Tocilizumab outperforms anti-TNF-α in refractory uveitic macular edema

Patients with refractory uveitic macular edema are more likely to achieve complete response with tocilizumab than with antitumour necrosis factor alpha (anti-TNF-α) drugs, as reported in a study.

The study included 204 adult uveitic macular edema patients (median age 40 years, 42.2 percent men) with inadequate response to systemic corticosteroids and/or disease modifying antirheumatic drugs. Uveitis was secondary to Behçet’s disease in 17.2 percent of the patients, birdshot chorioretinopathy in 11.3 percent, and sarcoidosis in 7.4 percent.

A total of 149 patients received anti-TNF-α agents (infliximab 5 mg/kg at weeks 0, 2, 6 and every 4–6 weeks [n=69] or adalimumab 40 mg/14 days [n=80]) and 55 received tocilizumab [8 mg/kg every 4 weeks intravenously [n=39] or 162 mg/week subcutaneously [n=16]). The overall response rate at 6 months was 46.2 percent (complete response, 21.8 percent) with anti-TNF-α and 58.5 percent (complete response, 35.8 percent) with tocilizumab.

Multivariate analysis showed that treatment with tocilizumab conferred twofold higher odds of achieving complete response as compared with anti-TNF-α agents (odds ratio [OR], 2.10, 95 percent confidence interval [CI], 1.06–4.06; p=0.03).

However, there was no significant between-group difference in terms of relapse rate (hazard ratio, 1.00, 95 percent CI, 0.31–3.18; p=0.99) or occurrence of low vision (OR, 1.02, 95 percent CI, 0.51–2.07; p=0.95) or corticosteroid-sparing effect (p=0.29).