Evolving consensus for immunomodulatory therapy in non-infectious uveitis during the COVID-19 pandemic.

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; Pavesio, Carlos (2021). Evolving consensus for immunomodulatory therapy in non-infectious uveitis during the COVID-19 pandemic. The British journal of ophthalmology, 105(5), pp. 639-647. BMJ Publishing Group 10.1136/bjophthalmol-2020-316776

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BACKGROUND

Immunomodulatory 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.

METHODS

A 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.

RESULTS

Highest 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.

CONCLUSION

Consensus 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Ophthalmology

UniBE Contributor:

Tappeiner, Christoph

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1468-2079

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Christoph Tappeiner

Date Deposited:

04 Dec 2020 17:27

Last Modified:

25 Apr 2021 01:32

Publisher DOI:

10.1136/bjophthalmol-2020-316776

PubMed ID:

32586933

Uncontrolled Keywords:

Choroid Ciliary body Conjunctiva Cornea Drugs Epidemiology Imaging Immunology Infection Inflammation Iris Macula Retina Telemedicine Treatment lasers Treatment medical Vitreous

BORIS DOI:

10.7892/boris.148992

URI:

https://boris.unibe.ch/id/eprint/148992

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