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Joshua Luis, Priyanka Sanghi, Edward Hindle, Angela L Rees, Mark C Westcott; MRI Screening for Adalimumab Therapy in Uveitis. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6111.
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The use of tumour necrosis factor-alpha (TNF-α) antagonists such as Adalimumab is becoming increasingly common in the management of uveitic syndromes which are refractory to first-line management. An important consideration when commencing this class of medication is the possibility of inducing demyelinating disease. In this study, we present the findings from a neuroimaging screening program for patients with uveitis prior to commencing Adalimumab.
Records from all patients seen at a specialist screening clinic for Adalimumab treatment in Moorfields Eye Hospital between 1st November 2017 and 1st November 2018 were analysed retrospectively. The aim of the screening was to elicit any contra-indications to commencing Adalimumab with relevant history-taking and examination. The screening protocol for performing an MRI included patients with a diagnosis of idiopathic intermediate uveitis (IIU) or typical symptoms of demyelinating disease such as paraesthesia and numbness. Patient demographics, underlying disease aetiology and the outcomes of the MRI scans were recorded and analysed.
Ninety-two cases were identified during this period, three cases did not proceed to Adalimumab treatment due to clinical reasons and were therefore excluded from analysis. Eighty-nine cases were analysed, 56 of these did not require MRI scanning according to our screening protocol, recent scans were available in 19 cases as a part of their prior clinical management, and 14 scans were performed as a direct result of screening. MRIs strongly suggestive of demyelination (MRSSD) were found in 4 out of 14 (29%) scans, a further 4 scans showed non-specific white matter lesions, and the remaining 6 scans showed no abnormalities. MRSSD cases ranged between 25 and 55 years of age with a female majority (3/4), all cases had an underlying diagnosis of bilateral IIU and were predominantly symptomatic (3/4).
TNF-α antagonist induced demyelination is a concern in Adalimumab use, which necessitates appropriate neurological referral and reconsideration of immunosuppressive in high-risk cases. Within this study cohort, our current screening protocol shows a high yield of identifying pre-existing MRI changes. Bilateral IIU and the presence of neurological symptoms both appear to be positive predictors.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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