Biologic Switching Strategies for Anti-Tumor Necrosis Factor Alpha Refractory Noninfectious Uveitis: Systematic Review and Meta-Analysis of Clinical Approach.
Yoo-Ri Chung, Carmen Antía Rodríguez-Fernández, Ji Hun Song et al.
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In 30 seconds
This systematic review and meta-analysis assessed biologic switching in patients with noninfectious uveitis refractory to anti-TNFα therapy. It included 136 studies in the review, with 89 contributing to the meta-analysis. Across 466 patients, the pooled response rate after switching was 83% (95% CI: 76%-90%). Response rates were 77% (95% CI: 65%-87%) for switching between anti-TNFα agents and 89% (95% CI: 80%-96%) for switching to another biologic class; the difference was not statistically significant in the primary analysis (P = 0.0995). Evidence certainty was low.
Key findings
- The overall pooled response rate after biologic switching was 83% (95% CI: 76%-90%; 466 patients).
- Intraclass switching had a 77% response rate (95% CI: 65%-87%), compared with 89% (95% CI: 80%-96%) for interclass switching (P = 0.0995).
- Sensitivity analysis found response rates of 71% (95% CI: 59%-82%) for intraclass and 85% (95% CI: 77%-93%) for interclass switching (P = 0.044).
- The certainty of evidence for the overall pooled response rate was graded as low.
Why it matters
For patients whose noninfectious uveitis responds inadequately to anti-TNFα therapy, switching biologics may be associated with clinical response. The higher pooled response estimate for switching to a different biologic class may inform consideration of switching strategies, but the primary comparison was not statistically significant and the evidence is low certainty.
What to keep in mind
Most included studies were case reports or case series, and the overall certainty of evidence was low; pooled response estimates therefore warrant cautious interpretation.