Switching biologic agents for uveitis

Purpose To observe whether switching between biological agents helps to gain or maintain uveitis remission in cases with sight-threatening refractory uveitis. Methods We reviewed the case notes of seven patients with refractory uveitis, who had switched between biological agents. The switch between biological agents (infliximab or adalimumab) was for gaining control of systemic symptoms, uveitis, or for the ease of administration. Results There were three adults (one each with sarcoidosis, ankylosing spondylites, and sero-negative polyarthropathy) and four children with juvenile idiopathic arthritis. The adults were switched twice between the various biological agents to gain adequate control of their systemic disease or to ease administration of the drug. All the children were switched to a second biological agent for gaining uveitis remission. Following the final switch, the concomitant immunosuppression in all the patients either reduced or remained unchanged, and only two patients remained on additional prednisolone (10 mg/day). Conclusions Our case series provides preliminary evidence that in cases of refractory uveitis with loss of initial clinical response to one biological agent, switching to another agent can restore control of intraocular inflammation. In addition, switching helps to control systemic symptoms and allows ease of administration. Eye (2009) 23, 1868-1870; doi:10.1038/eye.2009.203; published online 31 July 2009