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


CONCLUSIONS
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.
Murphy
Conor C
CC
Division of Ophthalmology, University of Bristol, Bristol, England.
Greiner
Kathrin
K
Plskova
Jarka
J
Duncan
Linda
L
Frost
Andrew
A
Isaacs
John D
JD
Rebello
Peppy
P
Waldmann
Herman
H
Hale
Geoff
G
Forrester
John V
JV
Dick
Andrew D
AD
D000328:Adult; D005260:Female; D006801:Humans; D007143:Immunoglobulin Heavy Chains / Q000009:adverse effects / Q000627:therapeutic use*; D007142:Immunoglobulin gamma-Chains; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D010865:Pilot Projects; D011788:Quality of Life; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use*; D011993:Recombinant Fusion Proteins / Q000009:adverse effects / Q000627:therapeutic use*; D012449:Safety; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D015866:Uveitis, Posterior / Q000188:drug therapy*; D014792:Visual Acuity / Q000502:physiology
D007143:Immunoglobulin Heavy Chains; D007142:Immunoglobulin gamma-Chains; D018124:Receptors, Tumor Necrosis Factor; D011993:Recombinant Fusion Proteins; D014409:Tumor Necrosis Factor-alpha; C099374:Ro 45-2081