Uveitis research review

April 2, 2024 Dr Jo Sims

The Humira in ocular inflammations taper (HOT) study

F Pichi, S Smith et al

American Journal of Ophthalmology 2024; 258: 85-97


Review: This study examined factors impacting the risk of relapse in patients with non-infectious uveitis who undergo adalimumab (Humira) tapering. It was a retrospective, multicentre study including 328 patients.


Adalimumab tapering was commenced after a mean of 100.8 weeks of inactivity. Recurrence was observed in 39.6% of patients after a mean of 44.7 weeks. Recurrence rate was significantly higher in younger patients and a faster adalimumab taper was associated with increased recurrence rate. A more extended period of remission before tapering was associated with a lower rate of recurrence (hazard ratio=0.97 per 10-weeks longer period of inactivity, p=0.04).


Comment: Tapering of medication in patients with chronic uveitis remains a significant management challenge and this paper is an important addition to the literature. Clinically, it’s hard to distinguish between uveitis in remission from uveitis that is well-controlled on medication. Adalimumab, an anti-tumour necrosis factor (TNF) blocker, is increasingly used in the management of chronic non-infectious uveitis due to efficacy and favourable side-effect profile. This large study helps support the approach taken in clinical practice in cases of moderate or severe uveitis, aiming for at least two years of inactivity before reducing medication (and longer for more severe cases). Long-term follow-up remains important following treatment cessation due to the high relapse rate.


Tubulointerstitial nephritis and uveitis syndrome in paediatric patients

Janetos T, Lee P, Goldstein D

Ocular Immunology and Inflammation 2023; 31(10): 1955-1964


Review: This review article looks at tubulointerstitial nephritis and uveitis syndrome (TINU) in the paediatric population. TINU is increasingly recognised as an important cause of uveitis in children, with one large series estimating a prevalence of 32% in patients under 20 with bilateral anterior uveitis. It can also occur in adults but seems more common in children and diagnosis is important since recognition of kidney disease can help improve health outcomes. The article focuses on clinical manifestations, which are now expanding to recognise that posterior uveitis, granulomatous features and insidious onset can also occur. The eye disease is usually chronic and immunomodulatory treatment is often needed, whereas kidney disease may be self-limiting. The authors recommend new uveitis patients have routine screening for kidney disease, including creatinine and urine beta-2 microglobulin.


Comment: This is an excellent review of TINU, a condition seen with reasonable frequency in paediatric uveitis patients in Auckland and less commonly in adults. The most important take-home message is to include screening for kidney disease in the standard screening tests performed for uveitis.


IMT vs systemic steroids in iCNV secondary to idiopathic multifocal choroiditis

Airaldi M, Monteduro D et al

American Journal of Ophthalmology 2024; Jan 13


Review: This study examined the effect of immunomodulatory treatment (IMT) on visual and treatment outcomes of inflammatory choroidal neovascularisation (iCNV) in patients with multifocal choroiditis and compared them to patients who received steroids on an ‘as needed’ basis.


It was a multicentre retrospective study and included 66 eyes of 58 patients, equally divided into two groups, with a study period of two years. Results showed the group receiving IMT had a lower relative risk of iCNV reactivation (0.64, p=0.04). Relapses of multifocal choroiditis-related inflammation were associated with a higher risk of iCNV reactivation. Visual acuity outcomes were better in the group receiving IMT (mean 69.1 letters vs 77.1 letters).


Comment: iCNV is a common complication of posterior uveitis and usually these patients respond promptly to intravitreal anti-VEGF. However, the optimal management to reduce risk of repeated reactivations of iCNV and loss of vision has not been clear as there have been no large, randomised trials. This is an important study and the largest to date to have examined outcomes of multifocal choroiditis patients managed with different strategies. Its findings are similar to those of smaller studies, with patients having better outcomes when treated proactively with immunomodulatory treatment, rather than the more reactive steroid approach. The authors suggest IMT should be recommended for multifocal choroiditis patients. Patients with iCNV from conditions other than MFC were not included in the study, however, so any generalisation of the results is not possible.



Dr Jo Sims is a medical retina and uveitis specialist at Eyes and Eyelids and Greenlane Clinical Centre, where she set up the uveitis service. She is a trustee for Macular Degeneration NZ and is on the Pharmac ophthalmology subcommittee.