1. Evolving consensus for immunomodulatory therapy in non-infectious uveitis during the COVID-19 pandemic
- Author
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Agrawal, Rupesh, Testi, Ilaria, Lee, Cecilia S, Tsui, Edmund, Blazes, Marian, Thorne, Jennifer E, Okada, Annabelle A, Smith, Justine R, McCluskey, Peter J, Kempen, John H, Tappeiner, Christoph, Agarwal, Manisha, Bodaghi, Bahram, Nguyen, Quan Dong, Gupta, Vishali, De Smet, Marc D, Zierhut, Manfred, and Pavesio, Carlos
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Good Health and Well Being ,COVID-19 ,Clinical Decision-Making ,Consensus ,Cross-Sectional Studies ,Glucocorticoids ,Humans ,Immunomodulation ,Immunosuppressive Agents ,Practice Guidelines as Topic ,Risk Assessment ,SARS-CoV-2 ,Surveys and Questionnaires ,Uveitis ,Choroid ,Imaging ,Inflammation ,Telemedicine ,Conjunctiva ,Immunology ,Macula ,Retina ,Infection ,Iris ,Treatment medical ,Epidemiology ,Cornea ,Vitreous ,Treatment lasers ,Ciliary body ,Drugs ,COVID-19 IMT Study Group ,Opthalmology and Optometry ,Public Health and Health Services ,Ophthalmology & Optometry ,Clinical sciences ,Ophthalmology and optometry - Abstract
BackgroundImmunomodulatory therapy (IMT) is often considered for systemic treatment of non-infectious uveitis (NIU). During the evolving coronavirus disease-2019 (COVID-19) pandemic, given the concerns related to IMT and the increased risk of infections, an urgent need for guidance on the management of IMT in patients with uveitis has emerged.MethodsA cross-sectional survey of international uveitis experts was conducted. An expert steering committee identified clinical questions on the use of IMT in patients with NIU during the COVID-19 pandemic. Using an interactive online questionnaire, guided by background experience and knowledge, 139 global uveitis experts generated consensus statements for IMT. In total, 216 statements were developed around when to initiate, continue, decrease and stop systemic and local corticosteroids, conventional immunosuppressive agents and biologics in patients with NIU. Thirty-one additional questions were added, related to general recommendations, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) and hydroxychloroquine.ResultsHighest consensus was achieved for not initiating IMT in patients who have suspected or confirmed COVID-19, and for using local over systemic corticosteroid therapy in patients who are at high-risk and very high-risk for severe or fatal COVID-19. While there was a consensus in starting or initiating NSAIDs for the treatment of scleritis in healthy patients, there was no consensus in starting hydroxychloroquine in any risk groups.ConclusionConsensus guidelines were proposed based on global expert opinion and practical experience to bridge the gap between clinical needs and the absence of medical evidence, to guide the treatment of patients with NIU during the COVID-19 pandemic.
- Published
- 2021