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

© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ..

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.

Media Type:

Electronic Article

Year of Publication:

2021

Contained In:

The British journal of ophthalmology - Vol. 105, No. 5 (2021), p. 639-647

Language:

English

Contributors:

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
COVID-19 IMT Study Group

Links:

Volltext

Keywords:

*Immunomodulation
*SARS-CoV-2
COVID-19
Choroid
Ciliary body
Clinical Decision-Making
Conjunctiva
Consensus
Cornea
Cross-Sectional Studies
Drugs
Epidemiology
Glucocorticoids
Humans
Imaging
Immunology
Immunosuppressive Agents
Infection
Inflammation
Iris
Journal Article
Macula
Practice Guidelines as Topic
Retina
Risk Assessment
Surveys and Questionnaires
Telemedicine
Treatment lasers
Treatment medical
Uveitis
Vitreous

Notes:

Date Completed 30.04.2021

Date Revised 30.04.2021

published: Print-Electronic

Citation Status MEDLINE

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1136/bjophthalmol-2020-316776

PMID:

32586933

PPN (Catalogue-ID):

NLM31255785X