systemic inflammatory diseases. The systematic review of PubMed and Embase yielded 3663 records, from which 16 studies were included (13 non-controlled, 3 controlled trials). Most studies focused on Behcet's syndrome (BS) and juvenile idiopathic arthritis (JIA) and assessed the efficacy of tocilizumab (n = 11), rituximab (n = 3), secukinumab (n = 1), or anakinra/canakinumab (n = 1). A body of evidence supports the use of tocilizumab BS and JIA-associated uveitis, for improving visual acuity, reducing central macular thick-ness, inducing ocular remission, and sparing corticosteroids. Preliminary data suggest that rituximab may represent a valid alternative, particularly in JIA, while anakinra/canakinumab might play a role in BS-associated uveitis. The role of secukinumab appears limited.Expert opinion: Current evidence encourages investigations on the efficacy and safety of non-anti-TNFa agents in noninfectious non-idiopathic uveitis.