Drug-induced Inflammation in Patients on TNFα Inhibitors

Cunningham, Emmett T.; Pasadhika, Sirichai; Suhler, Eric B.; Zierhut, Manfred

doi:10.3109/09273948.2011.644383

Cited by 21 publications

(14 citation statements)

References 44 publications

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“…Inhibition of TNF-α is an effective therapy for treating a variety of inflammatory conditions, including rheumatoid arthritis, juvenile idiopathic arthritis, Crohn's disease, psoriatic arthritis, and ankylosing spondylitis. These agents have been used to treat ocular inflammation associated with these diseases as well as for the off label to treat both uveitis and scleritis [2,3,58-65]. The TNF-α inhibitors most commonly used for uveitis are infliximab, adalimumab, and less commonly etanercept.…”

Section: Reviewmentioning

confidence: 99%

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Drug-induced uveitis

London

Moorthy

Cunningham

2013

J OPHTH INFLAMM INFECT

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Section: Reviewmentioning

confidence: 99%

“…The anti-TNF agents, particularly etanercept, have also been noted to induce paradoxical, biopsy-proven sarcoidosis (or sarcoid-like granulomatosis), including ocular sarcoidosis (Figure 2) [2,77-81]. Affected patients had varied presentations.…”

Section: Reviewmentioning

confidence: 99%

Drug-induced uveitis

London

Moorthy

Cunningham

2013

J OPHTH INFLAMM INFECT

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“…The relevant pathogenetic mechanisms are still not completely understood [8]. Both toxic and inflammatory reactions have been discussed [7,11,12]. Clinical observations suggest that there is a strong association between the intake of vemurafenib and the occurrence of ocular inflammation, which might be due to the response on subclinical metastatic cells within the uvea or to the erroneous interaction of vemurafenib with antigens shared by melanocytes and the choroid.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous Treatment of Severe Vemurafenib-induced Uveitis and Metastatic Melanoma

Daniel¹,

Heinzelmann²

2016

J Clin Exp Ophthalmol

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Background: Vemurafenib, a serine-threonine kinase inhibitor, has been used to treat unresectable metastatic melanoma since 2011. Ocular adverse events are reported to be seldom and to regress after the discontinuation of vemurafenib and therapy with topical steroids. However, this approach must be weighed against the potential progression of melanoma. We present alternative options in uveitis treatment enabling the continuation of vemurafenib therapy.

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“…However, in patients receiving TNF-α inhibitors for treatment of other immune-mediated diseases, multiple case reports and series suggest that TNF-α inhibitors (infliximab,37–42 etanercept,37,40 and adalimumab40,41,43) may cause sarcoidosis-like conditions. Etiology remains unclear, but paradoxical sarcoidosis appearing during treatment is likely a class-effect of TNF-α inhibitors 44,45. TNF inhibitors analogously are effective for psoriasis, but they have also been reported to cause psoriasiform skin disease.…”

Section: Systemic Biologic Therapy For Noninfectious Uveitismentioning

confidence: 99%

Update on the use of systemic biologic agents in the treatment of noninfectious uveitis

Pasadhika¹,

Rosenbaum²

2014

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Uveitis is one of the leading causes of blindness worldwide. Noninfectious uveitis may be associated with other systemic conditions, such as human leukocyte antigen B27-related spondyloarthropathies, inflammatory bowel disease, juvenile idiopathic arthritis, Behçet’s disease, and sarcoidosis. Conventional therapy with corticosteroids and immunosuppressive agents (such as methotrexate, azathioprine, mycophenolate mofetil, and cyclosporine) may not be sufficient to control ocular inflammation or prevent non-ophthalmic complications in refractory patients. Off-label use of biologic response modifiers has been studied as primary and secondary therapeutic agents. They are very useful when conventional immunosuppressive therapy has failed or has been poorly tolerated, or to treat concomitant ophthalmic and systemic inflammation that might benefit from these medications. Biologic therapy, primarily infliximab, and adalimumab, have been shown to be rapidly effective for the treatment of various subtypes of refractory uveitis and retinal vasculitis, especially Behçet’s disease-related eye conditions and the uveitis associated with juvenile idiopathic arthritis. Other agents such as golimumab, abatacept, canakinumab, gevokizumab, tocilizumab, and alemtuzumab may have great future promise for the treatment of uveitis. It has been shown that with proper monitoring, biologic therapy can significantly improve quality of life in patients with uveitis, particularly those with concurrent systemic symptoms. However, given high cost as well as the limited long-term safety data, we do not routinely recommend biologics as first-line therapy for noninfectious uveitis in most patients. These agents should be used with caution by experienced clinicians. The present work aims to provide a broad and updated review of the current and in-development systemic biologic agents for the treatment of noninfectious uveitis.

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Drug-induced Inflammation in Patients on TNFα Inhibitors

Cited by 21 publications

References 44 publications

Drug-induced uveitis

Drug-induced uveitis

Simultaneous Treatment of Severe Vemurafenib-induced Uveitis and Metastatic Melanoma

Update on the use of systemic biologic agents in the treatment of noninfectious uveitis

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