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. (C) 2014 by the American Academy of Ophthalmology.