ArticleJournal of ophthalmic inflammation and infection2026
Comparative long-term outcomes of conventional immunomodulatory therapy, biologic agents, and combination therapy in chronic uveitis.
Article in Journal of ophthalmic inflammation and infection, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChronic non-infectious uveitis can lead to vision loss if not adequately controlled. Thus, steroid-sparing immunomodulatory therapy (IMT) is often required to achieve and maintain disease quiescence. It is unclear if biologic agents inhibiting tumor necrosis factor alpha (TNF-α) provide superior control of chronic uveitis compared to conventional IMTs on their own or as combination therapy.
methodsThis is a multicenter retrospective cohort study using the TriNetX US Collaborate network. Adult patients (≥18 years) with chronic non-infectious uveitis who achieved steroid-sparing quiescence on IMT were included. Patients were grouped by initial maintenance with conventional IMT (methotrexate, mycophenolate mofetil, or azathioprine), biologic TNF-α inhibitor (adalimumab or infliximab) or combination therapy (both conventional IMT and biologic agent), and the incidence of flares over 6, 12, 18 and 24 months of follow-up were analyzed. Outcomes were compared between groups using paired chi-squared tests on propensity score matched cohorts with relative risk (RR) and 95% confidence intervals calculated for each outcome.
resultsA total of 2,912 patients on conventional IMT, 736 patients on biologic therapy and 1,313 on combination therapy met the definition of steroid-sparing control. Patients on combination therapy had significantly lower rates of flares as compared to those on conventional IMT at 6 months (RR 0.53; p = 0.0070), 12 months (RR 0.52; p = 0.0011), 18 months (RR 0.56; p = 0.0022) and 24 months (RR 0.56; p = 0.0012). No difference in the rate of flares was found between combination versus biologic therapy, or conventional IMT versus biologic therapy at 6-, 12-, 18- and 24 months. Patients initially treated with conventional IMT had higher rates of augmentation or switching to biologic therapy at 12 months (RR 1.74; p = 0.0386), 18 months (RR 1.65; p = 0.0219) and 24 months (RR 1.65; p = 0.0114).
conclusionThe current study indicates that for patients with chronic uveitis who achieve steroid-sparing control on IMT, those treated with a combination of a conventional IMT and a biologic TNF-α inhibitor have a lower risk of disease activation as compared to those on conventional IMT.
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