Infliximab Therapy in Refractory Retinal Vasculitis of Behçet's Disease, Short and Long-Term Follow-up. Multicenter Study of 72 Patients

José Luis Martín-Varillas¹, Belén Atienza-Mateo¹, Vanesa Calvo-Río², Diana Prieto Peña², Monica Calderón Goercke², Rosalía Demetrio-Pablo³, Javier Loricera³, M. Victoria Hernández⁴, Alfredo Adan⁵, Marina Mesquida⁵, Diana Peiteado⁶, David Diaz-Valle⁷, Lucía Martínez-Costa⁸, Elia Valls-Pascual⁸, Miguel A. Caracuel⁹, Angel Garcia-Aparicio¹⁰, Jose M Herreras¹¹, Miguel Cordero-Coma¹², Carlos Alberto Montilla-Morales¹³, Alejandro Fonollosa¹⁴, Antonio Atanes¹⁵, Félix Francisco¹⁶, Ignacio Torre-Salaberri¹⁷, Olga Maíz¹⁸, Ana Blanco¹⁹, Cruz Fernandez-Espartero²⁰, Norberto Ortego Centeno²¹, Enrique Raya Álvarez²², Myriam Gandía²³, Francisco Javier López Longo²⁴, Maria Alcalde-Villar²⁵, Cristina Fernández-Carballido²⁶, Esperanza Pato Cour²⁷, Oscar Ruiz Moreno²⁸, Fernando Jiménez-Zorzo²⁹, Raquel Almodóvar González³⁰, Carmen Carrasco-Cubero³¹, Luis Francisco Linares³², Fredeswinda I. Romero-Bueno³³, Santos Insua³⁴, Senen González-Suárez³⁵, Marisa Hernández³⁶, Emma Beltrán³⁷, Juan Cruz³⁸, Carlos Férnandez Cid³⁹, Elena Aurrecoechea⁴⁰, Enar Pons¹, Miguel Angel González-Gay³ and Ricardo Blanco¹, ¹Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ²Rheumatology, Rheumatology. Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ³Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ⁴Rheumatology, Hospital Clinic. Barcelona. Spain, Barcelona, Spain, ⁵Hospital Clinic. Barcelona. Spain, Barcelona, Spain, ⁶Rheumatology, Rheumatology, La Paz University Hospital, Madrid, Spain, ⁷Hospital Clínico San Carlos. Madrid. Spain, Madrid, Spain, ⁸Hospital Universitario Doctor Peset. Valencia. Spain, Valencia, Spain, ⁹Hospital de Córdoba, Córdoba, Spain., Córdoba, Spain, ¹⁰Rheumatology, Hospital de Toledo. Toledo. Spain, Toledo, Spain, ¹¹Ophthalmology, Hospital Universitario, IOBA. Valladolid. Spain, Valladolid, Spain, ¹²Ophthalmology, Hospital de León. Spain, León, Spain, ¹³Hospital Clínico Universitario de Salamanca. Spain, Salamanca, Spain, ¹⁴Ophthalmology, Hospital de Cruces. Bilbao. Spain, Bilbao, Spain, ¹⁵Complejo Hospitalario Universitario A Coruña. Spain, A Coruna, Spain, ¹⁶Rheumatology, Hospital Doctor Negrín. Las Palmas de Gran Canaria. Spain, Las Palmas de Gran Canaria, Spain, ¹⁷Rheumatology, Hospital Universitario de Basurto. Bilbao. Spain, Bilbao, Spain, ¹⁸Hospital Universitario Donostia. San Sebastian. Spain, San Sebastián, Spain, ¹⁹Ophtamology, Hospital Universitario Donostia. San Sebastian. Spain, San Sebastian, Spain, ²⁰Rheumatology, Hospital de Móstoles. Madrid. Spain, Madrid, Spain, ²¹Medicine Department, Hospital Universitario San Cecilio. Granada. Spain, Granada, Spain, ²²Rheumatology, Hospital Universitario San Cecilio. Granada. Spain, Granada, Spain, ²³Rheumatology, Hospital Puerta del Mar. Cádiz. Spain, Cádiz, Spain, ²⁴Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain, ²⁵Hospital Severo Ochoa, Madrid, Spain, Madrid, Spain, ²⁶Rheumatology Division, Hospital General Universitario de Elda, Elda, Spain, ²⁷Rheumatology, Hospital Clínico San Carlos, Madrid, Spain, ²⁸Ophthalmology and Rheumatology, Hospital Miguel Servet. Zaragoza. Spain, Zaragoza, Spain, ²⁹Hospital Miguel Servet. Zaragoza. Spain, Zaragoza, Spain, ³⁰Rheumatology, Hospital Universitario Fundación Alcorcón. Madrid. Spain, Madrid, Spain, ³¹Hospital de Mérida. Spain, Mérida, Spain, ³²Rheumatology, Hospital Virgen de la Arrixaca. Murcia. Spain, Murcia, Spain, ³³Section for Autoimmune Diseases, Rheumatology, Fundación Jiménez Díaz University Hospital & Health Research Institute, Madrid, Spain, ³⁴Rheumatology, Hospital Universitario Santiago de Compostela. La Coruña. Spain, La Coruña, Spain, ³⁵Rheumatology, Hospital de Cabueñes. Gijón. Spain, Gijón, Spain, ³⁶Ophthalmology, Hospital General Universitario de Valencia. Spain, Valencia, Spain, ³⁷Rheumatology, Hospital del Mar. Barcelona. Spain, Barcelona, Spain, ³⁸Hospital de Pontevedra. Pontevedra. Spain, Pontevedra, Spain, ³⁹Ophthalmology, Hospital de Pontevedra. Pontevedra. Spain, Pontevedra, Spain, ⁴⁰Rheumatology, Hospital de Sierrallana, Torrelavega. Cantabria. Spain, Torrelavega, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Behcet's syndrome, immunosuppressants, infliximab, uveitis and vasculitis

