Documento de recomendaciones sobre el tratamiento con inmunodepresores de la uveítis no anterior, no infecciosa, no neoplásica / Recommendations statement on the immunosuppressive treatment of non-infectious, non-neoplastic, non-anterior uveítis

OBJETIVO: Desarrollar recomendaciones basadas en la mejor evidencia disponible y experiencia sobre el uso de inmunomoduladores en pacientes con uveítis, las uveítis intermedias (UI), posteriores (UP) y panuveítis (PanU) no infecciosas, no neoplásicas. MÉTODOS: Se seleccionó un grupo multidisciplinar de 5 expertos, que definió el alcance, usuarios y apartados del documento. Posteriormente, se realizó una revisión sistemática de la literatura sobre la eficacia y seguridad de los inmunomoduladores en pacientes con UI, UP y PanU no infecciosa, no neoplásica. Se generaron 34 recomendaciones en base a la evidencia encontrada en la revisión sistemática y a la experiencia de los expertos. Mediante la metodología Delphi, el grado de acuerdo con las recomendaciones se extendió a 25 expertos más que votaron según una escala de 1 (total desacuerdo) a 10 (total acuerdo). El acuerdo se definió como una puntuación ≥ 7 en al menos el 70% de los participantes. El nivel de evidencia y grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford. RESULTADOS: Se aceptaron las 34 recomendaciones generadas tras 2 rondas Delphi (se modificaron 3 recomendaciones). Se incluyen recomendaciones específicas para pacientes con UI, UP y PanU no infecciosa, no neoplásica, así como para distintas líneas de tratamiento. CONCLUSIONES: En los pacientes con UI, UP y PanU no infecciosas, no neoplásicas, estas recomendaciones pueden ayudar en la toma de decisiones terapéuticas, dada la ausencia de estudios con potencia estadística suficiente, u otros algoritmos universalmente aceptados sobre los que apoyar dichas decisiones

OBJECTIVE: To generate recommendations on the use of immunomodulators in patients with non-infectious, non-neoplastic intermediate uveitis (IU), posterior uveitis (PU) and panuveitis (PanU) based on best evidence and experience. METHODS: A multidisciplinary panel of 5 experts was established, who defined the scope, users, and sections of the document. A systematic literature review (SLR) was performed to assess the efficacy and safety of immunomodulatory drugs in patients with non-infectious, non-neoplastic, non-anterior uveitis. The results of the SLR were presented and discussed during an expert meeting in which 34 recommendations were generated. The level of agreement with the recommendations was also tested in 25 additional experts following a Delphi process. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of the experts voted ≥ 7. The level of evidence and grade or recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS: The SLR included 33 articles. The 34 recommendations were accepted after 2 Delphi rounds (3 of them were modified after the first round). They include specific recommendations on patients with non-infectious, non-neoplastic, PU and PanU, as well as different treatment guidelines. CONCLUSIONS: In patients with non-infectious, non-neoplastic, non-anterior uveitis these recommendations might help treatment decision making, due to the lack of robust evidence or other globally accepted algorithms

Recommendations statement on the immunosuppressive treatment of non-infectious, non-neoplastic, non-anterior uveitis. / Documento de recomendaciones sobre el tratamiento con inmunodepresores de la uveítis no anterior, no infecciosa, no neoplásica.

OBJECTIVE: To generate recommendations on the use of immunomodulators in patients with non-infectious, non-neoplastic intermediate uveitis (IU), posterior uveitis (PU) and panuveitis (PanU) based on best evidence and experience. METHODS: A multidisciplinary panel of 5 experts was established, who defined the scope, users, and sections of the document. A systematic literature review (SLR) was performed to assess the efficacy and safety of immunomodulatory drugs in patients with non-infectious, non-neoplastic, non-anterior uveitis. The results of the SLR were presented and discussed during an expert meeting in which 34 recommendations were generated. The level of agreement with the recommendations was also tested in 25 additional experts following a Delphi process. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of the experts voted ≥7. The level of evidence and grade or recommendation were assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. RESULTS: The SLR included 33 articles. The 34 recommendations were accepted after 2 Delphi rounds (3 of them were modified after the first round). They include specific recommendations on patients with non-infectious, non-neoplastic, PU and PanU, as well as different treatment guidelines. CONCLUSIONS: In patients with non-infectious, non-neoplastic, non-anterior uveitis these recommendations might help treatment decision making, due to the lack of robust evidence or other globally accepted algorithms.

