• Written By: Ramana S. (Bob) Moorthy, MD

    This pilot study found favorable short-term results for monthly treatment, but more research is needed.

    The effectiveness of infliximab and adalimumab in the treatment of explosive-onset Behҫet uveitis is an example of the efficacy of systemic tumor necrosis factor alpha (TNFα) inhibitors. However, the authors felt that intravitreal anti-TNFα  therapy deserves further investigation when inflammation is localized only to the eye or when systemic immunosuppressive therapy is not tolerated.

    Subjects included seven consecutive patients (13 eyes) between 18 and 60 years of age with active noninfectious uveitis. All patients had been treated with systemic corticosteroids and immune suppressive therapy, including antimetabolites, T-cell inhibitors and even systemic anti-TNFα, but were intolerant to therapy or relapsed prior to recruitment for the study.

    They were injected with 1.5 mg per 0.03 mL of adalimumab intravitreally at baseline, two weeks, and then every four weeks for a total of 26 weeks. Patients who showed no improvement during the study with a stable ERG received a higher dose at subsequent injections.

    Six patients (12 eyes) completed the full course of treatment. Seven of these 12 eyes improved at least two ETDRS lines, three out of three eyes had resolution of anterior chamber cells, and nine of 10 eyes with vitreous haze had no haze at 26 weeks. Five of 8 eyes with macular edema had complete resolution, with a median time to resolution of six weeks. 

    The authors note that four of the patients had Behçet uveitis, which might have positively affected the results given the relapsing-remitting course of the disease and the favorable response of Behçet disease-associated uveitis to treatment with systemic anti-TNFα.

    Although it is not far-fetched to consider intravitreal injections of adalimumab monthly for the treatment of noninfectious uveitis, more robust data, including other forms of uveitis (besides mainly Behçet disease), need to be extensively studied.