Intravitreal Tumor Necrosis Factor Inhibitors in the Treatment of Refractory Diabetic Macular Edema

Wu, Lihteh; Hernández-Bogantes, Erick; Roca, José A.; Arévalo, J. Fernando; Barraza, Karen; Lasave, Andrés F.

doi:10.1097/iae.0b013e3181eac7a6

Cited by 89 publications

(56 citation statements)

References 28 publications

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“…Inflammatory reactions were also observed by Wu and colleagues in 8 patients with diabetic macular edema (20% of total patients) who underwent intravitreal injection of infliximab (2 mg) (24) similar to 4 cases reported by Giganti and colleagues who injected infliximab (0.5 mg) in 2 patients with macular edema and 2 patients with neovascular ARMD where 100% of the patients showed uveitis (25) . Both infliximab and bevacizumab are monoclonal humanized antibodies.…”

Section: Discussionsupporting

confidence: 56%

Intravitreal bevacizumab combined with infliximab in the treatment of choroidal neovascularization secondary to age-related macular degeneration: case report series

Freitas¹,

Isaac²,

Tannure³

et al. 2013

Arq. Bras. Oftalmol.

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Intravitreal bevacizumab combined with infliximab in the treatment of choroidal neovascularization secondary to age-related macular degeneration: case report series ABSTRACTPurpose: To evaluate the feasibility of the combined use of bevacizumab (Avastin ® ) and combined with infliximab (Remicade ® ) in the treatment of naive choroidal neovascularization due to age-related macular degeneration eyes. Methods: Intravitreal injections of bevacizumab combined with infliximab in 6 neovascular age-related macular degeneration eyes. All patients underwent complete ophthalmologic examination on the initial visit and at days 1, 30, 60, 90, 120, 150 and 180 following the first injection. Optical coherence tomography and fluorescein angiography were performed during at initial visit and monthly during the 6 months follow-up period. Electroretinography was performed before and 30 days after initial injection, in order to evaluate retinal toxicity induced by such treatment. Results: Thirty days after the first injection, 5 eyes (83%) shown decrease in macular thickness. No change was seen in electroretinogram in any eyes compared to initially performed electroretinogram. All phakic eyes developed cataract. One patient developed vitritis and was submitted to medical treatment successfully. At the end of the 6 months follow-up period, 4 patients showed significant improvement in the exudative process of choroidal neovascularization. One eye had mild persistent submacular fluid without active choroidal neovascularization, and another eye had persistent amount of intraretinal fluid due to active choroidal neovascularization. Conclusion:The combined use of bevacizumab with infliximab in eyes with neovascular age-related macular degeneration was effective in reducing leakage and improving the macular thickness. However, it is not possible to assert that the results were related to synergic effects of the combination therapy. A controlled study with more cases is necessary to precisely define the complica tion rates; however the dosage and/or association of drugs studied in this research should not be recommended in clinical practice due to cataract as well as inflam matory reaction. Keywords

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Section: Discussionsupporting

confidence: 56%

Intravitreal bevacizumab combined with infliximab in the treatment of choroidal neovascularization secondary to age-related macular degeneration: case report series

Freitas¹,

Isaac²,

Tannure³

et al. 2013

Arq. Bras. Oftalmol.

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“…Thus, the adhesion of monocytes, neutrophils and other leukocytes in experimental DR is likely to be enhanced by the release of chemokines from retinal tissue, the expression of adhesion molecules on the retinal vasculature, and the expression of integrins by circulating leukocytes. [156,157]. In fact, these studies found adverse effects, including vitritis and uveitis, in some eyes receiving Inflixamab.…”

Section: Additional Cytokines In Drmentioning

confidence: 96%

Angiogenic Factors and Cytokines in Diabetic Retinopathy

Abcouwer¹

2011

J Clin Cell Immunol

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Diabetic retinopathy (DR) is a sight-threatening complication of both type-1 and type-2 diabetes. The recent success of treatments inhibiting the function of vascular endothelial growth factor (VEGF) demonstrates that specific targeting of a growth factor responsible for vascular permeability and growth is an effective means of treating DRtargets involved in the control of retinal vascular function. However, additional treatment options and preventative measures are still needed and these require a greater understanding of the pathological mechanisms leading to the disturbance of retinal tissue homeostasis in DR. Although severe DR can be treated as a vascular disease, abundant data suggests that inflammation is also occurring in the diabetic retina.Thus, anti-inflammatory therapies may also be useful for treatment and prevention of DR. Herein, the evidence for altered expression of angiogenic factors and cytokines in DR is reviewed and possible mechanisms by which the expression of VEGF and cytokines may be increased in the diabetic retina are examined. In addition, the potential role for microglial activation in diabetic retinal neuroinflammation is explored.

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“…21 Those data suggested that both intravitreal adalimumab and intravitreal infliximab had no effect on refractory diabetic macular edema. Moreover, intravitreal injections of infliximab may lead to serious intraocular inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, intravitreal injections of infliximab may lead to serious intraocular inflammation. 21 On the other hand, IVA did not lead to retinal damage in animal models at a dose of 0.5 mg in one study 22 and up to 5 mg in another study. 23 No information is available on the stability and efficacy of reconstituted or aliquoted adalimumab for multiple use to date.…”

Section: Discussionmentioning

confidence: 99%

Intravitreal Adalimumab in Active Noninfectious Uveitis: A Pilot Study

Hamam

Barikian

Antonios

et al. 2014

Ocular Immunology and Inflammation

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Intravitreal Tumor Necrosis Factor Inhibitors in the Treatment of Refractory Diabetic Macular Edema

Abstract: Both intravitreal adalimumab and infliximab do not appear to benefit eyes with refractory diabetic macular edema. Intravitreal injections of infliximab may elicit a severe intraocular inflammatory reaction.

Cited by 89 publications

References 28 publications

Intravitreal bevacizumab combined with infliximab in the treatment of choroidal neovascularization secondary to age-related macular degeneration: case report series

Intravitreal bevacizumab combined with infliximab in the treatment of choroidal neovascularization secondary to age-related macular degeneration: case report series

Angiogenic Factors and Cytokines in Diabetic Retinopathy

Intravitreal Adalimumab in Active Noninfectious Uveitis: A Pilot Study

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