Fundamentals of Care for Uveitis International Consensus Group. Guidance on Noncorticosteroid Systemic Immunomodulatory Therapy in Noninfectious Uveitis: Fundamentals Of Care for UveitiS (FOCUS) Initiative

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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 reviewof the
literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library,
EMBASE,CINAHL,SCOPUS,BIOSIS, andWeb 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.Atotal of 44 globally representativegroupmembersmet 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
Translated title of the contributionFundamentos de Cuidado para Uveitis International Consensus Group. Guía sobre el tratamiento inmunomodulador sistémico no corticosteroide en la uveítis no infecciosa: Iniciativa Fundamentos del cuidado de la UveitiS (FOCUS)
Original languageEnglish
Pages (from-to)757-773
Number of pages17
JournalOphthalmology
Volume125
Issue number5
DOIs
StatePublished - May 1 2018

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