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Freekje Van Asten, Paulien HuisinhetVeld, Robert W.A.M. Kuijpers, Aniki Rothova, Eiko de Jong, Carel C B Hoyng; Adalimumab Therapy for Refractory Birdshot Chorioretinopathy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3119.
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© ARVO (1962-2015); The Authors (2016-present)
To report the outcomes of adalimumab (Humira®) in the treatment of birdshot chorioretinopathy (BSCR) refractory to conventional immunomodulatory therapy.
In this retrospective non-comparative case series we included nineteen patients (38 eyes) with HLA-A29 positive BSCR who received adalimumab treatment, identified by chart review, at ophthalmology departments of the Radboud university medical center, Nijmegen, the Netherlands, and the Erasmus university medical center, Rotterdam, the Netherlands. All patients received 40mg adalimumab subcutaneously at 2-week intervals during the study period, in addition to previously initiated immunosuppressive medication. Data regarding previous immunosuppressive therapy were recorded. The main outcome measures included change in visual acuity (VA), inflammatory signs on fluorescein angiographic (FA) and optical coherence tomography (OCT), concomitant immunosuppressive requirements, and side effects. Results were assessed at six months and one year follow up and compared to the situation six months and one year before the start of adalimumab.
From the start of adalimumab treatment, over a follow up of one year, the mean (± SD) Snellen VA improved from 0.47 (± 28 letters) to 0.71 (± 10 letters) (p=0.030). The trend of a decreasing VA in the year prior to adalimumab treatment reversed to a trend of increasing VA after the start of adalimumab, to finally equal the VA of two years before. The effect of adalimumab on the pathologic features on FA and OCT was less evident, with only two patients fully free of inflammatory signs at the end of follow up. After one year, 53% of patients were able to decrease the use of concomitant immunosuppressive medications. Compared to start, more patients received adalimumab monotherapy at one year follow up (53% at one year versus 21% at start, p 0.047). Three out of 19 patients perceived relatively mild possible treatment-related side effects, two of which discontinued treatment within the year.
The data of this study suggest that adalimumab is effective and mostly well tolerated during the first year of treatment in otherwise treatment-refractory cases of BSCR. However, complete remission of the inflammatory process is rarely achieved.
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