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A. Nagpal, N. R. Acharya; Biologic Agents for the Treatment of Refractory Uveitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4727.
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To describe the clinical characteristics and outcomes of uveitis patients on biologic agents at a tertiary referral center.
Retrospective case series of all patients on biologics seen in a 5 month time period at the Francis I. Proctor Foundation. Correlation between eyes in the same patient was accounted for by using generalized estimating equations.
26 patients, 10 males and 16 females, with a mean age of 33 (range 10-59), were included in this cohort of patients. They included 11 Whites, 8 Hispanics, 3 African-Americans, 1 Middle Easterner and 3 Asians. Diagnoses included HLA-B27 associated diseases (8), idiopathic (8), Bechets disease (5), juvenile idiopathic arthritis (2), Wegeners granulomatosis (1), neonal onset multisystem inflammatory disorder (1), and psoriatic arthritis (1). 11 patients had anterior uveitis, 13 had panuveitis, 1 had posterior uveitis, and 1 had scleritis and peripheral ulcerative keratitis. 20 out of 26 patients had binocular involvement. The average number of previous medications used (not including topical corticosteroids) was 3.28 (range 1-6).18 patients were on infliximab, 5 on adalimumab, 1 on etanercept, 1 on anakinra, and 1 on rituximab. One patient on infliximab was changed to abatacept due to the formation of ds-DNA antibodies. This was the only adverse event in our series. 16 patients were on concurrent systemic immunomodulatory therapy (IMT). The average length of time on biologic agents was 24 months (range 1 - 84 months). 25 patients (92.5%) were able to decrease the dose of concurrent IMT. All except 1 patient was able to reduce oral corticosteroids to below 10 mg. 4 patients failed to achieve control of their inflammation with the initial biologic agent, and 3 were subsequently controlled with a second biologic agent.Mean logmar vision immediately prior to starting biologic treatment was 0.56 (20/70), 95% CI 0.30 to 0.82. Mean last recorded logmar vision was 0.43 (20/50), 95% CI 0.24 to 0.61. On average, there was a 0.16 decrease in logmar vision (approximately 1.6 line gain) post treatment, 95% CI -.25 to -.07, P < 0.001. At last follow-up, all except 1 patient had trace or no inflammation. 4 of 6 patients with cystoid macular edema pre-biologic therapy improved with treatment.
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