ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2723

Adalimumab Therapy Optimization in Refractory Uveitis Due to Behçet’s Disease after Achieving Remission. interventional Versus Control Group

Belén Atienza-Mateo1, José Luis Martín-Varillas1, Nuria Vegas-Revenga1, Lucia C. Domínguez-Casas1, Vanesa Calvo-Río1, Emma Beltrán2, Juan Sánchez-Burson3, Marina Mesquida4, Alfredo Adán4, M Victoria Hernández4, Marisa Hernández Garfella2, Elia Valls Pascual5, Lucía Martínez Costa5, Agustí Sellas-Fernandez6, Miguel Cordero Coma7, Manuel Díaz-Llopis8, Roberto Gallego8, David Salom8, Norberto Ortego9, José L. García-Serrano9, José-Luis Callejas-Rubio9, José M. Herreras10, Ángel M García-Aparicio11, Olga Maíz12, Ana Blanco13, Ignacio Torre14, David Díaz Valle15, Esperanza Pato15, Elena Aurrecoechea16, Miguel A. Caracuel17, Fernando Gamero18, Enrique Mínguez19, Carmen Carrasco Cubero20, Alejandro Olive21, Julio Vázquez22, Oscar Ruiz Moreno23, Fernando Jiménez-Zorzo24, Javier Manero24, Myriam Gandia Martinez25, Esteban Rubio-Romero26, F. Javier Toyos-Sáenz de Miera27, Javier López-Longo28, JM Nolla29, Marcelino Revenga30, Rosalia Demetrio31, Enar Pons31, Miguel Angel González-Gay1 and Ricardo Blanco32, 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, 2Hospital General Universitario de Valencia, Valencia, Spain, 3Hospital de Valme, Sevilla, Spain, 4Hospital Clinic, Barcelona, Spain, 5Hospital Peset, Valencia, Spain, 6Hospital Vall d´Hebron, Barcelona, Spain, 7Hospital de León, León, Spain, 8Hospital Universitario La Fe, Valencia, Spain, 9Hospital San Cecilio, Granada, Spain, 10Hospital Universitario IOBA, Valladolid, Spain, 11Hospital Donosti, San Sebastián, Spain, 12Hospital Donosti, San Sebastian, Spain, 13Ophthalmology, Hospital Universitario Donostia. San Sebastian. Spain, San Sebastián, Spain, 14Hospital Basurto, Bilbao, Spain, 15Hospital Clínico San Carlos, Madrid, Spain, 16Hospital Sierrallana, Torrelavega, Spain, 17Hospital Córdoba, Córdoba, Spain, 18Hospital San Pedro Alcántara, Cácerer, Spain, 19Hospital Clínico Zaragoza, Zaragoza, Spain, 20Hospital Universitari Germans Trias i Pujol, Barcelona, Spain, 21Hospital Universitari Germans Trias i Pujol, Barcelona, Spain, 22Hospital de Ferrol, A Coruña, Spain, 23Ophthalmology and Rheumatology., Ophtalmology. Hospital Miguel Servet. Zaragoza. Spain, Zaragoza, Spain, 24Hospital Miguel Servet, Zaragoza, Spain, 25Hospital Puerta del Mar, Cádiz, Spain, 26Hospital Universitario Virgen del Rocío, Sevilla, Spain, 27Hospital Universitario Virgen Macarena, Sevilla, Spain, 28Hospital Gregorio Marañón, Madrid, Spain, 29Hospital Universitari de Bellvitge, Barcelona, Spain, 30Hospital Universitario Ramón y Cajal, Madrid, Spain, 31Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria., Santander, Spain, 32Hospital Universitario Marqués de Valdecilla, Santander, Spain

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ,

Session Information

Date: Tuesday, November 7, 2017

Title: Vasculitis Poster III: Other Vasculitis Syndromes

Session Type: ACR Poster Session C

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

Background/Purpose: Adalimumab (ADA) therapy has been approved by the EMA and the FDA in non-infectious and non-anterior uveitis. After loading, the maintenance dose is 40 mg subcutaneously every other week. However, the duration of ADA therapy is not well established. Our purpuse is to assess the long-term follow-up of a large series of patients with refractory uveitis due to Behçet Disease (BD) undergoing ADA therapy who experienced clinical remission and to compare the outcome of BD patients in whom ADA treatment was optimized when clinical remission was achieved with those in whom ADA optimization was not performed (control group).

Methods: Multicenter study that included 74 patients with BD uveitis refractory to glucocorticoids and conventional immunosuppressive drugs who required treatment with ADA. BD uveitis remission was defined if there was not apparent anterior and posterior chamber inflammation for at least 3 months. Based on a shared decision between the patient and the physician, once ocular remission was achieved, ADA therapy was optimized. It was performed increasing the interval between ADA doses progressively as follows: Initially every 3 weeks and then every 4, 6, 7 and 8 weeks up to discontinuation. Ocular inflammation was evaluated according to “SUN” (Am J Ophthalmol 2005; 140: 509-516). Macular thickening was evaluated with Optical Coherence Tomography (OCT).

