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Master Thesis

Efficacité des anti-TNF alpha dans le traitement des uvéites non infectieuses: étude rétrospective sur 21 patients

Abstract : Anti-TNF alpha therapy is not approved by the US Food and Drug Administration for the treatment of non-infectious uveitis, although its use in this indication has been increasing in recent years. Objective: To assess the efficacy of anti-TNF alpha therapy in patients with non-infectious uveitis. Patients and methods: From January 1st, 2010 to October 1st, 2015, all patients with non-infectious uveitis treated with anti-TNF alpha agents and followed in the departments of ophthalmology and internal medicine of the University Hospital of Bordeaux (France) were included in this single-center observational retrospective study. The primary endpoint was the control of ocular inflammation defined by an absence of anterior chamber and vitreous cells, a reduction of macular edema and an absence of vasculitis or papilledema. The secondary endpoints included the acurate study of macular thickness, evaluation of visual acuity improvement, changes in other treatments (corticosteroids and immunosuppressive therapy) and adverse effects. Results: 21 patients were included, 10 men and 11 women. There were 7 patients with Behcet’s disease, 3 patients with Birdshot’s disease, 2 patients with sarcoidosis, and 9 patients with idiopathic uveitis. Ocular inflammation with anti-TNF alpha therapy was controlled at 3 months (M3) for 80.9 % of patients, at 6 months (M6) for 94.7 % of patients, at 12 months (M12) for 83.3% of patients and more than 12 months (mean follow-up period of 30.3 months) for 86.7 % of patients. Macular edema improved from 452 µm at baseline to 334.6 µm at M3, 337.1 µm at M6 and 307.5 µm at M12. Visual acuity also improved, with a visual acuity of 0.51 (LogMAR) before treatment, 0.33 at M3, 0.28 at M6 and 0.24 at M12. Oral corticosteroids were reduced or discontinued for 87.5 % of patients, with a mean dose of Prednisone decreasing from 19.7 mg before treatment to 5.2 mg at M12. 76.5 % of patients no longer required local corticosteroids. Only 9.5% of patients still remained on a combined immunosuppressive therapy (Methotrexate) at M12. 28.6% of patients experienced side effects, including 9.5% of patients with serious side effects. Conclusion: Our study confirms the efficacy of anti-TNF alpha therapy for the control of short-term and long-term ocular inflammation, with high rates of complete clinical remission and good tolerability to treatment for most patients.
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Master Thesis
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Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Friday, January 8, 2016 - 4:45:15 PM
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Audrey-Élodie Mercier. Efficacité des anti-TNF alpha dans le traitement des uvéites non infectieuses: étude rétrospective sur 21 patients. Médecine humaine et pathologie. 2015. ⟨dumas-01253135⟩



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