Background Uveitis is an inflammatory disease which causes approximately 10% of blindness cases. Although it has several etiologies, the most frequent is autoimmune. The treatment in autoimmune uveitis is based on the use of steroids, immunosuppressive therapy and, most recently, TNFα antagonists treatment, with promising results.
We describe the long-term TNFα antagonists treatment results in patients with autoimmune uveitis refractory to immunosuppressive therapy.
Objectives To evaluate the long-term efficacy of TNFα antagonists treatment in autoimmune uveitis; the primary outcome measures were the visual acuity and the number of ocular inflammation relapses.
Methods Retrospective case series study. Patients with autoimmune uveitis refractory to immunosuppressive therapy, who started a TNFα antagonists treatment, were included.
It was considered as refractory if the patient had been treated with the highest dose of immunosuppressive therapy/steroids without a decrease in the inflammatory ocular activity.
Treatment efficacy was analyzed by measuring the visual acuity of 42 eyes at baseline, 6 and 12 months. It was also analyzed the number of uveitis relapses pre and post-treatment.
Results 24 patients were included (16 men 66.7% and 8 women, 33.3%), mean age 38.7 years (7-72 range). The diagnosis were: Spondyloarthropaty 9 (7 ankylosing spondylitis, 1 Reiter's syndrome, 1 axial Psoriatic arthritis), Behçet disease 3, juvenile idiopathic arthritis 3, Birdshot chorioretinopathy 2, Sarcoidosis 1, Idiopathic uveitis 6. Uveitis location was: 14 anterior, 1 intermediate, 3 posterior and 6 panuveitis. Six patients had unilateral uveitis and 18 had bilateral. During follow-up 7 patients developed cataract, 2 patients developed glaucoma and 2 patients developed optic nerve damage. All of them received previously immunossupresive therapy: Oral steroids (10), Salazopyrin (9), Metotrexate (7), Hydroxychloroquine (1), Azathioprine (7), Cyclosporine (4) and two of them other biologic agents previously (Infliximab, Abatacept). TNFα antagonists treatment used were Adalimumab 15, Infliximab 6, Etanercept 3. The average time of biological therapy has been 38 months (12-108 range)
Visual acuity in 42 analyzed eyes remained stable over time. It was, at baseline, 0.71±0.36, at 6 months 0.77±0.32 (p=0.054), and at 12 months 0.71±0.37 (p=0.974), remaining stable at the study end point. Analyzing separately anterior uveitis and the rest of them, differences in visual acuity weren't founded. The number of relapses has significantly decreased since the treatment started, from a mean of 3.58±2.6 at baseline to 0.08±0.28 (p<0.05) at six months visit and 0.21±0.41 (p<0.05) at 12 months visit.
Conclusions Therefore, TNFα antagonists treatment has proved to keep the visual acuity in autoimmune uveitis patients. The number of relapses has drastically dropped off after treatment beginning.
Disclosure of Interest None declared