title: Review of the biologic agents used for immune-mediated inner ear disease.
abstract: OBJECTIVE
  Immune-mediated inner ear disease (IMIED) is one of the few reversible forms of sensorineural hearing loss. Treatment is based on high-dose corticosteroids, although long-term therapy is associated with serious adverse effects; this has led to the use of other agents or different routes of administration such as transtympanic delivery. This study analyses the role of biological agents in IMIED management.
  
  
  METHODS
  We searched PUBMED for studies that examined the response to treatment with different biological agents in patients with IMIED. The following data were extracted from the selected studies and entered into a standardised database: exclusion and inclusion criteria, characteristics of the patients studied, treatment, outcome measures and response rates achieved.
  
  
  RESULTS
  Thirteen studies were included in this review. A TNF alpha inhibitor (etanercept, infliximab, adalimumab) was used in 8 studies, an IL-1 antagonist (anakinra) was used in 3 studies and rituximab, an antibody directed against the CD20 surface antigen on B lymphocytes, was evaluated in 2 studies. Most studies achieved a hearing improvement or stabilisation in more than 70% of treated patients.
  
  
  CONCLUSIONS
  Biological agents can play a role in the management of patients with IMIED, at least in those patients who do not respond to conventional therapy or whose hearing is not stabilised. However, specially-designed randomised controlled clinical trials are needed to assess their effectiveness.
authors: Servicio de Otorrinolaringología, Hospital El Escorial, Universidad Francisco de Vitoria, San Lorenzo de El Escorial, Madrid, España. dlobo28@gmail.com
authors: David
authors: D
authors: Lobo
authors: José R
authors: JR
authors: García-Berrocal
authors: Almudena
authors: A
authors: Trinidad
authors: José M
authors: JM
authors: Verdaguer
authors: Rafael
authors: R
authors: Ramírez-Camacho
mesh_terms: D001685:Biological Factors / Q000627:therapeutic use*; D006801:Humans; D007759:Labyrinth Diseases / Q000188:drug therapy* / Q000276:immunology*
chemical_list: D001685:Biological Factors