ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2297

Golimumab Versus Tocilizumab in Uveitis Related to Refractory Juvenile Idiopathic Arthritis. National Multicenter Study of 33 Patients

Lucia C. Domínguez-Casas1, Vanesa Calvo-Río1, Inmaculada Calvo2, Mª Isabel González-Fernández3, Berta Lopez Montesinos3, Marina Mesquida4, Alfredo Adan4, M. Victoria Hernández4, Olga Maiz-Alonso5, Ana Blanco6, Antonio Atanes7, Beatriz Bravo8, Consuelo Modesto9, Gisela Díaz-Cordovés10, Miguel Cordero-Coma11, David Diaz-Valle12, Carlos Fernández-Cid13, Juan Cruz14, Oscar Ruiz Moreno15, MC Gonzalez-Vela16, Rosalía Demetrio-Pablo17, Nuria Vegas-Revenga1, Carlos Fernández-Díaz1, Jose L. Hernández18, Miguel Angel González-Gay1 and Ricardo Blanco1, 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, 2Pediatric Rheumatology, Rheumatology. Hospital Universitario La Fe. Valencia. Spain, Valencia, Spain, 3Rheumatology. Hospital Universitario La Fe. Valencia. Spain, Valencia, Spain, 4Hospital Clinic. Barcelona. Spain, Barcelona, Spain, 5Hospital Universitario Donostia. San Sebastian. Spain, Donostia, Spain, 6Ophtamology. Hospital Donostia. San Sebastian. Spain, San Sebastian, Spain, 7Rheumatology, Complejo Hospitalario Universitario A Coruña (CHUAC). Spain, A Coruna, Spain, 8Rheumatology. Hospital Universitario Virgen de las Nieves. Granada. Spain, Granada, Spain, 9Hospital Universitari Vall d'Hebron. Barcelona. Spain, Barcenola, Spain, 10Rheumatology, Hospital Regional Universitario de Málaga. Spain, Málaga, Spain, 11Ophthalmology, Hospital de León. Spain, León, Spain, 12Hospital Clínico San Carlos. Madrid. Spain, Madrid, Spain, 13Ophtalmology. Hospital de Pontevedra. Pontevedra. Spain, Pontevedra, Spain, 14Rheumatology. Hospital de Pontevedra. Pontevedra. Spain, Pontevedra, Spain, 15Ophthalmology and Rheumatology., Ophtalmology. Hospital Miguel Servet. Zaragoza. Spain, Zaragoza, Spain, 16Pathology Anatomy, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, 17Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, 18Internal Medicine, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ,

Session Information

Date: Tuesday, November 7, 2017

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects Poster III: Juvenile Arthritis

Session Type: ACR Poster Session C

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

Background/Purpose:

Uveitis is a severe manifestation of Juvenil Idiopathic Arthritis (JIA). Systemic treatment is based on conventional immunosuppresants. Anti-TNFa are used in refractory cases, mainly adalimumab (ADA) or infliximab (IFX) (Levy-Clarke et al. Ophthalmology 2014). However, sometimes they are ineffective, contraindicated or non tolerated. The next therapeutic step is not defined. The main objective of this study was to compare Golimumab (GLM) vs Tocilizumab (TCZ) in uveitis related to JIA and refractory to conventional immunosuppressive drugs and anti-TNFα drugs.

Methods:

National multicenter study of 33 patients diagnosed with uveitis associated to JIA. The patients were refractory to conventional treatment with high dose of corticosteroids and at least a) 1 conventional immunosuppressive systemic treatment and b) 1 anti-TNFa. For this reason it was decided to iniciate treatment with TCZ or GLM. TCZ was used in 25 patients: 8 mg/kg/4 w/iv (n=21), 8 mg/kg/2 w/iv (n=2); 8 mg/kg/8 w/iv (n=1) and 2.9 mg/kg sc/w (n=1). GLM was used in 8 patients (50 mg/sc/month). The main parameters assessed were the visual acuity (VA), degree of intraocular inflammation, vitreous inflammation and macular thickening (by OCT). Quantitative variables were expressed with mean±SD or median [IQR], according to its distribution. They were compared with the Student t or the Mann-Whitney U test, respectively. Dichotomous variables were expressed as percentages and compared by the chi-square test.

