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Çam F, Celiker H. Efficacy, retention rate and safety of adalimumab treatment in patients with non-infectious uveitis and scleritis: a real-world, retrospective, single-centre study. Eye (Lond) 2024; 38:893-901. [PMID: 37884704 DOI: 10.1038/s41433-023-02800-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 09/26/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES To evaluate the outcomes of adalimumab (ADA) treatment of patients with non-infectious uveitis and scleritis, focusing on efficacy, retention rate, and safety. METHODS This retrospective, clinical cohort study included 62 patients (104 eyes) with active ocular inflammation treated with ADA. Primary outcomes were efficacy and cumulative drug retention rate (DRR) of ADA. The secondary outcomes included changes in ocular inflammatory parameters, changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT), corticosteroid-sparing effect, impact of concomitant use of disease-modifying antirheumatic drug (DMARD) and ADA as first or ≥2nd biotherapy line on DRR, and adverse events. RESULTS Forty-five patients (72.6%) achieved inactive disease at the end of follow-up. DRR at 6, 12, 24, and 48 months was 96.8%, 89.2%, 63.1%, and 63.1%, respectively. Of the 18 patients whose bi-weekly ADA treatment was escalated to weekly ADA due to primary or secondary inefficacy, 10 patients had inactive disease finally. BCVA improved (p < 0.001) and CMT decreased (p < 0.001) significantly at 6, 12, and 24 months after ADA therapy compared to baseline. Percentage of patients treated with ≥10 mg/day corticosteroid (61.3% vs. 6.4%) and DMARDs combined with ADA (46.8% vs. 37.1%) were lower at 6 months than at baseline. Concomitant DMARDs (p = 0.579) and use of ADA as first or ≥2nd biotherapy line (p = 0.527) had no significant effect on DRR. Most common adverse event was tuberculosis-related infections. CONCLUSIONS ADA seems to be effective and safe with good DRR to control ocular inflammation. Escalation to weekly ADA treatment may be an effective option in patients with primary or secondary inefficacy.
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Affiliation(s)
- Furkan Çam
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey
| | - Hande Celiker
- Department of Ophthalmology, Marmara University School of Medicine, Istanbul, Turkey.
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Song SH, Woo SJ. Efficacy and Safety of Switching from Adalimumab Originator to SB5, Adalimumab Biosimilar for Noninfectious Uveitis. Ocul Immunol Inflamm 2024:1-5. [PMID: 38194436 DOI: 10.1080/09273948.2023.2295544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE To evaluate the efficacy and safety of switching from adalimumab originator (Humira, AbbVie) to SB5, adalimumab biosimilar (Adalloce, Samsung Bioepis) in patients with noninfectious uveitis (NIU). METHODS Fifteen patients (29 eyes) with NIU who were switched from adalimumab originator to SB5 and followed up for 6 months or longer were retrospectively included. Data consisted of best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), anterior chamber (AC) cell grade, anterior vitreous (AV) cell grade, vitreous haze grade, central macular thickness (CMT, μm), and macular volume (MV, mm3) at pre-switching, 2, 4, and 6 months post-switching. RESULTS There were no significant differences in BCVA, AC and AV cell grades, and vitreous haze grades at 2, 4, and 6 months post- compared with pre-switching, and no significant differences in CMT and MV at 2 and 6 months post-switching. CMT and MV decreased from 260.55 ± 67.44 μm and 8.37 ± 1.14 mm3 at pre-switching to 244.14 ± 60.31 μm (p = 0.032) and 8.11 ± 1.20 mm3 (p = 0.027) at 4 months post-switching, respectively. There was no recurrence of uveitis, as defined by AC cell grade, vitreous haze, or BCVA. Four patients (27%) were switched back to adalimumab originator after a mean of 9 weeks, due to discomfort during the injection (three patients) and technical difficulty with the new injection device (one patient). No other adverse events occurred after switching to SB5. CONCLUSION Switching from adalimumab originator to SB5 for NIU does not result in clinically significant differences in treatment efficacy and safety.
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Affiliation(s)
- Seok Hyeon Song
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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Ferreira LB, Williams KA, Best G, Haydinger CD, Smith JR. Inflammatory cytokines as mediators of retinal endothelial barrier dysfunction in non-infectious uveitis. Clin Transl Immunology 2023; 12:e1479. [PMID: 38090668 PMCID: PMC10714664 DOI: 10.1002/cti2.1479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/22/2023] [Accepted: 11/21/2023] [Indexed: 06/30/2024] Open
Abstract
Characterised by intraocular inflammation, non-infectious uveitis includes a large group of autoimmune and autoinflammatory diseases that either involve the eye alone or have both ocular and systemic manifestations. When non-infectious uveitis involves the posterior segment of the eye, specifically the retina, there is substantial risk of vision loss, often linked to breakdown of the inner blood-retinal barrier. This barrier is formed by non-fenestrated retinal vascular endothelial cells, reinforced by supporting cells that include pericytes, Müller cells and astrocytes. Across the published literature, a group of inflammatory cytokines stand out as prominent mediators of intraocular inflammation, with effects on the retinal endothelium that may contribute to breakdown of the inner blood-retinal barrier, namely tumour necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, IL-8, IL-17 and chemokine C-C motif ligand (CCL)2. This article reviews the function of each cytokine and discusses the evidence for their involvement in retinal endothelial barrier dysfunction in non-infectious uveitis, including basic laboratory investigations, studies of ocular fluids collected from patients with non-infectious uveitis, and results of clinical treatment trials. The review also outlines gaps in knowledge in this area. Understanding the disease processes at a molecular level can suggest treatment alternatives that are directed against appropriate biological targets to protect the posterior segment of eye and preserve vision in non-infectious uveitis.
