title: 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.
  
  
  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.
authors.affiliation: Division of Ophthalmology, University of Bristol, Bristol, England.
authors.forename: Conor C
authors.initials: CC
authors.lastname: Murphy
authors.forename: Kathrin
authors.initials: K
authors.lastname: Greiner
authors.forename: Jarka
authors.initials: J
authors.lastname: Plskova
authors.forename: Linda
authors.initials: L
authors.lastname: Duncan
authors.forename: Andrew
authors.initials: A
authors.lastname: Frost
authors.forename: John D
authors.initials: JD
authors.lastname: Isaacs
authors.forename: Peppy
authors.initials: P
authors.lastname: Rebello
authors.forename: Herman
authors.initials: H
authors.lastname: Waldmann
authors.forename: Geoff
authors.initials: G
authors.lastname: Hale
authors.forename: John V
authors.initials: JV
authors.lastname: Forrester
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Dick
mesh_terms: 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
chemical_list: 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