ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2625

Biologic Therapy In Refractory Uveitis Of Behcet’s Syndrome: Switching and Dose Modification. Multicenter Study Of 124 Patients

F. Ortiz-Sanjuán1, Vanesa Calvo-Río2, Ricardo Blanco3, Emma Beltrán4, Juan Sánchez-Bursón5, Marina Mesquida6, Alfredo M. Adan6, M Hernandez Grafella7, E Valls Pascual8, L Martínez-Costa9, A Sellas-Fernàndez10, Miguel Cordero-Coma11, Manuel Diaz-llopis12, David Salom12, Jl García Serrano13, Norberto Ortego13, JM Herreras14, Alejandro Fonollosa15, A Aparicio16, O Maíz17, A Blanco18, I Torre19, Cruz Fernández-Espartero20, V Jovani21, D Peitado-Lopez22, Esperanza Pato23, J Cruz24, J. Carlos Fernandez-Cid25, Elena Aurrecoechea26, M García27, M Caracuel28, Carlos Montilla29, A Atanes30, F Francisco31, S Insua32, S González-Suárez33, A Sánchez-Andrade34, F Gamero35, Luis Linares36, F Romero-Bueno37, J García38, AJ García González39, Raquel Almodovar40, E Minguez41, C Carrasco Cubero42, Alejandro Olivé Marqués43, J Vázquez44, O Ruiz Moreno45, F Jimenez-Zorzo45, J Manero45, Javier Loricera2 and Miguel Angel González-Gay1, 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IFIMAV. Santander. Spain, Santander, Spain, 2Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Spain, Santander, Spain, 3Hospital Marques de Valdecilla, Santander, Spain, 4Rheumatology, Hospital General Universitario de Valencia. Spain, Valencia, Spain, 5Hospital de Valme. Sevilla, Sevilla, Spain, 6Ophthalmology, Hospital Clínic of Barcelona, Barcelona, Spain, 7Ophthalmology, Hospital General Universitario, Valencia, Valencia, Spain, 8Rheumatology, Hospital Peset Valencia, Valencia, Spain, 9Ophthalmology, Hospital Peset Valencia, Valencia, Spain, 10Rheumatology, Hospital Val d´Hebron. Barcelona, Barcelona, Spain, 11Departament of Ophthalmology, Hospital de León, León, Spain, 12Department of Ophthalmology, Hospital Universitario La Fe de Valencia, Valencia, Spain, 13Hospital San Cecilio. Granada, Granada, Spain, 14Hospital Universitario, IOBA. Valladolid, Valladolid, Spain, 15Ophtalmology Service, Hospital de Cruces. Bilbao, Baracaldo, Spain, 16Rheumatology., Hospital de Toledo., Toledo, Spain, 17Rheumatology, Hospital Donosti San Sebastian, San Sebastián, Spain, 18Ophthalmology., Hospital Donosti San Sebastian, San Sebastián, Spain, 19Rheumatology., Hospital Basurto. Bilbao, Bilbao, Spain, 20Servicio de Reumatología, Hospital Universitario de Móstoles. Madrid, Madrid, Spain, 21Rheumatology., Hospital General de Alicante., Alicante, Spain, 22Rheumatology, Hospital Universitario La Paz Madrid, Madrid, Spain, 23Rheumatology, Hospital Clínico San Carlos. Madrid, Madrid, Spain, 24Rheumatology, Hospital de Pontevedra, Pontevedra, Spain, 25Departament of Ophthalmology, Hospital de Pontevedra, Pontevedra, Spain, 26Rheumatology, Hospital Sierrallana. Torrelavega, Torrelavega, Spain, 27Rheumatology., Hospital La Princesa. Madrid, Madrid, Spain, 28Rheumatology., Hospital de Córdoba., Córdoba, Spain, 29Rheumatology Service, Hospital Universitario de Salamanca, Salamanca, Spain, 30Rheumatology., HUCA La Coruña., A Coruña, Spain, 31Rheumatology., Hospital Doctor Negrín Canarias., Canarias, Spain, 32Rheumatology., Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain, 33Rheumatology., Hospital Cabueñes, Gijón, Gijón, Spain, 34Rheumatology., Hospital Lucus Augusti Lugo, Lugo, Spain, 35Rheumatology., Hospital San Pedro Alcantara Caceres, Caceres, Spain, 36Rheumatology, Hospital Universitario Virgen de la Arrixaca. Murcia, Murcia, Spain, 37Rheumatology., Fundación Jimenez Díaz. Madrid, Madrid, Spain, 38Rheumatology, Hospital 12 de Octubre. Madrid, Madrid, Spain, 39Rheumatology., Hospital 12 de Octubre. Madrid, Madrid, Spain, 40Rheumatology Unit, Hospital Universitario Fundación Alcorcón. Madrid, Alcorcon. Madrid, Spain, 41Ophthalmology, Hospital Clínico de Zaragoza, Zaragoza, Spain, 42Rheumatology., Hospital de Mérida, Mérida, Spain, 43Hospital Germans Trias i Pujol. Badalona, Barcelona, Spain, 44Rheumatology, Hospital de Ferrol. A Coruña, A Coruña, Spain, 45Hospital Universitario Miguel Servet. Zaragoza, Zaragoza, Spain

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Vasculitis III

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Several situations can be observed in patients undergoing biologic therapy in uveitis associated to Behçet´s syndrome (BS): a) Patients are switched to another therapy because of insufficient response (IR), toxicity, or change in the route of administration, b)remission is achieved and discontinuation or reduction of dose is performed. 

