Abstract
Purpose :
The key role of tissue necrosis factor alpha (TNF alpha) has been shown in the pathophysiology of thyroid eye disease. In this study we aimed to report the effect of anti-TNF alpha agents in treatment of patients with active thyroid eye disease (TED) who could not take or failed to respond to corticosteroids.
Methods :
Data of all patients with active TED from January 2014 to December 2018, that received anti-TNF alpha agents because they could not take steroids or showed resistance to them,were reviewed. Data included visual acuity, clinical activity score (CAS), extra-ocular motility, eyelid swelling and erythema, conjunctival injection and chemosis, carancular congestion, keratopathy and dysthyroid optic neuropathy. Those with follow-up less than 9 months were excluded.
Results :
Data of eight eligible patients were analyzed. Mean age was 54.6 (SD= 7.08, range=42-65) years. Five were male. The reason for abandonment from corticosteroid included: gastrointestinal bleeding (n=1), congestive heart failure (n=1), diabetic hyperosmolar state (n=1), non- or inadequate response to corticosteroid regimen (n=5). Patients received one anti-TNF alpha agent as single main treatment including infliximab (n=3), etanercept (n=3), Adalimumab (n=2). CAS score decreased from baseline 5.5 (SD= 1.69) to 0.5 (SD= 0.75) (p=0.0001). Proptosis value showed decreased from baseline 24.12 mm (SD= 2.23) to 22.12 (SD=1.88) after treatment (p=0.037). The patients that received adalimumab showed resolution of diplopia and decrease in proptosis in comparison to none of the other six patients. Mean follow up time was 27.75 (range: 15-46, SD= 10.30) months. Four (50%) patients were current smokers. Five patients had DON before anti-TNF alpha. Four of them were smokers. Three of them improved by anti-TNF alpha medication only. We did not observe any complication associated with the use of anti-TNF alpha agents.
Conclusions :
This study supports the efficacy of anti-TNF alpha agents in active TED. Further they may be considered in patients that cannot take corticosteroids or are resistant to steroid therapy. Results of this study justify future comparative studies to verify efficacy of this modality of treatment in patients with active TED.
This is a 2021 ARVO Annual Meeting abstract.