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Kourtney Houser, Heather Leisy, Stephen Huddleston, R Christopher Walton; Switching Tumor Necrosis Factor Alpha Antagonists in Patients with Scleritis. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2538.
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© ARVO (1962-2015); The Authors (2016-present)
To describe the outcomes of patients with noninfectious scleritis after switching from one TNF-α antagonist (TNFA) to a second TNFA after failure or intolerance of the first.
Retrospective, interventional, consecutive case series of all patients with non-necrotizing scleritis treated with at least two TNFA between 2000 and 2010 at a single institution. Information regarding associated systemic diseases, scleritis severity, systemic immunosuppressive therapy, duration of treatment of the initial TNFA and reason for discontinuation was collected. Outcome measures were time to resolution of inflammation after initiation of the second TNFA, presence of inflammation after 6 and 12 months, medication side effects and ocular complications.
11 patients (4 male, 7 female) with mean follow-up 33.1 months (median 22 months, range 6-113 months) were included in the study. Initial TNFA was entanercept (n=7), infliximab (n=3) or golimumab (n=1), with median duration of therapy of 10 months (range 2-74 months). Reasons for discontinuation of initial TNFA were secondary failure (n=7), primary failure (n=3), and intractable headache (n=1). Patients were switched to adalimumab (n=8) or infliximab (n=3) for their second TNFA. Median time to resolution of inflammation after initiation of second TNFA was 4 months (range 1.5-11 months). After 6 months, 9 patients were in remission, 1 patient had less severe scleritis, and 1 patient had persistent, active scleritis. After 12 months, 10 patients had achieved remission, and 1 patient had persistent active scleritis. Of the 10 patients who achieved remission, one patient discontinued the second TNFA following 10 months of successful therapy due to a severe infusion reaction. The remaining 9 patients maintained complete remission of inflammation for at least 12 months with the second TNFA. Complications occurring during treatment with the second TNFA included new or worsening posterior subcapsular cataract (n=2), ocular hypertension (n=1), and severe infusion reaction secondary to infliximab (n=2).
Our results suggest that failure of one TNFA in patients with scleritis does not preclude successful treatment with a second TNFA. Thus, switching to a second TNFA after failure of a first may be a useful treatment option in patients with refractory scleritis.
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