Infliximab Versus Adalimumab in Severe Uveitis: Multicenter Study from the French Uveitis Network

Hélène Vallet¹, Pascal Sève², Lucie Biard³, Elodie Feurer⁴, Sophie Rivière⁵, Philip Bielfeld⁶, Laurent Perard⁷, Boris Bienvenu⁸, Sébastien Abad⁹, Aude Rigolet¹⁰, Alban Deroux¹¹, Antoinette Perlat¹², Damien Sène¹³, Isabelle Marie¹⁴, Emmanuel Heron¹⁵, Eric Hachulla¹⁶, Olivier Fain¹⁷, Gaëlle Clavel¹⁸, Jean Sibilia¹⁹, Nathalie Tieulié²⁰, Yoland Schoindre²¹, Jean Baptiste Fraison²², Guillaume Moulis²³, Thomas Papo²⁴, Gilles Blaison²⁵, Julie Gueudry²⁶, Olivier Lidove²⁷, Phuc LE Hoang²⁸, Catherine Chapelon²⁹, Mathieu Resche Regon³⁰, Patrice Cacoub¹³, Bahram Bodaghi²⁸ and David Saadoun³¹, ¹Internal medicine, DHU 2iB Internal Medicine Referal Center for Autoimmune diseases Pitie Hospital, Paris, France, ²Internal medicine, CHU Lyon, Lyon, France, ³Biostatistics, Saint-Louis Hospital, Paris, France, ⁴Internal Medicine, Hôpital de la Croix Rousse, Lyon, France, ⁵service de médecine interne A,, CHU de Montpellier, Montpellier Cedex 5, France, ⁶CHU de Dijon, Dijon, France, ⁷Hôpital Edouard Herriot, Lyon, France, ⁸Internal Medicine, Hospital Caen, Caen, France, ⁹Hôpital Avicenne, Bobigny, France, ¹⁰Médecine Interne 1, Hôpital Pitié-Salpêtrière, Paris, France, ¹¹Internal Medicine, CHU Grenoble, Grenoble, France, ¹²Internal medicine, CHU de Rennes, Rennes, France, ¹³Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France, ¹⁴Service de médecine interne, CHU de Rouen, Rouen, France., Rouen, France, ¹⁵Internal medicine, Hôpital des XV-XX, Paris, France, ¹⁶CHU Lille, Lille, France, ¹⁷Internal Medicine, Hospital J. Verdier, Bondy, France, ¹⁸Rheumatology, Fondation Rothschild, Paris, France, ¹⁹Rheumatology, Hôpital de Hautepierre, Strasbourg, France, ²⁰CHU Nice, Nice, France, ²¹Department de Internal Medicine and Clinical Immunology, Hôpital Pitié-Salpêtrière, AP-PH, UPMC, Paris, France, ²²Hôpital Jean Verdier, Bondy, France, ²³CHU Purpan, Toulouse, France, ²⁴CHU Bichat, Paris, France, ²⁵Internal Medicine, Hopital de Colmar, Colmar, France, ²⁶Ophtalmology, CHU de Rouen, Rouen, France, ²⁷Internal Medicine, Bichat-Claude Bernard Hospital, University Paris-7, Paris, France, ²⁸Ophtalmology, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié Salpétrière, Paris, France, ²⁹Department of Internal Medicine 2. Referal center for SLE/APS, CHU Pitié-Salpêtrière, Paris, France, ³⁰biostatistics Saint Louis Hospital, paris, France, ³¹Department of Internal Medicine and clinical Immunology. French National Reference Center for Autoimmune Diseases. DHU I2B (Inflammation, Immunotherapy and Biotherapy), UPMC, Paris VI, Hôpital Pitié Salpétrière, AP-HP, UPMC, Univ Paris 06, Paris, France

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Adalimumab, infliximab and uveitis

Session Information

Date: Monday, November 9, 2015

Title: Miscellaneous Rheumatic and Inflammatory Diseases Oral Session II

Session Type: ACR Concurrent Abstract Session

Session Time: 2:30PM-4:00PM

Background/Purpose:

Anti-tumour necrosis factor (TNF) molecules have become a valuable addition to the therapeutic armamentarium for patients with severe uveitis. However, direct comparison of safety and efficacy of infliximab (IFX) and adalimumab (ADA) is lacking.

