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  • FRI0498 Comparative study of the treatment of refractory cystoid macular oedema to conventional immunosuppressive therapy: tocilizumab vs anti-tnf. multicenter study of 59 patients

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FRIDAY, 15 JUNE 2018
Vasculitis
FRI0498 Comparative study of the treatment of refractory cystoid macular oedema to conventional immunosuppressive therapy: tocilizumab vs anti-tnf. multicenter study of 59 patients
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  1. J.L. Martín-Varillas1,
  2. V. Calvo-Río1,
  3. R. Demetrio-Pablo1,
  4. B. Atienza-Mateo1,
  5. J. Loricera1,
  6. M.V. Hernández2,
  7. A. Adán2,
  8. M. Mesquida2,
  9. S. Insua3,
  10. J.M. Herreras4,
  11. O. Maíz5,
  12. A. Blanco5,
  13. M. Gandía6,
  14. D. Díaz7,
  15. L. Martínez8,
  16. E. Valls8,
  17. G. Díaz9,
  18. M. Díaz10,
  19. I. Calvo10,
  20. I. Torre11,
  21. A. Atanes12,
  22. L. Linares13,
  23. M. Hernández14,
  24. E. Beltrán15,
  25. M. Cordero16,
  26. E. Aurrecoechea17,
  27. F.F. Hernández18,
  28. R. Almodovar19,
  29. Ó. Ruiz20,
  30. F. Jiménez20,
  31. J.M. Nolla21,
  32. C. Modesto22,
  33. M.A. González-Gay1,
  34. R. Blanco1
  1. 1Rheumatology and Ophthalmology, HUMV, IDIVAL, Santander
  2. 2Rheumatology and Ophthalmology, H Clinic, Barcelona
  3. 3Rheumatology, H Santiago Compostela, Santiago Compostela
  4. 4Ophthalmology, H Valladolid, Valladolid
  5. 5Rheumatology and Ophthalmology, H Donosti, San Sebastián
  6. 6Rheumatology, H Puerta del Mar, Cádiz
  7. 7Ophthalmology, H San Carlos, Madrid
  8. 8Rheumatology and Ophthalmology, H Peset, Valencia
  9. 9Rheumatology, H Málaga, Málaga
  10. 10Rheumatology and Ophthalmology, H La Fe, Valencia
  11. 11Rheumatology, H Basurto, Bilbao
  12. 12Rheumatology, H Coruña, Coruña
  13. 13Rheumatology, H Arritxaca, Murcia
  14. 14Ophthalmology, H Valencia, Valencia
  15. 15Rheumatology, H del Mar, Barcelona
  16. 16Ophthalmology, H León, León
  17. 17Rheumatology, H Sierrallana, Torrelavega
  18. 18Rheumatology, H Doctor Negrín, Las Palmas
  19. 19Rheumatology, H Alcorcón, Madrid
  20. 20Rheumatology and Ophthalmology, H Miguel Servet, Zaragoza
  21. 21Rheumatology, H Bellvitge
  22. 22Rheumatology, H Vall d’Hebron, Barcelona, Spain

Abstract

Background Cystoid macular oedema (CME) is the most serious complication of uveitis. This potentially severe complication may lead to irreversible visual loss.1–2

Objectives To compare efficacy and safety of Tocilizumab (TCZ) vs. Anti-TNF-α drugs in patients with refractory CME to conventional immunosuppressant (IS).

Methods Multicenter study of patients with refractory CME to treatment with glucocorticoids and at least 1 conventional IS. The main objective was the improvement of macular thickness. Secondary objectives were the enhancement in best corrected visual acuity (BCVA) and the degree of ocular inflammatory activity.

Results 59 patients/112 affected eyes. Causes of uveitis were: Behçet’s disease (n=41), Birdshot’s retinochoroidopathy (n=4), Juvenile Idiopathic Arthritis (n=9), Sarcoidosis (n=1) and idiopathic (n=4). No significant differences were observed at baseline in both groups (TCZ vs Anti-TNF-α) in sex (♂/♀; 8/17 vs. 15/19), mean age (35.6±18.9 vs 40.0±9.1), BCVA (0.40±0.31 vs. 0.48±0.31), Tyndall (1 [0–1] vs. 1 [0–2]), vitritis (1 [0–2] vs. 1 [0–3]) and macular thickness (431.8±165.9 vs. 397.1±138.1) (table 1).

25 patients were treated with TCZ as follows: 8 mg/kg/4 weeks (n=24) and 162 mg sc/2 weeks (n=1). Anti-TNF-α therapy was used in the remaining 34 as follows: IFX (n=12) (5 mg/kg 0, 2 y 6 weeks and every 4–8 weeks) and ADA (n=22) (40 mg/sc/2 weeks).

We observed a rapid and sustained improvement in macular thickness after 1 year follow-up in both groups, without objectifying significant differences between them. In the same way, secondary ocular parameters also improved (table 1).

View this table:
Abstract FRI0498 – Table 1

Conclusions TCZ and Anti-TNF-α are effective in the treatment of CME refractory to conventional therapy.

References [1] Calvo-Río V, Blanco R, Beltrán E, et al. Anti-TNF-alfa therapy in patients with refractory uveitis due to Behçet’s disease: a 1-year-follow-up study of 124 patients. Rheumatol. 2014;53(12):2223–31.

[2] Calvo-Río V, Blanco R, Santos-Gómez M, et al. Efficacy of anti-il6-receptor tocilizumab in refractory cystoid macular edema of Birdshot retinochoroidopathy report of two cases and literature review. Ocul Immunol Inflamm. 2017;25(5):604–609.

Disclosure of Interest None declared

https://doi.org/10.1136/annrheumdis-2018-eular.3999

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