Tocilizumab in Uveitic Macular Edema Refractory to Previous Immunomodulatory Treatment

Deuter, Christoph; Zierhut, Manfred; Igney-Oertel, Annette; Xenitidis, Theodoros; Feidt, Alexandra; Sobolewska, Bianka; Stuebiger, Nicole; Doycheva, Deshka

doi:10.3109/09273948.2015.1099680

Cited by 56 publications

(25 citation statements)

References 23 publications

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“…[9][10][11] Additionally, TCZ in adults with non-anterior uveitis and refractory uveitis-related cystoid macula edema is well established. [14][15][16][17][18][19][20][21] The STOP-Uveitis Study demonstrated that monthly intravenous TCZ infusions significantly improved the visual, anatomic and inflammatory outcomes in patients with non-anterior uveitis with limited systemic and ocular adverse effects. 14 Comparable results were seen with sarilumab subcutaneous, another anti-IL-6 receptor, in adult uveitis.…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab as an Effective Treatment Option in Children with Refractory Intermediate and Panuveitis

Wennink

Ayuso

Vries

et al. 2020

Ocular Immunology and Inflammation

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Purpose: To describe the results of tocilizumab treatment in children with refractory non-anterior uveitis. Methods: A case series of seven children with refractory non-anterior uveitis (onset ≤16 years) with leakage on fluorescein angiogram (FA) were treated with tocilizumab intravenously every 4 weeks (eight mg/kg). Minimum follow-up was 6 months. Reported outcomes are changes in BCVA, central macular thickness (CMT) on OCT image, FA scores, dose of systemic steroids, complications and side effects. Results: In all patients, there was an improvement of macular edema and capillary leakage on FA. The median FA score decreased from 14 (10-18) at baseline to 8 (2-9) after 6 months of treatment (p = .018). The CMT decreased from 321 (314-384) to 295 (255-312) (p = .043). BCVA improved in five eyes and worsened in one eye due to cataract. No systemic or ocular complications were reported. Conclusion: Tocilizumab is an effective therapeutic option for reducing disease activity in children with refractory non-anterior uveitis.

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Section: Discussionmentioning

confidence: 99%

Tocilizumab as an Effective Treatment Option in Children with Refractory Intermediate and Panuveitis

Wennink

Ayuso

Vries

et al. 2020

Ocular Immunology and Inflammation

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“…[9][10][11] Small retrospective studies demonstrated the efficacy of tocilizumab in the treatment of refractory uveitic macular edema. [44][45][46] As an alternative for IL-6, T h 17 polarization might be driven through an IL-1b/IL-1R signaling pathway downstream of Mincle/ caspase activation and recruitment domain 9 (CARD 9)dependent signaling and inflammasome activation. The latter pathway is activated by, for example, mycobacterial peptidoglycan 47 and also plays a central role in autoimmune diseases of the eye.…”

Section: Discussionmentioning

confidence: 99%

The Cytokine Interleukin-6 and the Chemokines CCL20 and CXCL13 Are Novel Biomarkers of Specific Endogenous Uveitic Entities

El‐Asrar

Berghmans

Al-Obeidan

et al. 2016

Invest. Ophthalmol. Vis. Sci.

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IL-6-driven immune responses are more potent in HLA-B27-associated uveitis and BD than in VKH disease, sarcoidosis, and IGU. CCL20 appears to be a specific biomarker of HLA-B27-associated uveitis, whereas CXCL13 appears to be a biomarker of VKH disease and IGU. Our findings suggest that IL-6, CCL20, and CXCL13 could serve as drug targets for treatment of specific clinical entities of endogenous uveitis.

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“…; Deuter et al. ; Goldhardt & Rosen ). As long‐standing CME will result in irreversible damage to as a result of outer retinal and photoreceptor damage, anatomical resolution of the CME will not lead to improvement in BCVA (Androudi et al.…”

Section: Discussionmentioning

confidence: 99%

“…In Androudi et al (2010), intravitreal adalimumab showed no efficacy in improving BCVA or decreasing CMT; however, it should be noted that in this particular study, all patients had refractory CME at baseline. Uveitic CME is thought to result from increased vascular permeability due to the breakdown of BRB and is a major risk factor for vision loss (Fardeau et al 2015;Goldhardt & Rosen 2016) and often difficult to manage (Androudi et al 2010;Fardeau et al 2015;Deuter et al 2016;Goldhardt & Rosen 2016). As longstanding CME will result in irreversible damage to as a result of outer retinal and photoreceptor damage, anatomical resolution of the CME will not lead to improvement in BCVA (Androudi et al 2010).…”

Section: Summary Of Evidencementioning

confidence: 99%

Efficacy and safety of intravitreal anti‐tumour necrosis factor drugs in adults with non‐infectious uveitis – a systematic review

Leal

Rodrigues

Sousa

et al. 2018

Acta Ophthalmologica

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Anti-tumour necrosis factor (TNF) drugs have been extensively used in non-infectious uveitis (NIU), when corticosteroids or conventional immunosuppressive drugs cannot adequately control inflammation or intolerable side-effects occur. However, systemic anti-TNF therapies are also associated with a myriad of side-effects. Therefore, intravitreal administration of anti-TNF biologics has been employed to minimize patient morbidity and systemic adverse effects, while maintaining therapeutic effectivity. We undertook a systematic review to determine evidence of efficacy and safety of intravitreal administration of anti-TNF drugs in adults with NIU. We conducted this systematic review according to the PRISMA guidelines. The protocol was registered with PROSPERO (CRD42016041946). We searched CENTRAL, MEDLINE and EMBASE, from inception to April 2017, as well as clinical trial registries and grey literature. The qualitative analysis included all studies of adult patients with a diagnosis of NIU and who received intravitreal anti-TNF drugs with a 4-week minimum follow-up. A total of 4840 references were considered for title and abstract screening. Seven full texts were screened, and five studies were considered for analysis. All studies were open-label, single-centre, prospective, non-randomized, interventional case series with a follow-up between 4 and 26 weeks, employing either adalimumab in two studies and infliximab in three. Three studies showed a treatment effect of anti-TNF intravitreal injections, while one study revealed short-term improvement and one study revealed no efficacy of anti-TNF intravitreal therapy. None of the studies reported ocular adverse effects but only two studies included electrophysiological assessment in the safety analysis and no study assessed systemic human anti-drug antibodies. The available evidence is not sufficiently robust to conclude about the clinical effectivity of intravitreal anti-TNF in NIU and so no recommendation can be made. In conclusion, intravitreal injection of anti-TNF antibodies remains a possible treatment option to be explored through robust clinical investigation.

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Tocilizumab in Uveitic Macular Edema Refractory to Previous Immunomodulatory Treatment

Abstract: Treatment with tocilizumab can be considered in chronic uveitic macular edema even if previous immunomodulatory therapy has failed.

Cited by 56 publications

References 23 publications

Tocilizumab as an Effective Treatment Option in Children with Refractory Intermediate and Panuveitis

Tocilizumab as an Effective Treatment Option in Children with Refractory Intermediate and Panuveitis

The Cytokine Interleukin-6 and the Chemokines CCL20 and CXCL13 Are Novel Biomarkers of Specific Endogenous Uveitic Entities

Efficacy and safety of intravitreal anti‐tumour necrosis factor drugs in adults with non‐infectious uveitis – a systematic review

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