Rituximab for the treatment of refractory ocular inflammation

Purpose To report the efficacy of rituximab in the treatment of ocular inflammation refractory to standard immunosuppressive therapy. Methods We retrospectively reviewed medical records of 9 patients with Wegener Granulomatosis, Behcet disease, Rheumatoid arthritis (RA) and Juvenile idiopathic arthritis (JIA) whose disease was refractory to standard immunosuppressive therapy. We recorded main outcome measures such as changes in best corrected visual acuity, patient’s complaints, intraocular or orbital inflammation, concomitant immunosuppressive therapy. All patients had been treated with at least 3 different immunosuppressive agents and corticosteroids at 1 mg/Kg/d. Rituximab was administered intravenously 1000 mg, in 2 doses, 2 weeks apart, in combination with standard treatment, repeated until ocular inflammation was controlled. Results 6 patients were affected of Wegener disease (4 orbital granulomatosis, 1 Tolosa-Hunt syndrome and 1 scleritis), 1 patient had scleritis and intermediate uveitis due to Behcet disease and 2 patients had iridocyclitis (RA and JIA). Over a mean follow-up of 19 months, patients underwent a mean of 4 infusions. All patients had either stabilization or improvement of ocular inflammation. BCVA improved in 4 patients and was stable in other 4. According to European league of arthritis and rheumatism (EULAR), 8 patients were in remission and one had response to treatment. 8 patients were able to taper the immunosuppressive therapy and corticosteroids <7.5mg. Conclusion Rituximab was effective and showed a beneficial response to treatment including induction of clinical remission of inflammation in most patients. It may be a rescue treatment in patients who are refractory to standard therapy. Commercial interest