Comparative Study on Anti-TNF vs Tocilizumab for Treatment of Refractory Uveitic Cystoid Macular Edema Due to Behcet's Disease: Multicenter Study of 49 Patients

Belén Atienza-Mateo¹, Iván Ferraz-Amaro², Emma Beltrán Catalán³, Alfredo Adán⁴, Marisa Hernandez Garfella⁵, Lucía Martínez-Costa⁶, Miguel Cordero Coma⁷, Manuel Diaz-Llopis⁸, José M. Herreras⁹, Ana Blanco¹⁰, Ignacio Torre¹¹, David Díaz-Valle¹², Antonio Atanes-Sandoval¹³, Felix Hernandez¹⁴, Santos Insua¹⁵, Julio Sánchez¹⁶, raquel almodovar¹⁷, Oscar Ruiz-Moreno¹⁸, Myriam Gandia Martinez¹⁹, Joan M. Nolla²⁰, José Luis Martin-Varillas²¹, Vanesa Calvo-Río²², Diana Prieto-Peña²³, Miguel Ángel gonzalez-Gay²⁴ and Ricardo Blanco²², ¹Group "Research in genetic epidemiology and atherosclerosis of systemic diseases and in bone metabolic diseases of the locomotor system", IDIVAL; and Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain, ²Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, ³Hospital del Mar, Barcelona, Spain, ⁴Hospital Clinic, Barcelona, Spain, ⁵Hospital General Universitario de Valencia, Valencia, Spain, ⁶Hospital Peset, Valencia, Valencia, Spain, ⁷Hospital de León, Leon, Spain, ⁸Hospital Universitario La Fe, Valencia, Spain, ⁹Hospital Universitario IOBA, Valladolid, Spain, ¹⁰Hospital Universitario de Donostia, San Sebastián, ¹¹Hospital Universitario de Basurto, Bilbao, Spain, ¹²Hospital Clínico San Carlos, Madrid, Madrid, Spain, ¹³Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain, ¹⁴Hospital Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain, ¹⁵Hospital Universitario Santiago de Compostela, A Coruña, Spain, ¹⁶Hospital Universitario 12 de Octubre, Madrid, Spain, ¹⁷Hospital Universitario Fundación de Alcorcón, Madrid, Spain, ¹⁸Hospital Universitario Miguel Servet, Zaragoza, Zaragoza, Spain, ¹⁹Hospital Puerta del Mar, Cádiz, Spain, ²⁰Hospital Universitario de Bellvitge, Barcelona, Barcelona, Spain, ²¹Hospital Sierrallana, Torrelavega, Spain, ²²Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain, ²³Hospital Universitario Marqués de Valdecilla, santander, Spain, ²⁴Research group on Genetic Epidemiology and Atherosclerosis in Systemic Diseases and in Metabolic Bone Diseases of the Musculoskeletal System, IDIVAL, Division of Rheumatology, Hospital Universitario Marqués de Valdecilla; School of Medicine, Universidad de Cantabria, Santander, Spain. Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

Meeting: ACR Convergence 2021

Keywords: Anti-TNF Drugs, Behçet's Syndrome, Cystoid Macular Edema, Tocilizumab

Session Information

Date: Tuesday, November 9, 2021

Title: Vasculitis – Non-ANCA-Associated & Related Disorders Poster II (1862–1888)

Session Type: Poster Session D

Session Time: 8:30AM-10:30AM

Background/Purpose: Posterior segment involvement is the most serious affection of uveitis in Behçet’s disease (BD), with cystoid macular edema (CME) being the leading cause of blindness. Anti-TNF, especially adalimumab (ADA) and infliximab (IFX), have demonstrated efficacy as first-line biologic agents in BD-related uveitis [Arthritis Rheumatol. 2019;71(12):2081-2089; Ophthalmology. 2018;125(9):1444-1451]. Moreover, the anti-IL6R tocilizumab (TCZ) has shown excellent results in highly refractory BD-uveitis and noninfectious uveitic CME [Rheumatology (Oxford). 2018;57(5):856-864; Am J Ophthalmol.2019;200:85-94; Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7; Clin Exp Rheumatol. 2016;34(6 Suppl 102): S34-S40. Our aim was to compare the efficacy of ADA vs IFX vs TCZ in patients with refractory CME due to BD.

