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Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis
Ophthalmology ( IF 13.7 ) Pub Date : 2018-01-06 , DOI: 10.1016/j.ophtha.2017.11.017
Andrew D. Dick , James T. Rosenbaum , Hassan A. Al-Dhibi , Rubens Belfort , Antoine P. Brézin , Soon Phaik Chee , Janet L. Davis , Athimalaipet V. Ramanan , Koh-Hei Sonoda , Ester Carreño , Heloisa Nascimento , Sawsen Salah , Sherveen Salek , Jay Siak , Laura Steeples , Massimo Accorinti , Nisha Acharya , Alfredo Adan , Rupesh Agrawal , Nurullah Akkoc , Saed Al Ghamdi , Turki Al Ghamdi , Anood Al Saati , Nasser Alsabaani , Mohamed Al-Shamarani , Artur Bachta , Talin Barisani-Asenbauer , Nicholas Beare , Fernanda Belga Ottoni Porto , Ricardo Blanco , Anita Chan Sook Yee , Vinod Chandran , Christophe Chiquet , Hiok Hee Chng , Andrius Cimbalas , Luca Cimino , Miguel Cordero-Coma , Couto Cristobal , Miguel Cuevas , João Eurico da Fonseca , Joke de Boer , Alejandra de la Torre , Ilse De Schryver , Larissa Derzko-Dzulynsky , David Diaz-Valle , Claudia Eugenia Duran Merino , Andrea Facsko , Luis Figueira , Alejandro Fonollosa , Eric Fortin , Richard Gale , Mauro Galeazzi , Sandra Garcia , Jose Maria Garcia Ruiz de Morales , Nataša Gašperšič , Debra Goldstein , Marta Guedes , Yan Guex-Crosier , Ahmet Gul , Rola Hamam , Muhammad Haroon , Kenichi Hasegawa , Arnd Heiligenhaus , Claire Hooper , Yih-Shiou Hwang , De-Kuang Hwang , Xavier Juanola , Toshikatsu Kaburaki , Sibel Kadayifcilar , John Kempen , Takeshi Kezuka , Amin Kherani , Maarja Kirsimäe , Kaisu Kotaniemi , Aleksandra Kraut , Agnieszka Kubicka-Trząska , Lucia Kuffova , Susan Lightman , Lyndell Lim , Wee Kiak Lim , Peter McCluskey , Mairide McGuire , Pierfrancesco Mirabelli , Elisabetta Miserocchi , Marta Misiuk-Hojło , Cristina Muccioli , Santiago Muñoz , Conor Murphy , Philip I. Murray , Zoltan Nagy , Kenichi Namba , Piergiorgio Neri , Quan Nguyen , Donncha O'Gradaigh , Mohammed Omair , Kati Otsa , Yilmaz Ozyazgan , Franco Pablo , Maria Pia Paroli , Uwe Pleyer , Gyula Poór , Rui Proença , Theodore Rabinovitch , Russell Read , Margarita Rebrov , Claudia Recillas-Gispert , Aniki Rothova , Sergio Schwartzman , Pascal Seve , Srilakshmi Sharma , Joanne Sims , Nicolette Sohár , Eric Suhler , Sándor Szántó , Zsuzsanna Szepessy , Christoph Tappeiner , Jennifer Thorne , Ilknur Tugal Tutkun , Anna Turno-Kręcicka , Joachim Van Calster , Irene van der Horst-Bruinsma , Nataša Vidovič Valentinčič , Albert Vitale , Stephanie Voorduin Ramos , Nenad Vukojevic , Denis Wakefield , François Willermain , Nilufer Yalcindag , Joyce Hisae Yamamoto , Stephen Yeh , Reda Zemaitiene , Olga Ziouzina

Topic

An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics.

Clinical Relevance

The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents.

Methods

An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic review of the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE, CINAHL, SCOPUS, BIOSIS, and Web of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review. A total of 44 globally representative group members met in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence.

Results

In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed.

Conclusions

Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents.



中文翻译:

非感染性葡萄膜炎非皮质类固醇全身免疫调节治疗指南

话题

一项由专家领导的国际共识倡议,旨在为生物制剂时代的非感染性葡萄膜炎的治疗提供系统的,循证的建议。

临床相关性

用于治疗人眼疾病的生物制剂的可利用性已经改变了非感染性葡萄膜炎管理的实践模式。当前的指南不足以确保非皮质类固醇全身免疫调节剂的最佳使用。

方法

一个由9名葡萄膜炎专家(包括眼科医生和风湿病学家)组成的国际专家指导委员会确定了临床问题,并与6名接受葡萄膜炎培训的书目研究人员一起进行了系统评价和荟萃分析的首选报告项目,对文献进行了系统评价(英语从1996年1月到2016年6月进行语言学习; Medline [OVID],中央Cochrane库,EMBASE,CINAHL,SCOPUS,BIOSIS和Web of Science)。出版物包括随机对照试验,具有足够随访的前瞻性和回顾性研究,15个或更多病例的病例系列,同行评审的文章以及主要会议的人工搜索会议摘要。拟议的声明在130名国际葡萄膜炎专家中散发,以供审核。

结果

总共解决了10个问题,得出了21个基于证据的指导声明,涉及以下主题:何时开始非皮质类固醇免疫调节治疗,包括生物制剂和非生物制剂;治疗前要收集什么数据;何时修改或退出治疗;如何根据个人疗效和安全性选择药物;以及特定的葡萄条件下的证据。建议还讨论了共同的决策,提供者之间的沟通和安全监控。未解决药物经济学方面的考虑。

结论

基于已发表的文献,专家意见和实践经验,制定了共识指南,以弥合临床需求和医学证据之间的差距,以支持使用非皮质类固醇免疫调节剂治疗非感染性葡萄膜炎患者。

更新日期:2018-01-06
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