Outcomes in Autoimmune Retinopathy Patients Treated With Rituximab

Davoudi, Samaneh; Ebrahimiadib, Nazanin; Yasa, Cagla; Sevgi, Duriye Damla; Roohipoor, Ramak; Papavasilieou, Evangelia; Comander, Jason; Sobrin, Lucia

doi:10.1016/j.ajo.2017.04.019

Cited by 38 publications

(31 citation statements)

References 24 publications

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“…These observations are also consistent with clinical improvements reported in AIR patients with rituximab. 31,32 Apart from B cells, two other cell types were also associated with changes in GVF area: monocytes and NKT cells. The correlation we see between increased peripheral monocytes and worsening of the GVF may indicate that there is increased release of monocytes into the peripheral blood in response to ongoing retinal injury from AIR, which leads to worsening of the visual field.…”

Section: Discussionmentioning

confidence: 99%

Correlation of Immunological Markers with Disease and Clinical Outcome Measures in Patients with Autoimmune Retinopathy

Stanwyck

Chan

Sood

et al. 2020

Trans. Vis. Sci. Tech.

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To determine if immunological markers (1) are significantly different between autoimmune retinopathy (AIR) patients and controls and (2) correlate with disease progression in AIR patients. Methods: We enrolled patients with a possible AIR diagnosis, as well as control participants without eye disease, autoimmunity, or cancer. Immunological markers were tested in all participants. In addition, AIR patients had up to three blood draws for testing over their disease course. For AIR patients, clinical measures, including visual acuity (VA) and Goldmann visual field (GVF) area, were recorded at each draw. We used the Mann-Whitney U test to compare the immunological markers between AIR patients and controls. We used multilevel mixed-effect regression to investigate the correlation between markers and clinical parameters over time in AIR patients. Results: Seventeen patients with AIR and 14 controls were included. AIR patients had a higher percent of monocytes (Z = 3.076, P = 0.002). An increase in immunoglobulin G against recoverin was correlated with a VA decrease (β = 0.0044, P < 0.0001). An increase in monocyte proportion was correlated with a decrease in GVF area (β = −7.27, P = 0.0021). Several markers of B-cell depletion were correlated with GVF improvement. Conclusions: Monocytes may play a role in AIR pathophysiology and be a disease activity marker. B-cell depletion markers correlated with clinical parameter improvement, particularly GVF. Translational Relevance: This work elucidates immunologic markers that may improve the accuracy of diagnosis and treatment of AIR.

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Section: Discussionmentioning

confidence: 99%

Correlation of Immunological Markers with Disease and Clinical Outcome Measures in Patients with Autoimmune Retinopathy

Stanwyck

Chan

Sood

et al. 2020

Trans. Vis. Sci. Tech.

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“…There have also been reports of long-acting intravitreal fluocinolone acetonide implants being used for treatment of paraneoplastic and non-paraneoplastic AIR in patients refractory to or intolerant of systemic therapy [17]. More recently rituximab, an immunosuppressive agent targeting the CD20 protein on B lymphocytes, has been shown to be effective at stabilizing or improving clinical and laboratory markers of CAR, MAR, and npAIR in some patients [18,19]. This was true for our patient who despite initial improvement with prednisone and methotrexate, later progressed on these therapies and has shown GVF and OCT improvement after receiving rituximab infusions.…”

Section: Discussionmentioning

confidence: 99%

Autoimmune retinopathy associated with monoclonal gammopathy of undetermined significance: a case report

et al. 2020

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Background: Monoclonal gammopathy of undetermined significance (MGUS) is a plasma cell dyscrasia and precursor to multiple myeloma. It has known ocular manifestations, but has not previously been shown to have an association with autoimmune retinopathy. Case presentation: A 57 year-old female presented with 1 year of progressive, bilateral, peripheral vision loss, photopsias, and nyctalopia. Her fundus examination and extensive ancillary testing were concerning for hereditary versus autoimmune retinopathy. The patient was found to have anti-retinal antibodies against carbonic anhydrase II and enolase proteins with a negative genetic retinal dystrophy panel. Malignancy work-up was negative, but the patient was diagnosed with MGUS, a premalignant condition. The patient was treated with immunosuppressive therapies, with rituximab demonstrating the most robust therapeutic response with respect to patient symptoms and ophthalmic testing. Conclusions: MGUS should be considered as a potential etiology of autoimmune retinopathy in patients without other autoimmune or malignant disease processes. Immunosuppressive therapy may be helpful in limiting disease progression, with rituximab showing efficacy in retinopathy refractory to other agents.

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“…While our review concentrates on IRDs, AO has been applied to many other conditions including albinism, 14 age-related macular degeneration, 88 89 diabetic retinopathy 90 and autoimmune retinopathy, 91 and also in basic and applied research, including facilitating insights in visual system neurophysiology. 92 …”

Section: Discussion and Future Possibilitiesmentioning

confidence: 99%

Adaptive optics imaging of inherited retinal diseases

et al. 2017

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Adaptive optics (AO) ophthalmoscopy allows for non-invasive retinal phenotyping on a microscopic scale, thereby helping to improve our understanding of retinal diseases. An increasing number of natural history studies and ongoing/planned interventional clinical trials exploit AO ophthalmoscopy both for participant selection, stratification and monitoring treatment safety and efficacy. In this review, we briefly discuss the evolution of AO ophthalmoscopy, recent developments and its application to a broad range of inherited retinal diseases, including Stargardt disease, retinitis pigmentosa and achromatopsia. Finally, we describe the impact of this in vivo microscopic imaging on our understanding of disease pathogenesis, clinical trial design and outcome metrics, while recognising the limitation of the small cohorts reported to date.

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Outcomes in Autoimmune Retinopathy Patients Treated With Rituximab

Cited by 38 publications

References 24 publications

Correlation of Immunological Markers with Disease and Clinical Outcome Measures in Patients with Autoimmune Retinopathy

Correlation of Immunological Markers with Disease and Clinical Outcome Measures in Patients with Autoimmune Retinopathy

Autoimmune retinopathy associated with monoclonal gammopathy of undetermined significance: a case report

Adaptive optics imaging of inherited retinal diseases

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