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Affiliation(s)
| | - Keryn A Williams
- Flinders University College of Medicine and Public HealthAdelaideSAAustralia
| | - Giles Best
- Flinders University College of Medicine and Public HealthAdelaideSAAustralia
| | - Cameron D Haydinger
- Flinders University College of Medicine and Public HealthAdelaideSAAustralia
| | - Justine R Smith
- Flinders University College of Medicine and Public HealthAdelaideSAAustralia
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Avarand M, Esen Baris M, Taheri L, Guven Yılmaz S. Efficacy of Pegylated Interferon Alpha-2a in Uveitic Macular Edema Refractory to Biologic Agents. Ocul Immunol Inflamm 2023; 31:1900-1905. [PMID: 37917790 DOI: 10.1080/09273948.2023.2271980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To report the efficacy of pegylated interferon alpha-2a (Roferon, Hoffmann-La Roche brands, Switzerland) in uveitic macular edema refractory to biologic agents. METHODS Herein, we present two cases of non-infectious uveitis with cystoid macular edema (CME) who were unresponsive to immunosuppressant treatment, and whose uveitis and macular edema recurrences were prevented with subcutaneous injections of pegylated interferon α-2a. RESULTS Two young males (27- and 30-year-old) diagnosed with non-infectious uveitis and CME were on immunosuppressive treatment. Although both received systemic steroids and biologic agents, macular edema persists. After initiation of pegylated interferon alpha-2a (Pegasys, Genentech, USA) CME regressed significantly and did not occur during their follow-ups of 14 and 12 months. CONCLUSION Pegylated interferon-alpha-2a can be used as an effective alternative to interferon alpha-2a in uveitic macular edema cases, resistant to other immunosuppressive agents.
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Affiliation(s)
| | - Mine Esen Baris
- Department of Ophthalmology, School of Medicine, Ege University, Izmir, Turkey
| | - Leila Taheri
- Department of Ophthalmology, School of Medicine, Ege University, Izmir, Turkey
| | - Suzan Guven Yılmaz
- Department of Ophthalmology, School of Medicine, Ege University, Izmir, Turkey
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Chang EL, Sobrin L. Local versus Systemic Therapy for Noninfectious Uveitis (NIU). Semin Ophthalmol 2023; 38:15-23. [PMID: 36471661 DOI: 10.1080/08820538.2022.2152707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The mainstay of treatment for noninfectious uveitis (NIU) is immunosuppressant therapy. This may come in a localized form that is administered specifically to the eye or a systemic form that penetrates ocular tissues. Over the last twenty years, both local and systemic treatments have undergone advancements in pharmaceutical development. In this review, we will discuss new therapies and analyze the risks and benefits for all existing NIU therapies. Some of these therapies include topical, intravitreal, periocular, and systemic steroids, as well as systemic antimetabolites, tumor necrosis factor-α inhibitors, T-cell inhibitors, anti-CD 20 agents, interleukin-6 inhibitors, alkylating agents, and intravenous immunoglobulin.
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Affiliation(s)
- Eileen L Chang
- Harvard Medical School, Massachusetts Eye & Ear Infirmary, Boston, USA
| | - Lucia Sobrin
- Harvard Medical School, Massachusetts Eye & Ear Infirmary, Boston, USA
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Corredores Dieb J, Vofo B, Amer R. Long-term Experience with Anti-tumor Necrosis factor- α Therapy in the Treatment of Refractory, Non-infectious Intermediate, Posterior, and Panuveitis. Ocul Immunol Inflamm 2022:1-8. [PMID: 36538811 DOI: 10.1080/09273948.2022.2152983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/19/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022]
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 initiation of biological therapy). Median interval between the start of conventional immunomodulatory therapy (IMT) to the introduction of biological 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%). Mean follow-up time after baseline was 40 ± 34.08 months. In the year preceding the institution of TNF-α inhibitors, the 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 < .0005). Forty-four eyes (42.30%) experienced flare over the entire follow-up period. Mean time to first flare was 14.5 ± 9.26 months. At baseline, the mean dose of prednisone was 25.5-±20.8 mg/day. A marked decrease to a mean prednisone dose of 7.85 ± 9.7 mg/day was observed at 6 months (p = .03). In patients treated with adalimumab, the mean time to prednisone dose ≤7.5 mg/day was 4.02 ± 4.89 months compared to 15.64 ± 21.34 months in patients treated with infliximab (p = .03). 64.3% of patients treated by infliximab had Behçet uveitis compared to 27.7% of patients treated by adalimumab. 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 < .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 = .023), better presenting logMAR VA (odds ratio, 0.266; 95% CI, 0.172-0.361; p < .0005) and when adalimumab was used (odds ratio, 0.354; 95% CI, 0.190-0.519, p < .0005). CONCLUSIONS Anti-TNF-α therapy was successful in controlling refractory NIPPU in the majority of cases. It significantly reduced flare rate, exerted steroid-sparing effects, and preserved visual potential. Adalimumab use, better initial visual acuity, and earlier introduction of anti-TNF- α therapy were associated with a lower risk of visual loss.
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Affiliation(s)
| | - Brice Vofo
- Department of Ophthalmology, Hadassah Medical Center, Jerusalem, Israel
| | - Radgonde Amer
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Zhang J, Yan H, Li J, Li B. Aqueous Humor Factors' Predictive Effects in Treating Refractor Macular Edema: An Overview. J Interferon Cytokine Res 2022; 42:515-524. [PMID: 36036998 DOI: 10.1089/jir.2022.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The refractory macular edema (RME) seriously affects the patient's vision due to its repetition and ineffective drug response. RME is mainly related to the inflammatory pathway and angiogenesis pathway. At present, microglia activation and angiogenesis have also been widely focused on. With the promotion of the concept of precision diagnosis and treatment, intraocular fluid is becoming a popular evidence-based method. The detection and evaluation of aqueous humor factors can provide more accurate evidences and guidance for the treatment of RME. The purpose of this article is to review the treatment prediction and assessment progress of aqueous humor cytokines for the RME, giving evidence to provide a basis for expanding the diagnosis and treatment ideas of RME and guiding the development of personalized medical treatment.
