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Ahmed Al-Janabi, Amgad El Nokrashy, Lazha Sharief, Susan Lightman, Oren Tomkins-Netzer; Tumor necrosis factor inhibitors improve inflammatory control in eyes with refractory non-infectious uveitis.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):407.
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There has been a recent rise in the use of biologic agents and specifically tumor necrosis factor α (TNFα) inhibitors for eyes with uveitis that are refractory to systemic corticosteroids and other, second-line immunosuppressive agents. The aim of this study was to determine the immunosuppressive effect of TNFα inhibitors on the inflammatory activity and visual function in refractory eyes with non-infectious intermediate, posterior or panuveitis (NIIPPU).
This is a cross sectional study of patients diagnosed with NIIPPU and active intra-ocular inflammation. Patients were included if they had active NIIPPU while under treatment with systemic corticosteroids and an additional second-line immunosuppressive agent. Following the initiation of treatment with an TNFα inhibitor agent (baseline) information was gathered regarding disease activity, ocular complications and visual functional.
129 eyes of 66 patients (25 female) were included in this study. Twenty eight patients (55 eyes, 42.6%) received adalimumab, 36 patients (70 eyes, 54.3%) received infliximab and 2 patients (4 eyes, 3.1%) received etanercept. Average patient follow-up was 7.3±0.4 years following treatment with TNFα inhibitors. At baseline, best corrected visual acuity was 0.57±0.07 LogMAR and remained stable throughout follow-up (p=0.89), while the percentage of patients with severe vision loss remained stable at 27.3%. Following baseline patients were able to significantly reduce their dose of systemic prednisolone from an average of 18.4±1.5mg to 9.8±1mg per day at 3 months (p=0.02), thereafter remaining stable. Following baseline eyes were significantly less likely to have flares than before treatment (2.1±0.6 vs. 0.7±0.1 flares per year, p=0.02) and more likely to remain quiescent (32% vs. 6.2%, p<0.0001).
Treatment with TNFα inhibitors results in improved long-term disease control while maintaining visual function.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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