ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 413

Golimumab in Refractory Uveitis Associated to Juvenile Idiopathic Arthritis. Multicenter Study of 7 Cases and Literature Review

Natalia Palmou-Fontana1, Carlos Fernández-Díaz1, Vanesa Calvo-Río1, Marina Mesquida2, Alfredo Adan3, M. Victoria Hernández4, Miguel Cordero-Coma5, David Diaz-Valle6, Oscar Ruiz Moreno7, Carlos Férnandez Cid8, Miguel Angel González-Gay9 and Ricardo Blanco10, 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, 2Ophtalmology, Hospital Clinic, Barcelona, Spain, 3Ophthalmology, Ophthalmology Department. Hospital Clínic de Barcelona, Barcelona, Spain, 4Rheumatology, Hospital Clinic. Barcelona. Spain, Barcelona, Spain, 5Departament of Ophthalmology, Hospital de León, León, Spain, 6Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain, 7Ophthalmology and Rheumatology., Hospital Miguel Servet, Zaragoza, Spain, 8Ophthalmology, Hospital de Pontevedra, Pontevedra, Spain, 9Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain, 10Rheumatology Department. Hospital Universitario Marqués de Valdecilla, Santander, Spain

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Sunday, November 13, 2016

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects - Poster I: Juvenile Idiopathic Arthritis, Uveitis

Session Type: ACR Poster Session A

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

Background/Purpose: According to a recent expert panel, in refractory juvenile idiopathic arthritis (JIA)-related uveitis, infliximab or adalimumab may be considered (Levy-Clarke et al. Ophthalmology 2014; 121:785-796). In some cases these biologic agents are not effective, or not tolerated. Golimumab (GLM) is a novel fully humanized anti-TNF-α monoclonal antibody. Our aim was to assess the efficacy of GLM in refractory uveitis associated with JIA.

Methods: Multicenter study of uveitis related to JiA and refractory to at least a) one standard synthetic immunosuppressive drug and, b) one anti-TNFα drug. The results were expressed as mean±SD or as median (25,75 interquartile range [IQR]) as appropriate. The Wilcoxon signed-rank test was used to compare continuous variables. Also a review of the literature regarding the effectiveness of GLM in uveitis related to JiA was performed.

Results:   We assessed 7 (5 women/2 men) patients with 13 affected eyes; mean age 21.7±7.5 years. Uveitis was bilateral in 6. Cystoid macular edema (CME) was present in 3 patients (5 eyes). Besides corticosteroids and synthetic immunosuppressive drugs, patients had received a median of 2 biological agents (range 0-3): adalimumab (n=6), etanercept (n=1), infliximab (n=3), abatacept (n=2). GLM dosage regimen was 50 mg/sc every 4 weeks. GLM yielded an improvement in all ocular parameters. After 6 months of therapy the number of anterior chamber cells decreased from a median of 1 [0.25-1.5] to 0 [0-0.5] (p=0.02), vitritis from 0 [0-1] to 0 [0-0] (p=0.6); and optical coherence tomography (in 3 patients with CME) from 313.6±77.05 to 261.4±75.1 µm (p=0.03). Moreover, the best-corrected visual acuity increased from 0.5 to 0.62 (p=0.018). After a mean follow-up of 16.8±11.4 months, a complete remission of uveitis was achieved in 4 of 7 patients. The only observed adverse effects were local erythema at the injection site in 2 patients. A literature review of refractory JIA related uveitis treated with GLM is summarized in Table.

Conclusion:   GLM appears to be a useful therapy in refractory JIA-related uveitis. TABLE

Cordero-Coma M et al, 2014 (1) Miserocchi E et al, 2014 (2) William M et al, 2012 (3) Present series
Number of cases, N 4 13 3 7
Sex (women/men) 3/1 10/3 2/1 5/2
Age (mean±SD, years) 25.5±5.80 25±5.37 17.33±8.73 21.71±7.48
Uveitis pattern (bilateral/unilateral) 3/1 13/0 2/1 6/1
Previous treatment MTX, SSZ, AZA, ETN, IFX, ADA MTX, ETN, IFX, ADA, RTX, ABA MTX, AZA, IFX, DCZ, ADA, ETN, ABA CFM, CyA, MTX, IFX, ETN, ADA
GLM regimen 50mg/sc every 4 weeks 50mg/sc every 4 weeks 50mg/sc every 3 weeks 50mg/sc every 4 weeks
Ocular remission after GLM, N 4 11 2 4
Adverse effects related to GLM none 1 pulmonary infection 1 skin reaction none skin reaction
Months in treatment with GLM (mean±SD) 6 months 22.38±7.47 months 10±6.92 months 16.38±11.43 months
GLM withdrawal no no one patient for inefficacy one patient for inefficacy

Abbreviations:MTX: Methotrexate; SSZ: Sulfasalazine; AZA: Azathioprine; IFX:Infliximab; ETN: Etarnecept; ADA: Adalimumab; ABA: Abatacept; RTX: Rituximab; CyA :Cyclosporine; CFM: cyclophosphamide (1) Cordero-Coma M, et al. Mediators Inflamm. 2014; 2014: 717598 (2) Miserocchi E, et al. Ocul Immunol Inflamm. 2014; 22: 90-5 (3) William M, et al. J Ophthalmic Inflamm Infect. 2012; 2: 231-3

Disclosure: N. Palmou-Fontana, None; C. Fernández-Díaz, None; V. Calvo-Río, None; M. Mesquida, None; A. Adan, AbbVie, Santen and Allergan, 9; M. V. Hernández, None; M. Cordero-Coma, None; D. Diaz-Valle, None; O. Ruiz Moreno, None; C. Férnandez Cid, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Palmou-Fontana N, Fernández-Díaz C, Calvo-Río V, Mesquida M, Adan A, Hernández MV, Cordero-Coma M, Diaz-Valle D, Ruiz Moreno O, Férnandez Cid C, González-Gay MA, Blanco R. Golimumab in Refractory Uveitis Associated to Juvenile Idiopathic Arthritis. Multicenter Study of 7 Cases and Literature Review [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/golimumab-in-refractory-uveitis-associated-to-juvenile-idiopathic-arthritis-multicenter-study-of-7-cases-and-literature-review/. Accessed .

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