Anti-TNF-α versus tocilizumab in the treatment of refractory uveitic macular edema: a multicenter study from the French Uveitis Network - Archive ouverte HAL Access content directly
Journal Articles Ophthalmology: Journal of The American Academy of Ophthalmology Year : 2021

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

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Pascal Sève
Julie Gueudry
Sara Touhami
Patrice Cacoub
David Saadoun
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  • PersonId : 988949

Abstract

Objective 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. Design Multicenter retrospective observational study. Subjects Adult patients with uveitic macular edema refractory to systemic corticosteroids and/or disease modifying anti-rheumatic drugs. Methods Patients received anti-TNF-α agents [IFX 5 mg/kg at weeks 0, 2, 6 and every 4-6 weeks (n=69) and ADA 40 mg/14 days (n=80)] and tocilizumab [8 mg/kg every 4 weeks intravenously (n=39) and 162 mg/week subcutaneously (n=16)]. Main Outcome Measures Analysis of complete and partial response rates, relapse rate, low vision (visual acuity in at least one eye ≥ 1 LogMAR), corticosteroid sparing effect and adverse events at 6 months. 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 low vision (OR=1.02 [0.51-2.07], p=0.95) or corticosteroid-sparing effect (p=0.29). Adverse events were reported in 20.6% of patients, including 10.8% of serious adverse events. Conclusions Tocilizumab seems to improve complete response of uveitic macular edema compared to anti-TNF-α agents.
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hal-03478342 , version 1 (13-12-2021)

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Attribution - NonCommercial - NoDerivatives - CC BY 4.0

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Mathilde Leclercq, Anaïs Andrillon, Georgina Maalouf, Pascal Sève, Philip Bielefeld, et al.. Anti-TNF-α versus tocilizumab in the treatment of refractory uveitic macular edema: a multicenter study from the French Uveitis Network. Ophthalmology: Journal of The American Academy of Ophthalmology, 2021, S0161-6420 (21), pp.00900-3. ⟨10.1016/j.ophtha.2021.11.013⟩. ⟨hal-03478342⟩
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