Anakinra in the Treatment of Patients with Refractory Scleritis: A Pilot Study

Bottin, Caroline; Fel, Audrey; Butel, Nathalie; Domont, Fanny; Rémond, A; Savey, Léa; Touitou, Valérie; Alexandra, J.F.; LeHoang, Phuc; Cacoub, Patrice; Bodaghi, Bahram; Saadoun, David

doi:10.1080/09273948.2017.1299869

Cited by 24 publications

(12 citation statements)

References 25 publications

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“…The advent of biologic therapy has revolutionized the management of noninfectious intraocular inflammation. However, most of the reported literature is primarily focused in the treatment of uveitis [14], whereas the efficacy and safety of biologics in scleritis have mainly been addressed by single case reports and small case series [6][7][8][9][10][11]15].…”

Section: Discussionmentioning

confidence: 99%

“…Similar results were reported in other studies as well. Treatment with the interleukin-(IL-) 1 receptor antagonist anakinra resulted in a rapid improvement within 1 month in a case series of 10 consecutive patients affected by severe and refractory nonnecrotizing scleritis [7]. Silpa-Archa et al reported the achievement of inflammation control with steroid-sparing effect in 50% of their scleritis patients under the IL-6 inhibitor tocilizumab.…”

Section: Discussionmentioning

confidence: 99%

“…Beyond TNF-α inhibition, a prospective randomized double-masked trial by Suhler et al found that the anti-CD 20 monoclonal antibody rituximab is effective and well tolerated during a 24-week follow-up period [5]. However, only small case series or isolated case reports have been reported on the use of other different biologics [6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

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New Potential Weapons for Refractory Scleritis in the Era of Targeted Therapy

Fabiani

Sota

Maza

et al. 2020

Mediators of Inflammation

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Objective. To assess the efficacy of biologic drugs, beyond tumor necrosis factor- (TNF-) α inhibitors, in the management of noninfectious refractory scleritis, either idiopathic or associated with systemic immune-mediated disorders. Patients and Methods. This is a retrospective study assessing the efficacy of several biologic agents (rituximab, anakinra, tocilizumab, and abatacept) and the small molecule tofacitinib in the treatment of scleritis through assessment of scleral inflammation and relapses, as well as treatment impact on best-corrected visual acuity (BCVA) and safety profile. Results. Fourteen patients (19 eyes) were enrolled in the study. Scleritis inflammatory grading significantly improved from baseline to 3 months (p=0.002) and from baseline to the last follow-up visit (p=0.002). Scleritis relapses significantly decreased between the 12 months preceding and following biologic therapy (p=0.007). No differences regarding BCVA were observed (p=0.67). Regarding adverse events, only one patient developed pneumonia and septic shock under rituximab treatment. Conclusions. Our results, though limited to a low number of patients, highlight the effectiveness of different biologic therapies in the treatment of noninfectious refractory scleritis, showing to control scleral inflammation and allowing a significant reduction in the number of relapses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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New Potential Weapons for Refractory Scleritis in the Era of Targeted Therapy

Fabiani

Sota

Maza

et al. 2020

Mediators of Inflammation

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“…Bottin et al 43 describen 10 pacientes con escleritis resistente a tratamiento inmunosupresor (tratamiento medio previo de 13 meses) a los que se trató con anakinra, antagonista de la interleucina 1. La tasa de respuesta completa fue del 90% a los dos meses de tratamiento.…”

Section: Tratamientounclassified

Lo mejor del año en uveítis 2017

Martínez-Rubio

Martínez-Lopez-Corell

Pascual-Camps

et al. 2018

Vis. Pan-Am.

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“…NLRP3 may be involved in lung fibrosis, and increased circulating levels of IL‐18 have been identified as a potential biomarker for interstitial lung disease in RA patients . Increased circulating levels of IL‐1β have been documented in patients with severe scleritis , and importantly, a recent small pilot trial has shown efficacy for anakinra in the treatment of refractory scleritis associated with systemic inflammatory disorders . Many autoimmune diseases also lead to an increased risk of cardiovascular disease, and the inflammasome contributes to this risk through its known effects on plaque progression, destabilization of plaque (for review, see ref.…”

Section: Introductionmentioning

confidence: 99%

Advances in Disease Mechanisms and Translational Technologies: Clinicopathologic Significance of Inflammasome Activation in Autoimmune Diseases

Kahlenberg

Kang

2020

Arthritis & Rheumatology

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Autoimmune diseases are characterized by dysregulated immune tolerance to self and inflammatory damage to tissues and organs. The development of inflammation involves multiple innate and adaptive immune pathways. Inflammasomes are multimeric cytosolic protein complexes that form to mediate host immune responses upon recognizing pathogen‐ or damage‐associated molecular patterns via pattern‐recognition receptors (PRRs). The accelerating pace of inflammasome research has demonstrated important roles for inflammasome activation in many pathologic conditions, including infectious, metabolic, autoinflammatory, and autoimmune diseases. The inflammasome generally comprises a PRR, procaspase 1, and an adaptor molecule connecting the PRR and procaspase 1. Upon inflammasome activation, procaspase 1 becomes active caspase 1 that converts pro–interleukin‐1β (proIL‐1β) and proIL‐18 into mature and active IL‐1β and IL‐18, respectively. The cytokines IL‐1β and IL‐18 have multipotent effects on immune and nonimmune cells and induce and promote systemic and local inflammatory responses. Human studies have shown increased levels of these cytokines, altered activation of inflammasome‐related molecules, and/or the presence of inflammasome activators in rheumatic diseases, including systemic lupus erythematosus, rheumatoid arthritis, crystal‐induced arthropathies, and Sjögren's syndrome. Such changes are found in the primary target organs, such as the kidneys, joints, and salivary glands, as well as in the cardiovascular system. In animal models of rheumatic diseases, inflammation and tissue damage improve upon genetic or pharmacologic targeting of the inflammasome, supporting its pathogenic role. Herein, we review the clinicopathologic significance and therapeutic targeting of inflammasome activation in rheumatic diseases and related conditions based on recent findings.

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Anakinra in the Treatment of Patients with Refractory Scleritis: A Pilot Study

Abstract: This pilot study suggests the efficacy of anakinra in patients with refractory scleritis.

Cited by 24 publications

References 25 publications

New Potential Weapons for Refractory Scleritis in the Era of Targeted Therapy

New Potential Weapons for Refractory Scleritis in the Era of Targeted Therapy

Lo mejor del año en uveítis 2017

Advances in Disease Mechanisms and Translational Technologies: Clinicopathologic Significance of Inflammasome Activation in Autoimmune Diseases

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