Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis

Fundamentals Of Care for UveitiS (FOCUS) Initiative

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 & 31 others 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, Lucia Kuffova, Conor Murphy, Fundamentals of Care for Uveitis International Consensus Group

*Corresponding author for this work

Research output: Contribution to journalReview article

23 Citations (Scopus)
5 Downloads (Pure)

Abstract

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.

Original languageEnglish
Pages (from-to)757-773
Number of pages17
JournalOphthalmology
Volume125
Issue number5
Early online date6 Jan 2018
DOIs
Publication statusPublished - 1 May 2018

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Immunomodulation
Uveitis
Biological Factors
Guidelines
Consensus
Delphi Technique
Therapeutics
Safety
Pharmaceutical Economics
Eye Diseases
Practice Management
Expert Testimony
Biological Products
Libraries
Publications
Meta-Analysis
Decision Making
Language
Randomized Controlled Trials
Retrospective Studies

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Dick, A. D., Rosenbaum, J. T., Al-Dhibi, H. A., Belfort, R., Brézin, A. P., Chee, S. P., ... Fundamentals of Care for Uveitis International Consensus Group (2018). Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative. Ophthalmology, 125(5), 757-773. https://doi.org/10.1016/j.ophtha.2017.11.017

Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis : Fundamentals Of Care for UveitiS (FOCUS) Initiative. / Dick, Andrew D.; Rosenbaum, James T.; Al-Dhibi, Hassan A.; Belfort, Rubens; Brézin, Antoine P.; Chee, Soon Phaik; Davis, Janet L.; Ramanan, Athimalaipet V.; Sonoda, Koh Hei; Carreño, Ester; Nascimento, Heloisa; Salah, Sawsen; Salek, Sherveen; Siak, Jay; Steeples, Laura; Accorinti, Massimo; Acharya, Nisha; Adan, Alfredo; Agrawal, Rupesh; Akkoc, Nurullah; Al Ghamdi, Saed; Al Ghamdi, Turki; Al Saati, Anood; Alsabaani, Nasser; Al-Shamarani, Mohamed; Bachta, Artur; Barisani-Asenbauer, Talin; Beare, Nicholas; Porto, Fernanda Belga Ottoni; Blanco, Ricardo; Yee, Anita Chan Sook; Chandran, Vinod; Chiquet, Christophe; Chng, Hiok Hee; Cimbalas, Andrius; Cimino, Luca; Cordero-Coma, Miguel; Cristobal, Couto; Cuevas, Miguel; Eurico da Fonseca, João; de Boer, Joke; de la Torre, Alejandra; De Schryver, Ilse; Derzko-Dzulynsky, Larissa; Diaz-Valle, David; Merino, Claudia Eugenia Duran; Facsko, Andrea; Figueira, Luis; Kuffova, Lucia; Murphy, Conor; Fundamentals of Care for Uveitis International Consensus Group.

In: Ophthalmology, Vol. 125, No. 5, 01.05.2018, p. 757-773.

