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Careen Lowder, Maria Choudhary, Rula hajj-ali, Sunil Srivastava; Anti-Tumor Necrosis Factor Agents in Inflammatory Eye Disease. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2539.
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To compare the effectiveness of anti-tumor necrosis factor (anti-TNF) agents in adults with non-infectious inflammatory eye disease.
This was a retrospective chart review of patients with non-infectious uveitis and scleritis treated with anti-TNF agents between 2003 and 2011. Patients >18 years with non-infectious inflammatory eye disease on anti-TNF agents were included. Primary outcomes were time to first remission and time to sustained remission (absence of inflammation and prednisone dose of <10 mg). Proportional hazards regression model was used to adjust for subjects who used more than one anti-TNF agent. Multivariate analysis with backward variable selection was performed to adjust for significant covariates.
Ninety four patients were included: mean age 45.1 (range 19 - 79 years), 69% (65) women, median follow up 40 months; 43 (45.7%) had anterior uveitis, 23 (24.5%) pan, 9 (9.6%) posterior, 3 (3.2%) intermediate uveitis and 16 (17%) had scleritis. 41 patients were on infliximab, 31 on etanercept and 22 on adalimumab. Median survival time to first remission was 1.41 (SD: 7.99) months for infliximab, 1.94 (SD: 8.94) for adalimumab and 3.42 (SD: 14.74) for etanercept (p = 0.048) (Figure 1). Median time to sustained remission was 2.04 months (SD: 6.37) for infliximab, 4.37 (SD: 8.67) for adalimumab and 4.34 (SD: 24.74) for etanercept (p = 0.046) (Figure 2). Patients with psoriatic arthritis had better time to first remission (p = 0.0136, HR = 2.685, 95% CI = 1.225 - 5.882) and time to sustained remission (p= 0.003, HR = 3.379, 95% CI = 1.425 - 8.010). Dose regimens used to achieve sustained remission: etanercept 50 mg once a week, adalimumab 40 mg every 2 weeks and infliximab, mean dose 4.9 mg/kg (median 5.2) with interval range of 1.1 - 7.9 weeks. 95.3% of patients on infliximab, 69% on etanercept and 66.7% on adalimumab achieved sustained remission (p =0.0018).
Patients on infliximab achieve their first remission and sustained remission earlier compared to those on etanercept and adalimumab. The association with psoriasis carried a good prognosis.
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