Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Uveitis is a common extra-articular manifestation in patients with spondyloarthritis (SpA) requiring, in most severe cases, the use of biological therapy, especially tumour necrosis factors inhibitors (TNFi). Currently, the most frequently TNFi used are infliximab and adalimumab. However, in cases of failure or adverse events related to these drugs, other TNFi (with indication for SpA patients) such as certolizumab pegol (CZP) could be an effective option for both uveitis and SpA control, as we have previously reported (1). Our purpose is to analyze the effectiveness and safety profile of CZP in patients with SpA-associated- uveitis refractory to previous immunosuppressive or biological therapy.
Observational, multicentric, retrospective study. Inclusion criteria were: patients with SpA and with a diagnosis of uveitis (confirmed by an Ophtalmologist) as main extra-articular SpA manifestation, refractory to previous immunosuppressive or biological agents and who received CZP for at least 6 months. Variables analyzed: age, sex, diagnosis, type of uveitis, duration since the first uveitis episode and number of eyes affected; previous treatment (NSAID, disease-modifying anti-rheumatic drugs (DMARDs), immunosuppressive, biological therapy); outcome and time to follow-up.
Twenty-two eyes of 13 patients (10 men); age 50.4 ± 11.7 (range 29-71 years) were included in the study. Diagnosis were: ankylosing spondylitis (n=7), psoriatic arthritis (n=4), non-radiographic axial SpA (n=1) and SpA associated to inflammatory bowel disease (n=1). Type of uveitis: 14 anterior (63.6%), 6 panuveitis (27.2%), and 2 intermediate uveitis (9.1%). Mean disease duration was 161.7 ± 138.5 months (range 5-420). 84.6% patients had previously received biological therapy (53.8% > 2 biological agents). 69.2% received CZP in monotherapy and 5 patients received concomitant treatment: 4 methotrexate and 1 azathioprine. In all cases CZP was started due to inefficacy to previous treatment except for 2 cases whose primary reason was the concurrence of adverse events or intolerance. After a follow-up of 17.8 ± 9.9 months (range 6-39), 8 patients are still on CZP treatment. Thirteen eyes showed improvement of visual acuity (59.1%), 7 remained stable and 2 worsened. During the follow-up no serious adverse events were reported. Five cases withdrew CZP treatment: 2 due to worsening of articular symptoms but with no uveitis activity; 1 due to persistence of macular edema and 2 due to uveitis activity. Two patients switched to infliximab, one to golimumab, one to adalimumab and one required switch to tocilizumab due to persistence of macular edema. In all 13 patients except 2, CZP achieved a good control of SpA activity.
CZP demonstrates moderate effectiveness in patients with SpA-associated-uveitis refractory to previous TNFi treatment, with a good safety profile.
References: 1. Llorenç V et al. Ocul Immunol Inflamm. 2016; 24: 167-72.
To cite this abstract in AMA style:Hernández MV, Mesquida M, Llorens V, Sainz de la Maza M, Blanco R, Calvo V, Maiz O, Blanco A, Urruticoechea-Arana A, De Dios JR, Ahijado-Guzman P, Judez E, Tejón P, Peña MS, Sivera F, Adan A, Sanmarti R. Effectiveness of Certolizumab Pegol in Patients with Uveitis Associated to Spondyloarthritis Refractory to Other Tumour Necrosis Factor Inhibitors [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/effectiveness-of-certolizumab-pegol-in-patients-with-uveitis-associated-to-spondyloarthritis-refractory-to-other-tumour-necrosis-factor-inhibitors/. Accessed January 21, 2020.
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