Anti‐TNF‐alpha Therapy for Exudative ARMD

Abstract Purpose: Angiogenesis is a major pathway in the pathogenesis of exudative age related macular degeneration (ARMD). There is evidence of an important inflammatory component as well. In ARMD patients with co‐existing inflammatory diseases treated with anti‐TNFa, a positive effect of these drugs on exudative ARMD was reported. As theoretical and clinical elements provided a rationale for the use of anti‐TNFa medication in ARMD, a prospective non‐randomised study was started. Methods: A non‐randomised pilot study (calculated n=40) included patients with active CNV in ARMD. Treatment consisted of Infliximab IV, standard dose/scheme, for 1 year. ETDRS VA, contrast sensitivity, OCT, Fluorescein/ICG angiography, QOL and serological examinations were performed at set time points according to an IRB‐Ethical committee approved protocol. All patients were aware of the standard of care (intravitreal anti‐VEGF injections/risk endophthalmitis 1/1000) and the experimental nature of this study. All participants could switch to anti‐VEGF therapy at any time. Results: Compared to baseline, change in visual acuity (ETDRS lines) was 0.04±0.5 ; 0.04±1.0 ; ‐0.33±1.0 ETDRS lines at 2 (n=20),4 (n=12) and 6 (n=6) months after start of Infliximab.1 patient switched to anti‐VEGF therapy when disease remained active. 2 patients left the study for unrelated causes. Conclusions: Preliminary results of this non‐randomised prospective study using IV anti‐TNFa therapy for exudative ARMD are promising. So far, in all but one patient, stabilisation of disease and VA could be found. Final study results are necessary to confirm these preliminary results. If confirmed, a combination of anti‐VEGF and anti‐TNFa therapy could be an attractive treatment modality for ARMD.