Abstract
Purpose :
To determine the efficacy of tumor necrosis factor (TNF) inhibitor agents in establishing scleritis quiescence and having a systemic corticosteroid sparing effect within the first year of TNF inhibitor therapy.
Methods :
We conducted a multicenter retrospective chart review of patients with scleritis treated with a TNF inhibitor (adalimumab, infliximab, etanercept, golimumab, certolizumab) for at least six months between May 2016 and May 2021. Data on demographics, concurrent systemic diseases, prior therapeutic history, concurrent treatment with systemic corticosteroids, clinician assessment of scleritis activity and reason(s) for TNF inhibitor discontinuation was collected at pre-specified time points. We evaluated for scleritis quiescence and concurrent doses of systemic corticosteroids at 6 and 12 months.
Results :
We identified 46 patients (56.5% female) treated for scleritis with TNF inhibitors. Mean ± SD age was 56 ± 13.5 years (range 15-87) when starting a TNF inhibitor. Underlying systemic autoimmune disease was present in 74% of subjects; rheumatoid arthritis was most common. Most patients had received prior immunosuppressive therapy (91%). 43 patients had active scleritis at time of initiation of TNF inhibitor therapy (33 adalimumab, 6 infliximab, 3 certolizumab, 1 etanercept). At 6 months 79% (34/43) of subjects obtained scleritis quiescence with TNF inhibition. At 12 months 77% (30/39) of subjects remained quiescent. Baseline daily corticosteroid use (22.5 ± 21.6 mg) decreased to 5.4 ± 8.4 mg by 6 months (p<0.001) and to 2.6 ± 5.9 mg by 12 months (p<.0001) of anti-TNF therapy.
Conclusions :
TNF inhibitors are an effective scleritis therapy and provide significant systemic corticosteroid sparing effect.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.