Intravenous daclizumab for recalcitrant ocular inflammatory disease

To evaluate outcomes of patients with recalcitrant ocular inflammation treated with intravenous daclizumab. Retrospective case-series. Seventeen patients (33 eyes) with ocular inflammation who had failed several previous systemic immunomodulatory therapies were included in this study. Daclizumab was infused intravenously at a dose of 1 mg per kilogram every 2 weeks. The dose and intervals were adjusted according to control of inflammation off systemic and/or topical corticosteroid therapy. Control of ocular inflammation without corticosteroid therapy was the primary efficacy end point. The mean patient age at the commencement of daclizumab therapy was 34.8(range 8-64 years). Three patients were less than 16 years of age at the initiation of therapy. The duration of drug use was 23.6 +/- 15.7 months (range 8-68 months), and the time to control inflammation was 9.8 +/- 11.3 weeks, which was achieved in 15 patients (88.2%). Flare-up rate was 44 per 100 person-years follow-up. Fifteen of 33 eyes (45%) had an improvement in the visual acuity, 13 eyes (39.3%) had stable acuities, and five eyes (15%) had a worsening of their acuities. Two patients (14%) exhibited worsening of ocular inflammation, and were declared as treatment failures. Side effects associated with daclizumab included nausea, fatigue and muscle aches. Daclizumab is effective in controlling inflammation in patients with stubborn non-infectious ocular inflammation. It has a corticosteroid-sparing effect, can be used as long-term therapy in children and adults, and is capable of inducing durable remission.