Session Information

Date: Tuesday, October 23, 2018

Title: Miscellaneous Rheumatic and Inflammatory Diseases Poster III: Sarcoid, Inflammatory Eye Disease, and Autoinflammatory Disease

Session Type: ACR Poster Session C

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

Background/Purpose:

Retinal vasculitis is a serious complication of uveitis due to Behçet’s disease (BD). The treatment is based on corticosteroids, conventional immunosuppressants (IS) and anti-TNF-α drugs in refractory cases. We assess the short and long-term efficacy of Infliximab (IFX) in refractory retinal vasculitis of BD.

Methods:

Multicenter study of 72 patients with retinal vasculitis of BD refractory to corticosteroids and at least 1 IS. Diagnosis of retinal vasculitis was realized with fluorescein angiography. We compared the efficacy of IFX between at baseline visit, and the 1st week, 3, 6 months and 1, 2, 3, 4, 5 and 6 years.

Results:

We studied 72 patients/129 affected eyes (40♂/32♀) with a mean age of 39.65±9.75 years. HLA-B51 was positive in 63%. Before IFX onset, patients had received: oral prednisone (n=70), methylprednisolone bolus (n=28), CyA (n=56), AZA (n=43), MTX (n=34) and other conventional immunosuppressants (n=22). IFX was administered as monotherapy in 17 patients and in the remaining 55, combined with conventional immunosuppressants.

IFX was administer as follows: 3 mg/kg/4w (n=1), 3 mg/kg/8w (n=4), 4 mg/kg/4w (n=1), 5 mg/kg/4w (n=12), 5 mg/kg/6w (n=16), 5 mg/kg/8w (n=37) y 5.5 mg/kg/8w (n=1).

Following IFX onset, an improvement in retinal vasculitis was observed, as well as in the rest of the ocular parameters. This enhancement was maintained (TABLE).

After a mean follow-up of 26.58±22.10 months, IFX was discontinued in 44 patients: remission (n=15), insufficient response (n=16), preference of another route of administration (n=8), pregnancy (n=1) and side effects (n=4; 1 miliary tuberculosis, 3 local reactions).

Conclusion:

IFX seems an effective and safe short and long-term treatment in retinal vasculitis of BD.

