Certolizumab-Induced Uveitis: A Case Report and Review of the Literature

Abstract

We report the case of a 64-year-old woman with rheumatoid arthritis and bilateral visual deterioration. The patient had been treated with certolizumab, a new tumor necrosis factor alpha (TNFα) antagonist, and her findings were consistent with bilateral uveitis, suggestive of sarcoidosis. Here, we review the literature on TNFα antagonist-induced sarcoidosis and report the first case of uveitis induced by certolizumab. Awareness of the possibility of this unique complication is important for both rheumatologists and ophthalmologists who treat patients with this new agent.

Ocular complications of tumour necrosis factor alpha inhibitors

“…In most reports the cause of ocular inflammation is not clear; however, one case of uveitis was associated with tuberculosis, consistent with the known risk of tuberculosis with TNF inhibition. 43 An association with sarcoidosis was noted in one report of orbital granuloma, 30 and one report of certolizumabassociated uveitis, 46 consistent with reports of systemic sarcoid-like granulomatosis developing during anti-TNF therapy. 77 Eye-care practitioners need to be aware that TNF inhibition may cause de novo or recurrent ocular inflammatory disease in any ocular structure, with multiple presentations including apparently idiopathic, tuberculosis, viral and sarcoid-like presentations.…”

“…Pan-uveitis (de novo, with associated increased intraocular pressure and angiographic optic nerve leakage) 1 45 Certolizumab Uveitis, suggestive of sarcoidosis 1 46 Vitreous Infliximab (intravitreal, 0.5 mg) Vitritis 1 45 Vascular Adalimumab Central retinal vein occlusion 1 47 Infliximab Central retinal vein occlusion 1 48 Branch retinal vein occlusion 3 [49][50][51] Vitreous haemorrhage 3 52,53 Retina Etanercept Retinal ablation 1 44 Optic nerve Adalimumab Non-arteritic anterior ischaemic optic neuropathy 1 54 Adalimumab Optic neuritis 2 55 Etanercept Optic neuritis 6 [56][57][58][59] Infliximab Optic neuritis 5 [60][61][62] Infliximab Anterior ischaemic optic neuropathy 3 63 Infliximab (intravitreal, 0.5 mg)…”

Tumor Necrosis Factor-Alpha Inhibitory Therapy for Non-Infectious Autoimmune Uveitis

“…Existing reports on the use of certolizumab suggest risk for development of autoimmunity. It has been associated with a lupus-like syndrome, as well as bilateral panuveitis secondary to an ocular sarcoidosis-like reaction in a patient with rheumatoid arthritis and no prior history of sarcoidosis; signs and symptoms were noted to resolve following cessation of certolizumab in these cases [25,26].…”

Ocular Sarcoidosis

“…Although rarely, there are multiple reports and series suggesting that anti-TNF agents (infliximab, 104-109 adalimumab, 108-110 etanercept 107, 108 and certolizumab 111 ) may cause sarcoidosis-like conditions, including uveitis.…”