Results: Ocular remission was achieved in 65 of 74 (86.6%) patients. ADA was optimized in 23 of these 65 patients (35.3%). In the remaining 42 patients ADA was maintained at standard dose (40 mg/sc/2 weeks). No demographic or ocular differences between the optimized (n=23) and the control group (n=42) were observed at the onset of ADA therapy. At last follow-up BCVA was significantly higher in the optimized group when compared to the control (non-optimized) group. No other significant clinical differences between both groups were seen (TABLE). No relevant adverse effects were seen in the optimized group. It was not the case in the non-optimized BD patients who had the following complications: 1 lymphoma, 1 pneumonia, 1 severe local reaction at the injection site and 1 bacteremia by E. coli. After 34.7±13.3 months follow-up, ADA intervals at last visit in the optimized group (n=23) were as follows: every 3 weeks (n=6), 4 weeks (10), 5 weeks (1), 8 weeks (2), and discontinued (n=4). ADA dose (40 mg/sc/2 weeks) has to be reinitiated at the standard dose (40 mg/sc/2 weeks) due to ocular relapses in only 2 of 23 patients had a, achieving again remission. Results were expressed as mean±SD for normally distributed variables or as median [25-75 IQR] for those that did not follow a normal distribution.

Conclusion: Most patients with refractory uveitis due to BD undergoing ADA therapy achieve remission. ADA optimization can be successfully perfomed.

Table.

Optimized Group

N=23

Non Optimized Group

N= 42

P

Demographic features

Age (years)

37.2±13.1

39.1±9.3

0.5

Sex (n, ♂/♀)

15/8

19/23

0.13

Positive HLA-B51(%)

61

74

0.26

Duration of uveitis (months) prior to ADA(median [IQR])

43 [23-74.5]

24 [6-36]

0.1

Previous Immunosuppressants (n) (mean±S.D.)

2±1.1

1.7±1.1

0.3

Ocular pattern at ADA onset

BCVA (mean±S.D.)

0.61±0.36

0.56±0.33

0.46

AC cells (median [IQR])

0 [0-2]

1 [0-2]

0.85

Vitritis (median [IQR])

1 [0-2]

1 [0-2]

0.66

OCT (mean±S.D.)

306.7±122.9

332.8±129.1

0.51

Ocular pattern at last visit

BCVA (mean±S.D.)

0.89±0.19

0.77±0.25

<0.01

AC cells (median [IQR])

0 [0-0]

0 [0-0]

0.7

Vitritis (median [IQR])

0 [0-0]

0 [0-0]

0.3

OCT (mean±S.D.)

250.5±17.9

249±26.1

0.87

Disclosure: B. Atienza-Mateo, None; J. L. Martín-Varillas, None; N. Vegas-Revenga, None; L. C. Domínguez-Casas, None; V. Calvo-Río, None; E. Beltrán, None; J. Sánchez-Burson, None; M. Mesquida, None; A. Adán, None; M. V. Hernández, None; M. Hernández Garfella, None; E. Valls Pascual, None; L. Martínez Costa, None; A. Sellas-Fernandez, None; M. Cordero Coma, None; M. Díaz-Llopis, None; R. Gallego, None; D. Salom, None; N. Ortego, None; J. L. García-Serrano, None; J. L. Callejas-Rubio, None; J. M. Herreras, None; Á. M. García-Aparicio, None; O. Maíz, None; A. Blanco, None; I. Torre, None; D. Díaz Valle, None; E. Pato, None; E. Aurrecoechea, None; M. A. Caracuel, None; F. Gamero, None; E. Mínguez, None; C. Carrasco Cubero, None; A. Olive, None; J. Vázquez, None; O. Ruiz Moreno, None; F. Jiménez-Zorzo, None; J. Manero, None; M. Gandia Martinez, None; E. Rubio-Romero, None; F. J. Toyos-Sáenz de Miera, None; J. López-Longo, None; J. Nolla, None; M. Revenga, None; R. Demetrio, None; E. Pons, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Atienza-Mateo B, Martín-Varillas JL, Vegas-Revenga N, Domínguez-Casas LC, Calvo-Río V, Beltrán E, Sánchez-Burson J, Mesquida M, Adán A, Hernández MV, Hernández Garfella M, Valls Pascual E, Martínez Costa L, Sellas-Fernandez A, Cordero Coma M, Díaz-Llopis M, Gallego R, Salom D, Ortego N, García-Serrano JL, Callejas-Rubio JL, Herreras JM, García-Aparicio ÁM, Maíz O, Blanco A, Torre I, Díaz Valle D, Pato E, Aurrecoechea E, Caracuel MA, Gamero F, Mínguez E, Carrasco Cubero C, Olive A, Vázquez J, Ruiz Moreno O, Jiménez-Zorzo F, Manero J, Gandia Martinez M, Rubio-Romero E, Toyos-Sáenz de Miera FJ, López-Longo J, Nolla J, Revenga M, Demetrio R, Pons E, González-Gay MA, Blanco R. Adalimumab Therapy Optimization in Refractory Uveitis Due to Behçet’s Disease after Achieving Remission. interventional Versus Control Group [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/adalimumab-therapy-optimization-in-refractory-uveitis-due-to-behcets-disease-after-achieving-remission-interventional-versus-control-group/. Accessed .

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