Efficacy of biological agents in patients with non- infectious uveitis, refractory to conventional immunosuppressive therapy

Aim: To evaluate the efficacy of biological agents in patients with non- infectious uveitis, refractory to conventional immunosuppressive therapy. Method: We performed a prospective study of 61 patients with non-infectious uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. All patients had least 3 sight-threatening and with posterior chamber inflammation uveitis recurrences which require use of high doses of steroids in the last year. Patients were treated for at least 12 months with biologic agents [interferon alpha 2a (İFN-α 2a) or anti tumor necrosis factor alpha (anti-TNF α)]. The frequency of uveitis attacks per year, increase in the best corrected visual acuity (BCVA) and steroid dependence of patients before and after treatment were evaluated. Results: A total of 61 patients were included in the study. Twenty-eight patients treated with IFN-α 2a and 33 patients treated with anti-TNF α. İnterferon-α 2a Group: Fifty-two eyes of 28 consecutive patients with Behcet's disease were included in this group. The mean treatment duration was 14,49±12,47 months. Treatment was discontinued in 7 (25%) patients due to adverse effects. The frequency of uveitis attacks per year was reduced significantly from 5,61 to 0,93, before and after IFNα therapy (p<0,001, Wilcoxon signed ranks). At the end of the study; 81% of patients were inactive. A total in 32 (84,2%) of 38 eyes, retained their potential vision and 19 (50%) eyes had at least two lines of visual acuity increase based on logMAR. The average BCVA was 0,72±0,74 logMAR before study, and progressed significantly to 0,53±0,76 logMAR at the end of the study (p<0,05, Wilcoxon signed ranks). Systemic steroids were either discontinued or tapered-off to ≤10mg/day prednisone equivalent in all patients. Anti-TNF α Group: Anti-TNF-α group, which is the second arm of the study group, 60 eyes of 33 patients were included. The mean treatment duration was 25,15±12,87 months. Infliximab was the first biologic agent in 16 cases (48,5%) and adalimumab was first in 17 (51,5%). Uveitis became inactive in 30 (96.8%) patients at the anti-TNF α therapy's first year. The frequency of uveitis attacks per year was reduced significantly from 4,0 to 0,75 before and after anti-TNF α therapy (p<0,001, Wilcoxon signed ranks). Before treatment the average BCVA was 0,66±0,75 logMAR and progressed significantly to 0,45±0,69 logMAR after treatment (p <0.05, Wilcoxon signed ranks). During the treatment with anti-TNF α agents in 24 (77,4%) patients were completely cut off steroid therapy. Conclusion: Biological agents, seem to be an effective treatment for noninfectious uveitis. In particular, they are highly useful when conventional immunosuppressive therapy fails or can not be tolerated.