Clinical Characteristics and Outcomes of Non-Infectious Uveitis Patients Treated with and without Systemic Immunomodulatory Therapy: A large retrospective cohort study

Author Block: Tina Felfeli 1, Arshia Eshtiaghi2, Jess Rhee3, Michael Balas2, Felicia Tai4, Laurence A. Rubin5, Nupura K. Bakshi6, Larissa Derzko-Dzulynsky7. 1Department of Ophthalmology and Vision Sciences, University of Toronto; Institute of Health Policy, Management and Evaluation (IHPME), University of Toronto, 2The Temerty Faculty of Medicine, University of Toronto, 3Faculty of Medicine, Schulich School of Medicine and Dentistry, 4Division of Ophthalmology, McMaster University, 5Division of Rheumatology, St. Michael’s Hospital, Unity Health Toronto, 6Department of Ophthalmology, Mount Sinai Hospital, 7Department of Ophthalmology, St. Michael’s Hospital, Unity Health Toronto.
 

Author Disclosure Block: T. Felfeli: None. A. Eshtiaghi: None. J. Rhee: None. M. Balas: None. F. Tai: None. L.A. Rubin: None. N.K. Bakshi: None. L. Derzko-Dzulynsky: None.

Abstract Body: 

Purpose: To study the clinical characteristics and long-term outcomes of patients with non-infectious uveitis (NIU) who are treated with systematic immunomodulatory therapy (IMT). 

Study Design: Retrospective cohort study. 

Methods: All consecutive adults (>=18 years old) with NIU under the care of five uveitis subspecialty tertiary care clinics between 2010 to 2021 were included. Demographics and clinical characteristics including response to IMT treatment and change in visual acuity were collected from medical records. Patient outcomes were assessed at initial presentation and at the latest available follow-up. Linear multivariable regression analysis was used to explore predictors of final visual acuity. 

Results: A total of 914 NIU patients (451 IMT and 463 non-IMT) with a median age of 51.0 (IQR: 37.0-65.0) years and 57% females were identified. Patients were followed for a median duration of 20.0 (IQR: 6.0-46.0) months. Over half of the patients had bilateral disease (55%), with a significantly higher proportion of bilateral cases in the IMT compared to the non-IMT group (p<0.001). The IMT group compared to the non-IMT group was more likely to have chronic uveitis (52% vs. 35%, p<0.001). IMT patients were treated with an average of 1.3 agents, while 2% of patients were trialed on five different systemic agents. First selected IMTs were discontinued and/or switched after a median duration of 16 (IQR: 5.0-39.0) months. Following treatment with prednisone, IMT patients were most commonly initiated on methotrexate, which was most commonly associated with nausea/vomiting (6% of patients on the agent). Eleven percent of all patients on IMT were started on a biologic as the first agent. The most common biologic agent used as a first line systemic treatment was adalimumab (61%), followed by infliximab (31%). The top three IMT with the highest proportion of optimal treatment response when taken alone or in combination with other agents were infliximab (79%), cyclosporine (75%) and adalimumab (70%). Multivariable regression analysis suggested that baseline visual acuity and anatomical uveitis classification were significant predictors of final visual acuity amongst patients with NIU (p<0.001). Conclusions: This cohort study demonstrates that patients with NIU on IMT are often trialed with multiple therapeutic agents before achieving an optimal treatment response. Our findings suggest that certain IMT agents may be more effective as first-line therapy for NIU. The best predictors of final vision outcome in patients with NIU are baseline visual acuity and anatomical uveitis classification.