High-dose daclizumab for the treatment of juvenile idiopathic arthritis-associated active anterior uveitis

Abstract

Purpose: To provide preliminary data regarding the safety and efficacy of high-dose intravenous daclizumab (Zenapax; Roche Inc, Nutley, New Jersey, USA) therapy for the treatment of juvenile idiopathic arthritis (JIA)-associated active anterior uveitis.

Design: Interventional case series; open-label prospective, phase II pilot study.

Methods: Six patients were recruited into the study and received daclizumab therapy at doses of 8 mg/kg at baseline, 4 mg/kg at week 2, and 2 mg/kg every 4 weeks thereafter, for a total of 52 weeks. The study was done at the National Eye Institute between June 29, 2005 and July 9, 2008. The primary outcome was a two-step decrease in inflammation grade assessed at week 12. Primary safety outcome was assessed at weeks 2 and 4. The ocular inflammation was assessed according to the Standardization of Uveitis Nomenclature criteria.

Results: Four of the 6 participants achieved two-step reduction in anterior chamber cells according to Standardization of Uveitis Nomenclature Working Group grading scheme for anterior chamber cells 12 weeks into the study and met the primary efficacy endpoint. One additional patient responded to reinduction whereas 1 patient failed reinduction and was considered an ocular treatment failure. Visual acuity improved from a mean of 68 Early Treatment Diabetic Retinopathy Study letters in the worse eye to a mean of 79.6 letters (2 Snellen lines). Three participants were terminated before 52 weeks: First, because of a rash possibly induced by daclizumab; Second, because of ocular treatment failure; and Last, because of uncontrolled systemic manifestations of JIA.

Conclusion: High-dose intravenous daclizumab can help reduce active inflammation in active JIA-associated anterior uveitis; however, patients need to be monitored for potential side effects. Larger randomized trials are needed to better assess treatment effect and safety.

Trial registration: ClinicalTrials.gov NCT00130637.

FIGURE 1

Anterior chamber (AC) cells over time in patients with juvenile idiopathic arthritis (JIA) receiving high-dose daclizumab. Grading of AC cells by weeks after intravenous daclizumab in each participant’s right (on the left) and left (on the right) eyes are demonstrated. Note that Patient 4 was considered an ocular treatment failure.

FIGURE 2

CD56^bright cells and AC inflammation in a patient with JIA receiving high-dose daclizumab. Grading of AC cells in the right eye of Patient 3 against CD56^bright cells (expressed in %) at regular intervals. Note that an expansion in CD56^bright cells is associated with a decrease in ocular inflammation whereas a decrease is associated with an increase in intraocular inflammation.