Background Over the past decade, the off-label use of biologic agents such as TNF-a antagonists has improved the treatment armamentarium for refractory immune-mediated uveitis, with particular success in Behçet’s disease associated uveitis.
Objectives To assess the long-term efficacy and safety of TNF-a antagonists (infliximab, [IFX]; adalimumab, [ADA]; and golimumab [GLM]) for the treatment of patients with Behçet’s disease (BD) and uveitis who failed to respond or did not tolerate conventional immunosuppressive (IS) treatment.
Methods Retrospective study of patients with Behçet’s uveitis treated with anti-TNF therapy in four tertiary referral hospitals of Spain. Data analyzed were the following: demographic characteristics, disease duration and type of uveitis; best-corrected visual acuity (BCVA); previous treatments; type, regime and duration of each biological agent used; outcomes (remission, loss of efficacy, number of uveitis attacks).
Results We included 59 eyes of 32 patients (16 males; mean age, 39±11.9 years old) with BD and refractory uveitis. Mean disease duration was 6.4±4.8 years. 18 patients (56.3%) were HLA-B51 positive. 66% of patients had panuveitis, 25% posterior, 6% anterior, and 3% intermediate uveitis. 84% of patients had bilateral ocular involvement. All patients received oral corticosteroids, and 63% had received ≥2 IS drugs at baseline. 25 patients (78%) were treated with IFX and 7 (22%) with ADA as initial therapy. 11/25 patients treated initially with IFX were switched to another anti-TNF agent due to adverse events (3 patients), loss of efficacy (3), patient’s choice (1), or uveitis relapse after IFX withdrawal (4): 9/11 were switched to ADA and 3/11 to GLM. Globally, 16/32 patients were treated with ADA and 3 with GLM. IFX was infused for a mean of 16.6 months (range, 2-48), ADA was administered for a mean of 30.2 months (range, 3-52), and GLM was given for a mean of 4 months (range, 3-6). Mean follow-up was 77.3 months (range, 8-276). 28 (87%) achieved uveitis remission. 12/32 patients were able to discontinue all systemic IS and CS. BCVA remained stable or improved in 53/59 eyes. Mean BCVA improved from 0.2±0.6 to 0.5±0.2 (p<0.05), and ocular attacks per year dropped from 37 in the year before therapy to 5 at final follow-up visit (p<0.05). 3 serious adverse events requiring IFX withdrawal were reported: 1 severe infusion reaction, 1 disseminated tuberculosis, and 1 prostatitis.
Conclusions Anti-TNF agents are effective biological drugs for the treatment of Behçet’s uveitis. Treatments were generally well tolerated and only 3 patients required withdrawal.
Disclosure of Interest: None Declared