Neutralizing tumor necrosis factor activity leads to remission in patients with refractory noninfectious posterior uveitis.

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
• Journal: Archives of ophthalmology (Chicago, Ill. : 1960) (Arch Ophthalmol) Vol. 122 Issue 6 Pg. 845-51 (Jun 2004) ISSN: 0003-9950 [Print] 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
• Tumor Necrosis Factor-alpha
• Ro 45-2081

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)