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R. Ursea, R.B. Nussenblatt, H.N. Sen, R.R. Buggage; The Role of Humanized Anti–IL–2 Receptor Antibody (HAT) Therapy in Incontrolled Uveitis . Invest. Ophthalmol. Vis. Sci. 2004;45(13):2673.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To present our experience with a heterogeneous group of patients with active refractory uveitis treated under a compassionate protocol with infusions of a humanized monoclonal antibody directed against the IL–2 receptor on activated T–cells (Daclizumab, Zenapax). Methods: Four patients with active, chronic, non–infectious, bilateral, severe, sight–threatening, intermediate or posterior uveitis persistent despite therapy with multiple immunosuppressive agents were treated with intravenous infusions of Daclizumab (1 mg/kg) at 2–4 week intervals. Patients underwent a complete ophthalmic and medical examination prior to each infusion for evidence of ocular inflammation and adverse events. Tapering of concomitant immunosuppressive therapy was attempted if the ocular disease became quiet. Results: Four female patients (2 with intermediate uveitis associated with multiple sclerosis, 2 with panuveitis, VKH and idiopathic) with an average age of 44.2 years and average disease duration of 90.5 months (range 47–129 months), were treated under the compassionate protocol. At the onset of Daclizumab therapy all had active intraocular inflammation with visual acuities worse than 20/40 in 7/8 eyes (range 20/40–hand motions). Three patients required treatment with 3 immunosuppressive agents (Prednisone, Cellcept, Methotrexate or Cyclosporine) and one required 2 agents (Prednisone and Cellcept). Although the active uveitis initially responded to Daclizumab therapy in all patients, disease recurrence was not prevented in the 2 patients with panuveitis. Of the two patients with MS associated uveitis, one was successful in tapering her immunosuppressive medications by >50%. Visual acuity remained stable in all patients. During the course of compassionate therapy one patient developed cutaneous zoster possibly related to the Daclizumab. Conclusions: Daclizumab (1mg/kg) has been shown to be effective in maintaining the control of intermediate and posterior uveitis in patients with inactive disease in lieu of standard immunosuppression. In these patients with active uveitis Daclizumab seemed to be useful in patients with MS associated intermediate uveitis. Future studies are required to determine efficacy of higher Daclizumab doses for the treatment of active uveitis.
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