Rituximab for refractory granulomatous eye disease

Abstract

Objective

To determine the effectiveness of rituximab therapy for patients with granulomatous disease of the eye.

Methods

Retrospective review was undertaken of cases seen at a single institution for ocular antineutrophil cytoplasmic antibody-associated vasculitis or sarcoidosis with persistent ocular disease despite systemic therapy. All patients were treated with rituximab and followed for at least 6 months.

Results

Nine patients were identified (five with antineutrophil cytoplasmic antibody-associated vasculitis, four with sarcoidosis), and all were treated for at least 6 months. Eight experienced improvement of eye disease and were able to reduce prednisone and other drug therapies. One patient remained stable, but still required high dosages of prednisone. All five patients with lung disease improved with rituximab therapy. Rituximab treatment was well tolerated. Two patients discontinued the drug due to leukopenia; however, both patients reinstituted rituximab at modified doses.

Conclusion

Rituximab therapy was effective in controlling granulomatous ocular disease in most cases. The drug was corticosteroid-sparing and effective in refractory cases, with no severe adverse events encountered.

Keywords:

• sarcoidosis
• wegener’s
• ANCA
• cyclophosphamide

Acknowledgments and disclosure

Written consent has been obtained for using patient photographs. The University of Cincinnati has received a research grant from Genentech for Dr Lower and Dr Baughman to study rituximab in pulmonary sarcoidosis. The authors report no conflicts of interest in this work.