The UK’s National Institute for Health and Care Excellence (NICE) has given preliminary approval to dexamethasone 0.7 mg intravitreal implant (Ozurdex, Allergan) and adalimumab (Humira, AbbVie) for sight-threatening non-infectious posterior uveitis.
If the cost regulator’s final appraisal determination (FAD) is confirmed as final guidance, the UK’s NHS will be required to offer both treatments as fully funded options for patients where the disease is active and there is worsening vision with risk of blindness.
The treatments would broaden the options for clinicians trying to help patients with a complicated condition. Currently, corticosteroids are the mainstay of treatment for uveitis after underlying conditions, such as infection, are ruled out.
However, systemic corticosteroids can cause severe side effects when used long term. When administered as drops, steroids cannot penetrate the blood-retinal barrier, but intravitreal injections must often be repeated and can also cause side effects, including cataracts and glaucoma.
A surgically placed nonbioerodible implant that releases fluocinolone into the vitreous has proved effective for up to 3 years, but may also lead to cataracts and glaucoma.