Challenges for further successful development of tumor necrosis factor targeting therapies for uveitis

Introduction: Uveitis is a heterogeneous group of ocular conditions characterized by inflammation of the uveal tract and is one of the leading causes of vision impairment. In developed countries, noninfectious uveitis (NIU) represents most cases and is challenging to treat due to its severity, chronicity, and high recurrence rates. The advent of anti-tumor necrosis factor-alpha (anti-TNF-alpha) agents have dramatically improved outcomes and changed treatment paradigms in NIU. Areas covered: The index article summarizes the present experience of anti-TNF-alpha agents in NIU pharmacotherapy and highlights the barriers to further research and development of anti-TNF-alpha agents for uveitis. Common challenges faced in NIU clinical drugs trials, specific difficulties in anti-TNF-alpha drug development, and promising competitor drug candidates are discussed and evaluated. Expert opinion: Anti-TNF-alpha agents have revolutionized NIU pharmacotherapy and greatly improved outcomes with good safety profiles. The great success of systemic infliximab and adalimumab in NIU treatment has resulted in little impetus for further development of this class of medication. Attempts have been made to deliver anti-TNF-alpha agents intravitreally but that has not been successful thus far. With expiring patents, competition from biosimilars and newer, novel molecules, it may not be viable to continue pursuing anti-TNF-alpha drug development.