June 2022
Volume 63, Issue 7
Open Access
ARVO Annual Meeting Abstract  |   June 2022
Long-term Experience with Anti-Tumor Necrosis Factor- α Therapy in the Treatment of Refractory, Non-infectious Intermediate, Posterior and Panuveitis
Author Affiliations & Notes
  • RADGONDE AMER
    Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
  • Brice Nguedia Vofo
    Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
  • Jamel Corredores
    Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
  • Footnotes
    Commercial Relationships   RADGONDE AMER Abbvie, Code R (Recipient); Brice Vofo None; Jamel Corredores None
  • Footnotes
    Support  NONE
Investigative Ophthalmology & Visual Science June 2022, Vol.63, 3193 – A0419. doi:
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      RADGONDE AMER, Brice Nguedia Vofo, Jamel Corredores; Long-term Experience with Anti-Tumor Necrosis Factor- α Therapy in the Treatment of Refractory, Non-infectious Intermediate, Posterior and Panuveitis. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3193 – A0419.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To study the efficacy and long-term effects of infliximab and adalimumab in patients with active refractory non-infectious intermediate, posterior or panuveitis (NIPPU).

Methods : Retrospective, longitudinal study.

Results : Included were 61 patients (104 eyes) of whom 34 were males (55.74%). Mean age at diagnosis of uveitis was 26.5±16.14 years. All patients had active uveitis at baseline (time of biologic therapy initiatoin). Median interval between start of conventional immunomodulatory therapy (IMT) to introduction of biologic therapy was 13.0 (IQR 26.0) months. Ocular inflammation was effectively controlled in 92 eyes (88.46%).The most commonly used TNF-α inhibitor was adalimumab in 47 patients (77%). In the year preceding the institution of TNF-α inhibitors, average number of flares was 1.5 ±1.1 /year and it decreased to 0.08 ±0.29/year in the first year after baseline (p<0.0005). Forty-four eyes (42.30%) experienced flare over the entire period. Mean time to first flare was 14.5±9.26 months. At baseline, mean dose of prednisone was 25.5-±20.8 mg/day. Marked decrease to mean prednisone dose of 7.85±9.7 mg/day was observed at 6 months (p=0.03). In patients treated with adalimumab, mean time to prednisone dose of 7.5 mg/day was 4.02±4.89 months compared to 15.64±21.34 months in patients treated with infliximab (p =0.03). Eyes treated with adalimumab experienced first flare at a mean time of 14.11±6.29 months whereas eyes treated with infliximab experienced first flare at 18.29±14.24 months after baseline (p<0.0005). The risk for moderate and severe visual loss was lower with shorter duration of uveitis before initiating anti-TNF-α treatment (odds ratio, 0.003; 95% CI, 0.000-0.005; p=0.023), better presenting logMAR VA (odds ratio, 0.266; 95% CI, 0.172-0.361; p <0.0005) and when adalimumab was used (odds ratio, 0.354; 95% CI, 0.190-0.519, p <0.0005).

Conclusions : Anti-TNF-α therapy was successful in controlling refractory NIPPU. It significantly reduced flare rate, exerted steroid-sparing effects and preserved visual potential. Both adalimumab and infliximab exhibited similar effectivity in controlling active inflammation and flare-ups with adalimumab exerting faster and bigger steroid-sparing effects. Adalimumab use, better initial visual acuity and earlier introduction of anti-TNF- α therapy were associated with a lower risk of visual loss.

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

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