Page 74 - Ebook-Book JCMS 2025

Efficacy and Safety of Immunomodulatory Therapy (IMT) ver-
sus Corticosteroids for Noninfectious Uveitis: A Meta-Analysis
of Visual Acuity Improvements, Adverse Ocular Events, and
Macular Edema Resolutions with Subgroup Analysis by IMT
Agents
Natchanon Champreeda*
Faculty of Medicine, Chulalongkorn University
*Corresponding Author E-mail: natchanon.cha@docchula.com
Background: Abstract
Noninfectious uveitis (NIU) is a significant cause of visual morbidity and often requires
long-term anti-inflammatory treatment. Corticosteroids remain the mainstay of therapy
but are associated with substantial ocular and systemic side effects. Immunomodulatory
therapy (IMT), including agents such as methotrexate and adalimumab, has been
introduced as a steroid-sparing alternative. However, the comparative efficacy and safety of
IMT versus corticosteroids remain uncertain.
Methods: A systematic literature search of PubMed, MEDLINE, and Scopus (2015–2024) was
performed to evaluate the efficacy and safety of IMT compared to corticosteroids in NIU.
Eligible studies were English-language RCTs or cohort studies with ≥6 months of follow-up,
comparing methotrexate or adalimumab to corticosteroids and reporting at least one
visual or safety outcome. Extracted outcomes included changes in visual acuity, incidence
of ocular adverse events, and macular edema resolution. Subgroup analyses were
conducted by IMT agents.
Results: Four randomized controlled trials comprising 453 eyes were included. Three evaluated
methotrexate, and one assessed adalimumab. Compared to corticosteroids, adalimumab
significantly improved visual acuity (mean difference [MD]: 6.50 [5.21, 7.79]; p < 0.00001),
whereas methotrexate did not show a significant effect (MD: 1.29 [−1.04, 3.63]; p = 0.14).
Ocular adverse events were comparable between IMT and corticosteroids (risk ratio [RR]:
1.11 [0.84, 1.46]; p = 0.32), with no significant safety differences between methotrexate and
adalimumab (p = 0.89). Neither agent significantly improved macular edema resolution.
Conclusions: Adalimumab is associated with superior visual outcomes compared to corticosteroids in
NIU, whereas methotrexate offers no significant visual benefit. Both IMTs demonstrated
similar safety profiles to corticosteroids. Neither agent showed benefit in macular edema
resolution, emphasizing the need for adjunctive therapies. Adalimumab may be preferred
as first-line IMT, while methotrexate remains a cost-effective alternative. Further long-term
studies are warranted.
72 Joint Conference in Medical Sciences 2025