Principles of immunosuppression in uveitis

Non infectious uveitis is a heterogeneous group of diseases mediated through autoimmune and autoinflammatory mechanisms. It is thus crucial to perform a complete work‐up to characterise the disease and eventually find a precise aetiology or a systemic associated condition. When the inflammation is bilateral and the vision threatened, systemic drugs are usually proposed. Despite tremendous progress in the understanding of the disease, treatments are generally based on the administration of non specific immunosuppressive molecules. Currently, high doses oral corticosteroids are first given, followed by a slow tapering of the dosage. If this strategy does not lead to disease control, a steroid‐sparing agent should be considered. Antimetabolites, T‐cell inhibitor and alkylating agents will be chosen (alone or in combination), depending on the severity of the disease and patients general status. Recently the development of biologic agents offers the possibility to target various specific molecules important in non infectious uveitis development. Nowadays, anti‐TNFα have been mostly tested with encouraging results. However, it is likely that different uveitis subtypes would require different biologic agents. In the future, the growing production of specific inhibitors might lead to a more tailored approach of uveitis treatment.