Comparative Efficacy and Safety of Systemic Immunomodulatory Therapies for Non-Infectious Uveitis: A Systematic Review With Pairwise and Network Meta-Analyses.

In 30 seconds

This systematic review and network meta-analysis compared systemic immunomodulatory therapies for non-infectious uveitis (NIU), including evidence from seven studies with 992 participants: six randomised trials and one prospective comparative cohort. In pairwise analysis, adalimumab reduced treatment failure compared with placebo (RR, 0.67; 95% CI, 0.58-0.78; p < 0.0001). Adalimumab also increased injection-site reactions (RR, 2.67; 95% CI, 1.73-4.12). Most network comparisons found no significant differences in safety outcomes; estimates for some outcomes were imprecise.

Key findings

• Adalimumab reduced treatment failure versus placebo (RR, 0.67; 95% CI, 0.58-0.78; p < 0.0001; I² = 28.1%).
• Injection-site reactions were more frequent with adalimumab than placebo (RR, 2.67; 95% CI, 1.73-4.12).
• The mortality estimate for adalimumab versus placebo was inconclusive (RR, 3.80; 95% CI, 0.42-34.15); three deaths occurred in adalimumab groups and none in placebo groups.
• Infliximab had an imprecise urinary tract infection signal versus placebo (RR, 40.98; 95% CI, 1.82-922.17), based on sparse events and one nonrandomized comparison.

Why it matters

NIU can cause irreversible visual impairment, so treatment failure and treatment-related harms are clinically important outcomes. This synthesis finds the most consistent efficacy evidence for adalimumab, while showing that comparative safety is less certain. The findings help frame the evidence available for systemic therapies without resolving how their benefits and risks compare across treatments.

What to keep in mind

The evidence base comprised only seven studies, including one prospective cohort. Some safety estimates were imprecise; the infliximab urinary tract infection signal relied on sparse events and one nonrandomized comparison.