Efficacy and safety of TNF-α inhibitors in non-infectious uveitis : a multicenter retrospective study

Abstract

Purpose: TNF-α inhibitors have been used over the last few years in noninfectious uveitis refractory to traditional immunosuppressive agents, with promising results. Most autoimmune uveitis are T-cell-mediated diseases, and TNF-α is one of the most important amplifying factors in the genesis of the inflammatory reaction. However, in the literature, TNF-α blockers have mostly been studied in uncontrolled trials, or case-series with small effectives. The purpose was to evaluate the efficacy and safety of anti TNF-α in a larger effective of patients.

Methods: Evolution of noninfectious uveitis in patients treated with anti TNF-α agents was retrospectively reviewed, for subjects managed of between July 2001 and June 2013 in six French Ophthalmology Departments. Ocular inflammation, visual acuity, and number of relapses were the main criteria for efficacy.

Results: We included 136 patients. Uveitis was granulomatous in 24%, bilateral in 85%, total in 63%, with retinal vascularitis in 32%, macular edema in 54% of cases. Conditions associated with uveitis were Behçet's disease (25%), juvenile idiopathic arthritis (26%), spondyloarthropathy (11%), sarcoidosis (4%), Birdshot retinochoroidopathy and Vogt Koyanagi Harada (15%), idiopathic (19%). TNF-α inhibitors (infliximab, 57%, adalimumab, 40%, etanercept, 3%) were introduced in patients who did not respond to conventional immunosuppressors in 88% of cases. Median duration of treatment was 18 months [8-33] with a median follow up of 27 months [8-53]. Complete or partial response was reported in 111 patients (n=118, 94%). Mean dosage of prednisone was significantly reduced after 6 and 12 months of treatment (n=101 ; 15mg [6-47.5] at introduction vs 10mg [8-15] at 6 months and 9mg [5-15] at 12 months; p<0.0001). Number of relapses was also significantly reduced (n=74; 4 [3-5]; 0 [0-1]; p<0.0001). Side effects were observed in 32 patients (n=130; 25%); they were severe in 3 cases (1 lymph node tuberculosis and 2 angioedema).

Conclusions: TNF-α inhibitors seem to be safe and effective in reducing inflammation with further tapering of corticosteroids, in severe cases of noninfectious uveitis.

Keywords: 557 inflammation • 555 immunomodulation/immunoregulation • 432 autoimmune disease