June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Anti-Tumor Necrosis Factor Agents in Inflammatory Eye Disease
Author Affiliations & Notes
  • Careen Lowder
    Cole Eye Institute, Cleveland Clinic, Cleveland, OH
  • Maria Choudhary
    Internal Medicine, Cleveland Clinic, Cleveland, OH
  • Rula hajj-ali
    Orthopedics and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH
  • Sunil Srivastava
    Cole Eye Institute, Cleveland Clinic, Cleveland, OH
  • Footnotes
    Commercial Relationships Careen Lowder, None; Maria Choudhary, None; Rula hajj-ali, None; Sunil Srivastava, Bausch and Lomb (F), Bausch and Lomb (C), Novartis (F), Allergan (F)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 2539. doi:
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    • Get Citation

      Careen Lowder, Maria Choudhary, Rula hajj-ali, Sunil Srivastava; Anti-Tumor Necrosis Factor Agents in Inflammatory Eye Disease. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2539.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To compare the effectiveness of anti-tumor necrosis factor (anti-TNF) agents in adults with non-infectious inflammatory eye disease.

 
Methods
 

This was a retrospective chart review of patients with non-infectious uveitis and scleritis treated with anti-TNF agents between 2003 and 2011. Patients >18 years with non-infectious inflammatory eye disease on anti-TNF agents were included. Primary outcomes were time to first remission and time to sustained remission (absence of inflammation and prednisone dose of <10 mg). Proportional hazards regression model was used to adjust for subjects who used more than one anti-TNF agent. Multivariate analysis with backward variable selection was performed to adjust for significant covariates.

 
Results
 

Ninety four patients were included: mean age 45.1 (range 19 - 79 years), 69% (65) women, median follow up 40 months; 43 (45.7%) had anterior uveitis, 23 (24.5%) pan, 9 (9.6%) posterior, 3 (3.2%) intermediate uveitis and 16 (17%) had scleritis. 41 patients were on infliximab, 31 on etanercept and 22 on adalimumab. Median survival time to first remission was 1.41 (SD: 7.99) months for infliximab, 1.94 (SD: 8.94) for adalimumab and 3.42 (SD: 14.74) for etanercept (p = 0.048) (Figure 1). Median time to sustained remission was 2.04 months (SD: 6.37) for infliximab, 4.37 (SD: 8.67) for adalimumab and 4.34 (SD: 24.74) for etanercept (p = 0.046) (Figure 2). Patients with psoriatic arthritis had better time to first remission (p = 0.0136, HR = 2.685, 95% CI = 1.225 - 5.882) and time to sustained remission (p= 0.003, HR = 3.379, 95% CI = 1.425 - 8.010). Dose regimens used to achieve sustained remission: etanercept 50 mg once a week, adalimumab 40 mg every 2 weeks and infliximab, mean dose 4.9 mg/kg (median 5.2) with interval range of 1.1 - 7.9 weeks. 95.3% of patients on infliximab, 69% on etanercept and 66.7% on adalimumab achieved sustained remission (p =0.0018).

 
Conclusions
 

Patients on infliximab achieve their first remission and sustained remission earlier compared to those on etanercept and adalimumab. The association with psoriasis carried a good prognosis.

 
 
Kaplan Meier curve showing time to first remission
 
Kaplan Meier curve showing time to first remission
 
 
Kaplan Meier curve showing time to sustained remission
 
Kaplan Meier curve showing time to sustained remission
 
Keywords: 555 immunomodulation/immunoregulation • 557 inflammation • 466 clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials  
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