Methods: Observational multicenter study of patients with BD-associated CME refractory to conventional and/or biological immunosuppressive drugs. From a cohort of 177 patients treated with anti-TNF and 14 patients treated with TCZ, we selected those with CME at baseline. CME was defined as macular thickness > 300μm (measured by optic coherence tomography). We analyzed in the 3 groups of treatment (ADA, IFX, TCZ) from baseline up to 4 years the evolution of macular thickness (main outcome), best-corrected visual acuity (BCVA) and intraocular inflammation (Tyndall and vitritis). Differences between basal and final follow-up were evaluated. Multivariable linear regression was used to assess the differences between the 3 groups.

Results: A total of 49 patients were included. ADA was used in 25 patients (40 eyes with CME), IFX in 15 (21 eyes with CME) and TCZ in 9 (11 eyes with CME). Thus, a sum of 72 affected eyes was analyzed. No statistically significant baseline differences were observed between the 3 groups (Table 1) except for a lower basal BCVA in patients treated with TCZ and a higher basal degree of intraocular inflammation in patients treated with ADA. Most patients from all groups had received several conventional immunosuppressive drugs. In addition, most patients in the group of TCZ had also received anti-TNF (5 patients received ADA, 1 received IFX and 2 received both ADA and IFX, in different times). Biological therapy was used in monotherapy or combined with azathioprine (n=10, 5 and 1 in ADA, IFX and TCZ group, respectively), cyclosporine A (n=10, 5 and 1) or methotrexate (n=4, 2 and 3). Macular thickness progressively decreased in the 3 groups, with no signs of CME after 1 year of treatment (Figure 1). Similarly, BCVA improvement and inflammatory ocular remission was reached in all groups.

Conclusion: Refractory CME associated to BD’s uveitis can be effectively treated with ADA, IFX or TCZ. Moreover, TCZ is effective in patients resistant to anti-TNF therapy.

Table 1. Demographic and clinical characteristics of 49 patients with cystoid macular edema due to Behçet’s disease receiving ADA, IFX or TCZ. Data are presented as mean ± SD or median (IQR) when data were not normally distributed. ADA, adalimumab; BCVA, best corrected visual acuity; CME, cystic macular edema; IFX, infliximab; TCZ, tocilizumab.

Figure 1. Evolution of ocular parameters in 49 patients with cystoid macular edema due to Behçet’s disease receiving ADA, IFX or TCZ.

Disclosures: B. Atienza-Mateo, None; I. Ferraz-Amaro, None; E. Beltrán Catalán, None; A. Adán, None; M. Hernandez Garfella, None; L. Martínez-Costa, None; M. Cordero Coma, None; M. Diaz-Llopis, None; J. Herreras, None; A. Blanco, None; I. Torre, None; D. Díaz-Valle, None; A. Atanes-Sandoval, None; F. Hernandez, None; S. Insua, None; J. Sánchez, None; r. almodovar, None; O. Ruiz-Moreno, None; M. Gandia Martinez, None; J. Nolla, None; J. Martin-Varillas, None; V. Calvo-Río, None; D. Prieto-Peña, None; M. gonzalez-Gay, None; R. Blanco, Brystol Myers Squibb, 6.

To cite this abstract in AMA style:

Atienza-Mateo B, Ferraz-Amaro I, Beltrán Catalán E, Adán A, Hernandez Garfella M, Martínez-Costa L, Cordero Coma M, Diaz-Llopis M, Herreras J, Blanco A, Torre I, Díaz-Valle D, Atanes-Sandoval A, Hernandez F, Insua S, Sánchez J, almodovar r, Ruiz-Moreno O, Gandia Martinez M, Nolla J, Martin-Varillas J, Calvo-Río V, Prieto-Peña D, gonzalez-Gay M, Blanco R. Comparative Study on Anti-TNF vs Tocilizumab for Treatment of Refractory Uveitic Cystoid Macular Edema Due to Behcet’s Disease: Multicenter Study of 49 Patients [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/comparative-study-on-anti-tnf-vs-tocilizumab-for-treatment-of-refractory-uveitic-cystoid-macular-edema-due-to-behcets-disease-multicenter-study-of-49-patients/. Accessed .

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