Documento de recomendaciones de tratamiento de la uveítis anterior no infecciosa / Treatment recommendations for non-infectious anterior uveitis

Fundamento y objetivo Desarrollar recomendaciones basadas en la mejor evidencia disponible y experiencia sobre el uso de inmunodepresores en pacientes con uveítis anterior (UA) no infecciosa no neoplásica. Material y métodos: Se seleccionó un grupo multidisciplinar de 5 expertos, que en la primera reunión de grupo nominal, acordó el alcance, usuarios y apartados del documento. Posteriormente, se realizó una revisión sistemática de la literatura sobre la eficacia y seguridad de los inmunodepresores en pacientes con UA no infecciosa no neoplásica. En la segunda reunión de grupo nominal, se generaron 33 recomendaciones en base a la evidencia encontrada en la revisión sistemática y a la experiencia de los expertos. Mediante la metodología Delphi, el grado de acuerdo con las recomendaciones se extendió a 25 expertos más que votaron según una escala de uno (total desacuerdo) a 10 (total acuerdo). El acuerdo se definió como una puntuación ≥7 en al menos el 70% de los participantes. El nivel de evidencia y grado de recomendación se clasificaron según el modelo del Center for Evidence Based Medicine de Oxford. Resultados: Se aceptaron las 33 recomendaciones generadas. Se incluyen recomendaciones específicas para pacientes con UA no infecciosa no neoplásica, así como para distintas líneas de tratamiento. Conclusiones: En los pacientes con UA no infecciosa no neoplásica, estas recomendaciones sobre el uso de inmunodepresores pueden servir como guía que ayude en la toma de decisiones terapéuticas, dada la ausencia de estudios con potencia estadística suficiente, u otros algoritmos universalmente aceptados sobre los que apoyar dichas decisiones (AU)

Background and objective: To develop recommendations on the use of immunodepressors in patients with non-infectious, non-neoplastic anterior uveitis (AU) based on best evidence and experience. Material and methods: A multidisciplinary panel of five experts was established, who, in the first nominal group meeting defined the scope, users, and chapters of the document. A systematic literature review was performed to assess the efficacy and safety of immunosuppressors in patients with non-infectious, non-neoplastic AU. All the above was discussed in a second nominal group meeting and 33 recommendations were generated. Through the Delphi methodology, the degree of agreement with the recommendations was tested also by 25 more experts. Recommendations were voted on from one (total disagreement) to 10 (total agreement). We defined agreement if at least 70% voted ≥7. The level of evidence and degree of recommendation was assessed using the Oxford Centre for Evidence-based Medicine's Levels of Evidence. Results: The 33 recommendations were accepted. They include specific recommendations on patients with non-infectious, non-neoplastic AU, as well as different treatment lines. Conclusions: In patients with non-infectious, non-neoplastic AU, these recommendations on the use of immunosuppressors might be a guide in order to help in the treatment decision making, due to the lack of robust evidence or other globally accepted algorithms (AU)

Treatment recommendations for non-infectious anterior uveitis. / Documento de recomendaciones de tratamiento de la uveítis anterior no infecciosa.

BACKGROUND AND OBJECTIVE: To develop recommendations on the use of immunodepressors in patients with non-infectious, non-neoplastic anterior uveitis (AU) based on best evidence and experience. MATERIAL AND METHODS: A multidisciplinary panel of five experts was established, who, in the first nominal group meeting defined the scope, users, and chapters of the document. A systematic literature review was performed to assess the efficacy and safety of immunosuppressors in patients with non-infectious, non-neoplastic AU. All the above was discussed in a second nominal group meeting and 33 recommendations were generated. Through the Delphi methodology, the degree of agreement with the recommendations was tested also by 25 more experts. Recommendations were voted on from one (total disagreement) to 10 (total agreement). We defined agreement if at least 70% voted ≥7. The level of evidence and degree of recommendation was assessed using the Oxford Centre for Evidence-based Medicine's Levels of Evidence. RESULTS: The 33 recommendations were accepted. They include specific recommendations on patients with non-infectious, non-neoplastic AU, as well as different treatment lines. CONCLUSIONS: In patients with non-infectious, non-neoplastic AU, these recommendations on the use of immunosuppressors might be a guide in order to help in the treatment decision making, due to the lack of robust evidence or other globally accepted algorithms.

Tratamiento con fármacos anti-TNF: utilidad de la monitorización de niveles de fármaco y anticuerpos antifármaco en la práctica clínica / Anti-tumor necrosis factor drug therapy: The usefulness of monitoring drug levels and anti-drug antibodies in clinical practice

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