Research output: Contribution to journalReview article

Dick, AD, Rosenbaum, JT, Al-Dhibi, HA, Belfort, R, Brézin, AP, Chee, SP, Davis, JL, Ramanan, AV, Sonoda, KH, Carreño, E, Nascimento, H, Salah, S, Salek, S, Siak, J, Steeples, L, Accorinti, M, Acharya, N, Adan, A, Agrawal, R, Akkoc, N, Al Ghamdi, S, Al Ghamdi, T, Al Saati, A, Alsabaani, N, Al-Shamarani, M, Bachta, A, Barisani-Asenbauer, T, Beare, N, Porto, FBO, Blanco, R, Yee, ACS, Chandran, V, Chiquet, C, Chng, HH, Cimbalas, A, Cimino, L, Cordero-Coma, M, Cristobal, C, Cuevas, M, Eurico da Fonseca, J, de Boer, J, de la Torre, A, De Schryver, I, Derzko-Dzulynsky, L, Diaz-Valle, D, Merino, CED, Facsko, A, Figueira, L, Kuffova, L, Murphy, C & Fundamentals of Care for Uveitis International Consensus Group 2018, 'Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative', Ophthalmology, vol. 125, no. 5, pp. 757-773. https://doi.org/10.1016/j.ophtha.2017.11.017
Dick, Andrew D. ; Rosenbaum, James T. ; Al-Dhibi, Hassan A. ; Belfort, Rubens ; Brézin, Antoine P. ; Chee, Soon Phaik ; Davis, Janet L. ; Ramanan, Athimalaipet V. ; Sonoda, Koh Hei ; Carreño, Ester ; Nascimento, Heloisa ; Salah, Sawsen ; Salek, Sherveen ; Siak, Jay ; Steeples, Laura ; Accorinti, Massimo ; Acharya, Nisha ; Adan, Alfredo ; Agrawal, Rupesh ; Akkoc, Nurullah ; Al Ghamdi, Saed ; Al Ghamdi, Turki ; Al Saati, Anood ; Alsabaani, Nasser ; Al-Shamarani, Mohamed ; Bachta, Artur ; Barisani-Asenbauer, Talin ; Beare, Nicholas ; Porto, Fernanda Belga Ottoni ; Blanco, Ricardo ; Yee, Anita Chan Sook ; Chandran, Vinod ; Chiquet, Christophe ; Chng, Hiok Hee ; Cimbalas, Andrius ; Cimino, Luca ; Cordero-Coma, Miguel ; Cristobal, Couto ; Cuevas, Miguel ; Eurico da Fonseca, João ; de Boer, Joke ; de la Torre, Alejandra ; De Schryver, Ilse ; Derzko-Dzulynsky, Larissa ; Diaz-Valle, David ; Merino, Claudia Eugenia Duran ; Facsko, Andrea ; Figueira, Luis ; Kuffova, Lucia ; Murphy, Conor ; Fundamentals of Care for Uveitis International Consensus Group. / Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis : Fundamentals Of Care for UveitiS (FOCUS) Initiative. In: Ophthalmology. 2018 ; Vol. 125, No. 5. pp. 757-773.
@article{72b498c72dcc4d1a824c9e9aa778ca6f,
title = "Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative",
abstract = "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.",
author = "Dick, {Andrew D.} and Rosenbaum, {James T.} and Al-Dhibi, {Hassan A.} and Rubens Belfort and Br{\'e}zin, {Antoine P.} and Chee, {Soon Phaik} and Davis, {Janet L.} and Ramanan, {Athimalaipet V.} and Sonoda, {Koh Hei} and Ester Carre{\~n}o and Heloisa Nascimento and Sawsen Salah and Sherveen Salek and Jay Siak and Laura Steeples and Massimo Accorinti and Nisha Acharya and Alfredo Adan and Rupesh Agrawal and Nurullah Akkoc and {Al Ghamdi}, Saed and {Al Ghamdi}, Turki and {Al Saati}, Anood and Nasser Alsabaani and Mohamed Al-Shamarani and Artur Bachta and Talin Barisani-Asenbauer and Nicholas Beare and Porto, {Fernanda Belga Ottoni} and Ricardo Blanco and Yee, {Anita Chan Sook} and Vinod Chandran and Christophe Chiquet and Chng, {Hiok Hee} and Andrius Cimbalas and Luca Cimino and Miguel Cordero-Coma and Couto Cristobal and Miguel Cuevas and {Eurico da Fonseca}, Jo{\~a}o and {de Boer}, Joke and {de la Torre}, Alejandra and {De Schryver}, Ilse and Larissa Derzko-Dzulynsky and David Diaz-Valle and Merino, {Claudia Eugenia Duran} and Andrea Facsko and Luis Figueira and Lucia Kuffova and Conor Murphy and {Fundamentals of Care for Uveitis International Consensus Group}",
note = "Supplemental material available at www.aaojournal.org. Supported by AbbVie, Inc., and the Fundamentals of Care for Uveitis Initiative National Faculty. This manuscript was developed subsequent to an AbbVie-sponsored literature review of noninfectious, nonanterior uveitis. The meeting was conducted to understand the available literature regarding the management of patients with noninfectious, nonanterior uveitis. The program involved a total of 139 experts from 28 countries, who were selected for participation by AbbVie. However, AbbVie was not involved in the development of the manuscript. The authors maintained complete control over the content and this manuscript reflects the opinions of the authors. AbbVie selected the discussion participants and reviewed the final manuscript draft for scientific accuracy, but the authors determined the final content. All authors made substantial contributions to the article or critically revised it for important intellectual content and approved the final manuscript. AbbVie provided funding to invited participants, including honoraria for their attendance at the meetings. Travel to and from the meetings was reimbursed. No payments were made to the authors for the development of this manuscript. Dhinakaran Sambandan, PhD, and Shula Sarner, PhD, of Lucid Partners, Burleighfield House, Buckinghamshire, United Kingdom, provided medical writing and editorial support to the authors in the development of this manuscript; financial support for these services was provided by AbbVie. AbbVie reviewed the manuscript, but was not involved in the methodology, data collection and analysis, or completion of this manuscript.",
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month = "5",
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pages = "757--773",
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TY - JOUR

