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Hillary Stiefel, Laura J Kopplin, Thomas Arno Albini, Srav Vegunta, Michael Chang, Eric B Suhler; Treatment of Refractory Inflammatory Cystoid Macular Edema with Pegylated Interferon Alfa-2A: A Retrospective Chart Review. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1872.
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Interferon alphas have been shown to be efficacious in the treatment of uveitis associated with Behcet’s disease, other forms of refractory uveitis, and inflammatory cystoid macular edema (CME) of various etiologies unresponsive to other treatments. Treatment has typically consisted of a non-pegylated form of interferon dosed daily or three times weekly. Pegylated interferon alfa-2A (pegIFN-2A) has a longer duration of action, thus we hypothesized it might provide effective treatment for patients with inflammatory CME with less frequent dosing.
We performed a retrospective chart review assessing the effect of 90-180 mcg of subcutaneous weekly pegIFN-2A in 7 eyes of 5 patients aged 22-80 years. Four patients had chronic uveitis, one had steroid-responsive idiopathic CME, and all had failed or been unable to tolerate a variety of immunosuppressive regimens. The main outcome measures were reduction in central macular thickness (CMT) and improvement in LogMar visual acuity. Statistical analysis was performed using a Wilcoxon signed-rank test.
Treatment with pegIFN-2A led to dramatic improvement in CMT in all 7 eyes, with a mean decrease in CMT from 479 um to 286 um (p <0.05). The vision in both eyes of one patient did not improve due to preexisting retinal atrophy. All other eyes showed improvement in vision, with a mean increase in LogMAR visual acuity from +0.66 to +0.10. Multiple patients were able to successfully taper the dosing interval to every two weeks without observed loss of effectiveness. One patient subsequently developed recurrent CME prompting sub-Tenon’s triamcinolone injection. Two patients have discontinued treatment for flu-like symptoms and rash, respectively, and treatment for one patient is currently being held given development of thrombocytopenia that recovered on discontinuation of pegIFN-2A.
Weekly pegIFN-2A is an effective treatment for refractory inflammatory CME, with the advantage of less frequent injections compared to non-pegylated interferon, although multiple subjects discontinued treatment due to medication-associated side effects. The use of pegIFN-2A should be studied in larger series of patients to further evaluate optimal dosing and tolerability of this promising treatment modality.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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