TABLE

	Basal	1^st week	1^st month	3^rd month	6^thmonth	1^st year	2^nd year	3^rd year	4^th year	5^th year	6^th year
Retinal Vasculitis (n, affected eyes, %)	117 (100%)	93 (79,5%) *	45 (38,5%) *	21 (17,9%) *	13 (11,1%) *	4 (3,1%) *	4 (3,1%) *	3 (2,6%) *	1 (0,9%) *	0 (0%) *	0 (0%) *
BCVA (mean±SD)	0,41±0,31	0,45±0,32 *	0,57±0,33 *	0,63±0,34 *	0,63±0,34 *	0,63±0,35 *	0,63±0,35 *	0,61±0,33 *	0,63±0,32 *	0,66±0,37 *	0,68±0,37 *
Tyndall (median [IQR])	1 [0-2]	0,5 [0-2] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *
Vitritis (median [IQR])	1 [0-2]	1 [0-2] *	0 [0-0,5] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *	0 [0-0] *
OCT (mean±SD)	346,9±140,7	339,6±125,6 *	310,8±101,4 *	285,4±74,5 *	264,7±57,1 *	268,6±52,7 *	265,2±43,7 *	253,8±31,0 *	239,8±33,8 *	208,0±26,0 *	184,7±4,1 *

*p<0,05

Disclosure: J. L. Martín-Varillas, None; B. Atienza-Mateo, None; V. Calvo-Río, None; D. Prieto Peña, None; M. Calderón Goercke, None; R. Demetrio-Pablo, None; J. Loricera, None; M. V. Hernández, None; A. Adan, None; M. Mesquida, None; D. Peiteado, None; D. Diaz-Valle, None; L. Martínez-Costa, None; E. Valls-Pascual, None; M. A. Caracuel, None; A. Garcia-Aparicio, None; J. M. Herreras, None; M. Cordero-Coma, None; C. A. Montilla-Morales, None; A. Fonollosa, None; A. Atanes, None; F. Francisco, None; I. Torre-Salaberri, None; O. Maíz, None; A. Blanco, None; C. Fernandez-Espartero, None; N. Ortego Centeno, None; E. Raya Álvarez, None; M. Gandía, None; F. J. López Longo, None; M. Alcalde-Villar, None; C. Fernández-Carballido, None; E. Pato Cour, None; O. Ruiz Moreno, None; F. Jiménez-Zorzo, None; R. Almodóvar González, None; C. Carrasco-Cubero, None; L. F. Linares, None; F. I. Romero-Bueno, None; S. Insua, None; S. González-Suárez, None; M. Hernández, None; E. Beltrán, None; J. Cruz, None; C. Férnandez Cid, None; E. Aurrecoechea, None; E. Pons, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Martín-Varillas JL, Atienza-Mateo B, Calvo-Río V, Prieto Peña D, Calderón Goercke M, Demetrio-Pablo R, Loricera J, Hernández MV, Adan A, Mesquida M, Peiteado D, Diaz-Valle D, Martínez-Costa L, Valls-Pascual E, Caracuel MA, Garcia-Aparicio A, Herreras JM, Cordero-Coma M, Montilla-Morales CA, Fonollosa A, Atanes A, Francisco F, Torre-Salaberri I, Maíz O, Blanco A, Fernandez-Espartero C, Ortego Centeno N, Raya Álvarez E, Gandía M, López Longo FJ, Alcalde-Villar M, Fernández-Carballido C, Pato Cour E, Ruiz Moreno O, Jiménez-Zorzo F, Almodóvar González R, Carrasco-Cubero C, Linares LF, Romero-Bueno FI, Insua S, González-Suárez S, Hernández M, Beltrán E, Cruz J, Férnandez Cid C, Aurrecoechea E, Pons E, González-Gay MA, Blanco R. Infliximab Therapy in Refractory Retinal Vasculitis of Behçet’s Disease, Short and Long-Term Follow-up. Multicenter Study of 72 Patients [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/infliximab-therapy-in-refractory-retinal-vasculitis-of-behcets-disease-short-and-long-term-follow-up-multicenter-study-of-72-patients/. Accessed .

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