Systemic Monoclonal Antibody Therapy (Daclizumab) in the Treatment of Cicatrizing Conjunctivitis in Stevens-Johnson Syndrome, Refractory to Conventional Therapy

Abstract

Purpose: At least one-year follow-up of a case series of young Stevens-Johnson syndrome (SJS) patients with cicatrizing ocular surface disease and recurrent inflammation (SJS-RI) treated with systemic humanized monoclonal antibody (daclizumab).

Methods: Five patients (median age 16 yr; range 8–34 yr) with SJS, with recurrent inflammation refractory to conventional immunotherapy, were enrolled in a prospective non-randomized case series study. Inclusion criteria were patients with SJS and ocular cicatrizing inflammatory disease with severe visual impairment, using topical or systemic anti-inflammatory and/or immunomodulatory drugs without clinical improvement resulting in persistent inflammation (SJS-RI). Treatment with Daclizumab 1 mg/Kg (intravenous) was scheduled in three cycles. First cycle with concomitant immunotherapy: a total of 5 doses, with 14 days interval between them (total of this cycle: 10 weeks). Second cycle: interval was increased to 3 weeks; the patients received 2 doses (the second cycle had a total of 6 weeks). Third cycle: maintenance phase with 4 weeks interval between each application, until at least 12 months of the total follow up. After the first cycle (5th dose), the patients were kept with preservative-free lubricants and systemic doxycycline.

Results: Control of ocular inflammation was observed at a median of 8 weeks (range 6–10 weeks) in all patients, with relapses in two patients at 20–36 weeks. Relapses were controlled with topical steroids at a median of 10 days, and within 2 weeks the steroids were tapered for both patients.

Conclusion: In this small case series, daclizumab demonstrated to play a beneficial role in the control of the inflammatory process of the recurrent inflammation in SJS, refractory to conventional immunomodulatory therapy.

KEYWORDS::

• Biologic drugs
• Cicatricial
• Daclizumab
• Recurrent inflammation
• Stevens-Johnson

Declaration of interest: The authors have no commercial or proprietary interest in any product mentioned in this article. The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.