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J.J. Huang, P. Choopong, C. Kafkala, N. Khan, C.S. Foster; Efficacy of Daclizumab Treatment of Patients With Birdshot Retinochoroidopathy Refractory to Corticosteroid–Sparing Systemic Immunosuppressive Therapy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2834.
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Purpose: To report the clinical outcomes of patients with birdshot retinochoroidopathy (BSRC) treated with daclizumab, a recombinant monoclonal IgG antibody to the high affinity human interleukin–2 (IL–2) receptor. These patients were refractory to or intolerant to the corticosteroid–sparing systemic immunosuppressive therapy. Methods: Charts of seven patients with BSRC at the Massachusetts Eye and Ear Infirmary (MEEI) were reviewed. Data on age, sex, presence of HLA–A29 haplotype, Snellen visual acuities, initial and final fluorescein angiogram (FA), initial and final electroretinogram (ERG), follow up time, previous treatment regimen, ocular and systemic symptoms of treatment, duration and efficacy of daclizumab treatment were recorded. Results: Six BSRC patients at the Massachusetts Eye Ear Infirmary (MEEI) treated on the regimens of CSA, mycophenolate mofetil (cellcept), and prednisone were switched to daclizumab secondary to intolerance of side effects. One additional patient had daclizumab added to her regimen of CSA and cellcept due to lack of efficacy on maximum therapy. Disease progression prior to daclizumab treatment in all patients was confirmed with clinical examination, FA, and ERG. Patients intolerant to side effects of the corticosteroid–sparing regimen were started on intravenous or subcutaneous daclizumab, while the previous regimen was tapered and ultimately stopped. Treatment duration of daclizumab varied from 5 to 16 months. In all seven patients, visual acuity stabilized or improved, and inflammation regressed on daclizumab therapy. Clinical improvement was noted subjectively from the patient and objectively on FA and ERG testing. BSCR patients intolerant to side effects of corticosteroid–sparing immuno–therapies and receiving daclizumab, had resolution of deleterious symptoms upon discontinuation of the medications. Conclusions: BSRC is a chronic posterior uveitis with associated progressive visual loss, optic neuropathy and retinal degeneration. Corticosteroid–sparing immuno–modulatory therapy required for treatment of chronic disease can be associated with side effects as well as disease progression on maximum tolerated medical therapy. The alternative use of daclizumab resulted in minimal side effects with significant efficacy in our patient sample.
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