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.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adalimumab-therapy-optimization-in-refractory-uveitis-due-to-behcets-disease-after-achieving-remission-interventional-versus-control-group/