Anti-TNF-α versus tocilizumab in the treatment of refractory uveitic macular edema: a multicenter study from the French Uveitis Network

International audience; ObjectiveTo analyze the factors associated with response (control of ocular inflammation and corticosteroid sparing effect) to biologics (anti-TNF-α agents and tocilizumab) in patients with refractory uveitic macular edema.DesignMulticenter retrospective observational study.SubjectsAdult patients with uveitic macular edema refractory to systemic corticosteroids and/or disease modifying anti-rheumatic drugs.MethodsPatients received anti-TNF-α agents [IFX 5 mg/kg at weeks 0, 2, 6 and every 4-6 weeks (n=69) and ADA 40 mg/14 days (n=80)] and tocilizumab [8 mg/kg every 4 weeks intravenously (n=39) and 162 mg/week subcutaneously (n=16)].Main Outcome MeasuresAnalysis of complete and partial response rates, relapse rate, low vision (visual acuity in at least one eye ≥ 1 LogMAR), corticosteroid sparing effect and adverse events at 6 months.Results204 patients (median age of 40 years [28-58] with 42.2% of men) were included. Main etiologies of uveitis included Behçet’s disease (17.2%), birdshot chorioretinopathy (11.3%) and sarcoidosis (7.4%). The overall response rate at 6 months was of 46.2% (21.8% of complete response) with anti-TNF-α agents and 58.5% (35.8% of complete response) with tocilizumab. In multivariate analysis, treatment with tocilizumab (OR 2.10 [95% CI 1.06–4.06], p=0.03) was independently associated with complete response of uveitic macular edema, compared to anti-TNF-α agents. Anti-TNF-α agents and tocilizumab did not differ significantly in terms of relapse rate (HR=1.00 [0.31-3.18], p=0.99) or occurrence of low vision (OR=1.02 [0.51-2.07], p=0.95) or corticosteroid-sparing effect (p=0.29). Adverse events were reported in 20.6% of patients, including 10.8% of serious adverse events.ConclusionsTocilizumab seems to improve complete response of uveitic macular edema compared to anti-TNF-α agents.