Results:

We studied 33 patients/61 affected eyes. There were no significant differences between both groups at baseline (TCZ vs GLM) in sex (♂/♀;4/21 vs 3/5; p=0,19), mean age (18.5±8.3 vs 19.9±8,7; p=0.55), positive ANA (95% vs 100%; p=0.7), uveitis duration before TCZ o GLM onset (116,4±93,6 vs 142,3±74,7 p=0,46), number of previous biological treatments (1.9±1.1 vs 2±1.4; p=0.84), VA (0.57±0.35 vs 0.5±0.37; p=0.42), combined immunosuppressive therapy (88% vs 75%; p=0.37), presence of cells in the anterior chamber (median [IQR] 1 [0-1] vs 1 [0.25-1.5]%; p=0,6), vitritis (0 [0-0] vs 0 [0-1]; p=0,7), macular thickening (358.7±92.2 vs 313.6±77.1; p=0.32).

Once the treatment was iniciated there were no significant differences in the ocular parameters TABLE.

After a men follow-up of 20.48±11.7 months with TCZ and 24.25±17 months with GLM the following side effects were observed; with TCZ: viral conjunctivitis + bullous impetigo (n=1), severe thrombocytopenia and pneumonia. This last patient showed hemolytic anemia, thrombocytopenia and splenomegaly, for this reason treatment with TCZ was discontinued. With GLM cutaneous reaction was observed in 2 patients.

Conclusion:

This study shows that both, TCZ and GLM, appear to be equally effective and safe for the treatment of uveitis associated to JIA refractory to conventional treatment and antiTNFa. Further studies should be performed.

TABLE

TCZ (n=25)

GLM (n=8)

p

Basal

VA

0.57±0,35

0.5±0.36

0.43

Cells in the anterior chamber

0.92±0.81

2.79±4.82

0.63

Vitritis

0.43±0.91

0.33±0.5

0.78

OCT

358.69±92.17

313.60±77.05

0.31

1st month

VA

0.59±0.33

0.56±0.32

0.75

Cells in the anterior chamber

0.26±0.52

2.33±4.57

0.083

Vitritis

0.31±0.71

0±0

0.32

OCT

313.40±91.28

292.50±111.42

0.57

6th month

VA

0.63 ±0.32

0.62±0.33

0.85

Cells in the anterior chamber

0.1±0.34

0±3.28

0.43

Vitritis

0.07±0.33

0.25±0.62

0.62

OCT

274.91±101.32

261.37±75.15

0.94

1st year

VA

0.63 ±0.34

0.54 ±0.31

0.35

Cells in the anterior chamber

0±0.2

0±0

0.71

Vitritis

0.058±0.23

0±0

0.81

OCT

245.45±29.34

255±120.8

0.74

































Results are expressed as mean±SD


Disclosure: L. C. Domínguez-Casas, None; V. Calvo-Río, None; I. Calvo, None; M. I. González-Fernández, None; B. Lopez Montesinos, None; M. Mesquida, None; A. Adan, AbbVie, Santen and Allergan, 9; M. V. Hernández, None; O. Maiz-Alonso, None; A. Blanco, None; A. Atanes, None; B. Bravo, None; C. Modesto, None; G. Díaz-Cordovés, None; M. Cordero-Coma, None; D. Diaz-Valle, None; C. Fernández-Cid, None; J. Cruz, None; O. Ruiz Moreno, None; M. Gonzalez-Vela, None; R. Demetrio-Pablo, None; N. Vegas-Revenga, None; C. Fernández-Díaz, None; J. L. Hernández, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Domínguez-Casas LC, Calvo-Río V, Calvo I, González-Fernández MI, Lopez Montesinos B, Mesquida M, Adan A, Hernández MV, Maiz-Alonso O, Blanco A, Atanes A, Bravo B, Modesto C, Díaz-Cordovés G, Cordero-Coma M, Diaz-Valle D, Fernández-Cid C, Cruz J, Ruiz Moreno O, Gonzalez-Vela M, Demetrio-Pablo R, Vegas-Revenga N, Fernández-Díaz C, Hernández JL, González-Gay MA, Blanco R. Golimumab Versus Tocilizumab in Uveitis Related to Refractory Juvenile Idiopathic Arthritis. National Multicenter Study of 33 Patients [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/golimumab-versus-tocilizumab-in-uveitis-related-to-refractory-juvenile-idiopathic-arthritis-national-multicenter-study-of-33-patients/. Accessed .

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