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Background <p>Chronic uveitis, a major cause of legal blindness in the United States, often requires long-term immunomodulatory therapy (IMT). This study aims to characterize trends in systemic IMT use among adults with chronic uveitis in United States from 2005 to 2025.</p> Methods <p>This cross-sectional time-series study used the TriNetX Network to analyze adults (ages ≥ 18) with chronic, non-infectious uveitis treated with methotrexate, mycophenolate, azathioprine, cyclosporine, tacrolimus, cyclophosphamide, adalimumab, infliximab and/or etanercept. Data was grouped into consecutive 3-year intervals, and Cochran–Armitage tests assessed changes in the proportion of patients treated with each medication.</p> Results <p>The total population included 12,035 adult patients. Academic and non-academic institutions shared similar trends in IMT usage. Overall, there was a reduction in the proportion of patients on methotrexate (44.2% in 2005–2007 to 37.6% in 2023–2025, <i>p</i> &lt; 0.0001), azathioprine (15.1% in 2005–2007 to 6.7% in 2023–2025, <i>p</i> &lt; 0.0001), cyclophosphamide (2.5% in 2011–2013 to 0.8% in 2023–2025, <i>p</i> &lt; 0.0001), infliximab (18.6% in 2005–2007 to 14.1% in 2023–2025, <i>p</i> &lt; 0.0001) and etanercept (9.0% in 2005–2007 to 2.0% in 2023–2025, <i>p</i> &lt; 0.0001). Conversely, treatment with adalimumab rose markedly among patients with chronic uveitis (8.0% in 2005–2007 to 34.6% in 2023–2025; <i>p</i> &lt; 0.0001). There was no change in the proportion of patients on mycophenolate (14.6% in 2005–2007 to 12.8% in 2023–2025; <i>p</i> = 0.5963).</p> Conclusion <p>Key shifts in management of chronic uveitis include the emergence adalimumab as a key steroid sparing agent, the continued role of methotrexate as the first-line steroid-sparing agent, and a marked decline in the use of many older immunomodulatory therapies.</p>

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Trends in immunomodulatory therapy for the treatment of chronic uveitis in the United States

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月25日

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  • Charles Zhang,
  • Sinan Ersan,
  • Jonathan B. Lin,
  • Mario Cale,
  • Thomas A. Albini

摘要

Background

Chronic uveitis, a major cause of legal blindness in the United States, often requires long-term immunomodulatory therapy (IMT). This study aims to characterize trends in systemic IMT use among adults with chronic uveitis in United States from 2005 to 2025.

Methods

This cross-sectional time-series study used the TriNetX Network to analyze adults (ages ≥ 18) with chronic, non-infectious uveitis treated with methotrexate, mycophenolate, azathioprine, cyclosporine, tacrolimus, cyclophosphamide, adalimumab, infliximab and/or etanercept. Data was grouped into consecutive 3-year intervals, and Cochran–Armitage tests assessed changes in the proportion of patients treated with each medication.

Results

The total population included 12,035 adult patients. Academic and non-academic institutions shared similar trends in IMT usage. Overall, there was a reduction in the proportion of patients on methotrexate (44.2% in 2005–2007 to 37.6% in 2023–2025, p < 0.0001), azathioprine (15.1% in 2005–2007 to 6.7% in 2023–2025, p < 0.0001), cyclophosphamide (2.5% in 2011–2013 to 0.8% in 2023–2025, p < 0.0001), infliximab (18.6% in 2005–2007 to 14.1% in 2023–2025, p < 0.0001) and etanercept (9.0% in 2005–2007 to 2.0% in 2023–2025, p < 0.0001). Conversely, treatment with adalimumab rose markedly among patients with chronic uveitis (8.0% in 2005–2007 to 34.6% in 2023–2025; p < 0.0001). There was no change in the proportion of patients on mycophenolate (14.6% in 2005–2007 to 12.8% in 2023–2025; p = 0.5963).

Conclusion

Key shifts in management of chronic uveitis include the emergence adalimumab as a key steroid sparing agent, the continued role of methotrexate as the first-line steroid-sparing agent, and a marked decline in the use of many older immunomodulatory therapies.