Evaluation of Corticosteroids, Immunosuppressants and Biotherapies in Patients with Birdshot Retinochoroidopathy.

Objective: To evaluate the therapeutic response to corticosteroids (CS), conventional immunosuppressants (IS) and biotherapies in patients with birdshot retinochoroidopathy (BSCR).

Methods: retrospective observational monocentric cohort study of 44 patients (87 eyes) with BSCR. We evaluated the therapeutic response between 4 and 12 months for venous vasculitis, capillary leakage, choroiditis and macular edema for the different therapeutic lines in each treated eye, a total of 225 evaluations. We defined responses as complete, partial, absent or quiescent according to a global inflammation score and according to the different inflammatory targets.

Results: Corticosteroids showed significant efficacy in choroiditis and vasculitis with 70% and 63% complete responses in these two criteria respectively, whereas their efficacy in capillary leakage was less evident with 38% lack of response. Conventional IS achieved a complete response in 54% of cases of choroiditis and 48% of cases of vasculitis, while their efficacy was less evident in macular edema, with partial or no response in 60% of cases. Anti-TNFα are fully effective in 41% of cases of choroiditis and in 50% of cases of venous vasculitis. Their efficacy in macular edema was very modest, with 77% of trials showing partial or no response. Anti-IL-6 drug was particularly effective in macular edema with complete resolution in 100% of cases, whereas in choroiditis there was no response in 100% of cases.

Conclusion: CS, IS and anti-TNF-α drugs were effective to varying degrees for all inflammatory targets, whereas TCZ was ineffective for choroiditis and moderately effective for retinal vasculitis.