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I. Rozenbaum, K. Narayana, P.A. Latkany, S. Schwartzman, C.M. Samson; Medical Treatment of Uveitis With Adalimumab . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2437.
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Tumor necrosis factor (TNF) has been identified as a cytokine with a central role in the pathogenesis of many chronic inflammatory diseases. TNF blockade is currently indicated for rheumatoid arthritis, Crohn’s disease, ankylosing spondylitis and psoriasis. The role of TNF blockade in the treatment of ocular inflammation is as yet undefined. Of the three available agents, etarnercept, infliximab and adalimumab, adalimumab (Humira) has been the least investigated for its role in treating ocular inflammation. We investigated the efficacy of adalimumab in treating uveitis.
Retrospective chart review of 9 patients, inadequately controlled on currently available therapy, who were treated with adalimumab for refractory uveitis at a uveitis specialty clinic. Specific diagnoses included necrotizing and diffuse scleritis, non–granulomatous and granulomatous anterior uveitis, idiopathic iritis, and panuveitis. All but one of the patients were female, age range 9 to 71. The patients were treated with subcutaneous injections of adalimumab for an average of 12.6 months (range 2.5 to 26.2 months). We evaluated the visual acuities and level of inflammation pre– and post–treatment and steroid sparing effect of the drug.
Five of the patients had previously failed several other steroid–sparing agents, including methotrexate, cyclosporine, mycophenolate mofetil, and etanercept. Out of nine patients in the study, one developed pulmonary side effects and discontinued the drug. All of the other participants either maintained or had improvement in visual acuity, although two of them had cataract extraction surgery with improvement of visual acuity. All but one patient had reduction of ocular inflammation. Six patients required lower doses of steroids after addition of adalimumab. Overall, one patient could not tolerate the drug, two patients did not respond to the drug favorably with continued flare–ups of uveitis, and six had improvement of symptoms and signs of their ocular disease.
Adalimumab may be a useful adjunct to the management of refractory uveitis. Controlled studies are needed to further evaluate its efficacy and safety.
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