Objectives To assess the efficacy of golimumab (GLM) in refractory uveitis associated to spondyloarthritis (SpA)
Methods Multicenter study of uveitis related to SpA that had been refractory to at least one immunosuppressive drug. The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, and macular thickness in cases of macular edema.
Results Nine patients (9 men) (11 affected eyes) with a mean age ± SD of 42.1±5.25 years (range 32-48) were evaluated. The pattern of ocular involvement was anterior uveitis (n=5) and anterior+intermediate (n=4). According to the course, uveitis was acute (n=1), chronic (n=4) or recurrent (n=4).
Besides oral steroids and before GLM onset they had received: intraocular corticosteroids (n=2), immunosupressive conventional drugs: MTX (n=7), AZA (3), SZP (4) and LFN (n=1) and biologic therapy: IFX ev 5mg/kg/6-8 week (n=3), ETN sc 50 mg/week (n=3), and ADA 40mg/2 week (n=2). GLM was started because of lack of efficacy of the previous treatments, at the standard dose of 50 mg/sc/month as a monotherapy (n=5) or combined (n=4) with MTX (n=2), AZA (n=1) and LFN (n=1).
Significant improvement of anterior chamber cells was observed (baseline: median 1 [IQR 0-3]), and (0 [0-1]) (p=0.01) and (0 [0-0]) (p=0.01) at 2 weeks and 6 months, respectively. The mean visual acuity also improved from a mean of 0.75±0.24 at baseline to 0.77±0.26 (p=0.1) and 0.85±0.27 (p=0.1) at 3 and 6 months, respectively, and the macular thickness (OCT) from a mean of 280±30 to 263±16 microns at 6 months. Corticosteroids were also tapered from a mean dose of prednisone at baseline of 31±20 mg/day to 27±18 and 14±11 mg/day at 2 weeks and 6 months respectively. After a mean follow-up of 13±7 months, 7 of 9 patients were on remission and the side-effects observed were not severe (injection site erythema in 1 case).
Conclusions Golimumab seems to be effective and safe in refractory uveitis related to SpA.
Disclosure of Interest None declared
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