title: Intravitreal tumor necrosis factor-alpha inhibitors for neovascular age-related macular degeneration suboptimally responsive to antivascular endothelial growth factor agents: a pilot study from the Pan American Collaborative Retina Study Group.
abstract: OBJECTIVE
  To compare the short-term visual and anatomic outcomes after intravitreal injections of 2 different tumor necrosis factor-α inhibitors to continued antivascular endothelial growth factor (VEGF) therapy in eyes with choroidal neovascularization (CNV) secondary to age-related macular degeneration that responded suboptimally to anti-VEGF agents.
  
  
  METHODS
  Retrospective comparative case series of 26 eyes. Eyes were injected intravitreally with 1 mg infliximab, 2 mg infliximab, 2 mg adalimumab, or 1.25 mg bevacizumab. The main outcomes measured were the best-corrected visual acuity (BCVA) and the central macular thickness (CMT) at 3 months of follow-up.
  
  
  RESULTS
  The mean log minimal angle of resolution BCVA changed from 1.04±0.23 at baseline to 1.06±0.51 at 3 months (P=0.9455) in the 1-mg infliximab group; 0.94±0.48 at baseline to 0.85±0.43 in the 2-mg infliximab group (P=0.2802); 1.58±0.50 at baseline to 1.38±0.43 in the adalimumab group (P=0.1116); and 1.08±0.1 at baseline to 1.03±0.16 in the bevacizumab group (P=0.9928). The mean CMT changed from 387±54 μm at baseline to 342±108 μm (P=0.1053) in the 1-mg infliximab group; 301±42 μm at baseline to 284±73 μm (P=0.4854) in the 2-mg infliximab group; remained unchanged at 348±106 μm (P=0.308) in the adalimumab group; and 362±66 μm to 340±27 μm in the bevacizumab group (P=0.4622). Adverse events included uveitis in 37.5% (6/16) of eyes injected with infliximab.
  
  
  CONCLUSIONS
  Intravitreal infliximab and adalimumab do not appear to benefit eyes with CNV that responded suboptimally to anti-VEGF agents. Intravitreal injections of infliximab may elicit a severe intraocular inflammatory reaction.
authors.affiliation: Instituto de Cirugia Ocular, San José, Costa Rica. lw65@cornell.edu
authors.forename: Lihteh
authors.initials: L
authors.lastname: Wu
authors.forename: J Fernando
authors.initials: JF
authors.lastname: Arevalo
authors.forename: Erick
authors.initials: E
authors.lastname: Hernandez-Bogantes
authors.forename: Caio V
authors.initials: CV
authors.lastname: Regatieri
authors.forename: José A
authors.initials: JA
authors.lastname: Roca
authors.forename: Michel E
authors.initials: ME
authors.lastname: Farah
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy* / Q000473:pathology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000069285:Infliximab; D058449:Intravitreal Injections; D008268:Macular Degeneration / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012189:Retrospective Studies; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D014605:Uveitis / Q000139:chemically induced; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D014792:Visual Acuity / Q000187:drug effects
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab; D000069285:Infliximab; D000068879:Adalimumab