Article Text

PDF
AB0586 Short and Long-Term Anti-TNF-Alpha Therapy in Refractory Uveitis. Study of 40 Adult Patients from A Single Universitary Center
  1. F.M. Ortiz-Sanjuán1,
  2. V. Calvo-Río1,
  3. R. Blanco1,
  4. J. Cañal-Villanueva2,
  5. J. Ventosa2,
  6. J. Loricera1,
  7. M. Santos-Gόmez1,
  8. T. Pina1,
  9. M.A. González-Gay1
  1. 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL
  2. 2Ophthalmology, Hospital Universitario Marqués de Valdecilla, Santander, Spain

Abstract

Objectives To assess the efficacy and safety of anti-TNFα drugs in refractory uveitis to conventional synthetic immunosuppressive drugs (CSISDs).

Methods Study of refractory uveitis from a single Universitary hospital who had failed to at least one CSISD. The degree of ocular inflammation was established according to SUN-2005. Macular thickness was evaluated by OCT. We compared data between baseline 1st month, and 1st, 2nd, 3rd and 4th year (Wilcoxon test).

Results We studied 40 adult patients/62 affected eyes (16 men/24 women); mean age, 39.3±11.5 years. The underlying pathologies were Spondyloarthritis-HLA-B27+ (n=7), Behçet disease (n=6), sarcoidosis (n=6), VKH (n=2), Birdshot (n=1), serpinginous (n=1), sympathic opthalmopathy (n=1), Juvenile Idiopathic Arthritis (n=1) and idiopathic uveitis (n=15).

Besides oral corticosteroids and before anti-TNFα, patients had received methylprednisolone i.v. (n=9), methotrexate (n=16), cyclosporine A (n=13) and azathioprine (n=10). The first anti-TNFα was: adalimumab (n=18; 45%) (40 mg/sc/2 weeks) and infliximab (n=22; 55%) (5 mg/kg/i.v./every 4-8 weeks. Anti-TNFα drugs were used as monotherapy (n=8), or combined with methotrexate (n=18), azathioprine (n=10), Cyclosporine A (n=3) and salazopyrine (n=1). Adalimumab was switched to golimumab (50 mg/sc/week) (n=2) and to tocilizumab (n=2). Infliximab was switched to adalimumab (n=8) and to golimumab (n=2).

Visual acuity (VA), Tyndall, vitritis and OCT experienced significant improvement at the 1st month, and 1st, 2nd and 3rd year. The mean OCT in cases of cystoid macular edema (OCT>300 μ) (n=11 eyes) improved from 382.2±98.4 (baseline) to 195.5±38.9 microns (1st year).

After a mean follow-up of 40.7±25 months anti-TNFα drugs was well tolerated in most cases. The most important side effects were pulmonary TBC (n=1), herpes zoster (n=2), urinary tract infection (n=3) and elevation of liver enzymes during treatment (n=2).

Conclusions Anti-TNFα therapy seems effective and relatively safe in refractory uveitis.

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

DOI 10.1136/annrheumdis-2014-eular.3369

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.