Our aim was to study these situations in a large series of BS patients receiving biologic therapy.

Methods:

Multicenter study of 124 patients with uveitis refractory to conventional therapy who required at least one biologic agent. Standard dose of Infliximab (IFX), generally 5 mg/kg/i.v. was given at 0, 2, 6 and then every 4-8 weeks, Adalimumab (ADA) 40 mg/sc/every other week, golimumab (Goli) 50 mg/4 weeks, tocilizumab (TCZ) 8 mg/kg/i.v./4 weeks and rituximab (RTX) 1g/i.v./15 days (2 doses) every 6 months.

Results:

The biological agent used as the first choice was either IFX in 77 patients or ADA in 47. All the IFX-treated patients received the standard dose at weeks 0, 2, 6 and then every 4-8 weeks. Initial IFX dosage was: a) IFX at 5 mg/k/i.v. (69 cases) with a maintenance dose every: 4 weeks (n=15 cases), 6 weeks (16), 7 weeks (1) or every 8 weeks (37). b) 3 mg/kg (7 cases) with a maintenance dose every: 4 weeks (1 case), 6 weeks (1) or every 8 weeks (5). c) IFX 4 mg/kg (1 case) with a maintenance dose every 4 weeks. Shortening infusion times for IFX administration as the maintenance treatment was required in 5 cases because of IR. Initial IFX therapy was changed to another single biologic agent in 32 cases; 30 to ADA (because of IR [16 cases], decision of changing from i.v. to subcutaneous route of administration[5 cases] or toxicity [9 cases]), 1 to RTX because of infusional reaction, and 1 to etanercept because of toxicity. Initial ADA therapy was changed to another single biologic agent in 5 cases; 2 to Goli (because of IR or toxicity in 1 case each) and 3 to IFX (2 cases because of IR and 1 because of toxicity). In 3 cases there was a double biologic switching, 1 case from ADA to IFX and to Goli, 1 case from IFX to ADA and to Goli and 1 case from ADA to IFX and to TCZ. Improvement was achieved in: a) 14 of the 16 patients switched from IFX to ADA due to IR; b) 3 of the 3 patients switched from ADA to another biologic due to IR. Persistent clinical remission was achieved in 66 (53.2%) patients and, the dose was reduced or the agent was discontinued. IFX was decreased from 5 to 3 mg/k/i.v. in 4 patients and the maintenance dose interval was increased in 23 cases. ADA maintenance dose interval was increased for more than two weeks in 13 patients. The biologic agent was discontinued in 26 cases (21 with IFX and 5 with ADA) that had clinically persistent remission. After a mean follow-up of 13.1 ± 9.2 months after biologic agent discontinuation, 21 of these 26 patients remained in remission while 5 of the 26 experienced a flare that led to the resumption of the therapy with same agent achieving remission again in all of them.

Conclusion:

Switching of biologic agents may be useful. Once clinical remission is achieved, dose reduction or in some cases discontinuation of the biologic agent may be obtained.

Disclosure:

F. Ortiz-Sanjuán,
None;

V. Calvo-Río,
None;

R. Blanco,
None;

E. Beltrán,
None;

J. Sánchez-Bursón,
None;

M. Mesquida,
None;

A. M. Adan,
None;

M. Hernandez Grafella,
None;

E. Valls Pascual,
None;

L. Martínez-Costa,
None;

A. Sellas-Fernàndez,
None;

M. Cordero-Coma,
None;

M. Diaz-llopis,
None;

D. Salom,
None;

J. García Serrano,
None;

N. Ortego,
None;

J. Herreras,
None;

A. Fonollosa,
None;

A. Aparicio,
None;

O. Maíz,
None;

A. Blanco,
None;

I. Torre,
None;

C. Fernández-Espartero,
None;

V. Jovani,
None;

D. Peitado-Lopez,
None;

E. Pato,
None;

J. Cruz,
None;

J. C. Fernandez-Cid,
None;

E. Aurrecoechea,
None;

M. García,
None;

M. Caracuel,
None;

C. Montilla,
None;

A. Atanes,
None;

F. Francisco,
None;

S. Insua,
None;

S. González-Suárez,
None;

A. Sánchez-Andrade,
None;

F. Gamero,
None;

L. Linares,
None;

F. Romero-Bueno,
None;

J. García,
None;

A. García González,
None;

R. Almodovar,
None;

E. Minguez,
None;

C. Carrasco Cubero,
None;

A. Olivé Marqués,
None;

J. Vázquez,
None;

O. Ruiz Moreno,
None;

F. Jimenez-Zorzo,
None;

J. Manero,
None;

J. Loricera,
None;

M. A. González-Gay,
None.

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