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Affiliation(s)
- Jie Zhang
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hui Yan
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jing Li
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bing Li
- Department of Ophthalmology, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
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8
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Bograd A, Fuchs D, Bächtiger J, Pfister IB, Spindler J, Hoogewoud F, Gugleta K, Böni C, Guex-Crosier Y, Garweg JG, Tappeiner C. Long-term Efficacy of TNF-alpha Inhibitors on Persistent Uveitic Macular Edema: A Swiss Multicenter Cohort Study. Ocul Immunol Inflamm 2022:1-8. [PMID: 35588311 DOI: 10.1080/09273948.2022.2075761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To assess the efficacy of tumor necrosis factor-alpha inhibitors (TNFi) on uveitic macular edema (ME) unresponsive to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). METHODS This multicenter retrospective study included patients with uveitic ME persisting despite csDMARDs. The effect of an additional TNFi on central retinal thickness (CRT), best corrected visual acuity (BCVA) and corticosteroid need was evaluated. RESULTS Thirty-five eyes (26 patients, mean age 42.9 ± 15.2 years) were included. CRT decreased from 425 ± 137 µm to 294 ± 66 µm (p < .001) and 280 ± 48 µm (p < .001) at 1 and 4 years of follow-up, respectively. BCVA improved from 0.28 ± 0.22 to 0.21 ± 0.48 (1 year, p = .013) and 0.08 ± 0.13 logMAR (4 years, p = .002). The proportion of patients requiring systemic corticosteroids decreased from 88.5% to 34.8% (1 year) and 15.4% (4 years). CONCLUSION The addition of a TNFi resulted in an improvement of CRT and BCVA for up to 4 years in uveitic ME but rescue treatments were needed for some patients.
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Affiliation(s)
- Alexandra Bograd
- Department of Ophthalmology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Dominic Fuchs
- Department of Ophthalmology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | | | | | - Jan Spindler
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Florence Hoogewoud
- Eye Hospital, FAA, Department of Ophthalmology, University of LausanneJules-Gonin, Lausanne, Switzerland
| | | | - Christian Böni
- Department of Ophthalmology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Yan Guex-Crosier
- Eye Hospital, FAA, Department of Ophthalmology, University of LausanneJules-Gonin, Lausanne, Switzerland
| | - Justus G Garweg
- Department of Ophthalmology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.,Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Christoph Tappeiner
- Pallas Klinik, Olten, Switzerland.,Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,University of Bern, Bern, Switzerland
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Tsui E, Rathinam SR, Gonzales JA, Thundikandy R, Kanakath A, Balamurugan S, Vedhanayaki R, Lim LL, Suhler EB, Al-Dhibi HA, Doan T, Keenan J, Ebert CD, Kim E, Madow B, Porco TC, Acharya NR. Outcomes of uveitic macular edema in the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Uveitis Trial. Ophthalmology 2022; 129:661-667. [PMID: 35143800 DOI: 10.1016/j.ophtha.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To evaluate the outcomes of uveitic macular edema at 6 months and 12 months in patients treated with methotrexate or mycophenolate mofetil. DESIGN Subanalysis of a block-randomized, observer-masked, multi-center clinical trial. SUBJECTS/PARTICIPANTS Patients were enrolled into the First-line Antimetabolites as Steroid-sparing Treatment (FAST) uveitis trial between August 2013 and August 2017. METHODS/INTERVENTION/TESTING Patients were randomized to oral methotrexate 25mg weekly or mycophenolate mofetil 1.5g twice daily for 12 months, along with a corticosteroid taper. In addition to standardized clinical examination, all patients underwent spectral domain optical coherence tomography imaging at each visit. At the 6-month primary endpoint, patients who achieved treatment success continued the same treatment for a subsequent 6 months and treatment failures switched to the other treatment group. MAIN OUTCOME MEASURES Pre-specified primary outcome at 6 months and 12 months outcomes of central subfield thickness and visual acuity. RESULTS Of 216 patients in the FAST Trial, 42 eyes of 30 patients in the methotrexate group and 55 eyes of 41 patients in the mycophenolate group had uveitic macular edema. Baseline median central subfield thickness was 359μm and 342μm in the methotrexate and mycophenolate groups, respectively. At 12 months, for those who stayed on the same treatment, macular thickness decreased from baseline by 23 μm (IQR, -39.0 to 13) and 18 μm (IQR, -68.5 to 9), in the methotrexate and mycophenolate groups, respectively, (P=0.76). In patients who switched treatment at 6 months, macular thickness decreased from baseline by 12.5 μm (IQR, -29.8 to -2.3) and 92 μm (IQR, -240 to -18) in the methotrexate and mycophenolate groups, respectively, (P=0.23). At 12 months, 7/19 (37%) eyes on methotrexate had resolution of macular edema compared to 15/25 (60%) eyes on mycophenolate (P=0.10). For those that switched treatments, 8/17 (47%) eyes on methotrexate and 6/11 (55%) eyes on mycophenolate had improvement of macular edema, (P=0.92) CONCLUSIONS: Treatment with methotrexate or mycophenolate mofetil for uveitic macular edema results in similar improvements in macular thickness at 6 and 12 months. At 12 months, approximately half of eyes in each antimetabolite group still had persistent macular edema.
