Anti-TNF-α versus tocilizumab in the treatment of refractory uveitic macular edema
Purpose
To analyze the factors associated with response (control of ocular inflammation and corticosteroid sparing effect) to biologics (anti-TNF-α agents and tocilizumab) in patients with refractory uveitic macular edema.
Methods
Multicenter retrospective observational study. Patients received anti-TNF-α agents [infliximab (n=69) and adalimumab (n=80)] and tocilizumab (n=55).
Results
204 patients (median age of 40 years [28-58] with 42.2% of men) were included. Main etiologies of uveitis included Behçet’s disease (17.2%), birdshot chorioretinopathy (11.3%) and sarcoidosis (7.4%). The overall response rate at 6 months was of 46.2% (21.8% of complete response) with anti-TNF-α agents and 58.5% (35.8% of complete response) with tocilizumab. In multivariate analysis, treatment with tocilizumab (OR 2.10 [95% CI 1.06–4.06], p=0.03) was independently associated with complete response of uveitic macular edema, compared to anti-TNF-α agents. Anti-TNF-α agents and tocilizumab did not differ significantly in terms of relapse rate (HR=1.00 [0.31-3.18], p=0.99) or occurrence of visual acuity ≥ 1 LogMAR (OR=1.02 [0.51-2.07], p=0.95) or corticosteroid-sparing effect (p=0.29). Side effects were reported in 20.6% of patients, including 10.8% of serious adverse events.
Conclusion
Tocilizumab seems to improve complete response of uveitic macular edema compared to anti-TNF-α agents.
Conflict of interest
No
Authors 1
Last name
LECLERCQ
Initials of first name(s)
M
Department
Internal Medicine-Rouen and Pitié-Salpêtrière
City
ROUEN AND PARIS
Country
France
Authors 2
Last name
ANDRILLON
Initials of first name(s)
A
Department
Biostatistics-Saint Louis
City
PARIS
Country
France
Authors 3
Last name
BODAGHI
Initials of first name(s)
B
Department
Ophthalmology-Pitié-Salpêtrière
City
PARIS
Country
France
Authors 4
Last name
SAADOUN
Initials of first name(s)
D
Department
Internal Medicine-Pitié-Salpêtrière
City
PARIS
Country
France
Authors 5
Last name
On behalf of the BIOVAS study group
Initials of first name(s)
B
Department
Internal Medicine-Ophthalmology
City
PARIS
Country
France
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