Session Information
Session Title: Miscellaneous Rheumatic and Inflammatory Diseases
Session Type: Abstract Submissions (ACR)
Background/Purpose
To evaluate the clinical response and safety of golimumab (GLM) in a series of patients with non-infectious uveitis refractory to other anti-TNFα drugs.
Methods
Multicenter study of 29 patients with uveitis that was refractory to previous standard synthetic immunosuppressive drugs and at least 1 anti-TNFα drug. GLM was given at the standard dose of 50 mg/sc/month. The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, and macular thickness.
Results
A total of 29 patients (44 affected eyes) (21 men/8 women) with a mean age of 34.6±9.5 years (range 11-48) were studied. Uveitis was bilateral (n=15 cases) or unilateral (n=14). The pattern of ocular involvement was anterior uveitis (n=19), panuveitis (n=6) and intermediate, anterior+intermediate, anterior+posterior and intermediate+posterior (one case each). Uveitis was acute (n=1), chronic (n=16) or recurrent (n=12).The underlying diseases were spondyloarthritis (n=9), psoriatic arthritis (n=5), juvenile idiopathic arthritis (n=4), Behçet disease (n=4), sarcoidosis (n=3), uveitis associated with HLA-B27 and ulcerative colitis (n=1), undifferentiated arthritis (n=1), pars planitis (n=1) and Vogt-Koyanagi-Harada (n=1).
Besides oral steroids and before GLM onset they had received: intraocular corticosteroids (n=11), intravenous pulses of methylprednisolone (n=6), methotrexate (n=23), cyclosporine A (n=6), azathioprine (n=7), adalimumab (n=17), infliximab (n=15), abatacept (n=2) and certolizumab (n=1). GLM was started because inefficacy (n=27) and/or toxicity (n=2) to other biologics. GLM was used as monotherapy (n=11) or in combination with methotrexate (n=10), azathioprine (n=4), leflunomide (n=2), and mycophenolate (n=2).
After one year of GLM therapy all the following variables improved significantly (p<0.05)(TABLE): a) The mean best corrected visual acuity (from 0.68±0.3 at baseline to 0.75±0.3); b) anterior chamber and vitreous inflammation (from 62.7% and 40.4% of eyes, to 12.5% and 0% respectively); c) Cystoid Macular Edema (OCT>300 μm), (from 50% to 0%), d) the mean OCT (from 318.9±76 to 244.2±43.2 μm); and d) the mean dose of prednisone (from 24±20.1 to 7.7±7.6 mg/day). After a mean follow-up of 13.1±8.5 (range 2-30) months the most important side-effects observed were Injection site erythema (n=3) and herpes zoster (n=1).
Conclusion
Our results suggest that GLM may be an effective and safe treatment for patients with uveitis refractory to other anti-TNFα drugs.
TABLE
|
Basal active patients, N active eyes (%)
|
1 week active eyes (%) |
1 month active eyes (%) |
3 months active eyes (%) |
6 months active eyes (%) |
1 year active eyes (%) |
|
|
Anterior chamber cells
|
22 62.7% |
55.5% * |
30.6% * |
23.25% * |
7.3% * |
9.7% * |
|
Vitritis
|
12 40.4% |
29.7% * |
21.9% * |
10.5% * |
2.7% * |
0% * |
|
Choroiditis
|
2 2.12% |
2.12% |
0% |
0% |
0% |
0% |
|
Retinitis
|
1 1.96% |
1.96% * |
0% * |
0% * |
0% * |
0% * |
|
Retinal vasculitis
|
3 5.88% |
5.88% * |
4.1% * |
0% * |
0% * |
0% * |
|
Macular thickness ≥ 300 microns
|
8 50% |
45.4% * |
22.7% * |
25% * |
20% * |
0% * |
*p<0.05 compare with baseline
Disclosure:
M. Santos-Gómez,
None;
F. Ortiz-Sanjuán,
None;
R. Blanco,
None;
J. Cañal Villanueva,
None;
A. Adan,
None;
M. Mesquida,
None;
M. V. Hernández,
None;
E. Rubio Romero,
None;
A. M. Garcia-Aparicio,
None;
A. Atanes,
None;
I. Torre Salaberri,
None;
F. Francisco,
None;
C. Fernández- Espartero,
None;
N. Palmou,
None;
V. Calvo-Río,
None;
J. Loricera,
None;
J. Ventosa,
None;
T. Pina Murcia,
None;
L. Riancho-Zarrabeitia,
None;
M. A. González-Gay,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/golimumab-as-an-alternative-therapy-in-patients-with-uveitis-refractory-to-other-anti-tnf%ce%b1-drugs-multicenter-study-of-29-cases/