SAN FRANCISCO — Only adalimumab is FDA-approved for the treatment of noninfectious intermediate and posterior uveitis and panuveitis; however, other biologics hold promise for the treatment of ocular inflammation, according to a presentation at Cornea Subspecialty Day at the American Academy of Ophthalmology annual meeting.
Biologics are recombinant antibodies or antibody-derived proteins that block activity of bioactive mediators, Debra A. Goldstein, MD, Magerstadt Professor of Ophthalmology a Northwestern University Feinberg School of Medicine, said.
“We typically start anti-metabolites after failure of traditional immunomodulatory therapy, but we do sometimes use these as first-line agents in peripheral ulcerative keratitis (PUK), necrotizing scleritis and in diseases that are immediately sight-threatening,” she said.
In her presentation, Goldstein talked about TNF alpha inhibitors, tocilizumab (an IL-6 inhibitor) and rituximab (an anti-CD20 monoclonal antibody).
There are five TNF alpha inhibitors, one of which is adalimumab. Goldstein said data from clinical trials demonstrated the efficacy of infliximab in RA-associated scleritis and uveitis; however, evidence also showed that etanercept appeared mostly ineffective in patients with uveitis and scleritis. There are few data on golimumab and certolizumab. With TNF alpha inhibitors, she also cautioned clinicians to think about exacerbation of underlying MS and tuberculosis.
Data also supported tocilizumab for the treatment of retinal vasculitis and macular edema, as well as rituximab for necrotizing scleritis and PUK, according to the presentation.
Other than adalimumab, most treatments for scleritis and keratitis are off-label, Goldstein said.
“My residents and fellows always say ‘Well, if it’s disease X, what drug do I use? If it’s disease Y, what drug do I use?’ but there isn’t any paradigm,” Goldstein said. “We have data that rituximab is good for scleritis and tocilizumab is good for vasculitis, but basically you have to treat each patients disease based on the patient – their symptoms, their comorbidities and their lifestyles.” – by Savannah Demko
Goldsetin DA. Biologics for Intraocular Inflammation. Presented at: American Academy of Ophthalmology annual meeting; Oct. 11-15, 2019; San Francisco.
Disclosures: Goldstein reports consulting for AbbVie, Allergan, Bausch+Lomb, Clearside and Santen Inc.