Anti-Tumor Necrosis Factor versus Tocilizumab in the Treatment of Refractory Uveitic Macular Edema A Multicenter Study from the French Uveitis Network

Purpose: To analyze the factors associated with response (control of ocular inflammation and corticosteroid-sparing effect) to biologics (anti-tumor necrosis factor [TNF]-alpha agents and tocilizumab) in patients with refractory uveitic macular edema (ME). Design: Multicenter, retrospective, observational study. Participants: Adult patients with uveitic ME refractory to systemic corticosteroids, disease-modifying anti-rheumatic drugs, or both. Methods: Patients received anti-TNF-alpha agents (infliximab 5 mg/kg at week 0, 2, 6, and every 4-6 weeks [n = 69] and adalimumab 40 mg/2 weeks [n = 80]) and tocilizumab (8 mg/kg every 4 weeks intravenously [n = 39] and 162 mg/week subcutaneously [n = 16]). Main Outcome Measures: Analysis of complete and partial response rates, relapse rate, low vision (visual acuity in at least 1 eye of >= 1 logarithm of the minimum angle of resolution), corticosteroid-sparing effect, and adverse events at 6 months. Results: Two hundred four patients (median age, 40 years [interquartile range, 28-58 years]; 42.2% men) were included. Main causes of uveitis included Behcet's disease (17.2%), birdshot chorioretinopathy (11.3%), and sarcoidosis (7.4%). The overall response rate at 6 months was 46.2% (21.8% of complete response) with anti-TNF-alpha agents and 58.5% (35.8% of complete response) with tocilizumab. In multivariate analysis, treatment with tocilizumab (odds ratio, 2.10; 95% confidence interval [CI], 1.06-4.06; P = 0.03) was associated independently with complete response of uveitic ME compared with anti-TNF-alpha agents. Anti-TNF-alpha agents and tocilizumab did not differ significantly in terms of relapse rate (hazard ratio, 1.00; 95% CI, 0.31-3.18; P = 0.99) or occurrence of low vision (odds ratio, 1.02; 95% CI, 0.51-2.07; P = 0.95) or corticosteroid-sparing effect (P = 0.29). Adverse events were reported in 20.6% of patients, including serious adverse events reported in 10.8% of patients. Conclusions: Tocilizumab seems to improve complete response of uveitic ME compared with anti-TNF-alpha agents. (C) 2021 by the American Academy of Ophthalmology