COVID-19 Status Should Influence Noninfectious Uveitis Treatment Decisions

By Reuters Staff

July 13, 2020

NEW YORK (Reuters Health) - In patients with noninfectious uveitis, the individual's COVID-19 status should influence decisions regarding immunomodulatory therapy (IMT), according to a survey-based study.

Noninfectious uveitis is commonly treated with IMT, which can include corticosteroids, conventional immunosuppressive agents, or biologics. Patients receiving IMT might be at increased risk of SARS-CoV-2 infection and/or a more severe course of COVID-19.

Dr. Rupesh Agrawal from National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore and colleagues in the COVID-19 IMT Study Group used a web-based survey to assess the opinions of the international uveitis specialist community on the approach to the management of IMT in patients with uveitis during the pandemic.

Consensus was achieved if more than 75% of the experts agreed on a proposed statement, and consensus for general recommendations was achieved if more than 75% of the experts gave the same answer to a proposed question.

A total of 139 specialists from the International Uveitis Study Group, International Ocular Inflammation Society, Uveitis Society of India, and Foster Ocular Immunology Society participated. Nearly half (42.4%) had more than 15 years of experience managing patients with noninfectious uveitis, and 38.84% treated more than 300 patients with IMT annually.

Consensus was achieved for not initiating IMT in patients who have suspected or confirmed COVID-19, according to the online report in British Journal of Ophthalmology.

Oral corticosteroids should be maintained for healthy patients with inactive uveitis, whereas local corticosteroids are preferred over increasing the dose of systemic corticosteroid therapy in patients with active uveitis.

Increased-risk patients with uveitis who are suspected of having COVID-19 or have tested positive for SARS-CoV-2 should not be started on oral corticosteroids or conventional immunosuppressive drugs; higher-dose oral corticosteroids should be tapered to a lower safer dose; and conventional immunosuppressive drugs should be decreased or stopped.

Recommendations were similar for high-risk and very-high-risk patients with noninfectious uveitis.

There was consensus for starting or maintaining NSAIDS in the treatment of scleritis for patients who were otherwise healthy and with no history of COVID-19 contact, but there was no consensus on treatment of healthy patients with a contact history or patients with possible/confirmed COVID-19.

Experts agreed that patients with noninfectious uveitis on conventional IMT or biologics should practice hand personal hygiene, avoid crowds, use masks, avoid unproductive attendances at the hospital, postpone long-term follow-up, and maintain self-isolation.

"Management of IMT during the COVID-19 pandemic involves many challenges," the authors conclude, and thus "any decision-making on IMT will benefit from multidisciplinary teams of experts involved in the care of the patient with suspected or confirmed COVID-19 infection."

Dr. Agrawal and 2 coauthors did not respond to a request for comments.

SOURCE: British Journal of Ophthalmology, online June 25, 2020.