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Affiliation(s)
- Edmund Tsui
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Stein Eye Institute at University of California, Los Angeles, California and David Geffen School of Medicine at University of California, Los Angeles, California
| | - Sivakumar R Rathinam
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - John A Gonzales
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California
| | - Radhika Thundikandy
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Anuradha Kanakath
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Coimbatore, India
| | - S Balamurugan
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Pondicherry, India
| | - R Vedhanayaki
- Uvea Services, Aravind Eye Hospitals and Postgraduate Institute of Ophthalmology, Madurai, India
| | - Lyndell L Lim
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Eric B Suhler
- Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Hassan A Al-Dhibi
- Division of Vitreoretinal Surgery and Uveitis, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia
| | - Thuy Doan
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California
| | - Jeremy Keenan
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California
| | - Caleb D Ebert
- F.I. Proctor Foundation, University of California, San Francisco, California
| | - Eric Kim
- F.I. Proctor Foundation, University of California, San Francisco, California
| | - Brian Madow
- Department of Ophthalmology, University of South Florida, Tampa, Florida
| | - Travis C Porco
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Nisha R Acharya
- F.I. Proctor Foundation, University of California, San Francisco, California; Department of Ophthalmology, University of California, San Francisco, California; Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
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10
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Leclercq M, Andrillon A, Maalouf G, Sève P, Bielefeld P, Gueudry J, Sené T, Moulinet T, Rouvière B, Sène D, Desbois AC, Domont F, Touhami S, El Chamieh C, Cacoub P, Bodaghi B, Biard L, Saadoun D. Anti-Tumor Necrosis Factor α versus Tocilizumab in the Treatment of Refractory Uveitic Macular Edema: A Multicenter Study from the French Uveitis Network. Ophthalmology 2021; 129:520-529. [PMID: 34793830 DOI: 10.1016/j.ophtha.2021.11.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To analyze the factors associated with response (control of ocular inflammation and corticosteroid-sparing effect) to biologics (anti-tumor necrosis factor [TNF]-α agents and tocilizumab) in patients with refractory uveitic macular edema (ME). DESIGN Multicenter, retrospective, observational study. PARTICIPANTS Adult patients with uveitic ME refractory to systemic corticosteroids, disease-modifying antirheumatic drugs, or both. METHODS Patients received anti-TNF-α agents (infliximab 5 mg/kg at week 0, 2, 6, and every 4-6 weeks [n = 69] and adalimumab 40 mg/2 weeks [n = 80]) and tocilizumab (8 mg/kg every 4 weeks intravenously [n = 39] and 162 mg/week subcutaneously [n = 16]). MAIN OUTCOME MEASURES Analysis of complete and partial response rates, relapse rate, low vision (visual acuity in at least 1 eye of ≥ 1 logarithm of the minimum angle of resolution), corticosteroid-sparing effect, and adverse events at 6 months. RESULTS Two hundred four patients (median age, 40 years [interquartile range, 28-58 years]; 42.2% men) were included. Main causes of uveitis included Behçet's disease (17.2%), birdshot chorioretinopathy (11.3%), and sarcoidosis (7.4%). The overall response rate at 6 months was 46.2% (21.8% of complete response) with anti-TNF-α agents and 58.5% (35.8% of complete response) with tocilizumab. In multivariate analysis, treatment with tocilizumab (odds ratio, 2.10; 95% confidence interval [CI], 1.06-4.06; P = 0.03) was associated independently with complete response of uveitic ME compared with anti-TNF-α agents. Anti-TNF-α agents and tocilizumab did not differ significantly in terms of relapse rate (hazard ratio, 1.00; 95% CI, 0.31-3.18; P = 0.99) or occurrence of low vision (odds ratio, 1.02; 95% CI, 0.51-2.07; P = 0.95) or corticosteroid-sparing effect (P = 0.29). Adverse events were reported in 20.6% of patients, including serious adverse events reported in 10.8% of patients. CONCLUSIONS Tocilizumab seems to improve complete response of uveitic ME compared with anti-TNF-α agents.
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Affiliation(s)
- Mathilde Leclercq
- Internal Medicine Department, CHU Rouen, Rouen, France; Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, and INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Anaïs Andrillon
- Department of Biostatistics and Medical Information, CRESS UMR 1153, INSERM, ECSTRRA Team, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
| | - Georgina Maalouf
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, and INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Pascal Sève
- Internal Medicine Department, Hôpital de la Croix- Rousse, Hospices Civils de Lyon, and Faculté de Médecine Lyon-Sud, Université Claude Bernard-Lyon 1, Lyon, France
| | - Philip Bielefeld
- Internal Medicine and Systemic Diseases Department (Médecine Interne 2), Dijon University Hospital, Dijon, France
| | - Julie Gueudry
- Ophthalmology Department, Hospital Charles Nicolle, CHU Rouen, and EA7510, UFR Santé, Rouen University, Rouen, France
| | - Thomas Sené
- Internal Medicine Department, Fondation Rothschild, Paris, France
| | - Thomas Moulinet
- Department of Internal Medicine, CHRU de Nancy, and Université de Lorraine, Inserm UMR_S 1116, Nancy, France
| | - Bénédicte Rouvière
- Internal Medicine and Pneumology Department, CHU de Brest, Hôpital La Cavale Blanche, Brest, France
| | - Damien Sène
- Internal Medicine Department, Lariboisière Hospital, and INSERM UMR 969, University of Paris, Paris, France
| | - Anne-Claire Desbois
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, and INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Fanny Domont
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, and INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Sara Touhami
- Ophthalmology Department, DHU ViewRestore, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Carolla El Chamieh
- Department of Biostatistics and Medical Information, CRESS UMR 1153, INSERM, ECSTRRA Team, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, and INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France
| | - Bahram Bodaghi
- Ophthalmology Department, DHU ViewRestore, Pitié Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Lucie Biard
- Department of Biostatistics and Medical Information, CRESS UMR 1153, INSERM, ECSTRRA Team, Saint-Louis University Hospital, AP-HP, University of Paris, Paris, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne Universités, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Centre National de Références Maladies Autoimmunes et Systémiques Rares, Centre National de Références Maladies Autoinflammatoires Rares et Amylose Inflammatoire, and INSERM, UMR S 959, Immunology-Immunopathology-Immunotherapy (I3), Paris, France.
