Anti-TNF-α therapy in patients with refractory uveitis due to Behçet's disease: a 1-year follow-up study of 124 patients.

Abstract

OBJECTIVE:

The aim of this study was to assess the efficacy of anti-TNF-α therapy in refractory uveitis due to Behçet's disease (BD).

METHODS:

We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load.

RESULTS:

Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (s.d. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-α drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-α therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 μm] and 35 (49 eyes) had cystoid macular oedema (OCT>300 μm) that improved from 420 μm (s.d. 119.5) at baseline to 271 μm (s.d. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases.

CONCLUSION:

Anti-TNF-α therapy is effective and relatively safe in refractory BD uveitis.

• Authors: Vanesa Calvo-Río, Ricardo Blanco, Emma Beltrán, Juán Sánchez-Bursón, Marina Mesquida, Alfredo Adán, María Victoria Hernandez, Marisa Hernandez Garfella, Elia Valls Pascual, Lucía Martínez-Costa, Agustí Sellas-Fernández, Miguel Cordero Coma, Manuel Díaz-Llopis, Roberto Gallego, David Salom, José L García Serrano, Norberto Ortego, José M Herreras, Alejandro Fonollosa, Angel M García-Aparicio, Olga Maíz, Ana Blanco, Ignacio Torre, Cruz Fernández-Espartero, Vega Jovani, Diana Peiteado-Lopez, Esperanza Pato, Juan Cruz, Carlos Fernández-Cid, Elena Aurrecoechea, Miriam García, Miguel A Caracuel, Carlos Montilla, Antonio Atanes, Félix Francisco Hernandez, Santos Insua, Senén González-Suárez, Amalia Sánchez-Andrade, Fernando Gamero, Luis Linares, Fredeswinda Romero-Bueno, A Javier García, Raquel Almodovar, Enrique Minguez, Carmen Carrasco Cubero, Alejandro Olive, Julio Vázquez, Oscar Ruiz Moreno, Fernando Jiménez-Zorzo, Javier Manero, Santiago Muñoz Fernández, Javier Rueda-Gotor, Miguel A González-Gay
• Journal: Rheumatology (Oxford, England) (Rheumatology (Oxford)) Vol. 53 Issue 12 Pg. 2223-31 (Dec 2014) ISSN: 1462-0332 [Electronic] England
• PMID: 24996907 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: [email protected].

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Biological Products
• Glucocorticoids
• Immunosuppressive Agents
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab
• Prednisone

Topics

• Adalimumab
• Adolescent
• Adult
• Aged
• Antibodies, Monoclonal (administration & dosage, adverse effects, therapeutic use)
• Antibodies, Monoclonal, Humanized (administration & dosage, adverse effects, therapeutic use)
• Behcet Syndrome (complications, drug therapy)
• Biological Products (adverse effects, therapeutic use)
• Child
• Drug Administration Schedule
• Drug Resistance
• Drug Therapy, Combination
• Female
• Follow-Up Studies
• Glucocorticoids (administration & dosage, therapeutic use)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Infliximab
• Male
• Middle Aged
• Prednisone (administration & dosage, therapeutic use)
• Treatment Outcome
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Uveitis (drug therapy, etiology)
• Young Adult