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Impact of COVID-19 pandemic on uveitis patients receiving immunomodulatory and biological therapies (COPE STUDY)
  1. Aniruddha Kishandutt Agarwal1,
  2. Sridharan Sudharshan2,
  3. Padmamalini Mahendradas3,
  4. Kalpana Babu4,
  5. Pratik Shenoy5,
  6. Mohit Dogra1,
  7. Reema Bansal1,
  8. Manisha Agarwal6,
  9. Jyotirmay Biswas2,
  10. S Balamurugan7,
  11. Rupesh Agrawal8,
  12. Vishali Gupta1
  1. 1 Advanced Eye Center, Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  2. 2 Department of Uvea, Medical and Vision Research Foundation, Sankara Nethralaya, Chennai, India
  3. 3 Department of Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, India
  4. 4 Department of Ophthalmology, Vittala International Institute of Ophthalmology, Bengaluru, India
  5. 5 Department of Vitreo-Retina, Shri Sadguru Seva Sangh Trust Chitrakoot Centre, Chitrakoot, India
  6. 6 Department of Vitreo-Retina, Dr. Shroff’s Charity Eye Hospital Delhi, New Delhi, India
  7. 7 Uvea Services, Aravind Eye Hospital Care System, Pondicherry, India
  8. 8 Department of Ophthalmology, Tan Tock Seng Hospital, Singapore, Singapore
  1. Correspondence to Vishali Gupta, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research,Chandigarh, India;vishalisara{at}; vishalisara{at}


Purpose To evaluate the change in the ongoing immunomodulatory (IMT) and biological therapies among patients with non-infectious uveitis (NIU), and determine the number of uveitis relapses during the COVID-19 pandemic.

Methods In this national multicentric prospective case series, data of subjects with NIU receiving corticosteroids, systemic IMT and/or biological agents were analysed. The data collection was performed from 1 March 2020 to 25 June 2020. Main outcome measures included change in the ongoing treatments with corticosteroids, IMT and biological agents, use of alternate therapies and rates of uveitis relapse.

Results In this study, 176 patients (284 eyes) with NIU (mean age: 33±17.1 years; males: 68) were included. A total of 121 eyes (90 patients) were deemed to have active NIU. Of these, seven subjects (7.8%) did not receive intravenous methylprednisolone despite need felt by the treating uveitis experts. In addition, 35 subjects (57.4%) received a rapid tapering dosage of oral corticosteroids despite active disease. A total of 161 (91.5%) subjects were receiving systemic IMT and 25 (14.2%) were on biological therapies. Overall, IMT was altered in 29/161 (18.0%) subjects. Twenty-two eyes were treated with intravitreal therapies in the study period. Fifty-three eyes (32.5%, 29 subjects) developed relapse of NIU, of which 25 subjects (86.2%) were deemed to have reactivation related to altered systemic IMT. No patient developed COVID-19 during follow-up.

Conclusions During the ongoing COVID-19 pandemic, uveitis specialists may tend to reduce the ongoing systemic IMT, or prefer less aggressive treatment strategies for NIU. These subjects may be at high risk of relapse of uveitis.

  • Inflammation
  • Immunology
  • Infection

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  • Twitter Aniruddha Agarwal @aniruddha9.

  • Contributors Conceptualisation and study design: AKA, VG, RA; study data, and data analysis and interpretation.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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