Long-term Outcomes of Rituximab therapy in patients with non-infectious posterior uveitis refractory to conventional immunosuppressive therapy

Abstract

Purpose : Posterior uveitis is a severe sight threatening eye disease and the treatment is challenging. We performed a retrospective study to assess long-term effectiveness of Rituximab (RTX) therapy in the treatment of patients with refractory non-infectious posterior uveitis.

Methods : A chart review identified 11 posterior uveitis patients (21 eyes) that were treated with RTX intravenous infusions who presented at the Massachusetts Eye Research and Surgery Institute between 2010 and 2015. RTX was administered as a dose regimen of 375 mg/m² intravenous infusion weekly for 8 consecutive weeks, and thereafter, monthly for 4 consecutive months; reassess for weaning or continuing monthly infusion was then performed. Main outcome measures of the treatment response were fluorescein angiography (FA) evidence of disc or vascular staining at 6, 12, 18 and 24 months and best-corrected visual acuity (BCVA). Secondary outcome measure was drug-related adverse events.

Results : Eleven patients (21 eyes) with refractory posterior uveitis treated with intravenous RTX were included. All the eligible subjects received several combinations of one or more disease-modifying antirheumatic drug (DMARDs) and at least one anti-TNF drug before the RTX therapy. Nine (81.8%) patients were female. Mean follow up was 29.3 ± 7.8 months. RTX was administered as complementary therapy due to prior inefficacy of other therapies in 7 (63.7%) patients and it was the only treatment in 4 (36.3%) patients who did not tolerate other drugs. Inflammation signs by FA were controlled in 9 (81.8 %) patients at the end of follow up. Baseline BCVA was 20/60 (logMAR 0.5 ± 0.1) and final BCVA was 20/30 (0.2 ± 0.1) (p=0.006). No significant side effects occurred secondary to this therapy.

Conclusions : Although randomized controlled trials are needed, the available evidence suggests the clinical use of RTX infusion in selected categories of patients with refractory chronic uveitis. RTX therapy was associated with stability and remission of recalcitrant posterior uveitis in patients who did not tolerate, had contraindications to, or did not respond to other therapies.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.