Objectives To assess the efficacy of Infliximab (IFX) and adalimumab (ADA) in refractory uveitis of Behçet’s syndrome.
Methods Study of 63 patients followed in the Uveitis Clinic of 24 hospitals. All of them were refractory to conventional therapy with systemic steroids and ≥1 immunosuppressive drug. Efficacy was evaluated according to SUN criteria, and macular thickness by optical coherence tomography (OCT). Outcomes and comparisons were made at week 1, week 2, month 1, month 6 and at 1 and 2 years. Statistical analyses were performed using the STATISTICA (Statsoft). Results were expressed: mean±1SD (normally distributed variables) or median [25th-75th interquartile range-IQR] (not normally). Continuous variables were compared with the Wilcoxon test.
Results We studied 63 patients/110 affected eyes (36M, 27W), mean age 38.9±9.0 years. Prior to anti-TNF, patients had received ivMprednisolone (n=20), cyclosporine (CyA) (n=53), methotrexate (MTX) (n=31) and azathioprine (AZA) (n=30). IFX was the anti-TNF more commonly used (64%). The remaining patients (36%) were treated with ADA. 14 patients (22%) required switching (12 from IFX→ADA; 2 ADA→IFX). Dosage: IFX 5 mg/kg/iv every 4-8 weeks or ADA 40 mgsc/2weeks. The median[IQR] follow-up from the onset of anti-TNF was 36 [20-60] months. Significant improvement of Visual acuity (VA), Tyndall and vitritis was observed soon (week 1). At 2 years,VA improved from 0.5±0.3 at basal to 0.7±0.3 (p<0.001), Tyndall from a median of 1.07 [0-2] to 0.09 [0-0] (p<0.001) and vitritis, from 1.0 [0-2] to 0.0 [0-0], respectively. Initially,17 patients (24 eyes) had cystoid macular edema (CME). Following anti-TNF OCT decreased from 320.2±120.9 to 260.4±42.8 at 2 years (p<0.001). The most serious side effect was a miliary tuberculosis in 1 patient at month 1 after the onset of IFX.
Conclusions Monoclonal anti-TNF therapy is effective and relatively safe in uveitis of Behcet’s syndrome refractory to conventional therapy.
Disclosure of Interest None Declared
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