Long-term Experience with Anti-tumor Necrosis factor- α Therapy in the Treatment of Refractory, Non-infectious Intermediate, Posterior, and Panuveitis

PurposeTo study the efficacy and long-term effects of infliximab and adalimumab in patients with active refractory non-infectious intermediate, posterior, or panuveitis (NIPPU).MethodsRetrospective, longitudinal study.ResultsIncluded were 61 patients (104 eyes) of whom 34 were males (55.74%). Mean age at diagnosis of uveitis was 26.5 +/- 16.14 years. All patients had active uveitis at baseline (time of initiation of biological therapy). Median interval between the start of conventional immunomodulatory therapy (IMT) to the introduction of biological therapy was 13.0 (IQR 26.0) months. Ocular inflammation was effectively controlled in 92 eyes (88.46%). The most commonly used TNF-alpha inhibitor was adalimumab in 47 patients (77%). Mean follow-up time after baseline was 40 +/- 34.08 months. In the year preceding the institution of TNF-alpha inhibitors, the average number of flares was 1.5 +/- 1.1/year and it decreased to 0.08 +/- 0.29/year in the first year after baseline (p < .0005). Forty-four eyes (42.30%) experienced flare over the entire follow-up period. Mean time to first flare was 14.5 +/- 9.26 months. At baseline, the mean dose of prednisone was 25.5-+/- 20.8 mg/day. A marked decrease to a mean prednisone dose of 7.85 +/- 9.7 mg/day was observed at 6 months (p = .03). In patients treated with adalimumab, the mean time to prednisone dose <= 7.5 mg/day was 4.02 +/- 4.89 months compared to 15.64 +/- 21.34 months in patients treated with infliximab (p = .03). 64.3% of patients treated by infliximab had Behcet uveitis compared to 27.7% of patients treated by adalimumab. Eyes treated with adalimumab experienced first flare at a mean time of 14.11 +/- 6.29 months, whereas eyes treated with infliximab experienced first flare at 18.29 +/- 14.24 months after baseline (p < .0005). The risk for moderate and severe visual loss was lower with shorter duration of uveitis before initiating anti-TNF-alpha treatment (odds ratio, 0.003; 95% CI, 0.000-0.005; p = .023), better presenting logMAR VA (odds ratio, 0.266; 95% CI, 0.172-0.361; p < .0005) and when adalimumab was used (odds ratio, 0.354; 95% CI, 0.190-0.519, p < .0005).ConclusionsAnti-TNF-alpha therapy was successful in controlling refractory NIPPU in the majority of cases. It significantly reduced flare rate, exerted steroid-sparing effects, and preserved visual potential. Adalimumab use, better initial visual acuity, and earlier introduction of anti-TNF- alpha therapy were associated with a lower risk of visual loss.

Automated summary

This study retrospectively evaluated the efficacy and long-term effects of infliximab and adalimumab in patients with refractory NIPPU. The results showed that anti-TNF-alpha therapy effectively controlled ocular inflammation and reduced flare rate. Early introduction of anti-TNF-alpha therapy and the use of adalimumab were associated with a lower risk of visual loss.