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Touhami S, Gueudry J, Leclercq M, Touitou V, Ghembaza A, Errera MH, Saadoun D, Bodaghi B. Perspectives for immunotherapy in noninfectious immune mediated uveitis. Expert Rev Clin Immunol 2021; 17:977-989. [PMID: 34264142 DOI: 10.1080/1744666x.2021.1956313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction: Noninfectious uveitis (NIU) is one of the leading causes of blindness worldwide. In adult patients, anterior NIU is usually managed with topical corticosteroids. In intermediate, posterior uveitis. and panuveitis, systemic corticosteroids are used especially in case of bilaterality or association with systemic disease. Biotherapies are recommended in case of inefficacy or intolerance to corticosteroids or conventional immunosuppressive drugs. Anti-TNF-α agents are by far the most widely used biotherapies. In case of failure or poor tolerance to anti-TNF-α, new targeted therapies can be proposed.Areas covered: We present and discuss an updated overview on biologics and biotherapies in NIU.Expert opinion: In case of dependency to systemic or intravitreal steroids, sight-threatening disease, and/or failure of conventional immunosuppressive drugs, anti-TNF-α are used as first-line biologics to achieve quiescence of inflammation. Anti-interleukin-6 is another option that may be proposed as first-line biologic or in case of poor efficacy of anti-TNF-α. Interferon can be directly proposed in specific indications (e.g. refractory macular edema, sight-threatening Behçet's uveitis). In the rare cases that remain unresponsive to traditional biotherapies, novel molecules, such as Janus-associated-kinase and anti-phosphodiesterase-4-inhibitors can be used. Therapeutic response must always be evaluated by clinical and appropriate ancillary investigations.
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Affiliation(s)
- Sara Touhami
- Department of Ophthalmology, DHU ViewRestore, Sorbonne Université, Paris, France
| | - Julie Gueudry
- Department of Ophthalmology Charles Nicolle University Hospital, Rouen, France
| | - Mathilde Leclercq
- Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département De Médecine Interne Et Immunologie Clinique, Paris, France, Centre National De Références Maladies Autoimmunes Systémiques Rares, Centre National De Références Maladies Autoinflammatoires Et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France.,CHU Rouen, Department of Internal Medicine, Rouen, France
| | - Valérie Touitou
- Department of Ophthalmology, DHU ViewRestore, Sorbonne Université, Paris, France
| | - Amine Ghembaza
- Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département De Médecine Interne Et Immunologie Clinique, Paris, France, Centre National De Références Maladies Autoimmunes Systémiques Rares, Centre National De Références Maladies Autoinflammatoires Et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Marie Hélène Errera
- Ophthalmology Department and Laboratory and DHU Sight Restore, Centre Hospitalier National d'Ophtalmologie Des Quinze-Vingts, Sorbonne Université, Paris, France.,Department of Ophthalmology, Pittsburgh University Hospital, Pittsburgh, PA, USA
| | - David Saadoun
- Sorbonne Université, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Département De Médecine Interne Et Immunologie Clinique, Paris, France, Centre National De Références Maladies Autoimmunes Systémiques Rares, Centre National De Références Maladies Autoinflammatoires Et Amylose Inflammatoire; Inflammation-Immunopathology-Biotherapy Department (DMU 3iD); INSERM 959, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, DHU ViewRestore, Sorbonne Université, Paris, France
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Sota J, Gentileschi S, Vitale A, Gaggiano C, De Bartolo G, Bianco MT, Frediani B, Tosi GM, Cantarini L, Fabiani C. Effectiveness of SB5, an Adalimumab Biosimilar, in Patients With Noninfectious Uveitis: A Real-Life Monocentric Experience. Asia Pac J Ophthalmol (Phila) 2021; 10:360-365. [PMID: 33756492 DOI: 10.1097/apo.0000000000000380] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Several concerns have arisen with biosimilars in terms of immunogenicity, safety issues, loss of efficacy, and extrapolation to other indications. The study aim was to evaluate the efficacy of SB5, an adalimumab biosimilar, in noninfectious uveitis (NIU). DESIGN Retrospective nonrandomized study. METHODS Data from patients with refractory NIU treated with SB5 (Imraldi, Biogen) were analyzed at baseline, 3 months after SB5 initiation and at the last follow-up in terms of uveitis relapses, occurrence of retinal vasculitis, resolution of uveitic macular edema (UME), best-corrected visual acuity, glucocorticoids (GCs)-sparing effect and drug survival. RESULTS Uveitis relapses decreased from 121 relapses/100 patients/year in the 12 months before SB5 initiation to 4 relapses/100 patients/year during the first 12 months of treatment (P = 0.0004). Uveitis was inactive in 46/47 eyes at the end of the study period. The number of eyes with active retinal vasculitis decreased during the study period (P < 0.0001). At baseline, 6 eyes presented UME, whereas no eye had UME at the last follow-up. Mean best-corrected visual acuity increased from 7.7 ± 3.41 at baseline to 8.9 ± 2.46 at the last follow-up (P = 0.0045). Mean GCs daily dosage decreased from 18.33 ± 10.33 mg at baseline to 5.75 ± 2.29 mg at the last follow-up (P = 0.018). The cumulative SB5 retention rate was 91.8% at both 12- and 20-month follow-up. CONCLUSIONS SB5 biosimilar is effective in NIU by drastically reducing uveitis relapses and the occurrence of retinal vasculitis. Moreover, SB5 biosimilar improved visual acuity, allowed a significant GCs-sparing effect and showed an excellent drug retention rate.
