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Fuchs D, Bograd A, Pfister IB, Bächtiger J, Spindler J, Hoogewoud F, Gugleta K, Böni C, Guex-Crosier Y, Garweg JG, Tappeiner C. Efficacy of TNF-Alpha Inhibitors to Control Inflammation and Prevent Secondary Complications in Non-Infectious Uveitis: A Real-Life Experience from Switzerland. Ocul Immunol Inflamm 2023:1-6. [PMID: 37797183 DOI: 10.1080/09273948.2023.2263095] [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: 08/14/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the efficacy of systemic tumor necrosis factor-alpha inhibitors (TNFi) in the treatment of non-infectious uveitis (NIU). METHODS This Swiss multicenter retrospective cohort study included patients with NIU requiring TNFi during the period from 2001 to 2018. Risk factors for the occurrence of new complications were identified using Cox regression analysis and hazard ratios (HR). RESULTS Seventy-one patients (126 eyes; mean age 40.6 ± 14.4 years, mean duration of uveitis 46.0 ± 61.8 months) were followed for 40.2 ± 17.3 months after addition of TNFi. Under TNFi, visual acuity improved from 0.2 ± 0.3 to 0.1 ± 0.3 logMAR (p < 0.001). The portion of patients under systemic corticosteroids decreased from 81.7% to 25.4% (p < 0.001), while that for conventional synthetic disease-modifying anti-rheumatic drugs insignificantly decreased from 63.4% to 50.7% (p > 0.05). In 80.2% of eyes, complications were present at baseline with epiretinal gliosis (39.7%), cataract (41.3%) and macular edema (ME; 27.8%) being the most common. New complications under TNFi were encountered in 49.2% of eyes, also including recurrence (5 eyes) or new onset of ME (14 eyes). The need for switching of TNFi was associated with further complications (HR 3.78, p = 0.012). CONCLUSION Although the efficacy and tolerability of TNFi in a real-life setting are favorable, treatment is often initiated late, i.e., after many eyes have already developed complications. Even with TNFi, new complications, particularly ME, cannot be completely avoided. Further research is needed to assess the impact of earlier initiation of TNFi therapy.
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Affiliation(s)
- Dominic Fuchs
- Department of Ophthalmology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Alexandra Bograd
- Berner Augenklinik, Bern, Switzerland
- Department of Ophthalmology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department of Ophthalmology, Pallas Klink, Olten, Switzerland
| | | | | | - Jan Spindler
- Berner Augenklinik, Bern, Switzerland
- Department of Ophthalmology University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Florence Hoogewoud
- Eye Hospital, FAA, Department of Ophthalmology, University of Lausanne Jules-Gonin, Lausanne, Switzerland
| | | | - Christian Böni
- Department of Ophthalmology University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Augenarztpraxis Bremgarten, Bremgarten, Switzerland
| | - Yan Guex-Crosier
- Eye Hospital, FAA, Department of Ophthalmology, University of Lausanne Jules-Gonin, Lausanne, Switzerland
| | - Justus G Garweg
- Berner Augenklinik, Bern, Switzerland
- Department of Ophthalmology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Tappeiner
- Department of Ophthalmology, Pallas Klink, Olten, Switzerland
- Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
- Department of Ophthalmology, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
- Medical Faculty, University of Bern, Bern, Switzerland
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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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