Anti-Tumor Necrosis Factor α versus Tocilizumab in the Treatment of Refractory Uveitic Macular Edema: A Multicenter Study from the French Uveitis Network

• Published in: Ophthalmology (Rochester, Minn.) Vol. 129; no. 5; pp. 520 - 529
• Main Authors: Leclercq, Mathilde, Andrillon, Anaïs, Maalouf, Georgina, Sève, Pascal, Bielefeld, Philip, Gueudry, Julie, Sené, Thomas, Moulinet, Thomas, Rouvière, Bénédicte, Sène, Damien, Desbois, Anne-Claire, Domont, Fanny, Touhami, Sara, El Chamieh, Carolla, Cacoub, Patrice, Bodaghi, Bahram, Biard, Lucie, Saadoun, David
• Format: Journal Article
• Language: English
• Published: United States Elsevier 01.05.2022
• Subjects: Adult; Antibodies, Monoclonal, Humanized; Female; Humans; Immunology; Life Sciences; Macular Edema - drug therapy; Macular Edema - etiology; Male; Middle Aged; Recurrence; Retrospective Studies; Treatment Outcome; Tumor Necrosis Factor Inhibitors; Tumor Necrosis Factor-alpha - therapeutic use; Uveitis - etiology; Vision, Low - complications; Anti–tumor necrosis factor α agents; Efficacy; Safety; Tocilizumab; Uveitic macular edema
• ISSN: 1549-4713; 0161-6420; 1549-4713
• DOI: 10.1016/j.ophtha.2021.11.013

To analyze the factors associated with response (control of ocular inflammation and corticosteroid-sparing effect) to biologics (anti-tumor necrosis factor [TNF]-α agents and tocilizumab) in patients with refractory uveitic macular edema (ME). Multicenter, retrospective, observational study. Adult patients with uveitic ME refractory to systemic corticosteroids, disease-modifying antirheumatic drugs, or both. Patients received anti-TNF-α agents (infliximab 5 mg/kg at week 0, 2, 6, and every 4-6 weeks [n = 69] and adalimumab 40 mg/2 weeks [n = 80]) and tocilizumab (8 mg/kg every 4 weeks intravenously [n = 39] and 162 mg/week subcutaneously [n = 16]). Analysis of complete and partial response rates, relapse rate, low vision (visual acuity in at least 1 eye of ≥ 1 logarithm of the minimum angle of resolution), corticosteroid-sparing effect, and adverse events at 6 months. Two hundred four patients (median age, 40 years [interquartile range, 28-58 years]; 42.2% men) were included. Main causes of uveitis included Behçet's disease (17.2%), birdshot chorioretinopathy (11.3%), and sarcoidosis (7.4%). The overall response rate at 6 months was 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 (odds ratio, 2.10; 95% confidence interval [CI], 1.06-4.06; P = 0.03) was associated independently with complete response of uveitic ME compared with anti-TNF-α agents. Anti-TNF-α agents and tocilizumab did not differ significantly in terms of relapse rate (hazard ratio, 1.00; 95% CI, 0.31-3.18; P = 0.99) or occurrence of low vision (odds ratio, 1.02; 95% CI, 0.51-2.07; P = 0.95) or corticosteroid-sparing effect (P = 0.29). Adverse events were reported in 20.6% of patients, including serious adverse events reported in 10.8% of patients. Tocilizumab seems to improve complete response of uveitic ME compared with anti-TNF-α agents.