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Affiliation(s)
- Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Stefano Gentileschi
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Carla Gaggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Giuseppe De Bartolo
- Department of Medicine, Ophthalmology Unit, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Maria Teresa Bianco
- Pharmacy Unit, Siena University Hospital 'Santa Maria alle Scotte', Siena, Italy
| | - Bruno Frediani
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Gian Marco Tosi
- Department of Medicine, Ophthalmology Unit, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Claudia Fabiani
- Department of Medicine, Ophthalmology Unit, Surgery and Neuroscience, University of Siena, Siena, Italy
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13
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Figueras-Roca M, Matas J, Llorens V, Sala-Puigdollers A, Navarro M, Zarranz-Ventura J, Adán A, Molins B. Systemic contribution of inflammatory mediators to the severity of diabetic and uveitic macular edema. Graefes Arch Clin Exp Ophthalmol 2021; 259:2695-2705. [PMID: 33710470 DOI: 10.1007/s00417-021-05149-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 01/24/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To assess whether serum cytokine and growth factor levels are associated with diabetic macular edema (DME) and uveitic macular edema (UME) objective severity. METHODS Cross-sectional observational study of 81 patients (1 eye/patient) with DME (n=48) and UME (n=33). Macular edema (ME) was defined upon central macular thickness (CMT) ≥ 300 μm on spectral domain optical coherence tomography (OCT). Serum samples were obtained from peripheral blood and IL-1β, IL-6, IL-8, IL-10, MCP-1, TNF-α, and VEGF levels were determined by Luminex analysis. Main outcome measure was the correlation between mediators' levels and CMT and macular volume (MV) on OCT for ME cases. RESULTS In DME, IL-6 levels were found to significantly correlate with MV (r=0.324; p=0.028) whereas in UME, IL-8 was significantly associated with both CMT (r=0.401; p=0.021) and MV (r=0.391; p=0.024). IL-8 independently correlated with CMT (ß=177.2; p=0.033) and MV (ß=3.17; p=0.008) in UME multivariate model. CONCLUSION Peripheral blood IL-6 and IL-8 levels could play a role in the severity of DME and UME, respectively. IL-8 even seems to be independently associated with CMT and MV in UME cases. Such systemic implications could enforce DME and UME personalized diagnostic and therapeutic approaches.
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Affiliation(s)
- Marc Figueras-Roca
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain.
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain.
| | - Jessica Matas
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Víctor Llorens
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Anna Sala-Puigdollers
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Manuel Navarro
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
| | - Javier Zarranz-Ventura
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Alfredo Adán
- Institut Clínic d'Oftalmologia (ICOF), Hospital Clínic, C/ Sabino de Arana 1, 08028, Barcelona, Spain
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Blanca Molins
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
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14
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Maleki A, Garcia CM, Asgari S, Manhapra A, Foster CS. Response to the Second TNF-α Inhibitor (Adalimumab or Infliximab) after Failing the First One in Refractory Idiopathic Inflammatory Retinal Vascular Leakage. Ocul Immunol Inflamm 2021; 30:1099-1108. [PMID: 33646065 DOI: 10.1080/09273948.2020.1869787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To determine the response to the second TNF-α inhibitor (adalimumab and infliximab) after failing the first agent in idiopathic inflammatory retinal vascular leakage.Materials and Methods: This was a retrospective observational case series. Patients with the diagnosis of idiopathic inflammatory retinal vascular leakage who had received both infliximab and adalimumab were included in the study.Results: Twelve and 15 patients received adalimumab (Group one) and infliximab (Group two) as the first treatment, respectively. The remission rates between Group one (58.3%) and Group two (66.7%) were not statistically significant. (P = .4) As the second agent, adalimumab was more effective in younger patients (27.5 ± 20.6) compared to older patients (48.75 ± 10.2). (P = .03). Moreover, patients with lower vision responded marginally better to infliximab as the second treatment (P = .06).Conclusion: Either TNF-α inhibitor, adalimumab and infliximab, can be employed in the treatment of the patients with idiopathic inflammatory retinal vascular leakage who fail one of these agents.
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Affiliation(s)
- Arash Maleki
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Cristina M Garcia
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Soheila Asgari
- Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
| | - Ambika Manhapra
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA
| | - Charles Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts, USA.,The Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts, USA.,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
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15
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Ferreira LB, Smith AJ, Smith JR. Biologic Drugs for the Treatment of Noninfectious Uveitis. Asia Pac J Ophthalmol (Phila) 2021; 10:63-73. [PMID: 33481396 DOI: 10.1097/apo.0000000000000371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT The management of noninfectious uveitis is constantly evolving. A new "biologic era" in treatment began after the effectiveness of tumor necrosis factor-alpha blocking drugs was demonstrated in rheumatologic inflammatory diseases. The goal of specific immunomodulation with a biologic drug is to target inflammation at the molecular level with a low rate of serious adverse events. The purpose of this review is to summarize current knowledge of biologic drugs in the treatment of noninfectious uveitis by describing clinical studies and recent pharmacological developments.
