Original ArticleAnti–Tumor Necrosis Factor α versus Tocilizumab in the Treatment of Refractory Uveitic Macular Edema: A Multicenter Study from the French Uveitis Network
Section snippets
Patients
This was a multicenter, retrospective, observational study conducted in participating internal medicine and ophthalmology departments of the French Uveitis Network between 2018 and 2020. Adult patients with refractory uveitic ME were included. Refractory ME was defined as ME resistant to a first-line therapy with systemic corticosteroids or disease-modifying antirheumatic drugs (i.e., mycophenolate mofetil, methotrexate, azathioprine, etc.) and that requires treatment escalation with anti–TNF-α
Results
Baseline data are summarized in Table 1. Two hundred four patients (57.8% women; median age, 40 years [IQR, 28–58 years]) were included in the study: 149 patients (73%) were treated with anti–TNF-α agents (80 with adalimumab and 69 with infliximab) and 55 patients (27%) received tocilizumab (39 intravenous and 16 subcutaneous). One hundred ten patients (53.9%) had panuveitis and 77 patients (37%) had retinal vasculitis. The main causes of uveitis were Behçet’s disease (35 patients [17.2%]),
Discussion
In this multicenter study, the French Uveitis Network analyzed the efficacy of anti–TNF-α agents or tocilizumab to control ocular inflammation and corticosteroid-sparing effect in a cohort of patients with refractory ME in sight-threatening noninfectious uveitis. The main conclusions drawn from this study are: (1) tocilizumab improved the odds of complete response of uveitic ME by 2 times as compared with anti–TNF-α agents, (2) risk of low VA in uveitic ME was increased by 3 times in Behçet’s
Acknowledgments
The authors thank Nikki Sabourin-Gibbs, Rouen University Hospital, for her help in editing the manuscript.
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Risk factors, clinical features and treatment of Behçet's disease uveitis
2023, Progress in Retinal and Eye ResearchBehçet's disease uveitis
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2023, Experimental Eye ResearchAnti-TNF vs tocilizumab in refractory uveitic cystoid macular edema due to Behcet's disease. Multicenter study of 49 patients
2023, Seminars in Arthritis and RheumatismCitation Excerpt :Although TCZ is not approved for the treatment of uveitis, some studies suggest the efficacy of TCZ in highly refractory CME cases [18,22,32]. Nonetheless, we only found a recent study comparing anti-TNF agents with TCZ in CME related BD [34]. Taking all these considerations into account, this multicenter study aims to compare the efficacy of anti-TNF, specifically ADA and IFX, with TCZ in patients with refractory CME due to BD.
Supplemental material available at www.aaojournal.org.
Disclosure(s):
All authors have completed and submitted the ICMJE disclosures form.
The author(s) have made the following disclosure(s): P.S.: Lecturer – AbbVie, Chugai
P.B.: Financial support – AbbVie, UCB, Novartis, MSD
S.T.: Consultant and Financial support – Allergan, Novartis Horus, Bayer Pharma
P.C.: Consultant, Advisory board, Financial support, Lecturer – Alnylam, Bayer, Innotech, Janssen, Mylan, Pfizer, Servier, Vifor, CNRS, INSERM, Université Pierre et Marie Curie
B.B.: Consultant – AbbVie, Allergan, Alimera, Novartis, Optos, Santen, Thea
D.S.: Consultant – AbbVie, Roche Chugai
HUMAN SUBJECTS: Human subjects were included in this study. The human ethics committees at Pitie-Salpêtrière Hospital approved the study. All research adhered to the tenets of the Declaration of Helsinki. Informed consent was not required as per French regulations for research on humans because of the retrospective strictly observational nature of the study.
No animal subjects were included in this study.
Author Contributions:
Conception and design: Sève, Bielefeld, Sené, Cacoub, Bodaghi, Biard, Saadoun
Analysis and interpretation: Leclercq, Andrillon, Maalouf, El Chamieh, Biard, Saadoun
Data collection: Leclercq, Maalouf, Sève, Bielefeld, Gueudry, Sené, Moulinet, Rouvière, Sène, Desbois, Domont, Touhami
Obtained funding: N/A; Study was performed as part of regular employment duties at French Uveitis Network. No additional funding was provided.
Overall responsibility: Leclercq, Andrillon, Maalouf, Gueudry, Touhami, Cacoub, Bodaghi, Biard, Saadoun
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These authors contributed equally as first authors.