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Rituximab used to treat recalcitrant noninfectious scleritis
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Rituximab, with and without additional immunomodulatory therapy, resulted in steroid-free remission of recalcitrant noninfectious scleritis in a majority of patients in one study.
The retrospective case series included 24 eyes of 15 patients with clinically diagnosed noninfectious scleritis who underwent rituximab infusion in accordance with varying treatment protocols. A rheumatologic protocol was implemented in eight patients, an oncologic protocol was implemented in three patients, and the Foster ocular inflammatory disease protocol was implemented in four patients. A mean of three immunomodulatory interventions had been tried and failed in the group of patients before inclusion in the study.
Initially, 14 of 15 patients showed improvement with the rituximab therapy. Longer-term follow-up data available at a mean 38 months for 13 patients showed steroid-free remission, the study’s primary endpoint, was achieved in four patients on rituximab alone and in another four patients who received combination therapy, for a success rate of 61%. Of the five remaining patients, two remain steroid dependent and three achieved medical remission on immunomodulatory therapy without rituximab, according to the study.
“Our long-term results, which show the need for more than one agent in patients who have previously failed alkylating agent monotherapy, corroborate our hypothesis that more aggressive rituximab regimens are needed by these patients with severe, recalcitrant scleritis,” the study authors wrote. – by Patricia Nale, ELS, and Kate Sherrer
Disclosures: Foster reports he is a consultant for, receives grant support from, receives fees from, is on the speakers bureau for or owns stock options in the following: Alcon, Aldeyra Therapeutics, Allergan, Bausch + Lomb Surgical, Clearside Biomedical, Dompé Pharmaceutical, Eyegate Pharma, Mallinckrodt Pharmaceuticals, Novartis, pSivida, Santen and Xoma. All other authors report no financial relationships.
Perspective
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Kenneth Beckman, MD, FACS
Cao and colleagues present a wonderful review of a little used but potentially very effective treatment for refractory noninfectious scleritis. Scleritis is a potentially sight-threatening disease and may be related to other potentially life-threatening conditions. While many therapies have been used with varying degrees of success, there are still many patients who do not respond to conventional therapies.
Rituximab has been shown to be effective in the treatment of some ocular inflammatory conditions. The authors in this study found that rituximab was effective for several patients in the treatment of refractory noninfectious scleritis. They also found that rituximab was relatively safe in this series. While this report used a fairly small sample size and was done in a retrospective fashion, it certainly shows the potential for another treatment of this challenging condition. Further investigation is still needed to determine dosing as well as true efficacy of this therapy.
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