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Pichi F, Smith SD, AlAli SH, Neri P. ADALIMUMAB DRUG MONITORING AND TREATMENT ADJUSTMENT TO DRUG ANTIBODIES IN NON-INFECTIOUS UVEITIS. Am J Ophthalmol 2024:S0002-9394(24)00428-8. [PMID: 39271091 DOI: 10.1016/j.ajo.2024.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 09/04/2024] [Accepted: 09/04/2024] [Indexed: 09/15/2024]
Abstract
PURPOSE To explore the incidence of antibodies against adalimumab (AAA) development in non-infectious uveitis (NIU) and to examine the impact of treatment adjustment in non-responders. DESIGN Retrospective case series. METHODS SETTING: Single-center study. STUDY POPULATION Patients with NIU treated with adalimumab OBSERVATION PROCEDURE: Blood samples for adalimumab and AAA were collected and therapeutic adjustments post-monitoring in non-responders were analyzed including changes in injection intervals, addition of conventional disease-modifying antirheumatic drugs (cDMARD), and treatment alterations to biologic DMARD. MAIN OUTCOME MEASURES Proportion of patients with positive AAA and active uveitis, decrease of AAA at final follow-up by different therapeutic interventions. RESULTS Of 42 patients who underwent laboratory investigations at 17.9 months after adalimumab initiation, 22 (52.4%) patients who were non-responders demonstrated AAA (1243 ng/mL) with a mean adalimumab trough levels of 3.0 μg/mL, significantly lower than the mean drug levels of patients without AAA (11.8 μg/mL). Fifteen (35.7%) patients were receiving concurrent treatment with a second immunosuppressive agent, but the mean antibody level and the mean adalimumab level were not statistically significantly different from the monotherapy group (P = 0.13 and P = 0.34). Reduction in AAA levels and relapse management was greatest among non-responders who were treated by increasing the adalimumab dose and adding an additional immunosuppressive drug (-3565 ng/mL), followed by patients who were shifted to a different biologic (-1153 ug/mL). CONCLUSIONS The presence of AAA was detected in 88% of non-responder patients and was associated with undetectable adalimumab drug levels. This underscores immunogenicity as a major cause of loss of response in uveitis patients receiving biotherapies. Increasing the dose of adalimumab injections together with the addition of low-dose cDMARDs was the most effective adjustment in immunized non-responders for whom the adalimumab drug concentration was low.
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Affiliation(s)
- Francesco Pichi
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Scott D Smith
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sahar H AlAli
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Piergiorgio Neri
- Eye Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Ruiz-Lozano RE, Mousa HM, Soifer M, Azar NS, Quiroga-Garza ME, Dzhaber D, Murillo S, Song A, Rabinovich CE, Perez VL. Adalimumab to treat noninfectious pediatric chronic anterior uveitis: a case series. Int Ophthalmol 2024; 44:376. [PMID: 39254907 PMCID: PMC11387437 DOI: 10.1007/s10792-024-03289-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 08/25/2024] [Indexed: 09/11/2024]
Abstract
PURPOSE Evaluate the response to adalimumab (ADA) in pediatric chronic anterior uveitis (pCAU). METHODS Retrospective chart review of pCAU patients treated with ADA. Outcomes evaluated included the proportion of patients achieving zero ocular inflammation and discontinuation of topical corticosteroids, visual outcomes, and incidence of uveitis recurrences after ≥ 12 months of prescribing ADA. Incidence and risk factors for developing anti-adalimumab antibodies (AAAs) were also evaluated. RESULTS Of 27 children aged 11 years, 16 (59%) were Caucasian and 6 (22%) African Americans. Thirteen (48%) patients had idiopathic pCAU, 12 (44%) had juvenile idiopathic arthritis (JIA) related pCAU, and 2 (7%) had tubulointerstitial nephritis and uveitis syndrome. At baseline, African American children had worse visual acuity (p = 0.026). At 1 year, 21 (78%) children achieved zero ocular inflammation (remission). Risk factors associated with non-remission were being African American (20% vs. 94%, p = 0.003) and experiencing ≥ 1 episode of uveitis recurrence (100% vs. 0%, p < 0.001). Six episodes of uveitis recurrence were documented in five children, four of whom were African American. Topical corticosteroids were discontinued in 83% of children, and visual acuity remained stable for 1 year. Twelve children were tested for AAAs due to arthritis or uveitis flare-ups, with five (42%) being positive. No significant factors were associated with the development of AAAs. CONCLUSIONS We found that ADA is effective in controlling inflammation, reducing the need for topical corticosteroids, and maintaining visual acuity in pCAU. There appears to be racial differences in African American children who had worse baseline disease and poorer outcomes. Studies are necessary to understand better and address these disparities.
