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Caroline Bottin, Audrey Fel, Valérie Touitou, Nathalie Butel, Anne-Laure Remond, patrice cacoub, Phuc Lehoang, David Saadoun, Bahram Bodaghi; Anti-interleukine-1 : a new therapeutic strategy in refractory scleritis.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):No Pagination Specified. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To report on the efficacy and safety of anti-interleukine-1 (anti-Il-1) as a biologic agent for severe scleritis in a retrospective case series of patients, refractory to conventional treatment including systemic corticosteroids and others immunosupressive agents. Scleritis is a subtype of ocular inflammation that may be associated with systemic auto-immune diseases such as rheumatoid arthritis, granulomatosis with polyangiitis and relapsing polychondritis.
We included patients with severe scleritis (at least 2 ocular relapses per year) and refractory to conventional immunosuppressive treatments, associated or not with systemic auto-immune diseases. All patients underwent a complete ophthalmological examination including visual acuity, multimodal imaging, laser flare photometry and biological analysis. Anakinra (100 mg/d subcutaneously) was administered with or without systemic corticosteroids. We noted the rate of inflammatory relapses, corticosteroids doses and safety.
We included 5 patients with a mean age of 53 years and sex ratio (M/F) of 2.5. They were regularly followed in the ophthalmology and internal medicine units of Pitié-Salpêtrière hospital, Paris, France, from January 2013 to December 2015 with a mean follow up of 11 months. Three patients had an associated auto-immune disease with severe scleritis (RA (n=1), polychondritis (n= 1) and Behçet’s disease (n=1)). Four patients were affected by diffuse anterior non necrotizing scleritis and one patient by anterior and posterior non necrotizing scleritis. A complete remission was observed in 4 patients the first week after initiation of anti-Il-1 therapy with no ocular relapse until the end of the study. Steroid sparing effect was obtained (average of 12 mg/day at baseline vs 4 mg/day at 6 months) and immunosuppressors could be stopped in 4 cases. A superficial facial cellulitis without abscess successfully managed with antibiotics was diagnosed in one patient after 24 months of therapy.
This case series suggests the efficacy of an anti-Il-1 alternative in patients with refractory scleritis with or without underlying auto-immune disorders. Futher prospective studies with a larger cohort and longer follow-up may be proposed to confirm efficacy and safety of this treatment.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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