Recombinant Human Tumor Necrosis Factor Receptor Fc Fusion Protein (Etanercept): Experience as a Therapy for Sight-threatening Scleritis and Sterile Corneal Ulceration

Abstract

Etanercept is an effective treatment for scleritis and sterile corneal ulceration and has a favorable benefit-to-risk ratio. It may be considered for therapy of progressive disease or cases that are unresponsive to traditional therapies.

Biologic agents in the management of inflammatory eye diseases

“…In contrast, Hernandez-Illas et al [ 50 ] described 10 patients with scleritis (eight with associated rheumatologic disease) who apparently responded well to etanercept treatment. However, data regarding concurrent immunosuppressive treatments and length of follow-up were not provided [ 50 ]. In a study by Murphy et al [ 51 ], three of four patients with scleritis treated with infl iximab achieved remission, although one had recurrent disease despite repeated infusions and eventually ceased them due to hypersensitivity.…”

“…In addition, a further three patients on etanercept actually developed scleritis after starting the drug [ 49 ]. In contrast, Hernandez-Illas et al [ 50 ] described 10 patients with scleritis (eight with associated rheumatologic disease) who apparently responded well to etanercept treatment. However, data regarding concurrent immunosuppressive treatments and length of follow-up were not provided [ 50 ].…”

Infliximab for the Treatment of Refractory Progressive Sterile Peripheral Ulcerative Keratitis Associated With Late Corneal Perforation: 3-Year Follow-Up

“…Etanercept is a human recombinant dimeric fusion protein that mimics the effects of naturally occurring soluble TNF-a receptors and has been used for the treatment of necrotizing scleritis and keratitis, but seems to be less efficacious for the treatment of ocular inflammation than infliximab. 2,6 This may be due to infliximab's ability to bind membrane-bound TNF-a in addition to free-floating cytokine. Recently, rituximab, a chimeric antibody against CD20-a, which depletes B lymphocytes, has been used to treat refractory PUK associated with Wegener granulomatosis, in addition to recalcitrant scleritis and anterior uveitis.…”

“…2 Neutralizing antibodies to TNF-a, such as infliximab, disrupt the downstream cascade that produces MMPs, which have been shown to slow corneal epithelial healing in mice. 6 The following is a description of a patient with sterile PUK and late corneal perforation treated successfully with infliximab with good visual outcome at 3-year follow-up after clear corneal phacoemulsification.…”

Tofacitinib Citrate for Ulcerative Keratitis in a Patient with Rheumatoid Arthritis

“…The pathogenesis suggests that inhibiting TNF-alpha allows for a decrease in MMPs,which would reduce the risk of corneal stroma degradation [2, 6, 7]. Similar findings and mechanisms were involved in the use of other TNF α inhibitors: etanercept, adalimumab, and rituximab, [8, 9]. …”