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Affiliation(s)
- Raul E Ruiz-Lozano
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Hazem M Mousa
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Matias Soifer
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Nadim S Azar
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Manuel E Quiroga-Garza
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Daliya Dzhaber
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - Sofia Murillo
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Ailin Song
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
| | - C Egla Rabinovich
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA
- Department of Pediatrics, Duke University Health System, Durham, NC, 27705, USA
| | - Victor L Perez
- Department of Ophthalmology, Foster Center for Ocular Immunology at Duke Eye Center, Duke University School of Medicine, Durham, NC, USA.
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA.
- McKnight Vision Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th St, Miami, FL, 33136, USA.
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Bromeo AJ, Karaca I, Ghoraba HH, Lyu X, Than NTT, Ongpalakorn P, Shin YU, Uludag G, Tran ANT, Thng ZX, Do DV, Or CMC, Nguyen QD. Risk factors for development of anti-adalimumab antibodies in non-infectious uveitis. Heliyon 2024; 10:e29313. [PMID: 38694084 PMCID: PMC11061690 DOI: 10.1016/j.heliyon.2024.e29313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 05/03/2024] Open
Abstract
Purpose To evaluate risk factors associated with development of anti-adalimumab antibodies (AAA) in patients with non-infectious uveitis treated with adalimumab. Methods A retrospective, cross-sectional, case-control study was done evaluating patients with non-infectious uveitis treated with adalimumab for at least 12 months and have undergone testing for AAA levels. Demographics, clinical characteristics, grading of ocular inflammation, and previous and concomitant immunomodulatory therapy were assessed. Univariate and multivariate analysis were done to estimate odds ratio (OR) with 95% confidence intervals for the various risk factors. Results A total of 31 patients were included in the analysis, in which 12 patients who tested positive (Group 1) were matched with 19 patients who tested negative for AAA (Group 2). The groups differed significantly in terms of sex (female) (91.7% vs 52.6%, p = 0.046), presence of systemic disease (91.7% vs 42.1%, p = 0.008), and presence of anterior chamber inflammation at baseline (100% vs 63.2%, p = 0.026). A history of interruption in anti-TNF therapy prior to starting or restarting adalimumab was found to have an increased odds for development of AAA (OR 16.89 [2.92, 107.11], p = 0.008), as well as flare-ups (reactivation of disease) during adalimumab therapy (OR 6.77 [1.80, 61.80], p = 0.027). Weekly dosing of adalimumab was shown to decrease odds of AAA development (OR 0.34 [0.02, 0.70], p = 0.040), while concomitant anti-metabolite therapy was not shown to be a statistically significant protective factor (OR 2.22 [0.50, 9.96], p = 0.148). Conclusions History of interruption in anti-TNF therapy and flare during adalimumab were associated with development of AAA, while weekly dosing of adalimumab was protective against AAA. Identification of those with higher risk of developing AAA may guide in clinical decision making to optimize management for these patients.