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Affiliation(s)
| | - Anthony J Smith
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
- Clinical Immunology and Allergy Unit, Flinders Medical Centre, Adelaide, Australia
| | - Justine R Smith
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
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16
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Biotherapies in Uveitis. J Clin Med 2020; 9:jcm9113599. [PMID: 33171664 PMCID: PMC7695328 DOI: 10.3390/jcm9113599] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/01/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022] Open
Abstract
Non-infectious uveitis (NIU) represents one of the leading causes of blindness in developed countries. The therapeutic strategy aims to rapidly control intra-ocular inflammation, prevent irremediable ocular damage, allow corticosteroid sparing and save the vision, and has evolved over the last few years. Anterior NIU is mostly managed with topical treatment in adults. However, for intermediate, posterior and pan-uveitis, notably when both eyes are involved, systemic treatment is usually warranted. Biotherapies are recommended in case of inefficacy or non-tolerance of conventional immunosuppressive drugs in non-anterior NIU. Anti-tumor necrosis factor alpha (anti-TNF-α) agents are by far the most widely used, especially adalimumab (ADA) and infliximab (IFX). In case of sight-threatening uveitis in Behçet's disease or in case of risk of severe recurrences, respectively IFX and ADA may be recommended as first-line therapy. Many questions are left unanswered; how long to treat NIU, how to discontinue anti-TNF-α agents, what biologic to use in case of anti-TNF-α failure? The objective of this review is to present an updated overview of knowledge on the use of biological treatments in NIU.
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17
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Gaggiano C, Sota J, Gentileschi S, Caggiano V, Grosso S, Tosi GM, Frediani B, Cantarini L, Fabiani C. The current status of biological treatment for uveitis. Expert Rev Clin Immunol 2020; 16:787-811. [PMID: 32700605 DOI: 10.1080/1744666x.2020.1798230] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Noninfectious uveitis represents one of the leading causes of blindness in developed Countries, compromising patients' quality of life and social functioning. The main treatment goals are the control of ocular inflammation, to avert and treat sight-threatening complications, thus preserving and/or restoring visual function. AREAS COVERED This manuscript deals with systemic therapy with biologic drugs for noninfectious uveitis. An extensive literature search in the MEDLINE database (via PubMed) has been performed up to June 2020. The major classes of biologic molecules employed in ocular inflammatory diseases have been reviewed, focusing on TNF inhibitors, IL-1, IL-6, IL-17, IL-23 inhibitors, interferons, rituximab, and abatacept efficacy and safety. An overview of most recent developments in the field has been provided as well, with reference to the experience with JAK inhibitors and with biosimilar drugs. EXPERT OPINION The development of the concept of targeted therapy and the subsequent introduction of biologic molecules in clinical practice have revolutionized the prognosis of uveitis. The target of a rapid and sustained steroid-free remission of ocular inflammation should be pursued for all patients early in the disease course, in order to have a better chance to improve the final visual outcome.
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Affiliation(s)
- Carla Gaggiano
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy.,Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena , Siena, Italy
| | - Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Stefano Gentileschi
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy.,Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Valeria Caggiano
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena , Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy.,Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy.,Rheumatology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy
| | - Claudia Fabiani
- Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease, and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena, Italy.,Ophthalmology Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Italy
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18
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Leclercq M, Langlois V, Girszyn N, Le Besnerais M, Benhamou Y, Levesque H, Muraine M, Gueudry J. Comparison of conventional immunosuppressive drugs versus anti-TNF-α agents in non-infectious non-anterior uveitis. J Autoimmun 2020; 113:102481. [PMID: 32586650 DOI: 10.1016/j.jaut.2020.102481] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 04/28/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of Disease-modifying antirheumatic drugs (DMARDs) and anti-TNF-α agents in patients with non-infectious non-anterior uveitis. METHODS Single center retrospective study including adult patients with non-infectious intermediate, posterior or pan-uveitis. Outcomes were compared between patients treated with DMARDs or anti-TNF-α agents. The primary outcome was treatment failure or occurrence of serious adverse events. Treatment failure was determined by ophthalmologic criteria. RESULTS Seventy-three patients were included, mostly female (52%). Among them, 39 were treated with DMARDs and 34 with anti-TNF-α agents. The main uveitis causes were idiopathic (30%), birdshot chorio-retinopathy (25%), sarcoidosis (16%) and Behçet's disease (14%). The primary outcome was observed in 56% of patients treated with anti-TNF-α agents versus 59% of patients treated with DMARDs (p = 0.82). Median time to observe the primary outcome was 16 months (anti-TNF-α group) versus 21 months (p = 0.52). There was no significant difference between the two groups in terms of treatment failure, corticosteroid sparing effect, visual acuity improvement or adverse events. Earlier control of ocular inflammation was achieved with anti-TNF-α agents than with DMARDs (p = 0.006). In relapsing patients, anti-TNF-α agents allowed better corticosteroid sparing (p = 0.06). CONCLUSION DMARDs could still be used as first-line therapy for non-infectious non-anterior uveitis after corticosteroid therapy. However, anti-TNF-α agents could be proposed as an alternative in cases of severe inflammation or initial high level of steroid dependency.
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Affiliation(s)
- Mathilde Leclercq
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France.
| | - Vincent Langlois
- Internal Medicine Department, Hospital Jacques Monod, Le Havre, France
| | - Nicolas Girszyn
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France
| | - Maëlle Le Besnerais
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France; INSERM U1096, UFR Santé, Rouen University, Rouen, France
| | - Ygal Benhamou
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France; INSERM U1096, UFR Santé, Rouen University, Rouen, France
| | - Hervé Levesque
- Internal Medicine Department, Hospital Charles Nicolle, Rouen, France; INSERM U1096, UFR Santé, Rouen University, Rouen, France
| | - Marc Muraine
- Ophthalmology Department, Hospital Charles Nicolle, Rouen, France
| | - Julie Gueudry
- Ophthalmology Department, Hospital Charles Nicolle, Rouen, France; EA7510, UFR Santé, Rouen University, Rouen, France
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19
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Radosavljevic A, Agarwal M, Bodaghi B, Smith JR, Zierhut M. Medical Therapy of Uveitic Macular Edema: Biologic Agents. Ocul Immunol Inflamm 2020; 28:1239-1250. [PMID: 32058830 DOI: 10.1080/09273948.2019.1709648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Introduction: Uveitic macular edema (UME) is a significant cause of visual impairment in all uveitis types. Methods: Reports that were cited in the MEDLINE database, that analyzed the effectiveness of biologics for UME in at least five patients, with a minimum follow-up of 3 months, published prior to April 1, 2019 were included. Reports that did not compare UME findings before and after the therapy, using either OCT or fluorescein angiography, were excluded. Results: Case series that analyzed the efficacy of intravitreal anti-VEGF agents showed modest, short-term benefit. Studies that investigated systemic anti-TNF agents in patients with noninfectious uveitis reported a therapeutic effect on UME. Anti-IL-6 antibodies have shown promising results for most severe cases of noninfectious UME. Interferon represents an option for patients with persistent UME in infectious and noninfectious uveitis. Conclusion: Multicenter, randomized controlled trials are needed to assess the effectiveness of each group of biologic agents in sufficient number of patients.
