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Abstract Number: 1249

Efficacy of Tocilizumab in Patients with Uveitis Refractory to Other Biologic Drugs: A Multicenter Study on 31 Cases

Leyre Riancho-Zarrabeitia1, Vanesa Calvo-Río1, Ricardo Blanco1, Inmaculada Calvo2, Emma Beltrán-Catalán3, Alfredo Adan4, Marina Mesquida4, Maria Victoria Hernández5, Marisa Hernández6, Antonio Atanes-Sandoval7, Luis Francisco Linares Ferrando8, Olga Maiz Alonso9, Ana Blanco10, Beatriz Bravo11, Gisela Díaz-Cordovés12, Trinitario Pina1, Montserrat Santos-Gómez1 and Miguel A González-Gay1, 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Spain, Santander, Spain, 2Pediatric Rheumatology, Hospital La Fe. Valencia. Spain, Valencia, Spain, 3Rheumatology, Hospital General Universitario de Valencia. Spain, Valencia, Spain, 4Ophthalmology, Hospital Clinic. Barcelona. Spain, Barcelona, Spain, 5Rheumatology, Hospital Clínic of Barcelona. IDIBAPS. University of Barcelona, Barcelona, Spain, 6Ophthalmology, Hospital General Universitario de Valencia. Spain, Valencia, Spain, 7Rheumatology Division. C. Hospitalario Universitario A Coruña, A Coruña, Spain, 8Rheumatology, Hospital Virgen de la Arrixaca. Murcia. Spain, Murcia, Spain, 9Rheumatology, Hospital Universitario de Donostia. San Sebastián. Spain, San Sebastián, Spain, 10Ophthalmology, Hospital Universitario de Donostia. San Sebastián. Spain, San Sebastián, Spain, 11Pediatrics, Hospital Virgen de las Nieves. Granada, Granada, Spain, 12Rheumatology, Hospital Regional Universitario (Carlos Haya). Málaga. Spain., Málaga, Spain

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Tocilizumab, treatment and uveitis

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Session Information

Session Title: Miscellaneous Rheumatic and Inflammatory Diseases

Session Type: Abstract Submissions (ACR)

Background/Purpose: To evaluate the clinical response and safety of Tocilizumab (TCZ) in a series of patients with non-infectious uveitis refractory to other biologic drugs.

Methods: Multicenter study of patients studied in the Uveitis Units of 14 hospitals from Spain. All patients had experienced inadequate response to at least one biologic agent. Intraocular inflammation, macular thickness, visual acuity, steroid sparing effect and immunosuppression load score were the outcome variables. Comparisons were made between baseline and 1st week, 1st month, 6th month and 1st year.

Results: We studied 31 patients/58 affected eyes (7 men/24 women) with a mean age of 31.7±17.2 years (range 8-70). Uveitis was bilateral (n=27 cases) or unilateral (n=4). The pattern of ocular involvement was anterior uveitis (n=11 cases), panuveitis (n=6), posterior (n=4), intermediate (n=3), panuveitis+ retinal vasculitis (n=3), retinal vasculitis without uveitis (n=2) and panuveitis+retinal vasculitis+papillitis (n=1). Uveitis was acute (n=1), chronic (n=26) or recurrent (n=4).

The main underlying diseases were: Juvenile Idiopathic Arthritis (n=13), Behçet disease (n=5), idiopathic uveitis (n=5), Birdshot retinopathy (n=3), idiopathic retinal vasculitis (n=2), spondyloarthritis (n=2) and rheumatoid arthritis (n=1).

Besides oral steroids and before TCZ onset they had received: intraocular corticosteroids (n=21), intravenous. methylprednisolone pulses (n=9), methotrexate (n=25), cyclosporine A (n=20), azathioprine (n=3), other synthetic immunosuppressive drugs (n=9), adalimumab (n=25), infliximab (n=12), etanercept (n=7), abatacept (n=6), rituximab (n=2), golimumab (n=2) and anakinra (n=1). TCZ was started because of inefficacy (n=28) and/or toxicity (n=3) to other biologics. TCZ was used as monotherapy (n=10) or in combination with methotrexate (n=12), leflunomide (n=4), cyclosporine A (n=4) and mycophenolate (n=1). After one year of TCZ therapy all the following variable improved statistically (p<0.05) (TABLE): a) mean best corrected visual acuity (from 0.46±0.3 at baseline to 0.58±0.3); b) anterior chamber cells and vitreous inflammation (from 58% and 60% of eyes, to 15.3% and 34%, respectively); c) cystoid macular edema (OCT>300 μm) (from 66.6% to 21%); d) the mean OCT (from 389.1±197.2 to 261.8±46.1 μm); and e) the median [IQR] dose of prednisone (from 30 [10-90] to 5 [0-5] mg/day). A non-statistically reduction in the mean of the immunosuppression load score (from 6.3±5.1 to 4.2±3.3, p=0.6) was also observed.

After a mean follow-up of 13.4±9.5 months the more important side-effects observed were bullous impetigo (n=1), mild thrombocytopenia (n=1), pneumonia (n=1) and infusional reaction (n=1).

Conclusion: Our results indicate that TCZ is an effective and safe therapy for patients with non-infectious uveitis refractory to other biologic agents.


TABLE.

Basal

Patients (n)

active eyes (%)

1 week

active eyes (%)

1 month

active eyes (%)

6 months

active eyes (%)

1 year

active eyes (%)

Anterior chamber cells

21

58%

46.66% *

21.7% *

17.6% *

15.3% *

Vitritis

20

60%

59% *

37.7% *

29% *

34% *

Choroiditis

10

29.2%

24.4% *

8.8% *

3% *

0% *

Retinitis

7

23.9%

11.9% *

14.3%

3.2% *

0% *

Retinal vasculitis

17

48.1%

46.9% *

27.1% *

14.7% *

14.8% *

Macular thickness ≥300 microns

15

66.6%

53.8%  *

41.6%  *

27% *

21% *

*p<0.05 compare with baseline


Disclosure:

L. Riancho-Zarrabeitia,
None;

V. Calvo-Río,
None;

R. Blanco,
None;

I. Calvo,
None;

E. Beltrán-Catalán,
None;

A. Adan,
None;

M. Mesquida,
None;

M. V. Hernández,
None;

M. Hernández,
None;

A. Atanes-Sandoval,
None;

L. F. Linares Ferrando,
None;

O. Maiz Alonso,
None;

A. Blanco,
None;

B. Bravo,
None;

G. Díaz-Cordovés,
None;

T. Pina,
None;

M. Santos-Gómez,
None;

M. A. González-Gay,
None.

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