title: Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders.
abstract: OBJECTIVE
  To provide recommendations for the use of anti-tumor necrosis factor α (TNF-α) biologic agents in patients with ocular inflammatory disorders.
  
  
  CONCLUSIONS
  Ocular inflammatory diseases remain a leading cause of vision loss worldwide. Anti-TNF-α agents are used widely in treatment of rheumatologic diseases. A committee of the American Uveitis Society performed a systematic review of literature to generate guidelines for use of these agents in ocular inflammatory conditions.
  
  
  METHODS
  A systematic review of published studies was performed. Recommendations were generated using the Grading of Recommendations Assessment, Development, and Evaluation group criteria.
  
  
  RESULTS
  Numerous studies including controlled clinical trials have demonstrated that anti-TNF-α biologic agents (in particular infliximab and adalimumab) are effective in the treatment of severe ocular inflammatory disease. Based on these studies, the expert panel makes the following recommendations.
  
  
  CONCLUSIONS
  Infliximab and adalimumab can be considered as first-line immunomodulatory agents for the treatment of ocular manifestations of Behçet's disease. Infliximab and adalimumab can be considered as second-line immunomodulatory agents for the treatment of uveitis associated with juvenile arthritis. Infliximab and adalimumab can be considered as potential second-line immunomodulatory agents for the treatment of severe ocular inflammatory conditions including posterior uveitis, panuveitis, severe uveitis associated with seronegative spondyloarthropathy, and scleritis in patients requiring immunomodulation in patients who have failed or who are not candidates for antimetabolite or calcineurin inhibitor immunomodulation. Infliximab and adalimumab can be considered in these patients in preference to etanercept, which seems to be associated with lower rates of treatment success.
authors.affiliation: St. Luke's Cataract and Laser Institute, Tarpon Springs, Florida.
authors.forename: Grace
authors.initials: G
authors.lastname: Levy-Clarke
authors.affiliation: Departments of Ophthalmology and Medicine, the Mount Sinai Medical School, New York, New York; Department of Epidemiology, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Jabs
authors.affiliation: Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
authors.forename: Russell W
authors.initials: RW
authors.lastname: Read
authors.affiliation: Departments of Ophthalmology and Medicine, Division of Rheumatology, Oregon Health & Science University, Portland, Oregon; Department of Ophthalmology, Legacy Devers Eye Institute, Portland, Oregon.
authors.forename: James T
authors.initials: JT
authors.lastname: Rosenbaum
authors.affiliation: Department of Ophthalmology, Moran Eye Institute, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Albert
authors.initials: A
authors.lastname: Vitale
authors.affiliation: Departments of Ophthalmology, Pathology, and Biological Structure, University of Washington School of Medicine, Seattle, Washington. Electronic address: russvg@u.washington.edu.
authors.forename: Russell N
authors.initials: RN
authors.lastname: Van Gelder
mesh_terms: D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000188:drug therapy; D001528:Behcet Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D000068582:Certolizumab Pegol; D000068800:Etanercept; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab; D009885:Ophthalmology / Q000458:organization & administration; D011092:Polyethylene Glycols / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D015423:Scleritis / Q000175:diagnosis / Q000188:drug therapy*; D012955:Societies, Medical / Q000458:organization & administration; D025242:Spondylarthropathies / Q000188:drug therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014481:United States; D014605:Uveitis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007140:Immunoglobulin Fab Fragments; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D011092:Polyethylene Glycols; C529000:golimumab; D000069285:Infliximab; D000068879:Adalimumab; D000068800:Etanercept; D000068582:Certolizumab Pegol