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

Grace Levy-Clarke, Douglas A. Jabs, Russell W. Read, James (Jim) Rosenbaum, Albert Vitale, Russell N. Van Gelder

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)785-796
Number of pages12
JournalOphthalmology
Volume121
Issue number3
DOIs
StatePublished - Mar 2014

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Biological Factors
Tumor Necrosis Factor-alpha
Uveitis
Immunomodulation
Eye Diseases
Eye Manifestations
Therapeutics
Panuveitis
Posterior Uveitis
Scleritis
Spondylarthropathies
Antimetabolites
Juvenile Arthritis
Patient Preference
Controlled Clinical Trials
Infliximab
Adalimumab
Guidelines

ASJC Scopus subject areas

  • Ophthalmology

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Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. / Levy-Clarke, Grace; Jabs, Douglas A.; Read, Russell W.; Rosenbaum, James (Jim); Vitale, Albert; Van Gelder, Russell N.

In: Ophthalmology, Vol. 121, No. 3, 03.2014, p. 785-796.

Research output: Contribution to journalArticle

Levy-Clarke, Grace ; Jabs, Douglas A. ; Read, Russell W. ; Rosenbaum, James (Jim) ; Vitale, Albert ; Van Gelder, Russell N. / Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. In: Ophthalmology. 2014 ; Vol. 121, No. 3. pp. 785-796.
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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 Beh{\cc}et'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.",
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