WAILEA, Hawaii – Current treatment choices for uveitis have drawbacks and none of the choices are ideal, but approvals for newer treatments are hampered by artificial criteria, according to a speaker.
Sunil K. Srivastava
Severe vision loss occurs in 25% to 33% of all uveitis cases, repeated bouts of inflammation increase risk of severe vision loss, and long-term use of high-dose corticosteroids is associated with high rates of morbidity, Sunil K. Srivastava, MD,said in a presentation at Retina 2015.
Systemic immunosuppression works up to 75% of the time, and local therapy works up to 90% of the time. Local short-term therapy works well in the short term, but long-term evidence is lacking. All broad-spectrum treatments have side effects, Srivastava said.
But there are novel therapies in the pipeline, both steroidal and nonsteroidal, as well as biologics, he said. However, getting drug approval is based on an endpoint that is not necessarily useful.
“Right now our criteria to get something approved is to use vitreous haze as our outcome measure. Unfortunately the studies that have been done recently – the failures – have been unable to meet that,” Srivastava said. “We’re limited by vitreous haze score, but this is an artificial standard that defines activity,” said Srivastava, who encouraged use of imaging to follow uveitic activity. –by Patricia Nale
Disclosure: Srivastava reports being a consultant or being on the advisory board for Bausch + Lomb, Allergan, Alimera, Clearside, Regeneron, Eleven, Santen, Sanofi, and Zeiss; he has received research grants from Bausch + Lomb, Allergan, Novartis, Clearside, Zeiss and Sonofi, and he receives licensing royalties from Bioptigen and Synergetics.