T1 - Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis

T2 - Fundamentals Of Care for UveitiS (FOCUS) Initiative

AU - Dick, Andrew D.

AU - Rosenbaum, James T.

AU - Al-Dhibi, Hassan A.

AU - Belfort, Rubens

AU - Brézin, Antoine P.

AU - Chee, Soon Phaik

AU - Davis, Janet L.

AU - Ramanan, Athimalaipet V.

AU - Sonoda, Koh Hei

AU - Carreño, Ester

AU - Nascimento, Heloisa

AU - Salah, Sawsen

AU - Salek, Sherveen

AU - Siak, Jay

AU - Steeples, Laura

AU - Accorinti, Massimo

AU - Acharya, Nisha

AU - Adan, Alfredo

AU - Agrawal, Rupesh

AU - Akkoc, Nurullah

AU - Al Ghamdi, Saed

AU - Al Ghamdi, Turki

AU - Al Saati, Anood

AU - Alsabaani, Nasser

AU - Al-Shamarani, Mohamed

AU - Bachta, Artur

AU - Barisani-Asenbauer, Talin

AU - Beare, Nicholas

AU - Porto, Fernanda Belga Ottoni

AU - Blanco, Ricardo

AU - Yee, Anita Chan Sook

AU - Chandran, Vinod

AU - Chiquet, Christophe

AU - Chng, Hiok Hee

AU - Cimbalas, Andrius

AU - Cimino, Luca

AU - Cordero-Coma, Miguel

AU - Cristobal, Couto

AU - Cuevas, Miguel

AU - Eurico da Fonseca, João

AU - de Boer, Joke

AU - de la Torre, Alejandra

AU - De Schryver, Ilse

AU - Derzko-Dzulynsky, Larissa

AU - Diaz-Valle, David

AU - Merino, Claudia Eugenia Duran

AU - Facsko, Andrea

AU - Figueira, Luis

AU - Kuffova, Lucia

AU - Murphy, Conor

AU - Fundamentals of Care for Uveitis International Consensus Group

N1 - Supplemental material available at www.aaojournal.org. Supported by AbbVie, Inc., and the Fundamentals of Care for Uveitis Initiative National Faculty. This manuscript was developed subsequent to an AbbVie-sponsored literature review of noninfectious, nonanterior uveitis. The meeting was conducted to understand the available literature regarding the management of patients with noninfectious, nonanterior uveitis. The program involved a total of 139 experts from 28 countries, who were selected for participation by AbbVie. However, AbbVie was not involved in the development of the manuscript. The authors maintained complete control over the content and this manuscript reflects the opinions of the authors. AbbVie selected the discussion participants and reviewed the final manuscript draft for scientific accuracy, but the authors determined the final content. All authors made substantial contributions to the article or critically revised it for important intellectual content and approved the final manuscript. AbbVie provided funding to invited participants, including honoraria for their attendance at the meetings. Travel to and from the meetings was reimbursed. No payments were made to the authors for the development of this manuscript. Dhinakaran Sambandan, PhD, and Shula Sarner, PhD, of Lucid Partners, Burleighfield House, Buckinghamshire, United Kingdom, provided medical writing and editorial support to the authors in the development of this manuscript; financial support for these services was provided by AbbVie. AbbVie reviewed the manuscript, but was not involved in the methodology, data collection and analysis, or completion of this manuscript.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85039978698&partnerID=8YFLogxK

U2 - 10.1016/j.ophtha.2017.11.017

DO - 10.1016/j.ophtha.2017.11.017

M3 - Review article

VL - 125

SP - 757

EP - 773

JO - Ophthalmology

JF - Ophthalmology

SN - 0161-6420

IS - 5

ER -