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C.Y. Lowder, A. Galor, V.L. Perez; Differential Effectiveness of Etanercept and Infliximab in Ocular Inflammation . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2829.
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Purpose: Anti–tumor necrosis factor alpha (anti–TNFα) agents (etanercept and infliximab)are being increasingly used in refractory inflammatory eye diseases. We reviewed our patients on anti–tumor necrosis factor therapy to determine whether these medications are equally efficacious. Methods: Case records of 18 patients treated with anti–TNFα therapy were reviewed for demographic information, ocular and systemic diagnoses, duration and dose of anti–TNFα treatment, concomitant ocular and systemic immunosuppressive medications, and treatment response. Treatment response was designated: "complete success" if at last follow–up, ocular inflammation was in remission on an anti–TNFα therapy, along with systemic and ocular medications; "partial success" if at last follow–up, ocular inflammation was improved from before treatment but was not in complete remission; "failure" if at last follow up patient had no improvement or an increase in ocular inflammation from prior to treatment. Results: Thirteen of 15 patients (87%) treated with infliximab for an average of 15 months (± 14) had either complete (8 patients, 53%) or partial control (5 patients, 33%) of their ocular inflammation. Two patients (13%) failed infiximab treatment. Twelve of 15 patients (80%) decreased topical corticosteroid use. Prednisone was tapered and discontinued in five of seven patients and two patients were maintained on 5 mg daily. In contrast, all seven patients (100%) treated with etanercept for an average of 23 months (± 21) failed treatment. Five of these seven patients were changed to infliximab therapy and four of five (80%) achieved either complete or partial response after initiation of therapy with infliximab. Three of seven patients (43%) initially responded to etanercept. A significant difference was found between patients treated with infliximab compared to those treated with etanercept with regards to response to therapy (p=0.0003) and topical corticosteroid use (p=0.015). Conclusions: Infliximab was more effective than etanercept in the treatment of recalcitrant uveitis. Long term data on efficacy is not yet available and persistent response to treatment remains to be assessed.
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