Abstract
Purpose: :
to report results in a small non–infectious posterior uveitis (PU) cohort treated with adalimumab. The human monoclonal antibody adalimumab specifically inhibits tumor necrosis factor alpha (TNF–α) and has been used successfully in rheumatoid arthritis and psoriasis.
Methods: :
6 Posterior Uveitis patients (10 eyes : idiopathic panuveitis (7), birdshot (2), Behcet (1) with insufficient response or severe side effects to classical therapy (steroids with methothrexate, cyclosporine, azathioprine, or interferon–α) were given adalimumab. Patients had uveitis 9.8 ± 4.0 years before adalimumab was initiated. Once every two weeks, 40 mg of adalimumab was delivered by subcutaneous injections as a steroid sparing (4/10) or steroid replacing immunosuppressive agent (6/10).Visual outcome, disease activity and side effects were recorded and analyzed by univariate statistical analysis (SPSS 12.0).
Results: :
after 6 ± 3 months of treatment visual acuity improved or stabilized in 50% and 20% of patients, respectively. Adalimumab with or without low dose steroids (< 10mg/day) was effective in reducing inflammatory activity in 70%. None of the treated patients reported side effects, and all preferred adalimumab to previous treatment regimens (with high dose steroids or interferon–α).
Conclusions: :
we have treated refractory uveitis succesfully in the past with anti–TNF–α therapy (infliximab, intravenous injections). In this study, adalimumab enabled us to safely administer effective anti–TNF–α therapy in an outpatient setting. Furthermore adalimumab has a favorable (subcutaneous) route of administration compared to previous anti–TNF–α regimen. A prospective randomized trial should establish its value in long–term treatment of posterior segment uveitis compared to classical immunosuppressive therapy.
Keywords: uveitis-clinical/animal model • pharmacology • immunomodulation/immunoregulation