ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2112

Anti-TNFα Versus Rituximab in Refractory Peripheral Ulcerative Keratitis Associated to Rheumatic Diseases. Multicenter Study of 24 Patients

Lucia C. Domínguez-Casas1, Vanesa Calvo-Río1, Olga Maiz-Alonso2, Ana Blanco3, Emma Beltran4, Lucía Martínez Acosta5, Maria Concepcion Alvarez de Buergo6, Esteban Rubio-Romero7, David Diaz-Valle8, R López-González9, Angel Garcia-Aparicio10, Antonio Juan Mas11, Enar Pons1, Rosalia Demetrio12, Nuria Vegas-Revenga1, José Luis Martín-Varillas1, Belén Atienza-Mateo1, Carlos Fernández-Díaz1, Jose L. Hernández13, Miguel Angel González-Gay1 and Ricardo Blanco1, 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, 2Hospital Universitario Donostia. San Sebastian. Spain, Donostia, Spain, 3Ophthalmology, Hospital Universitario Donostia. San Sebastian. Spain, San Sebastián, Spain, 4Rheumatology, Hospital General Universitario de Valencia. Spain, Valencia, Spain, 5Ophtalmology, Hospital Peset. Valencia. Spain, Valencia, Spain, 6Rheumatology, Hospital Río Carrión. Palencia. Spain, Palencia, Spain, 7Hospital Universitario Virgen del Rocío. Sevilla. Spain, Sevilla, Spain, 8Hospital Clínico San Carlos. Madrid. Spain, Madrid, Spain, 9Rheumatology, Complejo Hospitalario de Zamora. Spain, Zamora, Spain, 10Rheumatology, Hospital de Toledo. Toledo. Spain, Toledo, Spain, 11Rheumatology, Hospital Son Llàtzer. Palma de Mallorca. Spain, Mallorca, Spain, 12Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, 13Internal Medicine, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords:

Session Information

Date: Tuesday, November 7, 2017

Title: Miscellaneous Rheumatic and Inflammatory Diseases Poster II

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose:

Peripheral ulcerative keratitis (PUK) is a severe inflammation of the outer portions of the cornea that may lead to perforation. It may be associated to rheumatic diseases. The treatment is based on systemic corticoisteroids and conventional immunosuppressive drugs. In refractory cases biological therapy may be needed. Our aim was to compare anti-TNFα vs Rituximab (RTX) in refractory PUK.

Methods:

Multicenter study of 24 patients with PUK. All of them presented inadequate response to corticosteroids and at least 1 systemic traditional immunosuppressive drug.

Anti-TNFα were used in 17 patients: Adalimumab (n=9) 40 mg/sc every 1-2 weeks, infliximab (IFX) (n=7) 3-5 mg/kg iv/4-6 weeks, etanercept (n=1) 50 mg/week. RTX was used in 7 patients 1-2 g i.v. every 6 or 12 months.

The main outcomes were Best Corrected Visual Acuity (BCVA), signs of inflammation (scleritis and episcleritis), progression to corneal thinning, central keratolysis and ocular perforation.

Comparisons were made between baseline and 1st month, 6th month and 1st year (STATISTICA, StatSoft Inc. Tulsa, Oklahoma, USA). Quantitative variables were expressed as mean±SD or median [IQR], accordingly to its distribution. They were compared with the Student t or the Mann-Whitney U test respectively. Dichotomous variables were expressed as percentages and compared by the chi-square test.

Results:

We studied 24 patients/32 affected eyes. The underlying diseases in the anti-TNFα group were Rheumatoid Arthritis (RA) (n=14), Psoriasic Arthritis (n=2) and Behçet Disease (n=1); and in the RTX group: RA (n=5), granulomatous polyangiitis (n=1) and microscopic polyangiitis (n=1).

