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|
|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
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 November 15, 2019.
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