Non-Steroidal treatments as new strategies for uveitis treatment

Abstract

Uveitis refers to a group of conditions defined by intraocular inflammation, that can be infectious or non-infectious, being the latter the most common. Uveitis hasa very important socio economics impact because it affects working age patients, andit is the third cause of preventable legal blindness. Since the disease causessignificant morbidity and the use of traditional treatments (mainly corticosteroids)is restricted by limited effectiveness and considerable side effects, uveitisremains a challenging field to ophthalmologists and it represents a significantpublic health concern. The better understanding of the mechanisms involved in uveitisis very useful to design therapies that could be more effective and with fewerside effects. Insight gained in the research of rheumatologic and autoimmunediseases has been translated to the treatment of uveitis. The frequent strategyin autoimmune diseases tends to initially control inflammation bycorticosteroids, followed by a tapering and a rapidly introduction of awidespread immunosuppressor treatment, like metrotexate or micofenolate. Ifthis treatment fails in controlling inflammation, the next step is addingbiologic agents. Several lines of evidence strongly support that tumor necrosisfactor α (TNFα), interleukin (IL)-1, IL-2, IL-6, IL-17, as well as oxidativeand nitrosative stress play a key role in uveitic damage. The biologic responsemodifiers are molecules that specifically target cytokines or their signalingpathways. This chapter summarizes recent investigations showing that biologictreatments, such as anti-TNFα, anti-interleukins, and other antibodiestargeting inflammatory pathways, as well as melatonin could be promissorystrategies for uveitis treatment.