Outcomes of adalimumab therapy in refractory punctate inner choroidopathy and multifocal choroiditis

Graefes Arch Clin Exp Ophthalmol. 2022 Jun;260(6):2013-2021. doi: 10.1007/s00417-021-05539-9. Epub 2022 Jan 4.

Abstract

Purpose: This study aims to evaluate the outcomes of adalimumab (ADA) therapy in patients with refractory punctate inner choroidopathy (PIC) and multifocal choroiditis (MFC).

Methods: Demographic and clinical data, including LogMAR best-corrected visual acuity (BCVA), were retrospectively collected. Doses of prednisone, immunomodulatory therapies (IMT), and anti-vascular endothelial growth factor (VEGF) injections before and after baseline (ADA initiation) were recorded, as well as the time to clinical remission, time to first flare, and drug-associated adverse events.

Results: Seven patients (4 females, ten eyes) were included. The mean follow-up after baseline was 17.8 ± 11.1 months (range 6-33). The mean LogMAR BCVA was 0.35 ± 0.77 at 6 months before baseline and remained stable throughout 12 months after baseline (0.31 ± 0.46 at 12 months; p = 0.47). The mean dose of prednisone decreased from 17.3 ± 19.6 mg/day 6 months before baseline (range 0-60) to 2.6 ± 2.4 mg/day at the last follow-up (range 0-6, p = 0.03). The mean number of flares decreased significantly from 1.43 ± 0.79 over a 6-month period before baseline to 0.2 ± 0.45 (p = 0.02) at 6-12 months after baseline. The mean number of anti-VEGF injections was 4.17 ± 3.92 over the 12-month period before baseline, and it was 2.17 ± 3.06 (p = 0.31) during the first 12 months after baseline. No adalimumab-related adverse events were noted.

Conclusion: Adalimumab therapy for refractory PIC/MFC enabled a significant steroid-sparing effect, decreased disease flares, and preserved vision over a mean follow-up of 17.8 months.

Keywords: Adalimumab; Choroidal neovascular membrane; Multifocal choroiditis; Punctate inner choroidopathy; Steroid-sparing.

MeSH terms

  • Adalimumab / therapeutic use
  • Angiogenesis Inhibitors
  • Choroiditis* / diagnosis
  • Choroiditis* / drug therapy
  • Female
  • Fluorescein Angiography
  • Follow-Up Studies
  • Humans
  • Intravitreal Injections
  • Male
  • Multifocal Choroiditis
  • Prednisone / therapeutic use
  • Retrospective Studies
  • Tomography, Optical Coherence
  • Visual Acuity
  • White Dot Syndromes*

Substances

  • Angiogenesis Inhibitors
  • Adalimumab
  • Prednisone