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Treat early and embrace the evidence in favour of anti-TNF-α therapy for Behçet's uveitis
  1. Richard W J Lee,
  2. Andrew D Dick
  1. Academic Unit of Ophthalmology, Department of Clinical Science, University of Bristol, Bristol, UK
  1. Correspondence to Professor Andrew Dick, Bristol Eye Hospital, Lower Maudlin Street, Bristol BS1 2LX, UK; a.dick{at}

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How long must patients wait for us to exploit science to their advantage and turn evidence into practice? In this issue, Yamada et al (see page 282) provide crucial evidence in support of anti-tumour necrosis factor (TNF)-α therapy for the treatment of Behçet associated uveitis.1 The potential benefits of this class of drug have been long realised, but healthcare providers have rightly asked the question: are these expensive biologicals really any better than conventional treatment, and does their use put patients at unnecessary risk? At least for the former, it is increasingly evident that the answer is ‘yes.’

The journey from the laboratory bench to the clinic has been slower than would even normally be predicted for moving therapies into man. Experimental models of uveitis have provided abundant evidence of TNF-α's pivotal role in mediating retinal tissue destruction,2 and it is now 13 years since initial reports confirmed the benefits of TNF-α inhibition in minimising the severity of experimental autoimmune uveoretinitis.3 At that time, similar findings in other organ-specific autoimmune diseases had already ushered in a new era of hope for patients with conditions ranging from rheumatoid arthritis to Crohn disease.4 5 However, in ophthalmology, we are still struggling to realise the full benefit of TNF-α blockade, perhaps reflecting our reluctance as a specialty to embrace developments in systemic therapies for ocular disease.

To their credit, the Japanese have taken the …

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