Abstract
Purpose :
To compare the corticosteroid sparing efficacy of frequently used convetional antimetabolites for uveitis such as methotrexate (MTX), mycophenolate mofetil (MMF), azathioprine (AZA) to frequently used TNF inhibitors for uveitis such as adalimumab (ADA) and infliximab (INF).
Methods :
Eyes with noninfectious uveitis that had been on immunotherapy; either CONV or TNFI AND was determined to have active inflammation clinically AND/OR more than 7.5mg daily oral prednisone dosage was eligible for this analysis. Subjects who were on combined antimetabolites and TNF inhibitors were combined into the TNFi group. Primary outcome measure was corticosteroid-sparing success, defined as disease remission - inactive or slightly active uveitis AND 7.5mg or less daily oral prednisone at any visit during follow up. Kapan-Meier analysis was performed to calculate the cumulative success rate over time, and Cox regression model was used to compare the success between CONV vs. TNFi adjusted for age, race/ethnicity, smoking status, anatomic location of uveitis and duration of uveitis and visual acuity.
Results :
1335 eyes on CONV and 235 eyes on TNFi were eligible for the analysis. At 6 months, cumulative success rate was 35.7% in CONV eyes and 49.5% in TNFi eyes. This increased to 54.9% and 70.7% respectively by 1 year, 73.3% and 87.0% respectively by 2 years (Figure 1). In multivariable analysis, TNFi eyes were 1.5 times more likely than CONV to achieve corticosteroid-sparing success (adjusted hazard ratio: 1.54 95% confidence intervals: 1.29-1.84, p<.0001).
Conclusions :
Eyes with active noninfectious uveitis achieve disease quiescence and corticosteroid sparing success with CONV and TNFi. However, the likelihood of treatment success is higher in the TNFi group as compared to the CONV group. Achievement of success takes a long period of time in both groups.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.