Innovative uveitis therapies: targeting inflammation, macular edema

Dilraj S. Grewal, MD, FASRS, an associate professor of ophthalmology at Duke Eye Center, provides an in-depth overview of the current state of research and treatment innovations.

"It's an exciting time to be in uveitis," Grewel said. "You know, we've always seen our colleagues getting exciting clinical trial data for macular degeneration and diabetes, and yet, uveitis remains 10% of all blindness in the United States, even today. So there's a large unmet need to have therapies that go just beyond steroids or beyond what we have in our systemic armamentarium currently, which is mainly anti-metabolites and biologics."

Current clinical trials are exploring multiple treatment strategies, including systemic, local, intravitreal, and topical interventions.

So we're very fortunate to have a spectrum of clinical trials that are currently under various stages," he continued.

"We're looking at systemic therapies, looking at local therapies, intravitreal, as well as looking at topical therapies. And the unifying theme here is to provide control of disease activity without having the associated side effects that steroids bring with them.

"That's extremely important, because in the midst of a busy retina clinic, we often tend to ignore subtle signs of inflammation, or we don't fully evaluate inflammation in our patients that have uveitis. And we learn a lot from clinical trial design, as well, the importance of, for example, wide-field fluorescein angiography to fully characterize the extent of leakage, because leakage is a very defining marker of intraocular inflammation. And if you look at some of the trials that are out there right now, for example, brepocitinib, which is an oral JAK1 TYK2, small molecule inhibitor, and has shown positive results in the phase 2 NEPTUNE study.