Intravitreal Tumor Necrosis Factor-Alpha Inhibitors for Neovascular Age-Related Macular Degeneration Suboptimally Responsive to Antivascular Endothelial Growth Factor Agents: A Pilot Study from the Pan American Collaborative Retina Study Group

Abstract

Intravitreal infliximab and adalimumab do not appear to benefit eyes with CNV that responded suboptimally to anti-VEGF agents. Intravitreal injections of infliximab may elicit a severe intraocular inflammatory reaction.

Expression of TNF-α and IL-6 cytokines in the choroid and sclera of hypercholesterolemic rabbits

“…Indeed, TNF has been considered a therapeutic target in exudative AMD. Although the inhibition of TNF-α leads to the reduction in CNV size and leakage in experimental models (13) , clinical research studies have shown inconsistent results (16,28) . It has also been demonstrated that TNF-α stimulates the production of IL-6 (16) , an important marker of inflammation.…”

Reply

“…The Pan American Collaborative Retina Study Group has published the largest series on the use of intravitreal infliximab in both DME and exudative AMD. 1,36 The results have been clearly disappointing. Not only is intravitreal infliximab not effective in exudative AMD and DME but may also cause severe intraocular inflammation in a large percentage of patients.…”

Treatment of experimental autoimmune uveoretinitis with intravitreal injection of infliximab encapsulated in liposomes

“…However, repeated injections would be necessary to achieve prolonged therapeutic level of infliximab, which may lead to adverse effects and complications 16. In addition, high dose of intravitreal infliximab at the time of infusion may induce severe uveitis 17. To improve the efficacy and safety of intravitreal delivery, a controlled drug-release system is required that are biodegradable and can maintain the therapeutic concentration of drugs within the vitreous body.…”