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Affiliation(s)
| | - Mamta Agarwal
- Uveitis & Cornea Services, Sankara Nethralaya , Chennai, India
| | - Bahram Bodaghi
- Department of Ophthalmology, IHU FORESIGHT, Pitié-Salpêtrière Hospital, APHP, Sorbonne-University , Paris, France
| | - Justine R Smith
- College of Medicine and Public Health, Flinders University , Adelaide, Australia
| | - Manfred Zierhut
- Centre for Ophthalmology, University Tuebingen , Tuebingen, Germany
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Al-Janabi A, El Nokrashy A, Sharief L, Nagendran V, Lightman S, Tomkins-Netzer O. Long-Term Outcomes of Treatment with Biological Agents in Eyes with Refractory, Active, Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis. Ophthalmology 2019; 127:410-416. [PMID: 31607412 DOI: 10.1016/j.ophtha.2019.08.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/30/2019] [Accepted: 08/28/2019] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To examine a large cohort of patients treated with biologic agents for active noninfectious intermediate uveitis, posterior uveitis, or panuveitis (NIPPU) and to compare their efficacy and long-term effect. DESIGN Retrospective, longitudinal study. PARTICIPANTS Eighty-two patients (156 eyes) with active NIPPU after failure of treatment with corticosteroids and a second-line immunosuppression drug and treated with biologic agents who were treated at Moorfields Eye Hospital between 2001 and 2016. METHODS Information was gathered from the clinical notes of all patients. MAIN OUTCOME MEASURES Time to first disease flare, rate of treatment failure, best-corrected visual acuity, and risk factors for treatment failure. RESULTS Patients were followed on average for 4.7±0.4 years (724 eye-years). All patients demonstrated active uveitis at baseline, and 34 patients (41.5%) demonstrated a coexisting active systemic disease. Control of ocular inflammation was achieved in 136 eyes (87.2%). The average oral prednisolone dose at baseline was 16.4±1.7 mg/day, and by 6 months reduced to 6.5±0.7 mg/day (P < 0.0001), remaining stable for up to 5 years follow-up. Best-corrected visual acuity at baseline was 0.5±0.1 logarithm of the minimum angle of resolution (logMAR), improved to 0.4±0.1 logMAR (P = 0.008) at 3 months, and remained stable during follow-up. After baseline, 42.3% of eyes experienced flares, and the average number of flares reduced from 1.8±0.1 flares/year to 0.6±0.1 flares/year (P < 0.0001). Median time to first flare was 5.4 years (95% confidence interval [CI], 2.2-5.4 years) with a 5-year survival rate of 58.7%. Treatment failed in 37 eyes (23.7%), with a 5-year survival rate of 68.0% and an estimated time to 75% survival of 2.9 years (95% CI, 2.1-4.4 years). The risk for treatment failure was lower when treatment used adalimumab (odds ratio, 0.4; 95% CI, 0.2-0.9; P = 0.03) but was greater when systemic disease also was active at baseline (odds ratio, 3.2; 95% CI, 1.5-7.1; P = 0.004). CONCLUSIONS Overall, eyes treated with biologic agents after failure of treatment with corticosteroids and a second-line immunosuppression drug experienced satisfactory disease control (87.2%), reduced use of systemic immunosuppression, stable visual acuity, and a 23.7% risk of disease relapse. After multivariate adjustment, older age, treatment with adalimumab (versus infliximab), and inactive concomitant systemic disease were associated with a lower risk of treatment failure.
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Affiliation(s)
- Ahmed Al-Janabi
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Amgad El Nokrashy
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom; Mansoura Ophthalmic Center, Mansoura University, Cairo, Egypt
| | - Lazha Sharief
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Vivekka Nagendran
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Sue Lightman
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom
| | - Oren Tomkins-Netzer
- Moorfields Eye Hospital, Institute of Ophthalmology, University College of London, London, United Kingdom; Technion, Institute of Technology, Bnai Zion Medical Center, Haifa, Israel.
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Adán A, Moll-Udina A, Alba-Linero C, Figueroa-Vercellino JP, Llorenç V. Recent progress in the treatment of uveitic macular edema. EXPERT REVIEW OF OPHTHALMOLOGY 2019. [DOI: 10.1080/17469899.2019.1644168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Alfredo Adán
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Aina Moll-Udina
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Carmen Alba-Linero
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Juan Pablo Figueroa-Vercellino
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Victor Llorenç
- Hospital Clinic de Barcelona, Instituto de Oftalmología, Facultad de Medicina, Universidad de Barcelona, Barcelona, Spain
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Affiliation(s)
- Emmett T Cunningham
- a Department of Ophthalmology , California Pacific Medical Center , San Francisco , California , USA.,b The Department of Ophthalmology , Stanford University School of Medicine , Stanford , California , USA.,c The Francis I. Proctor Foundation, UCSF School of Medicine , San Francisco , California , USA
| | - Manfred Zierhut
- d Centre for Ophthalmology , University Tuebingen , Tuebingen , Germany
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