In this French nationwide study, we analyzed the efficacy and safety of IFX and ADA in patients with severe uveitis.

Methods: 203 patients (31 [20-42] years with 57% of women) with severe uveitis treated with anti-TNF alpha (IFX 5mg/kg at week 0, 2, 6 and every 6 weeks or ADA 40mg/2 weeks) were included. Because of the non-randomized design, the comparison of the anti-TNF treatments was performed using a propensity score approach. The probability of receiving either IFX or ADA, conditionally on baseline characteristics, was computed using a logistic regression model. The comparison of efficacy between IFX and ADA was considered as the primary end-point. Ocular involvement response to treatment was evaluated according to the SUN Workgroup criteria.

Results: Uveitis was bilateral in 163 cases (80%). Main etiologies of uveitis included Behçet’s disease (38%), juvenile idiopathic arthritis (20%), spondylarthropathies (11%) and sarcoidosis (5%). The median duration of disease before starting anti-TNF treatment was 42 [15-104] months. Ninety six percent of patients achieved complete or partial response to anti-TNF alpha therapy. In univariate analysis, the factors associated with complete response of uveitis included Behçet’s disease (OR=5.89 [1.65-21.0], p=0.006) and more than 5 uveitis flares before anti-TNFα treatment (OR: 2.37 [1.13-4.97], p=0.022). In contrast, previous immunosuppressive use was negatively associated with complete response to anti-TNFα (OR=0.25 [0.11-0.54]; p=0.0004). The complete response rate and the time to first improvement of uveitis were similar regardless the anti-TNFα (IFX or ADA) used (OR 0.88 [0.23-3.35]; p=0.85 and 0.93 [0.41-2.10] months; p=0.86, respectively) in a logistic regression model weighted by the inverse of propensity score. Side effects were reported for 28% of patients and 12% had serious adverse events. No significant difference was observed in terms of serious side effects between IFX and ADA (OR 0.25 [0.047-1.29]; p=0.097).

Conclusion: Overall efficacy and safety were equivalent between IFX and ADA in severe uveitis. Behçet’s patients had a 4 times higher odds of complete response to anti-TNFα therapy.

Disclosure: H. Vallet, None; P. Sève, None; L. Biard, None; E. Feurer, None; S. Rivière, None; P. Bielfeld, None; L. Perard, None; B. Bienvenu, None; S. Abad, None; A. Rigolet, None; A. Deroux, None; A. Perlat, None; D. Sène, None; I. Marie, None; E. Heron, None; E. Hachulla, None; O. Fain, None; G. Clavel, None; J. Sibilia, None; N. Tieulié, None; Y. Schoindre, None; J. B. Fraison, None; G. Moulis, None; T. Papo, None; G. Blaison, None; J. Gueudry, None; O. Lidove, None; P. LE Hoang, None; C. Chapelon, None; M. Resche Regon, None; P. Cacoub, None; B. Bodaghi, None; D. Saadoun, None.

To cite this abstract in AMA style:

Vallet H, Sève P, Biard L, Feurer E, Rivière S, Bielfeld P, Perard L, Bienvenu B, Abad S, Rigolet A, Deroux A, Perlat A, Sène D, Marie I, Heron E, Hachulla E, Fain O, Clavel G, Sibilia J, Tieulié N, Schoindre Y, Fraison JB, Moulis G, Papo T, Blaison G, Gueudry J, Lidove O, LE Hoang P, Chapelon C, Resche Regon M, Cacoub P, Bodaghi B, Saadoun D. Infliximab Versus Adalimumab in Severe Uveitis: Multicenter Study from the French Uveitis Network [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/infliximab-versus-adalimumab-in-severe-uveitis-multicenter-study-from-the-french-uveitis-network/. Accessed .

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