Drug-Induced Uveitis
Drug-Induced Uveitis
The anti-TNF-α agents etanercept, infliximab, and adalimumab have been implicated in the development of uveitis in a few anecdotal reports. Lim et al reviewed all cases of uveitis associated with etanercept, infliximab, and adalimumab reported to national databases between 1998 and 2006, after excluding patients with underlying disease likely to be associated with uveitis. Overall, in that review, there were 43 cases of uveitis associated with etanercept, 14 associated with infliximab, and 2 associated with adalimumab. After normalizing for the estimated number of patients treated with each medication, etanercept was associated with a greater number of uveitis cases than infliximab (odds ratio, 5.375; P<0.001) and adalimumab (odds ratio, 8.6; P<0.01), whereas no such association was found between adalimumab and infliximab (odds ratio, 1.6; P> 0.5). It is possible that, rather than causing uveitis, etanercept is simply less effective than the other TNF-α blockers in preventing the development of uveitis in susceptible patients.
Pieramici et al first reported a patient who developed unilateral anterior nongranulomatous uveitis and posterior synechiae 3 weeks after receiving the fourth dose of bevacizumab for neovascular age-related macular degeneration in the affected eye after the 3 initial injections were uneventful. The uveitis resolved within a week after receiving topical steroid therapy. Kay et al carried out a retrospective case series on a cohort of 978 consecutive bevacizumab injections and found that 7 eyes of 6 patients developed noninfectious uveitis (with anterior chamber and vitreous cellular reaction) after bevacizumab intravitreal injections. All patients developed symptoms within 1 day of injection. There was no hypopyon and the inflammation resolved rapidly after topical steroid therapy. A few other articles have also reported the occurrence of acute anterior uveitis after injection with intravitreal bevacizumab or ranibizumab. Glading et al reported 2 cases of anterior and posterior uveitis that occurred 4 weeks or more after the first intravitreal injection of aflibercept. Both of those patients had received other vascular endothelial growth factor inhibitors before aflibercept administration without signs of inflammation.
Biologic Drugs
Antitumor Necrosis Factor α (Anti-TNF-α) Agents
The anti-TNF-α agents etanercept, infliximab, and adalimumab have been implicated in the development of uveitis in a few anecdotal reports. Lim et al reviewed all cases of uveitis associated with etanercept, infliximab, and adalimumab reported to national databases between 1998 and 2006, after excluding patients with underlying disease likely to be associated with uveitis. Overall, in that review, there were 43 cases of uveitis associated with etanercept, 14 associated with infliximab, and 2 associated with adalimumab. After normalizing for the estimated number of patients treated with each medication, etanercept was associated with a greater number of uveitis cases than infliximab (odds ratio, 5.375; P<0.001) and adalimumab (odds ratio, 8.6; P<0.01), whereas no such association was found between adalimumab and infliximab (odds ratio, 1.6; P> 0.5). It is possible that, rather than causing uveitis, etanercept is simply less effective than the other TNF-α blockers in preventing the development of uveitis in susceptible patients.
Antivascular Endothelial Growth Factor Agents
Pieramici et al first reported a patient who developed unilateral anterior nongranulomatous uveitis and posterior synechiae 3 weeks after receiving the fourth dose of bevacizumab for neovascular age-related macular degeneration in the affected eye after the 3 initial injections were uneventful. The uveitis resolved within a week after receiving topical steroid therapy. Kay et al carried out a retrospective case series on a cohort of 978 consecutive bevacizumab injections and found that 7 eyes of 6 patients developed noninfectious uveitis (with anterior chamber and vitreous cellular reaction) after bevacizumab intravitreal injections. All patients developed symptoms within 1 day of injection. There was no hypopyon and the inflammation resolved rapidly after topical steroid therapy. A few other articles have also reported the occurrence of acute anterior uveitis after injection with intravitreal bevacizumab or ranibizumab. Glading et al reported 2 cases of anterior and posterior uveitis that occurred 4 weeks or more after the first intravitreal injection of aflibercept. Both of those patients had received other vascular endothelial growth factor inhibitors before aflibercept administration without signs of inflammation.
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