| Abstract | 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. |
| Authors | Conor C Murphy, Kathrin Greiner, Jarka Plskova, Linda Duncan, Andrew Frost, John D Isaacs, Peppy Rebello, Herman Waldmann, Geoff Hale, John V Forrester, Andrew D Dick
(Affiliation: Division of Ophthalmology, University of Bristol, Bristol, England.)
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| Journal | Archives of ophthalmology
(Arch Ophthalmol)
Vol. 122
Issue 6
Pg. 845-51
(Jun 2004)
ISSN: 0003-9950 United States |
| PMID | 15197059
(Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
|
| Chemical References |
- Immunoglobulin Heavy Chains
- Immunoglobulin gamma-Chains
- Receptors, Tumor Necrosis Factor
- Recombinant Fusion Proteins
- Ro 45-2081
- Tumor Necrosis Factor-alpha
|
| Topics |
- Adult
- Female
- Humans
- Immunoglobulin Heavy Chains
(adverse effects, therapeutic use)
- Immunoglobulin gamma-Chains
- Infusions, Intravenous
- Male
- Middle Aged
- Ophthalmoscopy
- Pilot Projects
- Quality of Life
- Receptors, Tumor Necrosis Factor
(therapeutic use)
- Recombinant Fusion Proteins
(adverse effects, therapeutic use)
- Safety
- Treatment Outcome
- Tumor Necrosis Factor-alpha
(antagonists & inhibitors)
- Uveitis, Posterior
(drug therapy)
- Visual Acuity
(physiology)
|
