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J. N. Martel, E. Esterberg, A. G. Nagpal, T. M. Lietman, I. G. Wong, T. P. Margolis, N. Acharya; Characteristics of Patients on Biologics for Ocular Inflammatory Disease and Clinical Outcomes With Infliximab. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2920.
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Biologic agents have provided additional treatment options for patients with ocular inflammation. However, there is limited information on the corticosteroid-sparing success of controlling ocular inflammation with these newer agents. We describe the clinical characteristics of patients with ocular inflammatory disease on biologics at a tertiary referral center, and the clinical outcomes of patients on infliximab.
Retrospective analysis of all patients (n=75) on biologics seen from 1999-2009 at the Francis I. Proctor Foundation. Patient charts were analyzed according to a standardized evaluation protocol and all visits of all patients were recorded. The proportion of patients on infliximab achieving control of inflammation (SUN classification of ≤ 0.5+ anterior chamber cell, anterior vitreous cell, vitreous haze) with and without corticosteroid-sparing success (prednisone ≤ 10 mg daily, prednisolone drops ≤ 4 times daily) was evaluated at 3, 6, and 12 month visits.
65% of patients were female, 51% were white, and 81% had bilateral disease. 40% had anterior uveitis, 4% intermediate uveitis, 16% anterior and intermediate uveitis, 28% panuveitis, and 12% had scleritis. 76% of patients had an underlying systemic inflammatory condition in addition to ocular inflammation. 74% of patients (n=55) on a biologic were on infliximab. 86% (95% CI 67-96) of patients on infliximab had control of inflammation at 3 months, 94% (95% CI 79-99) at 6 months, and 61% (95% CI 44-77) at 12 months. Both control of inflammation and corticosteroid-sparing success were achieved in 61% (95% CI 48-72) of patients at 3 months, 83% (95% CI 72-90) at 6 months, and 55% (95% CI 49-85) at 12 months on infliximab. Survival analysis showed the median time to treatment success (control of inflammation and corticosteroid-sparing) was 16 weeks (95% CI 10.5-21.5 weeks). 4 infliximab patients stopped treatment due to adverse reactions; all occurred several months after starting the drug.
Biologics appear to successfully control previously uncontrolled inflammation and are successful as corticosteroid-sparing agents. A prospective randomized trial would be of value in determining the comparative efficacy of biologics to classic immunomodulatory therapy for the long-term treatment of ocular inflammation.
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