Background Anti-TNF agents have deeply improved the therapeutic efficacy of spondyloarthritis (SpA)-related uveitis . Despite the benefits of anti-TNF drugs, patients need to stay on this treatment for a long time. There has been a clear medical need to consider the long-term safety and increased drug costs. Unanswered question for physicians is whether TNF blockers can be reduced or even stopped in SpA-related uveitis, or how can it be reduced in patients have achieved remission or LDA. The current study aimed to investigate the effectiveness and safety of adalimumab tapering strategy in SpA-related uveitis. We tried to find a way in balancing the quality of the patients' lives, the side effects and the cost-effectiveness.
Objectives The aim of this study was to evaluate the effectiveness of tapering of adalimumab combined with MTX in patients with spondyloarthritis (SpA)-related uveitis.
Methods We performed a retrospective analysis. SpA patients with uveitis admitted to a south China hospital were enrolled. Demographic information, clinical characteristics, laboratory findings, intraocular inflammation, visual acuity, and macular thickness were documented every 3 to 6 months.
Results In 32 cases of SpA-related uveitis who achieved clinical remission for at least 6 months after receiving a standard dose of adalimumab in combination of MTX, adalimumab was tapered and MTX was continued. Dosing interval of adalimumab were spaced by 30% every 3 months up to complete stop. Twenty-six cases without MTX were analyzed for comparison. No significant difference of demographic characteristics and BASDAI, CRP, ESR was found between the two groups at the baseline. During the first 12 months of adalimumab tapering, the mean BASDAI remained stable in both groups. No recurrent uveitis was found in the group with combined MTX. In the group without combined MTX, 2 patients (2/26, 7.7%) presented increased anterior chamber inflammation and visual acuity. At the end of 24 months, mean BASDAI, CRP and ESR remained low in both groups. Two cases (2/32, 6.3%) in the group of combined MTX were documented increased BASDAI higher than 4, but no recurrent uveitis was observed. Altogether 5 cases (5/32, 15.6%) in the group of combined MTX had recurrent uveitis, in which 4 cases (4/5, 80%) initiated adalimumab tapering at 6 months' remission. In comparison, 8 cases (8/26, 30.8%, p<0.001) in the group without combined MTX had recurrent uveitis, in which 6 cases initiated adalimumab tapering at 6 months' remission and 2 cases initiated adalimumab tapering at 9–12 months' remission. No patients had recurrent uveitis at 12 months' remission or longer in both groups. Adalimumab plus MTX were well tolerated in all patients.
Conclusions For maintaining remission of SpA-related uveitis, adalimumab tapering can be effective when combined with MTX. Initiation of the tapering after 12 months' remission largely lower the rate of recurrence.
Jaffe GJ, Dick AD, Brézin AP, et al. Adalimumab in Patients with Active Noninfectious Uveitis. N Engl J Med. 2016 Sep 8; 375(10):932–43.
Disclosure of Interest None declared
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