Table 2.
Studies assessing the systemic use of biologic agents in the treatment of macular edema associated with uveitis
| Author | Drug – delivery | Dose | Size | Follow-up | Outcome | Adverse events |
|---|---|---|---|---|---|---|
| Markomichelakis et al, 2011, prospective, observational study115 | IV infliximab vs | 5 mg/kg 1 infusion | 19 eyesa | 4 weeks | IV infliximab was significantly superior to the other groups in clearing retinal vasculitis, resolution of retinitis, and resolution of ME b IV infliximab-induced resolution of ME was significantly faster compared to the other groups |
None |
| IV dexamethasone vs | 1 g/day for 3 days | 8 eyesa | 4 weeks | None | ||
| IVT triamcinolone | 4 mg, single infusion | 8 eyesa | 4 weeks | None | ||
| Wroblewski et al, 2011, structured, retrospective chart review131 | IV daclizumab and | 1 mg/kg/2 weeks for 1 month, then 1 mg/kg/month | 39 patients (19 eyes with ME) | 40.3 months | Mean CMT decreased from 259 to 235 µm in the ME group FA leakage decreased in 32.5% and remained unchanged in 61.76% | Cutaneous reactions, elevated liver function tests, and infections 4/39 patients developed malignancies. Mean time of onset was 26 months |
| SC daclizumab | 2 mg/kg/2 weeks IV for 1 month, then 1 mg/kg/month SC | |||||
| Díaz-Llopis et al, 2012, prospective case series109 | SC adalimumab | 40 mg/2 weeks for 6 months | 131 patients (40 eyes with ME) | 6 months | Complete ME resolutionb with significant mean CMT reduction and BCVA improvement in 70% of patients with ME | Severe relapse of juvenile idiopathic arthritis (1/131) |
| Adán et al, 2013, prospective study126 | IV tocilizumab | 8 mg/kg/4 weeks | 5 patients (8 eyes) | 6 months | Significant CMT reductionb BCVA improvedc in 50%, stabilized in 25%, worsened in 25% | None |
| Dobner et al, 2012, retrospective study110 | SC adalimumab | 40 mg every 2 weeks | 60 patients 32 patients with MEd | 12–255 weeks | ME reductionb in 53.1% | Elevated liver enzyme count (2/60) Furuncolosis (1/60) |
| Al Rashidi et al, 2013, retrospective study111 | IV infliximab | 5 mg/kg at weeks 0, 2, and 6 followed by 5 mg/kg/8 weeks 13–43 infusions | 38 eyes (18 eyes with ME) | 12–112 months | Statistically significant CMTc reduction in the ME group Significant VA improvement compared to baseline (all patients) | Infusion reaction (1/38) |
| Calvo-Río et al, 2017, multicenter retrospective study127 | IV tocilizumab | 8 mg/kg/4 weeks | 25 patients (47 eyes) 9 patients with ME | 12 months (median follow- up) | Significant CMT reductionb in all patients with ME | Autoimmune thrombocytopenia (1/25) and pneumonia, autoimmune anemia and thrombocytopenia (1/25) Viral conjunctivitis and bullous impetigo (1/25) |
| Deuter et al, 2017, retrospective case analysis124 | IV tocilizumab | 8 mg/kg/4 weeks | 5 patients (8 eyes) | ≥3 months | Complete ME resolutionb in 62.5% ME improvement in all remaining cases | None |
| Fardeau et al, 2017, randomized controlled trial102 | SC IFN-α2a vs | 3 MU/3 times per week | 14 patients | 4 months | Intention-to-treat analysis showed no difference in CRT Per-protocol analysis showed significant difference between the corticosteroid and control group, and between the IFN-α2a and control group, but no difference between the IFN-α2a and corticosteroid group | Pancreatitis (1/14) Severe myalgia (1/14) Humor disorders (5/14) |
| Systemic corticosteroids vs | Methylprednisolone 500 mg/ day for 3 days followed by prednisone 1 mg/kg/day and further tapering | 15 patients | Hyperosmolar coma (1/15) Humor disorders (14/15) |
|||
| No treatment | 19 patients | Severe vision loss (2/19) | ||||
| Mesquida et al, 2018, retrospective noncomparative study125 | IV tocilizumab | 8 mg/kg/4 weeks | 12 patients | 24 months | Significant mean CMT reductionb and BCVA improvement compared with baseline | Grade I neutropenia (1/12) Community-acquired pneumonia (1/12) |
| Tugal-Tutkun et al, 2018, randomized, placebo- controlled trial121 | SC gevokizumab | 60 mg/4 weeks | 83 patientsd | 6 months | The emergence of ME was nonsignificantly decreased in the gevokizumab group | Drug hypersensitivity (1 patient) |
Notes:
a
All cases were diagnosed with Behçet’s disease uveitis.
b
Evaluated by optical coherence tomography.
c
Evaluated by optical coherence tomography and fluoroscein angiography.
d
The purpose of the study was to evaluate the emergence of exacerbations of Behçet’s disease uveitis.
Abbreviations: BCVA, best-corrected visual acuity; CMT, central macular thickness; CRT, central retinal thickness; IFN, interferon; IV, intravenous; IVT, intravitreal; ME, macular edema; SC, subcutaneous; VA, visual acuity.