Anti-TNF in ocular diseases

Abstract

Tumor necrosis factor-alpha (TNF-alpha) plays a role in the process of intraocular inflammation that is the cause that the use of TNF-alpha inhibitor agents is worldwide spread to treat different form of intraocular inflammations. In ophthalmology, anti-TNFs are applied in the treatment of uveitis and immune-vasculitis. The number of TNF-alpha inhibitors is increasing despite the fact that such kind of medication can be used “off-label” in the treatment of inflammations. TNF-alpha inhibitors are effective at first in that form of uveitis that is connected with systemic immunologic diseases: Mo. Behcet, rheumatoid arthritis (especially with juvenile idiopathic arthritis), Mo. Chrohn, Wegener granulomatosis, autoimmune diseases (lupus-like syndrome [LLS]). In cases of vasculitis, it can be used in giant cell arthritis, Takayasu arthritis, primary angiitis of the central nervous system, and Cogan syndrome. Anti–TNF-alpha also are effective in cases of autoimmune, noninfectious diseases of the eye: Mo. Harada, sympathetic ophthalmia. The most frequent anti–TNF-alpha that are used are etanercept, adalimumab, and infliximab. There are 3 other TNF-alpha inhibitors that are less widespread yet: golimumab, certolizumab, and tocilizumab. The advantage of the TNF-alpha inhibitors are that they have fewer side effects as corticosteroids and immunsuppressives but are more effective. Their only disadvantage: they are very expensive. None declared.