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Abstract
Abstract
Inhibition of TNF-alpha - a therapeutic alternative for chronic treatment resistant ocular inflammation
Nölle B.
Univ.-Klinikum Schleswig-Holstein, Campus Kiel
TNFa is a cytokine mediator of inflammation with important proinflammatory role in ocular inflammation. Blockade of TNF-alpha receptors with either the monoclonal antibody infliximab or etanercept is meanwhile a clinical routine procedure. These substances are accepted and admitted for treatment of chronic polyarthritis, juvenile chronic arthritis, psoriatric arthritis, and Crohn`s disease in cases of resistance/ineffectivity to routine immunosuppression or relevant contraindications. Reports of various applications of these substances in ocular inflammation confirm a rapid, mostly dramatic suppression of inflammation. However, these beneficial effects are often transitory. At present the ocular indications or contraindications are not clear cut evident. In addition, dosage and time of treatment can be optimized. There are no controlled studies available. However, if known contraindications are accepted (active microbial infection, especially tuberculosis, vaccination with living vaccine, severe heart insufficiency, hypersensitivity to mouse proteins, active multiple sclerosis, uncontrolled diabetes mellitus) the number and intensity of side effects is limited and acceptable. Cases with treatment resistant inflammation due to orbital granulomas in Wegener granulomatosis, rheumatic keratomalacia in chronic polyarthritis or in Sjögrens syndrome, acute anterior uveitis in Bechterew disease showed improvement with TNF-alpha blockade. At p