Background In non-infectious no anterior uveitis, adalimumab (ADA) is the only biologic that has shown efficacy in phase III randomized, double blind studies, such as VISUAL I and VISUAL II. (Brezin AP et al Arthritis Rheumatol 2015;67 (suppl 10): 2038 & Nguyen QD et al Arthritis Rheumatol 2015; 67 (suppl 10): 1388).
After a 80 mg loading dose, maintenance dose is the standard for other indications, 40 mg/sc/2 weeks.
Objectives Our objective is to test a series of Behcet's síndrome uveítis, and proving if once remission was obtained, it was posible to “optimize” the maintenance dose.
Methods Multicenter study of 174 patients with Behcet's síndrome refractory uveitis. All of them had insufficient response or intolerance to conventional treatment with corticosteroids and at least 1 systemic immunosuppressive drug. 71 patients started treatment with ADA and once remission was achieved, it was optimized in 23 of them.
The degree of ocular inflammation was assessed by “the Standardization of Uveitis Nomenclature (SUN) Working Group” (Am J Ophthalmol 2005; 140: 509–516), and macular thickness by optical coherence tomography (OCT). A comparison was made between the first visit before initializing ADA at standard dose, the start of the optimization of the drug, and the final visit.
The results are expressed as mean ± 1 SD for variables with a normal distribution, and as median [IQR 25–75] (range) when it is not normal. Comparison of continuous variables was performed using the Wilcoxon test.
Results 23 patients/42 affected eyes (15 men/8 women) who had a dose optimization were studied, the median age was 37.2 ± 13.4 years (range 10–62).
HLA-B51 was positive in 60.8%. Prior to ADA, and as systemic treatment besides oral steroids, they had received intravenous methylprednisolone bolus (n=7), cyclosporin A (CyA) (n=20), methotrexate (MTX) (n=11) and azathioprine (AZA) (n=11).
ADA monotherapy was used in 5 cases and also in combination with immunosuppressants: CyA (n=12), MTX (n=4) and AZA (n=2). The average remission before optimization of the dose was 15.3 ± 9 months. In 23 patients the interval dose of adalimumab was progressively increased to 3 weeks (n=6), 4 weeks (n=13), 5 weeks (n=1), 6 weeks (n=1) and 8 weeks (n=2).
Only 2 patients had to return to the standard dose of ADA due to serious outbreak after optimizing the drug, reaching again remission of uveitis. It was also posible to suspend ADA in 4 patients after 35.2 ± 9.3 months in remission, not presenting a new outbreak after a mean of 20 ± 6.9 months following the suspension. There were not serious side effects during a mean follow-up of 34.7 ± 13.3 months after starting ADA.
Conclusions Optimizing ADA therapy, once remission is achieved, seems feasible in Behcet's síndrome uveítis refractory to systemic treatment.
Disclosure of Interest None declared