Comparative Effects of Immunomodulatory Therapies in Non-Infectious Uveitis: A Systematic Review and Meta-Analysis

Non-infectious uveitis (NIU) is an immune-mediated, vision-threatening disease often requiring immunomodulatory therapy. We systematically evaluate the efficacy and safety of immunomodulatory therapies for the management of NIU. A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, the Cochrane Library, and ClinicalTrials.gov were searched up to December 2024. Randomized, controlled trials (RCTs) assessing the efficacy and safety of immunomodulatory agents for uveitis were included. Bayesian network meta-analyses were conducted to compare treatments across trials, while frequentist meta-analyses were performed to estimate the absolute treatment failure rate at month 6 and the overall SAEs rate. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Sixteen randomized controlled trials, involving 11 immunomodulatory therapies, were included from 6097 records retrieved. Among them, adalimumab plus corticosteroids was associated with significant reduction in hazard of treatment failure over time (HR 0.51, 95% CrI: 0.24–0.95) compared with corticosteroids monotherapy. The estimated overall treatment failure rate at month 6 was 37.6%, and the number of SAE was around 10.1%. No significant differences were observed in treatment failure rates at month 6, changes in BCVA or number of SAEs across treatments. Adalimumab plus corticosteroids significantly prolonged the relapse-free period compared with corticosteroids monotherapy. Mycophenolic acid showed favorable trend in both efficacy and safety. Despite immunomodulatory treatment, the risk of uveitis relapse still remains and warrants continued attention.