blockade of tumor necrosis factor-alpha: a role for adalimumab in neovascular age-related macular degeneration refractory to anti-angiogenesis therapy

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ID: 250193
2016
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Abstract
Aims: To report a case of wet age-related macular degeneration (wet-AMD) refractory to intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in a patient who showed visual and anatomical improvement and stabilization after starting a subcutaneous treatment course with adalimumab, an anti-tumor necrosis factor-alpha (TNF-α) drug, for concomitant Crohn's disease. Methods: Observational case report of a female patient. Ophthalmological evaluation was performed by slit lamp and ophthalmoscopy (posterior pole and anterior segment). Best-corrected visual acuity (BCVA) was determined, and imaging was performed by fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT). Intravitreal therapies used and treatment with anti-TNF-α were recorded. Results: A 64-year-old woman with wet-AMD was treated with fourteen intravitreal injections of ranibizumab (0.5 mg) for a period of 40 months with intervals of 1-6 months. She initially showed a good visual and anatomical response to periodic anti-VEGF treatment but during check visits, anatomical and functional responses deteriorated. At the 40-month follow-up, the patient had developed Crohn's disease, and her rheumatologist started treatment with adalimumab (40 mg subcutaneously every 2 weeks). During the 25 months of treatment with adalimumab, the patient did not require any additional intravitreal anti-VEGF treatments because her BCVA, clinical, and OCT findings improved and remained stable. Conclusions: We described a case of a patient with wet-AMD refractory to anti-VEGF therapy, which clinically benefited from subcutaneous adalimumab therapy. Treatment with subcutaneous anti-TNF-α in combination with anti-VEGF therapy avoids the high cost and risks related to multiple intravitreal anti-VEGF injections with good functional and anatomic outcomes.
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Authors Beatriz Fernández-Vega, Álvaro Fernández-Vega, Carlos Mario Rangel, Javier Nicieza, Eva Villota-Deleu, José A. Vega, Ronald M. Sanchez-Avila
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Journal bilimsel tamamlayıcı tıp regülasyon ve nöral terapi dergisi
Year 2016
DOI
10.1159/000445102
URL
http://www.karger.com/Article/FullText/445102
Keywords
anti-vascular endothelial growth factor wet age-related macular degenerationophthalmology tumor necrosis factor-alpha inhibitors

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