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Neutralizing Tumor Necrosis Factor Activity Leads to Remission in Patients With Refractory Noninfectious Posterior Uveitis
Conor C. Murphy, MMedSc, MRCOphth;
Kathrin Greiner, MD;
Jarka Plskova, PhD;
Linda Duncan, BSc;
Andrew Frost, MRCP, FRCOphth, PhD;
John D. Isaacs, FRCP, PhD;
Peppy Rebello, PhD;
Herman Waldmann, PhD;
Geoff Hale, PhD;
John V. Forrester, FRCOphth, MD;
Andrew D. Dick, FRCP, FRCOphth, MD
Arch Ophthalmol. 2004;122:845-851.
Objective To evaluate the efficacy and safety of tumor necrosis factor (TNF) inhibition with the p55 TNF receptor fusion protein (TNFr-Ig) for severe sight-threatening noninfectious posterior segment intraocular inflammation.
Methods Seventeen patients with refractory noninfectious posterior segment intraocular inflammation received TNFr-Ig by intravenous infusion in this nonrandomized, open-label, pilot study. The primary outcome measure was logMAR visual acuity. Secondary outcome measures were binocular indirect ophthalmoscopy score, cystoid macular edema, adverse effects, and vision-related (visual core module 1) and health-related (36-Item Short-Form Health Survey) quality of life.
Results Within 1 month of TNFr-Ig therapy, 9 patients (53%) achieved at least a 2-line improvement in visual acuity, 8 (57%) of 14 patients with vitreous haze before treatment achieved an improvement in binocular indirect ophthalmoscopy score to 0, and macular edema resolved in 5 (56%) of 9 affected patients. Twelve (71%) of the patients achieved complete cessation of intraocular inflammation following TNFr-Ig therapy. A reduction in concomitant immunosuppression was possible for 11 patients (65%) following TNFr-Ig therapy. However, all but 1 patient required continuing adjuvant therapy during the response to TNFr-Ig, which had a median duration of 3 months. Adverse effects included mild infusion reactions in 3 patients and transient lymphocytopenia in 2 patients.
Conclusion Therapy with TNFr-Ig was safe and effective for treating patients with sight-threatening noninfectious posterior segment intraocular inflammation resistant to conventional immunotherapy, but adjuvant immunosuppression and repeat infusions would be required to maintain long-term remission.
From the Division of Ophthalmology, University of Bristol, Bristol, England (Mr Murphy and Drs Frost and Dick); the Department of Ophthalmology, University of Aberdeen, Aberdeen, Scotland (Drs Greiner, Plskova, and Forrester and Ms Duncan); the School of Clinical Medical Sciences (Rheumatology), University of Newcastle, Newcastle upon Tyne, England (Dr Isaacs); and Sir William Dunn School of Pathology, University of Oxford, Oxford, England (Drs Rebello, Waldmann, and Hale). The authors have no relevant financial interest in this article.
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