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Colm David Andrews, Erika Damato, Annie Hinchcliffe, Kate Tilling, Andrew D Dick, Srilakshmi M Sharma; A prospective, longitudinal observational study of patients receiving TNFα inhibitors for refractory ocular inflammation.. Invest. Ophthalmol. Vis. Sci. 2017;58(8):1230.
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© ARVO (1962-2015); The Authors (2016-present)
TNFα inhibitors (TNFi) induce remission of uveitis in animal models and randomized clinical trials in adults. There remains a lack of long term studies reporting outcomes for uveitis in clinical practice. We present efficacy and safety data prospectively from an 8 year, single centre, cohort who were treated with infliximab or adalimumab for over a year. Outcomes were: rates of remission of ocular inflammation; corticosteroid (CS) withdrawal rates and adverse events during treatment.
Clinical data were prospectively recorded (2006-2014) at a tertiary uveitis referral centre at the clinic visit prior to starting a TNFi and during 6 monthly study visits. Biologic naïve, adult patients were given intravenous infliximab infusions (3–5mg/kg every 6–8 weeks after a loading phase) or subcutaneous adalumimab (40mg every 2 weeks). Clinical activity of uveitis was recorded according to international criteria frequency. Additional steroid bursts to control inflammation (e.g. short course of high dose oral CS, periocular, intravenous, intravitreal steroid therapy) and adverse events were recorded.
40 participants met inclusion criteria (62.5% Female). 78% were on inflixamab and 22% on adalibumab. 8% had anterior uveitis, 18% intermediate 32% posterior uveitis, 32% panuveitis, 11% scleritis. TNFi was given: to enable steroid withdrawal (26%), lack of efficacy of current therapy (68%) and for aggressive sight threatening disease (18%). 100% achieved remission (1.14PPY, mean time to remission: 415.62 days, sd: 218.75). 24.1% had a recurrence of inflammation (0.05PPY, mean time to recurrence: 858.00, sd: 696.35). 24 (60%) of eligible participants required an additional burst of CS during follow up (0.21PPY, mean time to CS burst: 668.41, sd: 452.91). An oral CS maintenance dose reduction of at least 1 step was achieved by 32 participants (80%). 64 adverse events occurred: headache (9), mild infusion reaction to infliximab (9), severe infusion reaction (3), nausea (6), vomiting (1), diarrhoea (1), arthralgia (2), infection (6), and skin rash (5).
TNFi achieved remission in 100% of patients although 25% experienced some recurrence of inflammation during the clinical course. Both drugs were well tolerated. Adverse events were mainly associated with infliximab.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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