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Ashwinee Ragam, Anton Kolomeyer, Christina Fang, Yinfei Xu, David Chu; Tumor Necrosis Factor-Alpha Inhibitors in the Treatment of Non-infectious, Non-necrotizing Scleritis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2541.
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To determine the effectiveness and steroid-sparing abilities of TNF-α inhibitors (TNFαI) in the treatment of chronic, non-infectious, non-necrotizing scleritis.
We conducted a retrospective chart review of patients treated at our institutions for non-infectious, non-necrotizing scleritis between April 2002 and November 2012. Only patients taking TNFαI for > 2 months were eligible. Outcome measures included inflammation grading, TNFαI dosing, concurrent corticosteroid (CS) and/or other immunomodulatory therapy dosing, visual acuity (VA), and adverse effects. Three TNFαIs were included: infliximab (Remicade), adalimumab (Humira), and etanercept (Enbrel).
Twenty-one patients (17 females [81%]) with a total of 33 affected eyes were included. Mean ± SD age at start of TNFαI use was 59.2 ± 13.4 years. All patients had an associated autoimmune disease. Mean duration of TNFαI use was 23.7 months. Inflammation control was achieved in 20 (95%) patients. Three (14%) patients with recurrent scleritis started out with no inflammation but were able prevent flare-ups for a mean duration of 13.6 months while on a TNFαI. Thirteen (62%) patients achieved control of active inflammation on their first trial of TNFαI after a mean duration of 5.3 months. Eight (61%) of these patients maintained quiet scleritis on the same TNFαI for a mean duration of 26.6 months, four (31%) of these patients experienced recurrences of inflammation, and one (8%) switched to a different TNFαI but maintained control of inflammation. Three (14%) patients failed their first trial of Humira and were switched to Remicade, achieving inflammation control after a mean duration of 1.0 month. One (5%) patient had an allergic reaction Remicade and was switched to Humira, achieving inflammation control after 1.1 month. Successful CS sparing was achieved in 13/14 (93%) patients on concurrent CS therapy. Of the 14 patients on concurrent methotrexate therapy, seven (50%) were able to lower their dose. VA improved or stayed the same in 22 (67%) eyes. Aside from one allergic reaction, no other patients experienced adverse effects from TNFαI use.
TNF-α inhibitors are effective and well-tolerated therapy for non-infectious, non-necrotizing scleritis. They can successfully reduce inflammation as well as decrease concurrent corticosteroid and methotrexate doses.
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