We thank Dr Sebastian and colleagues for their complimentary remarks regarding our study.1 In brief review, they describe 3 patients with uveitis who were refractory to treatment with conventional immunosuppression and etanercept, a soluble fusion protein that functions by binding free extracellular TNF. All of the 3 patients were judged to improve substantially after changing to alternate TNF-blocking agents, with the first 2 patients responding to infliximab and the third to adalimumab. Infliximab and adalimumab are monoclonal antibodies against TNF-α and are able to bind both soluble and membrane-bound TNF-α. Infliximab is administered by intravenous infusion whereas etanercept and adalimumab are administered by subcutaneous injection. As Dr Sebastian and colleagues indicate, there are no published controlled studies comparing the efficacy of these drugs, collectively referred to as TNF blockers, in the treatment of ocular inflammatory disease; however, the observations that infliximab may have differential efficacy as compared with etanercept and that infliximab may be useful in etanercept-refractory patients have been shown previously.2 The published experience with adalimumab in the treatment of uveitis is scant. At this point, we do not believe that sufficient evidence exists to assert that any single agent has achieved status as the first-line or “preferred-practice” TNF blocker for intraocular inflammatory disease.
Suhler EB, Smith JR, Wertheim MS, Lauer AK, Kurz DE, Pickard TD, Rosenbaum JT. Optimizing the Use of Tumor Necrosis Factor α Inhibitors in Refractory Uveitis—Reply. Arch Ophthalmol. 2006;124(10):1505-1506. doi:10.1001/archopht.124.10.1505-b