Efficacy of infliximab and tocilizumab in non-infectious retinal vasculitis: 12-month outcomes

Abstract

Purpose : Non-infectious retinal vasculitis (RV) is a rare, heterogeneous clinical condition which may result in sight-threatening consequences. Biologic agents are promising particularly in refractory cases. The index study aimed to evaluate the efficacy of infliximab (IFX) and tocilizumab (TCZ) infusions in non-infectious RV using the Angiographic Scoring for the Uveitis Working Group (ASUWOG) fluorescein angiography (FA) scoring system.

Methods : Records of 15 patients (27 eyes) who received IFX (5-10mg/kg) (Group 1) and 7 patients (10 eyes) who received TCZ (4-8mg/kg) (Group 2) were retrospectively evaluated to assess visual acuity (VA), anterior chamber cell and flare, vitreous haze, central subfield thickness (CST), and FA scoring at baseline and at 12 months of follow-up. The measurements were employed to assess the change in 12 months in each group.

Results : In Group 1 and 2, there was no underlying disease in 9 (60%) and 3 (42.9%) patients, respectively. Three (42.9%) patients in Group 2 had juvenile idiopathic arthritis (JIA) as the most common identified cause. Mean improvement in VA (log MAR) and CST were 0.08±0.25 and 42.2±80.8 µm in Group 1 (p=0.053 and <0.001); 0.02±0.24 and 58.9±85.9 µm in Group 2 (p=0.344 and 0.492), respectively. Mean FA scores were reduced from 13.3±5.3 and 11.6±4.6 at baseline to 5.3±5.8 and 4.2±2.5 at 12-months in Group 1 and 2 (p<0.001 and p=0.004), respectively. 15 eyes of 9 patients and 4 eyes of 3 patients had FA score <4 at 12 months in Group 1 and 2, respectively. In Group 2, 8 eyes of 5 patients (71.4%) had been treated with IFX prior to TCZ initiation. There were no significant safety concerns requiring treatment discontinuation during the follow-up in either Group 1 or 2.

Conclusions : IFX and TCZ infusions showed statistically significant improvement of non-infectious RV as shown by ASUWOG FA Scoring System. Both TCZ and IFX are appropriate therapeutic options for non-infectious RV. TCZ seems to be an effective treatment for patients with JIA-associated RV or those who failed IFX therapy.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.