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Neutralizing tumor necrosis factor activity leads to remission in patients with refractory noninfectious posterior uveitis

Lookup NU author(s): Professor John IsaacsORCiD


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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.

Publication metadata

Author(s): Murphy CC, Greiner K, Plskova J, Duncan L, Frost A, Isaacs JD, Rebello P, Waldmann H, Hale G, Forrester JV, Dick AD

Publication type: Article

Publication status: Published

Journal: Archives of Ophthalmology

Year: 2004

Volume: 122

Issue: 6

Pages: 845-851

ISSN (print): 0003-9950

ISSN (electronic): 1538-3601

Publisher: American Medical Association


DOI: 10.1001/archopht.122.6.845

PubMed id: 15197059


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