Scleritis: a paradoxical effect of etanercept? Etanercept-associated inflammatory eye disease.

Abstract

OBJECTIVE:

To describe 3 cases of scleritis associated with etanercept use for rheumatoid arthritis (RA) and to review the literature related to inflammatory eye diseases associated with the use of etanercept.

METHODS:

Three cases of severe scleritis during etanercept therapy were analyzed. A systematic review of the literature in PubMed, Embase, and the Cochrane Library was performed, from 1962 to July 2010.

RESULTS:

Three patients with seropositive RA developed scleritis 7-28 months after initiation of etanercept, for the first time during their long-lasting disease. In all patients the underlying disease had responded well to anti-tumor necrosis factor therapy. Ocular inflammation went into remission after discontinuation of etanercept, and no other relapses were observed. One patient experienced a dechallenge-rechallenge phenomenon (improvement in symptoms following discontinuation of the agent, then reappearance or worsening of symptoms on reexposure to the agent). Forty-two cases of inflammatory eye diseases believed to be associated with the use of etanercept have been reported in the literature: 33 uveitis, 8 scleritis, 1 orbital myositis, concerning 16 patients with RA, 10 with juvenile idiopathic arthritis, 14 with ankylosing spondylitis, and 2 with psoriatic spondyloarthropathy. Dechallenge was performed in 28 patients, leading to resolution of symptoms. Rechallenge was done in 6 cases, with clear exacerbation.

CONCLUSION:

Ocular inflammation is paradoxically a potential adverse effect of etanercept, even in previously uninvolved eyes.

• Authors: Cécile Gaujoux-Viala, Cecilia Giampietro, Thomas Gaujoux, Hang-Korng Ea, Clément Prati, Philippe Orcel, Daniel Wendling, Frédéric Lioté
• Journal: The Journal of rheumatology (J Rheumatol) Vol. 39 Issue 2 Pg. 233-9 (Feb 2012) ISSN: 0315-162X [Print] Canada
• PMID: 22174213 (Publication Type: Case Reports, Journal Article, Review, Systematic Review)

Chemical References

• Antibodies, Monoclonal, Humanized
• Antibodies, Monoclonal, Murine-Derived
• Antirheumatic Agents
• Immunoglobulin G
• Receptors, Tumor Necrosis Factor
• Rituximab
• Adalimumab
• Etanercept

Topics

• Adalimumab
• Adult
• Aged
• Antibodies, Monoclonal, Humanized (therapeutic use)
• Antibodies, Monoclonal, Murine-Derived (therapeutic use)
• Antirheumatic Agents (adverse effects, therapeutic use)
• Arthritis, Rheumatoid (drug therapy)
• Etanercept
• Female
• Humans
• Immunoglobulin G (adverse effects, therapeutic use)
• Male
• Receptors, Tumor Necrosis Factor (therapeutic use)
• Rituximab
• Scleritis (chemically induced)
• Treatment Outcome