Background Classic management of uveitis due to Behçet's disease (UBD) consists of conventional immunosuppressive drugs. However, UBD is often refractory requiring more intensive therapy.
Objectives To assess long-term response in UBD patients refractory to conventional therapy.
Methods Multicenter study of 165 patients with UBD followed-up in the uveitis units of 45 hospitals. All of them had inadequate response or intolerance to traditional treatment with corticosteroids and at least 1 systemic immunosuppressive drug. The degree of ocular inflammation was assessed as “the Standardization of Uveitis Nomenclature (SUN) working Group” (Am J Ophthalmol 2005; 140: 509-516), and macular thickness was assessed by optical coherence tomography (OCT). Comparisons were made between baseline and the 1st week, 2nd week, 1st month, 6th month, 1st, 2nd, 3rd,4th and 5th year.
Results 165 patients (89 men/76 women/297 affected eyes) with a mean age of 39.3±10.5 years (range 10-67) were studied. HLA-B51 was positive in 64.8%. Prior to biologic therapy and in addition to oral corticosteroids, patients had received the following drugs: Intravenous pulses of methylprednisolone (50 patients), cyclosporine A (CyA) (134), methotrexate (MTX) (72) and azathioprine (AZA) (87). Infliximab (IFX) was the first biologic used in 96 cases (58.2%) and adalimumab (ADA) in the remaining 69 (41.8%) patients. These agents were used as a monotherapy in 46 cases or in combination with immunosuppressive drugs: CsA (58 cases), MTX (34), AZA (24), mycophenolate (1), cyclophosphamide (1) and tacrolimus (1). The most common regimens were IFX 5 mg/kg/i.v. every 4-8 weeks and ADA 40 mg sc/2 weeks. In the course of the diseases, in cases of refractory uveitis to these drugs switching to other biologic agents was performed: golimumab (n=6), tocilizumab (5), rituximab (2), certolizumab (1) and etanercept (1). Nevertheless, in 30 cases the biologic agents were discontinued because of maintained clinical remission. Significant improvement observed since the 1sr week was observed in the visual acuity (VA), Tyndall and vitritis. OCT improvement was observed since the 2nd week (TABLE). At baseline, 57 patients (95 eyes) had macular thickening (OCT>250μ) and 33 patients (50 eyes) had cystoid macular edema (CME) (OCT>300μ). The OCT improved from 344.5±137.3 microns to 254.2±60.8 microns (p<0.01). After a mean follow-up of 38.3±22.4 months the most serious side effects were miliary TB (n=1), Mycobacterium avium pneumonia (n=1), melanoma (n=1), and fatal lymphoma (n=1).
Conclusions Biological treatment with IFX or ADA are effective and relatively safe in UBD refractory to conventional therapy.
Disclosure of Interest None declared