Anti-TNF-α Therapy in Patients with Chronic Non-Infectious Uveitis: The Experience of Jules Gonin Eye Hospital[1]

 

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Zusammenfassung

Hintergrund: Ziel dieser Studie ist ein Erfahrungsbericht der Augenklinik Jules Gonin über langfristige Ergebnisse der anti-TNF-α-Therapie bei chronischer, nichtinfektiöser Uveitis. Patienten und Methoden: Wir beobachteten Patienten mit chronischer, nichtinfektiöser Uveitis unter systemischer anti-TNF-α-Therapie. Indikation zur anti-TNF-α-Therapie bestand bei fehlendem Ansprechen auf die klassische immunosuppressive Therapie oder in Gegenwart ausgedehnter rheumatischer Erkrankung. Ergebnisse: Fünfzehn Patienten (28 Augen), 7 männliche und 8 weibliche (durchschnittliches Alter: 43 Jahre; Range: 7 bis 70 Jahre) wurden identifiziert. Die Diagnosen umfassten HLA-B27-assoziierte anteriore Uveitis (n = 4), Sarkoidose (n = 2), juvenile idiopathische Arthritis (n = 2), idiopathische retinale Vaskulitis mit begleitender Uveitis (n = 2), Pars planitis (n = 2), M. Adamantiades-Behçet (n = 1), Birdshot-Retinochoroidopathie (n = 1) und M. Crohn (n = 1). Die durchschnittliche Krankheitsdauer betrug 8 Jahre (Range: 1 bis 29 Jahre). Behandlungen wurden mit Infliximab (n = 11), Etanercept (n = 2), oder Adalimumab (n = 2) begonnen. Ein Patient unter Etanercept wurde aufgrund fehlenden Ansprechens auf Infliximab umgestellt. Klinische und angiografische Remission der Uveitis wurde während der ersten zwei Monate bei allen Patienten beobachtet, und hielt während der ganzen Beobachtungsperiode (durchschnittlich: 18 Monate; Range: 3 - 72). Rezidive wurden bei 3 Patienten beobachtet. Diese waren nach Therapieumstellung rückläufig. Nebenwirkungen wurden nur bei einem Patienten nachgewiesen (arterielle Hypotonie). Schlussfolgerungen: In dieser Fallserie mit chronischer, nichtinfektiöser Uveitis zeigte sich die anti-TNF-α-Therapie als effektiv und sicher. Weitere klinische Studien sind nötig, um die geeignete Dauer der Therapie zu bestimmen.

Abstract

Background: The purpose of this study is to describe the experience of Jules Gonin Eye Hospital on the long-term outcome of anti-TNF-α therapy in chronic non-infectious uveitis. Patients and Methods: We identified and followed those patients with chronic non-infectious uveitis who received systemic anti-TNF-α therapy. Anti-TNF-α therapy was administered when no response had been obtained with classical immunosuppressive therapies or in the presence of severe rheumatoid disease. Results: Fifteen patients (28 eyes), 7 male and 8 female (mean age, 43 years; range: 7 to 70 years) were identified. Diagnoses included HLA-B27-associated anterior uveitis (n = 4), sarcoidosis (n = 2), juvenile idiopathic arthritis (n = 2), idiopathic retinal vasculitis with uveitis (n = 2), pars planitis (n = 2), Adamantiades-Behçet disease (n = 1), birdshot retinochoroidopathy (n = 1), and Crohn’s disease (n = 1). Mean duration of ocular disease was 8 years (range: 1 to 29 years). Treatment with infliximab (n = 11), etanercept (n = 2), or adalimumab (n = 2) was initiated. One patient with etanercept was switched to infliximab due to lack of clinical response. Clinical and angiographic regression of uveitis was observed within the first two months of therapy in all patients, and was maintained throughout the entire follow-up period (mean 18 months; range: 3 - 72 months). Recurrence was observed in 3 patients, and resolved after adjustment of therapy. Adverse events were recorded in only one patient (arterial hypotension). Conclusions: In this series of patients with chronic non-infectious uveitis, anti-TNF-α therapy was effective and safe. Further clinical studies are needed to determine an adequate duration of therapy.

1 Presented at the 100th Annual Congress of the SOG/SSO, Montreux, 5-8.9.2007.

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1 Presented at the 100th Annual Congress of the SOG/SSO, Montreux, 5-8.9.2007.

Yan Guex-Crosier, MD, PD, MER

Jules Gonin Eye Hospital

15 av. de France

1004 Lausanne, Schweiz

Phone: ++ 41/21/6 26 85 95

Fax: ++ 41/21/6 26 81 22

Email: yan.guex@ophtal.vd.ch