Effectiveness of Certolizumab Pegol in Patients with Uveitis Associated to Spondyloarthritis Refractory to Other Tumour Necrosis Factor Inhibitors

M. Victoria Hernández¹, Marina Mesquida¹, Victor Llorens², Maite Sainz de la Maza², Ricardo Blanco³, Vanesa Calvo⁴, Olga Maiz⁵, Ana Blanco⁶, Ana Urruticoechea-Arana⁷, Juan Ramon De Dios⁸, Pilar Ahijado-Guzman⁹, Enrique Judez¹⁰, Patricia Tejón¹¹, M Soledad Peña¹², Francisca Sivera¹³, Alfredo Adan¹ and Raimon Sanmarti¹⁴, ¹Hospital Clinic. Barcelona. Spain, Barcelona, Spain, ²Ophthalmology Department. Hospital Clínic of Barcelona, Barcelona, Spain, ³Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ⁴Rheumatology Department. Hospital Universitario Marqués de Valdecilla., Santander, Spain, ⁵Hospital Donostia. Spain, San Sebastian, Spain, ⁶Ophthalmology Department. Hospital Donostia, San Sebastian, Spain, ⁷Rheumatology Department. Hospital Can Misses, IBIZA, Spain, ⁸Rheumatology Department. Hospital Universitario de Araba, Vitoria, Spain, ⁹Rheumatology Unit. Fuenlabrada’s Hospital, Madrid, Madrid, Spain, ¹⁰Rheumatology Department. Hospital de Albacete, Albacete, Spain, ¹¹Rheumatology Department. Hospital Universitario General de Castellón, Castellon, Spain, ¹²Ophtalmology Department. Hospital Universitario General de Castellón, Castellon, Spain, ¹³Sección de Reumatología, Hospital General Universitario de Elda., Elda, Spain, ¹⁴Arthritis Unit, Rheumatology Dpt, Hospital Clinic of Barcelona, Barcelona, Spain

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: certolizumab pegol, Spondylarthritis, tumor necrosis factor (TNF) and uveitis

Session Information

Date: Monday, November 6, 2017

Session Title: Spondyloarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment Poster II

Session Type: ACR Poster Session B

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

Background/Purpose:

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.

Methods:

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.

Results:

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.

Conclusion:

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.

Disclosure: M. V. Hernández, None; M. Mesquida, None; V. Llorens, None; M. Sainz de la Maza, None; R. Blanco, None; V. Calvo, None; O. Maiz, None; A. Blanco, None; A. Urruticoechea-Arana, None; J. R. De Dios, None; P. Ahijado-Guzman, None; E. Judez, None; P. Tejón, None; M. S. Peña, None; F. Sivera, None; A. Adan, AbbVie, Santen and Allergan, 9; R. Sanmarti, None.

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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