Treating chronic uveitis with fluocinolone acetonide implants


Study results show the device offers an effective long-term option for patients.

Treating chronic uveitis with fluocinolone acetonide implants

This article was reviewed by Hans W. Andrews, MD.

Results from a real-world study of the FDA-approved fluocinolone acetonide 0.18 mg in­travitreal implant (Yutiq, EyePoint Pharmaceuti­cals Inc.) showed that the device was effective for treating chronic noninfectious uveitis over the long term, according to Hans W. Andrews, MD, a resident at the Vanderbilt Eye In­stitute, in Nashville, Tennessee.

Uveitis is an important cause of visual loss, and corticosteroids remain the standard of care for patients. When the MUST trial [NCT00132691] compared the use of systemic and regional corticoste­roids to treat intermediate uveitis, posterior uveitis, and panuveitis, the best-corrected visual acuities (BCVAs) were very similar throughout the 5-year study.1

The implant group had better control of intraocular inflammation, but that group had sig­nificantly higher incidence rates of cataract and glaucoma. Based on these results, the investiga­tors concluded that regional therapy was a reason­able approach for treating unilateral uveitis when systemic therapy was ineffective or not feasible.

Related: Noninfectious uveitis: Meeting the challenge

Clinical trial

Hans W. Andrews, MD discusses treating chronic uveitis with fluocinolone acetonide implants

The POINT trial (NCT00991029) also evaluated regional steroid (periocular and intravitreal) therapy for uveitic macular edema (ME), and investiga­tors reported significantly reduced ME with intravitreal steroids (triam­cinolone and dexamethasone) com­pared with periocular triamcinolone. Results also showed improved BCVA by more than 5 letters in the intravit­real groups, but a risk of intraocular pressure (IOP) exceeding 24 mm Hg with intravitreal treatment.2 Andrews noted that about 40% of patients in all groups required IOP-lowering medication.

The Yutiq implant, which is inserted by an in-office procedure, delivers a low dose (0.2 μg) of fluocinolone acetonide for up to 3 years, lasts sig­nificantly longer than the dexamethasone implant (Ozurdex, Allergan), which requires replacement every 2 to 3 months.

The Yutiq implant was evalu­ated in 2 multicenter, randomized, phase 3 clini­cal studies in which it was compared with sham therapy.3 Study results reported that the device provided a significant reduction in the recurrence rate of uveitis at 6 and 12 months compared with sham (P < .001 for both comparisons). Andrews reported that in the Yutiq group, significantly (P < .01) more frequent cataract development and a trend toward higher IOP (P = .19).

Real-world efficacy

fluocinolone acetonide implants for chronic uveitis

Andrews and colleagues conducted a retrospec­tive chart review that included 103 consecutive eyes (68 patients; median age, 59 years) treated with the implant. Posterior uveitis was the most frequent uveitic type. The patients were evaluated at 1-, 3-, and 6-month intervals for improved vi­sual acuities (VAs) by 2 or more lines, recurrent intraocular inflammation, recurrent or improved ME, and the steroid-sparing effect.

Andrews pointed out that this is the largest study of the implant outside of a clinical trial.

“The VA remained stable after injection of the implant with a trend toward improvement by 6 months,” Andrews said. “The baseline VA was 20/50 that improved to about 20/32. Fifteen eyes had active uveitis at baseline, which resolved in all but 1 patient at 6 months. At baseline, 77% of eyes had no ME, which improved to 88% at 1 month and 89% at 3 months, and was stable at 87% at 6 months. The ME resolved within the first month of treatment in 50% and 62.5% at 3 months.”

Related: Confirming uveitis treatment efficacy in study

Twenty-four patients studied were taking more than 10 mg of oral pred­nisone daily and/or immunotherapy at baseline. One month after the Yutiq implant was inserted, 40% of patients decreased the oral prednisolone dose under 10 mg or decreased or discontinued immunotherapy. At the 3-month time point, that percentage was 57%, and remained stable at 53% at 6 months.

Related: Why uveitis is a leading and underestimated cause of visual morbidity in patients


Andrews concluded that the review of the results of the long-term Yutiq implant in 103 eyes showed that the fluocinolone acetonide injectable intravit­real implant is a convenient and effective adjunc­tive treatment for chronic uveitis.

“The results showed improved vision and ME, suppressed disease activity, and decreased sys­temic sys­temic steroid use and need for immunotherapy,” Andrews said.

The investigators are continuing to study the short- and long-term efficacy and adverse effects of this novel therapy.

1. Kempen JH, Altaweek MM, Drye LT, et al. Benefits of systemic anti-inflammatory therapy versus fluocinolone acetonide intraocular implant for intermediate uveitis, posterior uveitis, and panuveitis: fifty-four-month results of the multicenter uveitis steroid treatment (MUST) Trial and follow-up study. Ophthalmology. 2015;122(10):1967- 1975. doi:10.1016/j/ophtha.2015.06.042
2. Thorne JE, Sugar EA, Holbrook JT, et al. Periocular triamcinolone vs. intravitreal triamcinolone vs. intravitreal dexamethasone implant for the treatment of uveitic macular edema: the PeriOcular vs. INTravitreal corticosteroids for uveitic macular edema (POINT) trial. Ophthalmology. 2019;126(2):283-295. doi:10.1016/j. ophtha.2018.08.021
3. Jaffe GH, Forster CS, Pavesio CE, et al. Effect of an injectable fluocinolone acetonide insert on recurrence rates in chronic noninfectious uveitis affecting the posterior segment: twelve-month results. Ophthalmology. 2019;126(4);601-610. doi:10.1016/j. ophtha.2018.10.033
Hans W. Andrews, MD
This article is adapted from Andrews’ presentation at the American Academy of Ophthalmology’s 2020 virtual annual meeting. Andrews has no financial interest in this subject matter.

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