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Ophthalmology. 2014 Mar;121(3):785-96.e3. doi: 10.1016/j.ophtha.2013.09.048. Epub 2013 Dec 17.

Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders.

Author information

1
St. Luke's Cataract and Laser Institute, Tarpon Springs, Florida.
2
Departments of Ophthalmology and Medicine, the Mount Sinai Medical School, New York, New York; Department of Epidemiology, the Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
3
Department of Ophthalmology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.
4
Departments of Ophthalmology and Medicine, Division of Rheumatology, Oregon Health & Science University, Portland, Oregon; Department of Ophthalmology, Legacy Devers Eye Institute, Portland, Oregon.
5
Department of Ophthalmology, Moran Eye Institute, University of Utah School of Medicine, Salt Lake City, Utah.
6
Departments of Ophthalmology, Pathology, and Biological Structure, University of Washington School of Medicine, Seattle, Washington. Electronic address: russvg@u.washington.edu.

Abstract

TOPIC:

To provide recommendations for the use of anti-tumor necrosis factor α (TNF-α) biologic agents in patients with ocular inflammatory disorders.

CLINICAL RELEVANCE:

Ocular inflammatory diseases remain a leading cause of vision loss worldwide. Anti-TNF-α agents are used widely in treatment of rheumatologic diseases. A committee of the American Uveitis Society performed a systematic review of literature to generate guidelines for use of these agents in ocular inflammatory conditions.

METHODS:

A systematic review of published studies was performed. Recommendations were generated using the Grading of Recommendations Assessment, Development, and Evaluation group criteria.

RESULTS:

Numerous studies including controlled clinical trials have demonstrated that anti-TNF-α biologic agents (in particular infliximab and adalimumab) are effective in the treatment of severe ocular inflammatory disease. Based on these studies, the expert panel makes the following recommendations.

CONCLUSIONS:

Infliximab and adalimumab can be considered as first-line immunomodulatory agents for the treatment of ocular manifestations of Behçet's disease. Infliximab and adalimumab can be considered as second-line immunomodulatory agents for the treatment of uveitis associated with juvenile arthritis. Infliximab and adalimumab can be considered as potential second-line immunomodulatory agents for the treatment of severe ocular inflammatory conditions including posterior uveitis, panuveitis, severe uveitis associated with seronegative spondyloarthropathy, and scleritis in patients requiring immunomodulation in patients who have failed or who are not candidates for antimetabolite or calcineurin inhibitor immunomodulation. Infliximab and adalimumab can be considered in these patients in preference to etanercept, which seems to be associated with lower rates of treatment success.

PMID:
24359625
DOI:
10.1016/j.ophtha.2013.09.048
[Indexed for MEDLINE]

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