Outcomes of changing immunosuppressive therapy after treatment failure in patients with noninfectious uveitis.

Purpose: To evaluate the outcomes of changing immunosuppressive therapy for noninfectious uveitis after failure.
Design: Retrospective cohort study.
Participants: Patients with noninfectious uveitis managed at 2 tertiary uveitis clinics in the United Kingdom and Australia.
Methods: Participants with a history of using immunosuppressive therapy were identified in clinics, and notes were reviewed by doctors trained in uveitis therapy. Each treatment episode/course (starting or changing a therapy) was identified, and demographic details, clinical characteristics, drug used (second-line immunosuppressive agent [ISA] or biologicals), and drug doses were obtained.
Main Outcome Measures: For each treatment episode, the reasons for changing therapy, corticosteroid-sparing effects, and control of inflammation were determined.
Results: A total of 147 patients were identified who underwent 309 different treatment episodes. Fifty-five percent of patients eventually required a change in treatment after their first treatment episode/course. Forty-five episodes involved switching from one ISA to another, with 50% to 100% of these patients achieving "success" (prednisolone ≤10 mg and sustained control) with the new ISA. A combination of ISAs were used in 53 episodes, with "success" being achieved in 50% to 71% of these patients. Biological agents were used in 45 episodes, the most common one being infliximab, which achieved success in 80% of patients.
Conclusions: Our data suggest that control of inflammation can be achieved after switching or combining ISAs.
(Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)