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A.S. Al–Braiki, C. Lau, V. Menezo, S. Lightman; Efficacy of anti–TNF drugs in sever uveitis . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2671.
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Purpose: To determine the effectiveness of anti–TNF drugs in the management of severe uveitis. Methods: Patients with uveitis were recruited who had failed to control their intraocular inflammation or complications such as macular oedema, with a maintenance dose of corticosteroids of 10mg/day or less, plus immunosuppressive agents such as cyclosporin (5mg/kg/day), mycophenolate (1g bd) or methotrexate (10–15mg/week). Patients with a history of or who were considered high risk of previous exposure to TB were excluded. Either infliximab (5mg/kg in an infusion) or etanercept (25 mg s/c twice weekly) were given.The aim was to control the inflammation and allow steroid dose reduction to 10mg/day or less. Where possible other agents such as cyclosporin and mycophenolate were also reduced and/or discontinued. The length of time taken for disease relapse if it occurred was identified. Results: Eight patients met the inclusion criteria – 3 females, 5 males all Caucasian. 3 patients had an associated systemic disease – one each of juvenile idiopathic arthritis, ankylosing spondylitis and Reiter’s disease. 4 patients were given a single dose of infliximab, 1 had two doses of Infliximab (within 10 month interval when the inflammation relapsed). 3 had etanercept (one for 11 months and two for 21 months). Six months after initiating medication with anti–TNF the mean dose of prednisolone was reduced in all patients (16+/–2.9SE vs 9.3+/–7.2SE) p=0.042.5 patients were able to discontinue second line immunosuppressive at 3 months. Recurrence of inflammation (AC/VC 2+) occurred in 3 patients; one with posterior uveitis when steroid dose was 5mg and Cellcept 250mg OD 10 months after infliximab. He had a second Infliximab dose and the inflammation settled. The second patient with Reiters disease had Etanercept for 11 months and steroids were discontinued. He developed a severe disease relapse and high dose steroids was restarted. The third patient has a mild relapse when steroid dose was below 15g and is awaiting his 2nddose of Infliximab. All the other patients have remained stable for a mean follow–up 12.8 months (5–22 months) with controlled inflammation at a steroid dose of 10mg or less (two patients on 10mg,two patients on 5mg and one patient is off steroids). Conclusions: Anti–TNF therapy is a useful addition to control inflammation in situations where other agents may not have been effective. Regular infusions of infliximab may not be necessary, as with RA ,and still allows control of the inflammation for 4–5 months with significant reduction of the steroid dose to 10 mg or less without the need for second line immunosuppressive agents.
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