Corticosteroid sparing in birdshot chorioretinopathy: clinical predictors for biologic agents use
Purpose
To determine prognosis factors for biologic agents (BA) use in birdshot chorioretinopathy (BCR)
Methods
We conducted a retrospective study in Rouen University Hospital between 2004 and 2023. Patients with BCR who received corticosteroids (CS) plus mycophenolate mofetil (MMF) or interferon alpha-2a (IF) as first line treatment were reviewed. In case of uncontrolled inflammation, BA (anti-TNFα or tocilizumab (TCZ)) were proposed. We compared initial characteristics in patient with MMF/IF versus whom who required BA.
Results
Forty-three patients were included. Mean follow-up duration was 7.9 +/- 5.6 years. All patients received oral CS. Twenty-two patients were controlled with MMF/IF vs 21 who required BA use. Initial papillitis was statistically more frequent in the BA group vs the MMF/IF group (16/21 vs 6/22; p=0.001). Retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography was thicker in the BA group (145 vs 114 μm; p=0.008). Age at diagnosis, initial visual acuity, papillary angiographic diffusion and central macular thickness were not statistically significant. Mean deviation (MD) in the worst eye, evaluated by automatic visual field, was significantly worse in the BA group (-9.46 vs – 6.08; p=0.03). CS dependency (prednisone) significantly decreased with anti-TNFα vs MMF (12 vs 21 mg/d; p=0.001; 15 patients), with TCZ vs MMF (6 vs 21 mg/d; p<0.001; 13 patients) and with TCZ vs anti-TNFα (12 vs 4 mg/d; p<0.001; 9 patients). Three patients successfully discontinued systemic CS with TCZ and one with anti-TNFα.
Conclusion
Initial papillitis, RNFL thickness and MD could be clinical predictors for requiring BA in BCR.
Conflict of interest
No
Authors 1
Last name
GOUPILLOU
Initials of first name(s)
P
Department
Ophthalmology
City
Rouen
Country
France
Authors 2
Last name
LECLERCQ
Initials of first name(s)
M
Department
Internal Medicine
City
Rouen
Country
France
Authors 3
Last name
MURAINE
Initials of first name(s)
M
Department
Ophthalmology
City
Rouen
Country
France
Authors 4
Last name
GIRSZYN
Initials of first name(s)
N
Department
Internal Medicine
City
Rouen
Country
France
Authors 5
Last name
GUEUDRY
Initials of first name(s)
J
Department
Ophthalmology
City
Rouen
Country
France
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