Effects of non-medical infliximab biosimilar switching in ocular inflammatory diseases: A case series from a tertiary care center.

PURPOSE: To describe the course of care and outcomes for 3 uveitis patients formerly on Remicade that were non-medically switched to Inflectra. DESIGN: Retrospective observational case series. METHODS: •Setting: Tertiary care clinical practice.•Patient population: 3 Uveitis patients, observing both eyes for inflammation as applicable. Patients included if they had been on Inflectra for ≥2 infusions and history of Remicade use. Patients described herein had at least 1 adverse reaction to Inflectra and were switched to Remicade for medical necessity. Patients excluded if they were lost to follow-up or not examined for over 6 months during therapy.•Observation procedures/Interventions: Patients observed for adverse changes in clinical course while on Inflectra. Patients developing these changes on Inflectra were started or restarted on Remicade. RESULTS: The 3 patients described herein developed adverse complications while on Inflectra that required switching to Remicade. They were originally on Remicade, and their clinical course worsened beyond what had been controlled with Remicade alone. Our findings are limited by our small sample size, and further investigation is necessary to explore the scope of effects of non-medical biosimilar switching. CONCLUSION: Non-medical biosimilar switching from Remicade to Inflectra may induce detrimental side-effects and significant worsening of inflammation in patients with uveitis. Non-medical biosimilar switching from Remicade to Inflectra should be discouraged, and physician input should be sought in establishing an effective and medically-necessary treatment plan for patients with uveitis.

B-Scan Ultrasonography Findings in Unilateral Posterior Scleritis.

Purpose: To evaluate the B-scan ultrasound findings in unilateral posterior scleritis. Methods: This was a retrospective observational case series at a tertiary uveitis clinic. The study population included patients who had been diagnosed with milder forms of unilateral posterior scleritis since 2010 and had B-scan ultrasonography of that eye. The healthy eye of each patient was considered the control eye for that patient. Results: The average age of patients was 50.2 ± 17.8 (range, 18-67). Posterior scleritis was idiopathic in 6 (66.7%) patients and associated with rheumatoid arthritis in two and HLA-B27 ankylosing spondylitis in one patient. The thickness of the thickest area in the diseased eye was 2.08 ± 0.49 (range, 1.35-3.2) and the control eye was 1.53 ± 0.38 (range, 1.03-2.3). The difference between the symptomatic and control eye was statistically significantly different (P = 0.02). 1.7 mm was the cut-off-point on the receiver operating characteristics curve with the highest combined sensitivity and specificity of 87.5% and 88.9%, respectively. Comparing the thickness of the thickest section of the symptomatic eye of one patient with the same section in the other eye of the same patient, there was a difference of 20% or more in sclero-choroidal complex. Conclusions: In this study, the sclero-choroidal complex thickness higher than 1.7 mm has the highest combined sensitivity and specificity. Comparing the thickest section of the symptomatic eye of one patient with the same section in the other eye can be diagnostic.