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Optimizing the Use of Tumor Necrosis Factor Inhibitors in Refractory Uveitis—Reply

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In reply

We thank Dr Sebastian and colleagues for their complimentary remarks regarding our study.¹ In brief review, they describe 3 patients with uveitis who were refractory to treatment with conventional immunosuppression and etanercept, a soluble fusion protein that functions by binding free extracellular TNF. All of the 3 patients were judged to improve substantially after changing to alternate TNF-blocking agents, with the first 2 patients responding to infliximab and the third to adalimumab. Infliximab and adalimumab are monoclonal antibodies against TNF- and are able to bind both soluble and membrane-bound TNF-. Infliximab is administered by intravenous infusion whereas etanercept and adalimumab are administered by subcutaneous injection. As Dr Sebastian and colleagues indicate, there are no published controlled studies comparing the efficacy of these drugs, collectively referred to as TNF blockers, in the treatment of ocular inflammatory disease; however, the observations that infliximab may have differential efficacy as compared . . . [Full Text of this Article]

AUTHOR INFORMATION
Eric B. Suhler, MD; Justine R. Smith, MBBS, PhD; Michael S. Wertheim, MBChB, MRCOphth; Andreas K. Lauer, MD; Daryl E. Kurz, MD; Terri D. Pickard, COT; James T. Rosenbaum, MD

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