At baseline there were no significant differences between both groups in general features or in ocular involvement (TABLE). Before biological therapy they had received the following systemic drugs (anti-TNFα vs RTX) i.v. metilprednisolone (2 vs 4), doxycycline (7 vs 1), ascorbic acid (2 vs 0), MTX (11 vs 4), AZA (1 vs 2) and others (7 vs 3). In addition, 10 patients, in both groups, had to be undergoing to surgery: amniotic membrane (n=5), penetrating keratoplasty (n=2), conjunctival resection (n=2), tissue adhesives (n=2), conjunctival flap (n=1) and lamellar keratoplasty (n=1).

Once the treatment was iniciated the ocular evolution was similar (TABLE).

After a men follow-up of 22.53±22.60 (anti-TNFα) and 22.28±8.28 months with RTX the following severe side effects were observed: supraventricular tachycardia (n=1) with RTX and pulmonary Tuberculosis (n=1) with IFX.

Conclusion:

In this study, anti-TNFα therapy and RTX seem to be equally effective for the treatment of peripheral ulcerative keratits associated to rheumatic diseases refractory to conventional treatment.

TABLE. Evolution of ocular parameters with antiTNFa and RTX

anti-TNFα

n=17

RTX

n= 7

p

General features

Sex (♂/♀)

4/2

13/5

0.79

Mean age (years)

59.1±18.3

54.28±10.7

0.49

Ocular bilateral involvement #

23.53

57.14

0.13

Duration of underlying diseases (days)

183.06±18.3

138.85±77.68

0.59

Basal

BCVA*

0.58±0.38

0.56±0.34

0.68

Peripheral thinning #

18

9

0,77

Central keratolysis #*

4

1

0.59

Ocular perforation #

2

1

0.89

Scleritis #

3

8

0.001

Episcleritis #

3

4

0.15

Uveitis #

3

2

0.77

1st month

BCVA *

0.67±0.31

0.56±0.27

0.67

Peripheral thinning #

5

6

0.032

Central keratolysis #*

–

–

–

Ocular perforation #

–

–

–

Scleritis #

1

1

0.54

Episcleritis #

1

0

0.45

Uveitis #

1

2

0.23

6th month

BCVA *

0.7±0.25

0.73±0.29

0.67

Peripheral thinning #

9

3

0.14

Central keratolysis #*

0

3

0.028

Ocular perforation #

–

–

–

Scleritis #

–

–

–

Episcleritis #

–

–

–

Uveitis #

1

0

0.38

1st year

BCVA *

0.75±0.22

0.70±0.24

0.77

Peripheral thinning #

7

3

0.25

Central keratolysis #*

1

1

0.89

Ocular perforation #

0

1

0.30

Scleritis #

–

–

–

Episcleritis #

–

–

–

Uveitis #

1

0

0.35

* Results are expressed as mean±SD; # Results are expressed as %

Disclosure: L. C. Domínguez-Casas, None; V. Calvo-Río, None; O. Maiz-Alonso, None; A. Blanco, None; E. Beltran, None; L. Martínez Acosta, None; M. C. Alvarez de Buergo, None; E. Rubio-Romero, None; D. Diaz-Valle, None; R. López-González, None; A. Garcia-Aparicio, None; A. J. Mas, None; E. Pons, None; R. Demetrio, None; N. Vegas-Revenga, None; J. L. Martín-Varillas, None; B. Atienza-Mateo, None; C. Fernández-Díaz, None; J. L. Hernández, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Domínguez-Casas LC, Calvo-Río V, Maiz-Alonso O, Blanco A, Beltran E, Martínez Acosta L, Alvarez de Buergo MC, Rubio-Romero E, Diaz-Valle D, López-González R, Garcia-Aparicio A, Mas AJ, Pons E, Demetrio R, Vegas-Revenga N, Martín-Varillas JL, Atienza-Mateo B, Fernández-Díaz C, Hernández JL, González-Gay MA, Blanco R. Anti-TNFα Versus Rituximab in Refractory Peripheral Ulcerative Keratitis Associated to Rheumatic Diseases. Multicenter Study of 24 Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/anti-tnf%ce%b1-versus-rituximab-in-refractory-peripheral-ulcerative-keratitis-associated-to-rheumatic-diseases-multicenter-study-of-24-patients/. Accessed .

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