Intravitreal Administration of the Anti-Tumor Necrosis Factor Agent Infliximab for Neovascular Age-related Macular Degeneration
Accepted 2 December 2008. published online 10 February 2009.
Refers to article:
When Is Off-Label Drug Use in the Patient's Best Interest?
Philip J. Rosenfeld, Kenneth W. Goodman
American Journal of Ophthalmology
May 2009 (Vol. 147, Issue 5, Pages 761-763) Full Text |
Full-Text PDF (102 KB)
Purpose
To present our preliminary experience on intravitreal administration of an anti-tumor necrosis factor (TNF) monoclonal antibody for neovascular age-related macular degeneration (AMD).
Design
Prospective, noncomparative series of 3 patients previously treated with an anti-vascular endothelial growth factor agent.
Methods
Two intravitreal injections of 0.05 ml containing infliximab were administered in the first (1 and 2 mg, 2 months apart), second (2 mg each, 2 months apart), and third patient (2 mg each, 3 months apart). Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were monthly assessed for up to 7 months.
Results
In the first patient, BCVA increased from 20/200 to 20/100 and CFT decreased from 462 to 386 μm, 2 months after the first injection. The condition was further improved after the second injection (BCVA, 20/40; CFT, 210 μm), but recurrence occurred 7 months post-baseline. In the second patient, BCVA increased from 20/200 to 20/70 and CFT decreased from 512 to 420 and 184 µm, 2 and 4 months post-baseline, respectively. In the third patient, clinical improvement was documented after the first injection. A second injection attributable to recurrence resulted in improvement of BCVA from 20/100 to 20/30 and decrease of CFT from 388 to 282 µm, 2 months after the second injection.
Conclusions
These findings, although insufficient to consider “off-label” treatment with intravitreal infliximab, provide in vivo evidence of a pathogenetic link of locally produced and/or acting TNF to neovascular AMD. A randomized study of consecutive intravitreal injections of infliximab for AMD may be warranted.
aAttikon University Hospital, 2nd Department of Ophthalmology, University of Athens, Athens, Greece
bLaikon Hospital, 1st Department of Propedeutic Medicine, University of Athens, Athens, Greece
cDepartment of Ophthalmology, Henry Dynan Hospital, Athens, Greece
Inquiries to Panagiotis G. Theodossiadis, 13 Lykiou Street, 10675 Athens, Greece
ABSTRACT