Anti–tumor necrosis factor-α therapy in uveitis

Since the first reported use in 2001 of an anti–tumor necrosis factor-alpha (TNF-α) agent, infliximab, for the treatment of uveitis, several new anti–TNF-α agents have emerged for the treatment of refractory noninfectious uveitides, although their use remains off-label in the US. These agents have demonstrated remarkable clinical antiinflammatory efficacy and a potential immunoregulatory role in selected uveitis patients, but it is currently unclear whether they can modify the natural history of disease. We review the rationale and clinical indications for this therapy, the differences between agents, how to manage dosing and intervals, and how to screen for and identify potential side effects. We also present a summary of the science behind the use of anti–TNF-α agents in ocular inflammation and the evidence for their efficacy.