Background In patients undergoing a biologic due to uveitis associated to Behçet´s syndrome (BS) may occurr: a)switched to another because of insufficient response (IR), toxicity, or change in the route of administration, b)discontinuation or reduction of dose due to remission.
Objectives To study these situations in a large series of BS patients.
Methods Study of 108 patients with uveitis refractory to conventional therapy who required at least 1 biologic. Standard dose of Infliximab (IFX): 5 mg/k/iv at 0,2,6 and every 4-8 weeks, Adalimumab (ADA) 40 mg/sc/2 weeks, golimumab (Goli) 50 mg/4 weeks, tocilizumab (TCZ) 8 mg/kg/iv/4 weeks and rituximab (RTX) 1g/iv/15 days (2 doses) every 6 months.
Results Biologic used as the 1st choice: IFX (65 patients) or ADA (43). IFX-treated patients received IFX at 5 mg/k/i.v. (59 cases), 3 mg/kg (5), IFX 4 mg/kg (1). Initial IFX was changed to another single biologic in 26 cases; 24 to ADA, 1 to RTX, and 1 to etanercept. The initial ADA was changed to another single biologic in 6 cases; 2 to Goli, 4 to IFX and 1 to TCZ. In 3 cases there was a double biologic switching, ADA to Goli and to IFX (2 cases) and IFX to ADA and to TCZ (1 case). Improvement was achieved in: 9 of 11 patients with switching from IFX to ADA because of IR and in 2 of the 3 switched from ADA to another biologic.
In 54 (50%) patients in persistent remission the dose was reduced or discontinued. IFX was decreased from 5 to 3 mg/k/iv (4 patients) or the interval was increased (22 patients). ADA interval was increased for more than 2 weeks (11 patients). Biologic was discontinued in 17 cases (11 IFX and 6 ADA). After a mean follow-up of 10.4±8.7 months after discontinuation, 13 of 17 remained on remission while 4 had a flare that led to the resumption of the same agent achieving remission again.
Conclusions Switching of biologic agents may be useful. Once clinical remission is achieved, dose reduction or discontinuation of the biologic may be obtained
Disclosure of Interest None Declared
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