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Affiliation(s)
| | - Irmak Karaca
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Xun Lyu
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Prapatsorn Ongpalakorn
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Nopparat Rajathanee Hospital, Bangkok, Thailand
| | - Yong Un Shin
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, South Korea
| | - Gunay Uludag
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
| | | | - Zheng Xian Thng
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore
| | - Diana V. Do
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
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Raad F, Luque P, García Ledo S, Alda Lozano A, Llorens V, Espejo A, Heras H, Santana L, Trapiella L, Fanlo P, Adán A, Espinosa G, Navarrete N. Adalimumab for the Treatment of Non-Infectious Uveitis: A Real Life Experience. Ocul Immunol Inflamm 2024:1-7. [PMID: 38691840 DOI: 10.1080/09273948.2024.2344712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/14/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To describe the efficacy and safety of adalimumab for the treatment of non-infectious uveitis (NIU) in four Uveitis Units from tertiary Spanish hospitals. METHODS Multicenter and retrospective clinical cohort study including all patients with NIU treated with adalimumab from January 2012 to October 2022 in four uveitis units was performed. Efficacy was measured with the number of relapses, ocular inflammation and reduction in immunosuppression and corticosteroid dosage before and after adalimumab use. We collected data regarding adverse effects and examined the immunogenicity of adalimumab. RESULTS One hundred and twenty-two patients (59% females), with a mean age of 48.6 years (SD = 14.8) accounting for 217 eyes were included. The majority (92.6%) were Caucasian. Uveitis analyzed were predominantly panuveitis (34.7%), bilateral (77.9%), acute (41.5%), and non-granulomatous (90%). Most of them were immune mediated (42.6%), and the main reason to initiate adalimumab was refractory disease (96.7%). The analysis was statistically significant due to the reduction in the number of immunosuppressive drugs as well as the dose of oral corticosteroids and the number of relapses during follow-up (p < 0.001). The decrease in ocular inflammation parameters and the improvement in visual acuity (p < 0.05) were also significant. There were no deaths due to the drug and only one reported case of serious infection. In total, 10.9% of 73 patients tested developed anti-adalimumab antibodies and 4.1% lupus-like. CONCLUSIONS We consider adalimumab as a leading drug in the treatment of NIU with high safety and efficacy.
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Affiliation(s)
- Fátima Raad
- Department of Internal Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Paula Luque
- Department of Internal Medicine, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Sofía García Ledo
- Department of Internal Medicine, Hospital Universitario San Agustín, Avilés, Spain
| | | | - Víctor Llorens
- Department of Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Espejo
- Department of Ophthalmology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Henar Heras
- Department of Ophthalmology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Lucía Santana
- Department of Ophthalmology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis Trapiella
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Patricia Fanlo
- Internal Medicine Department, Systemic Autoimmune Unit, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Alfredo Adán
- Department of Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Gerard Espinosa
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Reference Centre for Systemic Autoimmune Diseases (UEC/CSUR) of the Catalan and Spanish Health Systems-Member of ERNReCONNET, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Nuria Navarrete
- Department of Internal Medicine, University Hospital Complex of Granada, Granada, Spain
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Pachón-Suárez DI, Zárate-Pinzón L, Cifuentes-González C, Rojas-Carabali W, Mejía-Salgado G, Pineda JS, Peña-Pulgar LF, de-la-Torre A. Immunogenicity of Adalimumab in Patients with Non-Infectious- Uveitis: Systematic Review and Meta-Analysis. Ocul Immunol Inflamm 2023:1-10. [PMID: 37796609 DOI: 10.1080/09273948.2023.2256850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE To review the prevalence, incidence, and risk factors for developing anti-drug antibodies (AAA) in patients with non-infectious uveitis (NIU) treated with Adalimumab (ADA). METHODS A systematic literature search was performed on PubMed, EMBASE, Virtual Health Library, Cochrane, and medRxiv. Meta-analysis was performed using random effects. RESULTS Nine out of 2,373 studies were included. The prevalence of AAA in NIU patients treated with ADA was 9% (95% CI: 2% to 37%, I2 = 95% with a P<0.01), it was significantly higher in real-life scenarios (observational studies) than in clinical trials. The pooled incidence at 12 months was 27% (CI 95% 16%-42% I2 = 0%). Several factors have been associated with AAA generation in NIU patients, including the non-use of concomitant immunosuppressants, presence of autoimmune systemic disease, female gender, etc. CONCLUSION This study showed that AAA prevalence is higher in real-life scenarios compared to clinical trials. Further research is needed to elucidate the factors that trigger AAA generation in NIU patients.
