Anti-TNF-α therapy in refractory uveitis associated with sarcoidosis: Multicenter study of 17 patients

Objectives: To assess anti-TNF-alpha therapy response in uveitis associated with sarcoidosis refractory to conventional immunosuppressive therapy. Methods: Open-label, multicenter, retrospective study on patients with sarcoid uveitis who underwent anti-INF-alpha therapy because of inadequate response to conventional therapy including corticosteroids and at least 1 systemic synthetic immunosuppressive drug. The main outcome measurements were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness, and immunosuppression load. Results: A total of 17 patients (8 men; 29 affected eyes; mean +/- standard deviation age 38.4 +/- 16.8; range: 13-76 years) were studied. The patients had bilateral hilar lymphadenopathy (58.8%), lung parenchyma involvement (47.1%), peripheral lymph nodes (41.2%), and involvement of other organs (52.9%). Angiotensin-converting enzyme was elevated in 58.8%. The most frequent ocular pattern was bilateral chronic relapsing panuveitis. The first biologic agent used was adalimumab in 10 (58.8%) and infliximab in 7 (41.2%) cases. Infliximab 5 mg/kg intravenously every 4-8 weeks and adalimumab 40 mg subcutaneously every 2 weeks were the most common administration patterns. In most cases anti-TNF-alpha therapy was given in combination with immunosuppressive drugs. The mean duration of follow-up was 33.9 +/- 17.1 months. Significant improvement was observed following anti-TNF-alpha therapy. Baseline results versus results at 2 years from the onset of biologic therapy were the following: the median of cells in the ocular anterior chamber (interquartile range-IQR) 0.5 (0-2) versus 0 (0-0) (p = 0.003), vitritis 0 (0-125) versus 0 (0 0) (p = 0.008), macular thickness (391.1 +/- 58.8 versus 247 +/- 40.5 mu m) (p = 0.028), and visual acuity 0.60 +/- 033 versus 0.74 +/- 0.27; p = 0.009. The median daily (interquartile range) dose of prednisone was also reduced from 10 (0-30) mg at the onset of the anti-TNF-alpha therapy to 0 (0-0) mg at 2 years (p = 0.02). Significant reduction was also achieved in the immunosuppressive load. Conclusion: Anti-TNF-alpha therapy is effective in sarcoid uveitis patients refractory to conventional immunosuppressive therapy. Infliximab and adalimumab allowed a substantial reduction in prednisone dose despite having failed standard therapy. (C) 2015 Elsevier Inc. All rights reserved.