Physicians seeking to avoid or reduce corticosteroid therapy for the treatment of noninfectious uveitis may consider using tumor necrosis factor-alpha (TNFα) inhibitors, also known as anti-TNFα agents. Given that some anti-TNFα agents are more effective for managing noninfectious uveitis, and given the potential associated side effects of anti-TNFα therapy, physicians seeking to use such agents should carefully consider their options when initiating or continuing treatment.
REVIEWING ANTI-TNFα OPTIONS
Adalimumab (Humira, AbbVie) and infliximab (Remicade, Janssen) are two popular anti-TNFα agents used to treat noninfectious uveitis. The US Food and Drug Administration (FDA) recently approved adalimumab for the treatment of noninfectious intermediate, posterior, and panuveitis, which makes it the first and only FDA-approved steroid-sparing drug for uveitis therapy.
In an interview with Thomas Albini, MD, for the Retina Today Uveitis Resource Center, Lucia Sobrin, MD, said that evidence in the literature points to the efficacy of adalimumab and infliximab.1 “Although there hasn’t been a head-to-head trial [between adalimumab and infliximab], they seem to be pretty equivalent,” she said. “Those are our go-to first-line anti-TNFα agents.”
Dr. Sobrin told Dr. Albini that a number of other anti-TNFα agents are commercially available. Dr. Sobrin noted that etanercept (Enbrel, Amgen) has been reported to be less effective than adalimumab and infliximab for treatment of uveitis, and that some reports have suggested it may precipitate uveitis. She noted that golimumab (Simponi Aria, Janssen) and certolizumab pegol (Cimzia, UCB), both of which are approved by the FDA for other indications, have been used effectively as rescue therapy in some case reports of patients who did not respond to infliximab or adalimumab. Limited experience with these two drugs in the uveitis sphere, Dr. Sobrin said, suggests that currently, adalimumab and infliximab remain first-line agents for anti-TNF treatment of uveitis.
Although both adalimumab and infliximab have been shown to be effective and well-tolerated, some patients have developed complications associated with use of anti-TNFα agents. A long-term safety and efficacy study of 143 patients with HLA-B27 positive ankylosing spondylitis–related uveitis treated with anti-TNFα agents showed that treatment was effective for uveitis.2 However, the study researchers observed four cases of tuberculosis and 28 cases of other minor side effects Other class effects of anti-TNF agents include increased risk of some forms of malignancy, infections, and demyelinating disease. Ophthalmologists using anti-TNFα therapy to treat uveitis patients with comorbidities should maintain vigilance for the occurrence of systemic side effects.
1. Albini TA, Sobrin L. Anti-TNF-alpha agents in uveitis management. Retina Today. Uveitis Resource Center. http://retinatoday.com/uveitis-resource-center.
2. Kim M, Won JY, Choi SY, et al. Anti-TNFα treatment for HLA-B27 positive ankylosing spondylitis-related uveitis [published online ahead of print July 25, 2016]. Am J Ophthalmol.
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