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Affiliation(s)
- Diana Isabel Pachón-Suárez
- Doctorado en Investigación Clínica, Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational, Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Laura Zárate-Pinzón
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational, Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational, Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational, Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Germán Mejía-Salgado
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational, Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
- Ophthalmology Interest Group-Universidad del Rosario. (OIG UR). Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Juan Sebastián Pineda
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational, Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
- Ophthalmology Interest Group-Universidad del Rosario. (OIG UR). Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Luisa Fernanda Peña-Pulgar
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational, Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
- Ophthalmology Interest Group-Universidad del Rosario. (OIG UR). Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational, Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
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Bellur S, McHarg M, Kongwattananon W, Vitale S, Sen HN, Kodati S. Antidrug Antibodies to Tumor Necrosis Factor α Inhibitors in Patients With Noninfectious Uveitis. JAMA Ophthalmol 2023; 141:150-156. [PMID: 36547953 PMCID: PMC9936342 DOI: 10.1001/jamaophthalmol.2022.5584] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/29/2022] [Indexed: 12/24/2022]
Abstract
Importance Tumor necrosis factor inhibitors (TNFis) can induce antidrug antibody (ADA) formation and loss of therapeutic response. However, the utility of ADA testing and the association between ADAs and treatment response in patients with noninfectious uveitis (NIU) is not well understood. Objective To assess the frequency of ADAs and their association with drug levels and clinical response in patients with NIU treated with adalimumab or infliximab. Design, Setting, and Participants This retrospective cross-sectional study included patients diagnosed with NIU who received adalimumab or infliximab and underwent testing for serum drug level and ADAs at the National Eye Institute from September 2017 to July 2021. Exposures Serum drug level testing with reflex testing for ADA levels was performed. Main Outcomes and Measures The main outcome was the association between drug levels and ADAs, clinical response, and concurrent antimetabolite use in patients treated with TNFis for NIU. Results Of 54 patients included in the study, 42 received adalimumab (mean [SD] age, 43.6 [19.6] years; 25 [59.5%] female) and 12 received infliximab (mean [SD] age, 42.7 [20.4] years; 7 [58.3%] male). In the adalimumab group, mean (SD) drug level was 9.72 (6.82) μg/mL, mean (SD) ADA level was 84.2 (172.9) arbitrary units/mL, and ADA frequency was 35.7% (15 of 42 patients). Mean drug level was lower in those with ADAs compared with those without ADAs (mean [SD], 2.8 [2.6] μg/mL vs 13.6 [5.2] μg/mL; difference: 10.8 μg/mL; 95% CI, 8.3-13.2 μg/mL; P < .001). There was a higher mean drug level with concurrent antimetabolite use compared with monotherapy (mean [SD], 11.0 [7.3] μg/mL vs 6.8 [4.5] μg/mL; difference: -4.2 μg/mL; 95% CI, -8.7 to 0.2 μg/mL; P = .06). Multivariable modeling showed that a 1-arbitrary unit increase in ADAs was associated with a -0.02 μg/mL (95% CI, -0.01 to -0.34 μg/mL) difference in mean drug level (P < .001). Favorable clinical response was associated with a threshold drug level above 2.7 μg/mL or an antibody level below 15.2 μg/mL. The mean (SD) drug level in the infliximab group was 27.02 (18.15) μg/mL, and no ADAs were detected. Conclusions and Relevance In this study, 35.7% of adalimumab-treated patients with NIU had ADAs. The presence of ADAs was associated with lower drug levels, and higher ADA levels were associated with increased risk of TNFi treatment failure. Although limited by the retrospective design, our results suggest that therapeutic drug monitoring may be considered among patients experiencing therapy failure to help exclude ADAs as a potential cause of treatment failure.
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Affiliation(s)
- Sunil Bellur
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Matthew McHarg
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Wijak Kongwattananon
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
- Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Susan Vitale
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - H. Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Shilpa Kodati
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
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Rosenbaum JT, Friedman M. Seasoning to Perfection: How to Optimize Anti-TNF Therapy. Ocul Immunol Inflamm 2021; 30:767-768. [PMID: 34424794 DOI: 10.1080/09273948.2021.1964032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- James T Rosenbaum
- Departments of Ophthalmology, Medicine, and Cell Biology, Oregon Health & Science University, Casey Eye Institute, Portland, Oregon, USA.,Legacy Devers Eye Institute, Legacy Health System, Portland, Oregon, USA.,Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Marcia Friedman
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
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