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Abstract：
Immunomodulatory therapy (IMT) is often considered for systemic treatment of non-infectious uveitis (NIU). During the evolving coronavirus disease-2019 (COVID-19) pandemic, given the concerns related to IMT and the increased risk of infections, an urgent need for guidance on the management of IMT in patients with uveitis has emerged.
A cross-sectional survey of international uveitis experts was conducted. An expert steering committee identified clinical questions on the use of IMT in patients with NIU during the COVID-19 pandemic. Using an interactive online questionnaire, guided by background experience and knowledge, 139 global uveitis experts generated consensus statements for IMT. In total, 216 statements were developed around when to initiate, continue, decrease and stop systemic and local corticosteroids, conventional immunosuppressive agents and biologics in patients with NIU. Thirty-one additional questions were added, related to general recommendations, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) and hydroxychloroquine.
Highest consensus was achieved for not initiating IMT in patients who have suspected or confirmed COVID-19, and for using local over systemic corticosteroid therapy in patients who are at high-risk and very high-risk for severe or fatal COVID-19. While there was a consensus in starting or initiating NSAIDs for the treatment of scleritis in healthy patients, there was no consensus in starting hydroxychloroquine in any risk groups.
Consensus guidelines were proposed based on global expert opinion and practical experience to bridge the gap between clinical needs and the absence of medical evidence, to guide the treatment of patients with NIU during the COVID-19 pandemic.
A cross-sectional survey of international uveitis experts was conducted. An expert steering committee identified clinical questions on the use of IMT in patients with NIU during the COVID-19 pandemic. Using an interactive online questionnaire, guided by background experience and knowledge, 139 global uveitis experts generated consensus statements for IMT. In total, 216 statements were developed around when to initiate, continue, decrease and stop systemic and local corticosteroids, conventional immunosuppressive agents and biologics in patients with NIU. Thirty-one additional questions were added, related to general recommendations, including the use of non-steroidal anti-inflammatory drugs (NSAIDs) and hydroxychloroquine.
Highest consensus was achieved for not initiating IMT in patients who have suspected or confirmed COVID-19, and for using local over systemic corticosteroid therapy in patients who are at high-risk and very high-risk for severe or fatal COVID-19. While there was a consensus in starting or initiating NSAIDs for the treatment of scleritis in healthy patients, there was no consensus in starting hydroxychloroquine in any risk groups.
Consensus guidelines were proposed based on global expert opinion and practical experience to bridge the gap between clinical needs and the absence of medical evidence, to guide the treatment of patients with NIU during the COVID-19 pandemic.
摘要：
免疫调节疗法（IMT）通常被认为用于非感染性葡萄膜炎（NIU）的全身治疗。在不断发展的2019年冠状病毒病(COVID-19)大流行期间，考虑到与IMT相关的担忧和感染风险的增加，迫切需要指导葡萄膜炎患者的IMT管理.
对国际葡萄膜炎专家进行了横断面调查。一个专家指导委员会确定了在COVID-19大流行期间NIU患者使用IMT的临床问题。使用交互式在线问卷，以背景经验和知识为指导，139位全球葡萄膜炎专家为IMT发表了共识声明。总的来说,围绕何时启动，开发了216个语句，continue,减少和停止全身和局部皮质类固醇，NIU患者的常规免疫抑制剂和生物制剂。增加了31个问题，与一般性建议有关，包括使用非甾体抗炎药（NSAIDs）和羟氯喹。
在怀疑或确认COVID-19的患者中不启动IMT，在严重或致命COVID-19的高风险和极高风险的患者中使用局部过度全身性皮质类固醇治疗，达成了最高共识。虽然在开始或开始使用NSAIDs治疗健康患者巩膜炎方面存在共识，在任何风险组中,开始使用羟氯喹均未达成共识.
共识指南是根据全球专家意见和实践经验提出的，旨在弥合临床需求和缺乏医学证据之间的差距。指导COVID-19大流行期间NIU患者的治疗。
对国际葡萄膜炎专家进行了横断面调查。一个专家指导委员会确定了在COVID-19大流行期间NIU患者使用IMT的临床问题。使用交互式在线问卷，以背景经验和知识为指导，139位全球葡萄膜炎专家为IMT发表了共识声明。总的来说,围绕何时启动，开发了216个语句，continue,减少和停止全身和局部皮质类固醇，NIU患者的常规免疫抑制剂和生物制剂。增加了31个问题，与一般性建议有关，包括使用非甾体抗炎药（NSAIDs）和羟氯喹。
在怀疑或确认COVID-19的患者中不启动IMT，在严重或致命COVID-19的高风险和极高风险的患者中使用局部过度全身性皮质类固醇治疗，达成了最高共识。虽然在开始或开始使用NSAIDs治疗健康患者巩膜炎方面存在共识，在任何风险组中,开始使用羟氯喹均未达成共识.
共识指南是根据全球专家意见和实践经验提出的，旨在弥合临床需求和缺乏医学证据之间的差距。指导COVID-19大流行期间NIU患者的治疗。
