A review of ocular adverse events of biological anti-TNF drugs

Abstract

The recent introduction of biological agents has revolutionized the treatment of chronic immune-inflammatory diseases; however, this new therapy did not come without significant side effects. Through large controlled studies indicating decrease in the number of uveitis flares, the role of TNF inhibitors therapy for non-infectious uveitis gained more ground. Paradoxically to its therapeutic effect, there are reports associating these drugs with the onset or recurrence of inflammatory eye disease. A number of studies have suggested possible roles for anti-TNF-α agents in precipitating or worsening an underlying inflammatory process, including the hypothesis of a disequilibrium in cytokine balance, but to date the mechanisms responsible for these adverse events are not fully understood. A PubMed literature search was performed using the following terms: ophthalmic complication, uveitis, inflammatory eye disease, optic neuritis, neuropathy, adverse events, anti-TNF, TNF alpha inhibitor, infliximab, etanercept, adalimumab, golimumab, certolizumab, and biologics. The data presented in this study was mainly derived from the use of TNF inhibitors in rheumatology, essentially because these drugs have been used for a longer period in this medical field. Many of the ocular adverse events reported on this review may be considered a paradoxical effect of anti-TNF therapy. We found a variety of data associating new onset of uveitis with anti-TNF therapy for rheumatic conditions, predominantly under etanercept. In conclusion, although there is increasing data on ocular adverse events, it remains to be seen whether the suggested link between TNF inhibitors and the onset of ocular inflammation is substantiated by more quality data. Nevertheless, the awareness of potential treatment side effects with anti-TNF should be highlighted.

Characteristics Associated with the Occurrence and Development of Acute Anterior Uveitis, Inflammatory Bowel Disease, and Psoriasis in Patients with Ankylosing Spondylitis: Data from the Chinese Ankylosing Spondylitis Prospective Imaging Cohort

“…In the CASPIC, tumor necrosis factor receptor fusion protein was the main target component of TNFi [ 13 ]. It has been reported that the receptor fusion protein may induce AAU development [ 23 , 24 ], explaining the result of our study. At the same time, we found that there was also new-onset AAU in patients with AS who used tumor necrosis factor monoclonal antibody (Supplementary Table S1).…”

Sarcoid-associated bilateral multifocal choroiditis secondary to adalimumab

“… 5 A recent review also indicates that etanercept is the agent most associated with paradoxical reaction, frequently in patients with concomitant spondyloarthritis. 6 To our knowledge, this is the first report of diffuse multifocal choroidal infiltrates in this setting.…”

Ocular Manifestations in Psoriasis Screening (OcMaPS) Questionnaire: A Useful Tool to Reveal Misdiagnosed Ocular Involvement in Psoriasis

“…However, in the absence of symptoms or a known ocular disorder, prior ophthalmologic control is not considered necessary [ 28 ]. As regards biologics, a recent review highlighted a variety of data associating the new onset of uveitis, as a paradoxical effect of anti-TNF therapy in rheumatic conditions, predominantly under etanercept [ 29 ]. On the other hand, adalimumab has been approved in uveitis and inflammatory bowel diseases, indirectly showing a common inflammatory background in these diseases [ 15 ].…”

“…On the other hand, adalimumab has been approved in uveitis and inflammatory bowel diseases, indirectly showing a common inflammatory background in these diseases [ 15 ]. An early recognition of ocular manifestation and a strict control of inflammatory activity in uveitis as well as in other ocular diseases may led to a dramatic reduction in the incidence of vision-threatening secondary complications [ 28 , 29 ]. However, the association between various ocular disorders and psoriasis is likely to be missed in patients if the physician is not specifically aware.…”