Background/Purpose

Anti-TNF-α therapy may be useful in cases of uveitis refractory to standard synthetic immunosuppressive drugs. Infliximab (IFX) and adalimumab (ADA) are the biologic agents more frequently used. To our knowledge information on Certolizumab Pegol (CZP) in patients with uveitis is scarce. Due to this, we assessed the efficacy of CZP in a series of patients with uveitis refractory to other anti-TNF-α drugs.

Methods

Study from 3 tertiary referral centers that included patients with uveitis that had been refractory to previous standard synthetic immunosuppressive and at least 1 anti-TNF-α drug. For the inclusion in the assessment a follow-up of at least 6 months was required.

Outcome was measured according to SUN criteria (Jabs et al. 2005) for anterior chamber inflammation (0 to 4+) and scale (0 to 4+) for vitreous haze (Bloch-Michel 1997). Best corrected visual acuity (BCVA) was measured by Snellen charts and converted to logarithm (LogMAR) (Jabs 2005). Macular thickness was defined by OCT.

Results

We studied 7 patients (14 affected eyes) (4 men/3 women) with a mean age of 42.4±8.8 years. The main underlying diseases were: Behçet disease (3 cases), idiopathic retinal vasculitis (1 case), ankylosing spondylitis (1 case), psoriatic arthritis and Crohn’s disease (1 case) and relapsing polychondritis (1 case). All patients suffered from long-lasting chronic-relapsing ocular inflammation with a median evolution time until CZP onset of 108 (range 68-302) months.

The 1st biological drug was IFX. It was changed to ADA because of serious adverse events (n=3) or loss of efficacy (n=4). However, ADA was withdrawn in all these cases because of inefficacy (n=6) or lupus-like reaction (n=1)]. Afterward, 3 patients were switched to golimumab (GLM) and 1 to etanercept (ETN) (TABLE). Due to inefficacy, all 7 patients were switched to CZP that was administered at the standard dose (induction dose of 400 mg q2w for 4 weeks followed by 200mg q2 w for maintenance). After a mean follow-up of 10.4±4.8 months since CZP onset, 5 (71.4%) patients achieved remission and 4 of them could withdraw oral prednisone. Mean logMAR visual acuity improved significantly from 0.41±0.48 at baseline to 0.34±0.45 at first month (p=0.03) and remained stable since then. Macular edema was present in 4 eyes (3 patients) at baseline. The mean OCT decreased from 328.3±96.5 microns at baseline to 303.1±81.8 at final visit (p=0.099). CZP was well tolerated in all cases and no adverse event was observed during follow-up.

Conclusion

CZP can be an alternative to other anti-TNF-α agents in patients with refractory uveitis.

TABLE