Objective: Autoimmune retinopathy (AIR) is an ophthalmic disorder in which autoantibodies damage the retina and its components, causing progressive vision loss. AIR has no established treatment, but systemic immunosuppression has shown favorable responses. Rituximab is an immunosuppressive agent which binds specifically to B lymphocytes. The objective of this study is to investigate the safety of rituximab as an effective treatment for AIR. Study Population: Five participants with AIR and visual acuity of 20/200 or better in at least one eye will receive rituximab. AIR must be confirmed by immunohistochemical demonstration of serum anti-retinal antibodies on normal, unfixed, frozen rhesus monkey or human retinas, as well as visual field and electroretinography (ERG) changes. Up to seven participants may be enrolled in order to obtain the five participants to be included in the analysis if participants withdraw prior to receiving rituximab. Design: The study duration is 18 months. Rituximab is administered as a cycle consisting of two separate rituximab infusions of 1,000 mg each, two weeks apart. Participants will receive their first rituximab cycle at baseline and evaluated for a second cycle six months later. Treatment success is defined as experiencing a ≥25% improvement in ERG response amplitudes or ≥3 decibel (dB) improvement in mean deviation on Humphrey Field Analyzer HFA (30-2) or improvement in threshold values >0.5 log in the existing scotomas on Goldmann Visual Field (GVF) or ≥25% improvement in the area of scotomas on GVF assessment as compared with baseline. As a result, participants could receive a maximum of two cycles in this study. Participants will return to the clinic six weeks and three months after their first infusion of each cycle for a safety visit. Study visits will continue every three months for the study duration. Outcome Measures: The primary outcome is the number of participants who meet the definition of treatment success within six months from baseline. Secondary efficacy outcomes include changes in visual acuity, the number of treatment successes at 9 and 12 months, the number of partial responders at 6, 9 and 12 months, changes in ERG or visual field as demonstrated by the HFA (30-2) or GVF, changes in optical coherence tomography (OCT), changes in fluorescein angiography (FA), changes in serum anti-retinal autoantibody or anti-retinal antibody staining, changes in color vision, positive visual symptoms or nyctalopia and changes in the participants quality-of-life as assessed by the NEI visual function questionnaire. For participants with ≥2 ERG measurements available prior to enrollment, an attempt will be made to compare the rate of decline pre-study period to the rate of decline post-enrollment period. Safety outcomes include the number and severity of systemic and ocular toxicities, adverse events, and infections and the proportion of participants with a loss of ≥15 ETDRS letter score.
|Grange, Landon; Dalal, Monica; Nussenblatt, Robert B et al. (2014) Autoimmune retinopathy. Am J Ophthalmol 157:266-272.e1|