Abatacept As First Line Biological Treatment for Severe Juvenile Idiopathic Arthritis-Related Uveitis. A Multicenter Study

Carolina Birolo¹, Maria Elisabetta Zannin², Svetlana Arsenyeva³, Rolando Cimaz⁴, Elisabetta Miserocchi⁵, Margarita Dubko⁶, Chantal Deslandre⁷, Fernanda Falcini⁸, Maria Alessio⁹, Francesco La Torre¹⁰, Ekaterina Denisova¹¹, Irina Nikishina¹² and Francesco Zulian¹³, ¹Department of Pediatrics, Rheumatology Unit, University of Padua, Padua, Italy, ²Department of Pediatrics, Ophthalmology Unit, University of Padua, Padua, Italy, ³Pediatric Department, Scientific Research Institute of Rheumatology RAMS, Moskow, Russia, ⁴Rheumatology Unit, A. Meyer Children's Hospital, Florence, Italy, ⁵Department of Ophthalmology, Scientific Institute San Raffaele, University Vita-Salute, Milan, Italy, ⁶State Pediatric Medical University, Saint-Petersburg, Russia, ⁷Rheumatology, Cochin Hospital, Paris, France, ⁸Department of Biomedicine, Division of Rheumatology AOUC, Excellence Centre for Research, Florence, Italy, ⁹Department of Pediatrics, Rheumatology Unit, University of Naples Federico II, Naples, Italy, ¹⁰DIMIMP-University, Rheumatologic Section, Bari, Italy, ¹¹Helmgoltz Moscow Recearch Institute of Eye Diseases, Moskow, Russia, ¹²Pediatric Department, Scientific Research Institute of Rheumatology RAMS, Moskow, Moskow, Russia, ¹³Department of Pediatrics, University of Padua, Padova, Italy

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Abatacept and juvenile idiopathic arthritis (JIA)

Session Information

Title: Pediatric Rheumatology: Clinical and Therapeutic Disease II: Juvenile Idiopathic Arthritis II

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Anterior uveitis is a serious complication of Juvenile Idiopathic Arthritis (JIA). Recently, Abatacept (ABA) has been used in children with JIA-uveitis who had failed previous anti-TNF agents but little is known about its efficacy as first-line biological agent in severe JIA-related uveitis. Aim of the present study was to compare safety and efficacy of ABA used as first biological agent (ABA1^st) with ABA used after one or more anti-TNF agents (ABA2^nd), in patients with severe JIA-related uveitis.

Methods:

A retrospective multicenter collection of data of patients with severe, MTX-resistant JIA-related uveitis treated with ABA at a monthly dosage of 10 mg/kg, administered intravenously as first line or second line biological agent, was performed. Absolute frequency of uveitis flares before and after ABA treatment, changes in ocular complications and ABA-related side effects have been recorded. The number of active joints was also assessed at each visit.

Results:

Thirty-five JIA patients (33 females, 2 males) with a mean 12.5 years of age, and 7.7 years of uveitis duration have been treated with ABA for 19.6 months (range 5-42). Twenty-seven patients with MTX-refractory uveitis and at least 12 months follow-up entered study. 11 were included in the ABA1^st group and 16 in the ABA2^nd group. Age at uveitis onset, number of uveitis flares during 12 months before ABA and number of complicated uveitis were comparable in the two groups. The mean uveitis duration was significantly shorter in ABA1^st (5.1 versus 9.5 years, p=0.009). The mean frequency of uveitis flares during the 12 months before and after ABA decreased from 4.1 to 1.0 in ABA1^st (p=0.001) and from 3.5 to 1.1 in ABA2^nd (p=0.001). The efficacy was comparable in both groups and in all ABA showed a better performance after the first six months of treatment as 21/30 (70%) uveitis flares occurred during the first semester. Pre-existing ocular complications improved or remained stable in all but 2 patients. 15/22 patients (68.2%) with active arthritis at baseline were in remission at 12 months follow-up; in the others, the mean number of active joints decreased from 10.1 to 7.0. In this regard, no significant difference was observed between the two ABA treatment modalities. Two patients (7.4%) experienced adverse events (1 post-infusion headache, 1 weight gain) but no serious events were observed. Two patients (7.4%) withdrew from the study (after 5 and 9 months) because of ABA inefficacy on both ocular and articular symptoms.

Conclusion:

Abatacept, used as first-line biological treatment or after one or more anti-TNF agents, induced a comparable sustained improvement of refractory JIA-related uveitis. Efficacy was more evident during the second semester in both groups. Abatacept represents a treatment of choice in patients failing standard immunosuppressive treatment and/or anti-TNF agents for severe JIA-related uveitis.

Disclosure:

C. Birolo,
None;

M. E. Zannin,
None;

S. Arsenyeva,
None;

R. Cimaz,
None;

E. Miserocchi,
None;

M. Dubko,
None;

C. Deslandre,
None;

F. Falcini,
None;

M. Alessio,
None;

F. La Torre,
None;

E. Denisova,
None;

I. Nikishina,
None;

F. Zulian,
None.

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