Management of repository corticotropin injection therapy for non‐infectious uveitis: a Delphi study

Purpose Diagnosis and management of non‐infectious uveitis (NIU), a major cause of blindness worldwide, are challenging. Corticosteroids, the cornerstone of therapy, are not appropriate for long‐term use, and while non‐biologic and biologic immunomodulators may be used for some patients, data on their efficacy and safety in this population are limited. Repository corticotropin injection (RCI), believed to affect uveitis by multiple mechanisms, has received regulatory approval for treatment of ophthalmic diseases including posterior uveitis, but is not widely used or discussed in guidelines for the management of uveitis and ocular inflammatory diseases. Methods The index study employed a modified Delphi process with a panel of 14 US‐based ophthalmologists. Consensus recommendations were developed through a series of three questionnaires. Panellists rated statements on a Likert scale from –5 (strongly disagree) to +5 (strongly agree). Results The Delphi panel provided consensus recommendations on examinations and testing needed for diagnosis, treatment goals, and the use of corticosteroids, as well as the use of non‐biologic and biologic immunomodulators. The panel reached consensus that RCI may be considered for posterior and pan‐uveitis, and dosing should be individualized for each patient. Dose reduction/discontinuation should be considered for excessive RCI‐related toxicity, hyperglycaemia and/or diabetic complications, excessive costs, or remission ≥ 2 years. Patients should be weaned from RCI if uveitis is stable and well controlled. Adverse events during RCI therapy can be managed by appropriate interventions, with dose reduction/discontinuation considered if events are severe or recurrent. Conclusions Expert consensus suggests RCI may be an appropriate treatment option for some patients with uveitis when other therapies are ineffective or intolerable.