Objectives To assess the efficacy of anti-TNFα drugs in Sarcoid Uveitis (SU) refractory to conventional synthetic immunosuppressive drugs (CSISDs).
Methods Multicenter study (12 hospitals) of refractory SU to oral corticosteroids and at least one CSISD. Ocular inflammation was evaluated according to “SUN-2005”, and macular thickness by OCT. Results are expressed as mean ± SD (normal distribution), or as median [25th-75th interquartile range (IQR)] (not normally distributed) and Comparison by Wilcoxon test.
Results We studied 16 patients/27 eyes (7men/9women) with a mean age of 38.4±17.2 years (range 13-76). They showed: elevated Angiotensin-Converting Enzyme (56.2%), bilateral hiliar lymphadenopathy (56.2%), lung parenchymal involvement (43.7%), and involvement of other organs (56.2%). A biopsy confirmed sarcoidosis in the 31.2% of cases. The most frequent pattern of uveitis was bilateral chronic remitting panuveitis and the most frequent ocular inflammatory findings were mutton-fat keratic precipitates and snow balls in vitreous. Besides oral corticosteroids and before anti-TNFα, patients had received i.v. methylprednisolone (n=1), methotrexate (n=12), cyclosporine A (n=5), or azathioprine (n=3). The first anti-TNFα was: adalimumab (n=9; 56.3%) (40 mg/sc/2 weeks) and infliximab (n=7; 43.7%) (5 mg/kg/i.v./every 4-8 weeks), and was used in combination (n=13) with MTX (n=10), AZA (n=2) and mycophenolate mofetil (n=1). Infliximab was successfully switched to golimumab (n=2) due to intolerance. The mean duration of anti-TNFα was 27.7±16.8 months. The results with anti-TNFα after 2 years were: Visual acuity: from a mean of 0.6±0.3 to 0.8±0.2 (p=0.03); Tyndall: from a median of 1 [IQR: 0-3] to 0 [IQR: 0-2] (p=0.017) and vitritis: from a median of 0 [IQR: 0-3] to 0 [IQR: 0-1] (p=0.03). Six patients (7 eyes) with cystoid macular edema (CME) (OCT>300μ) at baseline, improved from 372±58.3 to 241±1.4 microns at 2 years (p=0.17).
Conclusions Anti-TNF therapy seems effective in SU refractory to CSISDs.
Acknowledgements This study was supported by a grant from “Fondo de Investigaciones Sanitarias”PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from“Instituto de Salud Carlos III” (ISCIII) (Spain).
Disclosure of Interest : None declared