Background/Purpose:

Uveitis related to sarcoidosis is a potentially severe complication. Corticosteroids are the first line of treatment. In refractory cases or in those with unacceptable side effects, traditional synthetic immunosuppressive drugs are used. TNF-α has been implicated in the pathogenesis of sarcoidosis. Our aim was to evaluate both short and long-term response to anti-TNF therapy in uveitis associated to sarcoidosis refractory to standard systemic treatment.

Methods:

Multicenter study of 16 patients followed in the uveitis units from 12 hospitals. All of them presented inadequate response or intolerance to conventional therapy with corticosteroids and at least 1 systemic synthetic immunosuppressive drug.

The degree of ocular inflammation was evaluated according to “The Standardization of Uveitis Nomenclature (SUN) Working Group” (Am J Ophthalmol 2005; 140: 509-516), and macular thickness by optical coherence tomography (OCT). Results were expressed as mean± SD for variables with a normal distribution, or as median [25th-75th interquartile range (IQR)] when they were not normally distributed. Comparison of continuous variables was performed using the Wilcoxon test.

Results:

We studied 16 patients/ 27 affected eyes (7 men, 9 women) with a mean age of 38.4±17.2 years (range 13-76). Angiotensin-Converting Enzyme (ACE) was elevated at 56.2% of patients. We observed bilateral hilar lymphadenopathy (56.2%), lung parenchymal involvement (43.7%), peripheral lymph nodes (37.5%) and involvement of other organs (56.2%). In 31.2% of patients the diagnosis was confirmed by a biopsy. The most frequent pattern of ocular involvement was bilateral chronic relapsing panuveitis and the most characteristic findings were Mutton-fat keratic precipitates and snowballs in vitreous. Besides oral corticosteroids and before the onset of biologic therapy patients had received i.v. boluses of methylprednisolone (1 patient), methotrexate (MTX) (12), cyclosporine A (CyA) (5), or azathioprine (AZA) (3). The first biologic agent used was: infliximab (IFX) in 7 cases (43.7 %) and adalimumab (ADA) in 9 cases (56.3 %). They were used in 3 cases as monotherapy and in the remaining cases in combination with: MTX (10), AZA (2) and Mycophenolate mofetil (1). IFX 5 mg/kg /i.v./every 4-8 weeks and ADA 40 mg/sc/2 weeks were the most patterns of administration. During the follow-up, due to intolerance, IFX was successfully switched to golimumab in 2 cases. The mean duration of follow-up after the onset of anti-TNF therapy was 27.7±16.8 months.  Overall, improvement was observed after 2 years of therapy: Baseline results versus results after 2 years of biologic therapy were the following: Visual acuity (VA): baseline 0.6± 0.3; after 2 years: 0.8±0.2; p=0.03; Tyndall from a median [IQR] of 1 [0-3] to 0 [0-2] (p=0.017) and vitritis, from a median [IQR] of 0 [0-3] to 0 [0-1] (p=0.03). At baseline, 6 patients, (9 eyes) had macular thickening (OCT>250μ) and 6 patients (7 eyes) had cystoid macular edema (CME) (OCT>300μ). CME improved from 372±58.3 microns to 241±1.4 microns at 2 years (p=0.17).

Conclusion:

Anti-TNF therapy seems effective in patients with uveitis secondary to sarcoidosis refractory to conventional immunosuppressive therapy.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/biologic-therapy-in-refractory-uveitis-of-sarcoidosis-multicenter-study-of-16-patients/