Table 3.
Anti-IL-1 agents, tocilizumab, ustekinumab, abatacept, daclizumab, and alemtuzumab treatment in non-infectious scleritis
| First author, year reference | Study design | Biologic agent/small molecule, N | Type of scleritis | Systemic disease | Results | Safety profile | Mean follow-up (months) |
|---|---|---|---|---|---|---|---|
| Farhat, 2021 [84] | Case series | TCZ (n = 3) |
Diffuse AS (n = 2, 1 with concomitant uveitis) Nodular AS + uveitis (n = 1) |
RP | Complete resolution of scleritis | Transient neutropenia (n = 1) | 20 |
| Fabiani, 2020 [79] | Case series |
ANA (n = 3) ABA (n = 3) TCZ (n = 2) TFC (n = 1) |
Nodular AS (n = 1) PS (n = 2) Diffuse AS (n = 6) |
Idiopathic (n = 1) RA (n = 6) FMF (n = 1) Psoriatic arthritis (n = 1) |
Significant decrease in scleritis grading, in the number of relapses, GC-sparing effect and stable VA | No AE |
16 for ANA 31.7 for ABA 15.5 for TCZ 6 for TFC |
| Pyare, 2020 [94] | Case report | TFC (n = 1) | Necrotizing AS | Idiopathic | Resolution of scleral inflammation and remarkable improvement of symptom within 1 month of treatment | Tolerated and no AE | NR |
| Poelman, 2020 [83] | Case report | TCZ (n = 1) | AS | GCA | Rapid and sustained remission | No AE | 12 |
| Matsumoto, 2020 [89] | Case series | Ustekinumab (n = 1) | NS scleritis | Spondyloarthritis with Crohn’s disease | Clinical improvement | NR | NR |
| Iwahashi, 2019 [24] | CS | TCZ (n = 1) | AS + macular edema | RA | Complete resolution after a paradoxical posterior inflammation induced by infliximab | NR | 12 |
| Paley 2018 [93] | Case report | TFC (n = 1) | NS scleritis | Idiopathic | Resolution of scleritis within 3 weeks | NR | 9 |
| Bottin, 2018 [9] | Pilot study | ANA (n = 10) |
AS (n = 7) AS + PS (n = 3) PUK (n = 1) Uveitis, macular edema, and keratitis (n = 1) |
Idiopathic (n = 4) RP (n = 3) RA (n = 1) Psoriatic arthritis (n = 1) Behçet syndrome (n = 1) |
Clinical remission in 8 patients within 1 month and in one additional patient within 2 months, significant decrease in ocular relapse rate, GC-sparing effect |
ISR (n = 4) Dental abscess (n = 1) |
19.4 |
| Michael, 2017 [86] | Case report | TCZ (n = 1) | Nodular AS | RA, pyoderma gangrenosum, and SLE | Paradoxical reaction to TCZ. Complete resolution after TCZ withdrawal at 9 months | Nodular AS | – |
| Shimizu, 2017 [85] | Case report | TCZ (n = 1) | AS | RP | Sustained remission | NR | 14 |
| Knickelbein, 2016 [10] | Clinical trial | Gevokizumab (n = 8) | AS (n = 8) |
Idiopathic (n = 6) RA (n = 1) LES and SS (n = 1) |
Most eyes (7/9) met the primary outcome with reduction of scleral inflammation grading No changes in intraocular pressure and stable visual acuity |
No serious AE, ISR (n = 1), elevated liver enzymes (n = 1), irritable bowel syndrome (n = 3), hypotension (n = 1) | 12 |
| Silpa-Archa, 2016 [82] | Case series | TCZ (n = 6) |
AS (n = 5) AS + PS (n = 1) |
RA (n = 4) Inflammatory bowel disease (n = 1) Idiopathic (n = 1) |
Inflammatory control with GC-sparing success in 50% of patients at 9 months and a faster response compared to patients with uveitis |
Chest tightness at first 6 h after infusion (n = 1) Serious AE (n = 1) |
14.5 |
| Tode, 2015 [81] | Case report | TCZ (n = 1) | Necrotizing AS | Idiopathic | Clinical resolution, stable VA | NR | 24 |
| Kommaraju, 2014 [91] | Case report | Alemtuzumab (n = 1) | Diffuse AS | T cell prolymphocytic leukemia | Clinical improvement | Death due to the systemic disease | 19 |
| Botsios, 2007 [78] | Case series | ANA (n = 2) | Diffuse AS | RA | Clinical remission and improvement in VA. Dose reduction to alternate days in one patient, caused a scleritis relapse | NR for ANA. Paradoxical diffuse AS under etanercept therapy in 1 patient | 24 |
| Papaliodis, 2003 [90] | Case series | Daclizumab (n = 2) | NS scleritis | NS | improvement in inflammation in 1/2 | No serious AE | 11 |
ABA abatacept, AE adverse event, ANA anakinra, AS anterior scleritis, FMF familial Mediterranean fever, GC glucocorticoid, GPA granulomatosis with polyangiitis, ISR injection-site reaction, NR not reported, NS not specified, PS posterior scleritis, PUK peripheral ulcerative keratitis, RA rheumatoid arthritis, RP relapsing polychondritis, SLE systemic lupus erythematosus, SS Sjögren’s syndrome, TCZ tocilizumab, TFC tofacitinib, VA visual acuity