June 2013
Volume 54, Issue 15
Free
ARVO Annual Meeting Abstract  |   June 2013
Tumor Necrosis Factor-Alpha Inhibitors in the Treatment of Non-infectious, Non-necrotizing Scleritis
Author Affiliations & Notes
  • Ashwinee Ragam
    The Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ
  • Anton Kolomeyer
    The Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ
  • Christina Fang
    The Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ
  • Yinfei Xu
    The Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ
  • David Chu
    The Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ
    Metropolitan Eye Research and Surgery Institute, Palisades Park, NJ
  • Footnotes
    Commercial Relationships Ashwinee Ragam, None; Anton Kolomeyer, None; Christina Fang, None; Yinfei Xu, None; David Chu, Abbott (F), Novartis (F), Santen (F), Eyegate (F), Lux Biosciences (F), Bausch & Lomb (R)
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 2541. doi:
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    • Get Citation

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

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Abstract

Purpose: To determine the effectiveness and steroid-sparing abilities of TNF-α inhibitors (TNFαI) in the treatment of chronic, non-infectious, non-necrotizing scleritis.

Methods: 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).

Results: 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.

Conclusions: 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.

Keywords: 432 autoimmune disease • 555 immunomodulation/immunoregulation • 708 sclera  
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