Interferons and Intravenous Immunoglobulin

Abstract

In patients with severe, sight-threatening ocular inflammatory disease, successive therapeutic failures with conventional immunosuppressants may occur. In such cases, treatment with either exogenous interferon or intravenous immunoglobulin may be attempted. Increasingly, the highly complex interactions and manifold mechanisms of action of these immunomodulators are being unraveled. For interferons, there is a prodigious body of evidence demonstrating high response rates for ocular Behçet disease and the uveitis associated with multiple sclerosis, though patients with etiologically varied uveitis may also derive significant benefit. More so, it has become evident that uveitic cystoid macular edema is exceptionally sensitive to systemic interferon therapy. For intravenous immunoglobulin, rationale for its use in diseases involving pathogenic autoantibodies, such as ocular mucous membrane pemphigoid, is solid; indeed, even treatment-resistant cases of this disease respond favorably in most instances. Other uveitic entities, including birdshot chorioretinitis and Behçet disease, may also benefit from immunoglobulin therapy. Side effects are common and numerous with interferons, though rarely do they mandate treatment cessation. Exogenous immunoglobulins are much better tolerated, although serious adverse events may rarely occur. Further elucidation of their mechanisms of action and thoughtful consideration of how recombinant interferons and immunoglobulin may be applied to aberrant ocular immune physiology will permit more discriminate patient selection, maximizing treatment benefits while mitigating risk and cost.