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  • Tocilizumab vs. anti-TNFα agents for resolution of uveitic macular edema

    Uveitis

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    Review of: Anti-TNF-α versus tocilizumab in the treatment of refractory uveitic macular edema: A multicenter study from the French Uveitis Network

    Leclercq M, Andrillon A, Maalouf G, et al. Ophthalmology, in press

    Investigators conducted a retrospective study to assess the efficacy and safety of tocilizumab vs. anti–tumor necrosis factor alpha (TNFα) agent for the control of ocular inflammation in patients with noninfectious uveitis and macular edema (ME).

    Study design

    This was a multicenter retrospective observational study of 204 patients with refractory uveitic ME who were seen at participating departments of the French Uveitis Network between 2018 and 2020. Patients had received either tocilizumab or the anti-TNFα agents infliximab or adalimumab, per the discretion of their treating physician. The primary objective was defined as resolution of ME at 6 months, inactive intraocular inflammation, and oral corticosteroids given at a dosage of ≤10 mg/day.

    Outcomes

    At 6 months, complete resolution was seen in 36% of patients given tocilizumab and 22% of patients given adalimumab or infliximab. About 45% of patients who were under treatment had a relapse of uveitic ME (median time to relapse: 41 months). No difference was seen between therapies in terms of relapse rate and low visual acuity; the main factor associated with the latter was the presence of Behçet’s disease.

    Limitations

    The retrospective nature of the study was a limitation, in that long-term, complete longitudinal data were not available. Additionally, the infliximab dose was relatively low at 5 mg/kg; in patients with uveitis, doses can be higher, so that may have also contributed to the difference observed.

    Clinical significance

    There are multiple therapeutics available for the treatment of uveitic ME, including topical drops, local corticosteroid injections, oral prednisone, systemic immunosuppressive therapy, and combinations of vaious modalities. The results of this study show that in patients requiring systemic therapy who also have ME, both tocilizumab and anti-TNFα agents may be considered.