Egyptian Consensus Guidance for Treatment of Adults with Non-Infectious Uveitis

Developing and setting up an Egyptian consensus for the management of NIU. A two-phase survey was implemented to obtain expert opinions from Egyptian specialists in the management of non-infectious uveitis. A core team of specialists in management of NIU formulated 21 clinical questions that were structured according to the PICO format (population, intervention, comparison, and the outcome). The literature review team conducted a systemic literature review to address the PICO questions. Based on literature search, a set of 21 sectioned recommendation statements were developed. The differences in ethnicity and socioeconomic standards of the Egyptian population raised the need to develop an Egyptian consensus guidance for management of NIU. The management statements developed in this work were based on a thorough review of the literature and consensus agreement of a national expert panel. Systemic immunosuppression should be initiated during steroid tapering and should be used as first line along with steroids in case of underlying systemic disease. The panel recommended that maintenance dose of steroids should not exceed 7.5 mg daily. A major limitation facing the Egyptian health system is the socioeconomic status and limited insurance coverage. Hence, the use of conventional immunosuppression is usually exhausted before considering biologic therapy, and the role of biosimilars is emphasized to their relatively lower cost, similar efficacy, and safety in comparison to the original molecule. This guideline provides direction for rheumatologists and ophthalmologists making decisions on management of adults with non-infectious uveitis. Putting into consideration that clinical practice varies based on local pharmaceutical availability and patient demographics.

制定并建立埃及非感染性葡萄膜炎（non-infectious uveitis, 下文简称NIU）管理共识。本研究采用两阶段调查方案，收集埃及非感染性葡萄膜炎管理专科医师的专家意见。由NIU管理专家组成的核心小组，依据PICO格式（Population, Intervention, Comparison, Outcome，即人群、干预、对照与结局）构建了21项临床问题。文献综述团队针对上述PICO问题开展系统文献回顾。基于文献检索结果，制定了21项分模块的推荐意见。鉴于埃及人群的种族特征与社会经济水平存在差异，亟需制定适配埃及国情的NIU管理共识指南。本研究制定的管理方案基于全面的文献回顾与全国专家小组的一致共识。全身免疫抑制治疗应在糖皮质激素减量阶段启动；若患者存在基础全身性疾病，则需将其与糖皮质激素联合作为一线治疗方案。专家小组建议，糖皮质激素的日维持剂量不应超过7.5mg。埃及医疗体系面临的主要局限在于社会经济状况与保险覆盖范围有限，因此临床通常会优先使用传统免疫抑制剂，再考虑生物制剂治疗；同时鉴于生物类似药相较于原研药物成本更低、疗效与安全性相当，故强调其临床应用价值。本指南可为风湿科医师与眼科医师制定成人非感染性葡萄膜炎管理决策提供参考。需注意，临床实践需结合当地药品可及性与患者人口统计学特征进行灵活调整。