June 2017
Volume 58, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2017
A prospective, longitudinal observational study of patients receiving TNFα inhibitors for refractory ocular inflammation.
Author Affiliations & Notes
  • Colm David Andrews
    University of Oxford, Abingdon, United Kingdom
    Oxford University Hospitals Foundation Trust, Oxford University Hospitals Foundation Trust, United Kingdom
  • Erika Damato
    Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
  • Annie Hinchcliffe
    University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
  • Kate Tilling
    University of Bristol, Bristol, United Kingdom
  • Andrew D Dick
    University of Bristol, Bristol, United Kingdom
    University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
  • Srilakshmi M Sharma
    University of Oxford, Abingdon, United Kingdom
    Oxford University Hospitals Foundation Trust, Oxford University Hospitals Foundation Trust, United Kingdom
  • Footnotes
    Commercial Relationships   Colm Andrews, None; Erika Damato, None; Annie Hinchcliffe, None; Kate Tilling, None; Andrew Dick, None; Srilakshmi Sharma, None
  • Footnotes
    Support  Above and Beyond Charity, Bristol, UK.
Investigative Ophthalmology & Visual Science June 2017, Vol.58, 1230. doi:
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      Colm David Andrews, Erika Damato, Annie Hinchcliffe, Kate Tilling, Andrew D Dick, Srilakshmi M Sharma; A prospective, longitudinal observational study of patients receiving TNFα inhibitors for refractory ocular inflammation.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1230.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : TNFα inhibitors (TNFi) induce remission of uveitis in animal models and randomized clinical trials in adults. There remains a lack of long term studies reporting outcomes for uveitis in clinical practice. We present efficacy and safety data prospectively from an 8 year, single centre, cohort who were treated with infliximab or adalimumab for over a year. Outcomes were: rates of remission of ocular inflammation; corticosteroid (CS) withdrawal rates and adverse events during treatment.

Methods : Clinical data were prospectively recorded (2006-2014) at a tertiary uveitis referral centre at the clinic visit prior to starting a TNFi and during 6 monthly study visits. Biologic naïve, adult patients were given intravenous infliximab infusions (3–5mg/kg every 6–8 weeks after a loading phase) or subcutaneous adalumimab (40mg every 2 weeks). Clinical activity of uveitis was recorded according to international criteria frequency. Additional steroid bursts to control inflammation (e.g. short course of high dose oral CS, periocular, intravenous, intravitreal steroid therapy) and adverse events were recorded.

Results : 40 participants met inclusion criteria (62.5% Female). 78% were on inflixamab and 22% on adalibumab. 8% had anterior uveitis, 18% intermediate 32% posterior uveitis, 32% panuveitis, 11% scleritis. TNFi was given: to enable steroid withdrawal (26%), lack of efficacy of current therapy (68%) and for aggressive sight threatening disease (18%). 100% achieved remission (1.14PPY, mean time to remission: 415.62 days, sd: 218.75). 24.1% had a recurrence of inflammation (0.05PPY, mean time to recurrence: 858.00, sd: 696.35). 24 (60%) of eligible participants required an additional burst of CS during follow up (0.21PPY, mean time to CS burst: 668.41, sd: 452.91). An oral CS maintenance dose reduction of at least 1 step was achieved by 32 participants (80%). 64 adverse events occurred: headache (9), mild infusion reaction to infliximab (9), severe infusion reaction (3), nausea (6), vomiting (1), diarrhoea (1), arthralgia (2), infection (6), and skin rash (5).

Conclusions : TNFi achieved remission in 100% of patients although 25% experienced some recurrence of inflammation during the clinical course. Both drugs were well tolerated. Adverse events were mainly associated with infliximab.

This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.

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