ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 3041

Long Term Biological Therapy in Uveitis Refractory Due to Behçet’s Disease. Multicenter Study of 165 Patients. 

Montserrat Santos-Gómez1, Vanesa Calvo-Río1, Ricardo Blanco1, Emma Beltran2, Juan Sánchez Bursón Sr.3, Marina Mesquida4, Alfredo Adan4, M. Victoria Hernández5, F.Javier López-Longo6, Marisa Hernandez Grafella7, Elia Valls Pascual8, Lucía Martinez-Costa9, Agusti Sellas-Fernandez10, Miguel Cordero11, Manuel Díaz-Llopis12, Roberto Gallego13, Jose L. García Serrano14, JL Callejas Rubio15, Norberto Ortego-Centeno16, Jose M Herreras17, Alejandro Fonollosa18, Angel M. Garcia-Aparicio19, Olga Maiz Alonso20, Ana Blanco21, Ignacio Torre22, Cruz Fernández- Espartero23, Vega Jovani24, Diana Peiteado25, David Diaz Valle26, Esperanza Pato26, Juan Cruz27, Carlos Férnandez Cid28, Elena Aurrecoechea29, Miriam García-Arias30, Miguel Angel Caracuel-Ruiz31, Carlos Alberto Montilla Morales32, Antonio Atanes-Sandoval33, Félix Francisco34, Santos Insua35, Senen González-Suárez36, Amalia Sánchez-Andrade37, Fernando Gamero38, Luis Francisco Linares39, Fredeswinda Romero40, A. Javier García-González41, Raquel Almodóvar González42, Enrique Minguez43, Carmen Carrasco Cubero44, Alejandro Olivé45, Julio Vázquez46, Oscar Ruiz Moreno47, Fernando Jiménez-Zorzo48, Javier Manero48, Santiago MuÑoz Fernandez49, Cristina Fernández-Carballido50, Esteban Rubio Romero51, Fred Antón Pagés52, Javier Toyos-Saenz de Miera53, Myriam Gandía54, Carmen Gonzalez-Vela55, Enrique Raya56, Natalia Palmou1, Leyre Riancho-Zarrabeitia1 and Miguel Angel Gonzalez-Gay1, 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, 2Rheumatology, Hospital General Universitario de Valencia, Valencia, Spain, 3Rheumatology, Hospital de Valme., Sevilla, Spain, 4Ophthalmology, Hospital Clinic, Barcelona, Spain, 5Arthritis Unit, Rheumatology, Hospital Clinic, Barcelona, Spain, 6Hospital Gregorio Marañón, Madrid, Spain, 7Ophthalmology., Hospital General Universitario de Valencia, Valencia, Spain, 8Rheumatology, Hospital Universitario Dr Peset, Valencia, Spain, 9Ophthalmology, Hospital Universitario Dr Peset, Valencia, Spain, 10Rheumatology, Hospital Universitario Valle Hebron, Barcelona, Spain, 11Ophthalmology, Hospital de León, León, Spain, 12Hospital Universitario La Fe, Valencia, Spain, 13Ophthalmology, Hospital Universitario La Fe, Valencia, Spain, 14Ophthalmology, Hospital Universitario San Cecilio, Granada, Spain, 15Hospital Universitario San Cecilio, Granada, Spain, 16Systemic Autoimmune Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain, 17Ophthalmology, Hospital Universitario, IOBA, Valladolid, Spain, 18Ophtalmology, Hospital de Cruces, Bilbao, Spain, 19Rheumatology, Hospital Virgen de la Salud, Toledo, Spain, 20Rheumatology, Donostia University Hospital, Donostia, Spain, 21Ophthalmology, Donostia University Hospital, Donostia, Spain, 22Rheumatology, Hospital de Basurto, Bilbao, Spain, 23Rheumatology, Hospital La Zarzuela, Madrid, Spain, 24Rheumatology, Hospital General de Alicante, Alicante, Spain, 25Rheumatology, Hospital La Paz, Madrid, Spain, 26Hospital Clínico San Carlos, Madrid, Spain, 27Rheumatology, Hospital de Pontevedra, Pontevedra, Spain, 28Ophthalmology, Hospital de Pontevedra, Pontevedra, Spain, 29Rheumatology, Hospital de Sierrallana, Torrelavega, Spain, 30Rheumatology, Hospital La Princesa, Madrid, Spain, 31Plaza Cruz Roja, 1, Hospital Reina Sofia, Córdoba, Spain, 32Rheumatology, Hospital Universitario de Salamanca, Salamanca, Spain, 33Rheumatology, Complejo Hospitalario Universitario de La Coruña, La Coruña, Spain, 34Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain, 35Rheumatology, Hospital Universitario Santiago de Compostela, La Coruña, Spain, 36Rheumatology, Hospital de Cabueñes, Gijón, Spain, 37Hospital Lucus Augusti, Lugo, Spain, 38Rheumatology, Hospital San Pedro Alcántara, Cáceres, Spain, 39Rheumatology, Hospital Virgen de la Arrixaca, Murcia, Spain, 40Section for Autoimmune Diseases, Rheumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain, 41Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain, 42Rheumatology Unit, Hospital Universitario Fundación Alcorcón, Madrid, Spain, 43Ophthalmology., Hospital Clínico de Zaragoza, Zaragoza, Spain, 44Rheumatology, Hospital de Mérida, Mérida, Spain, 45Hospital Germans Trias i Pujol, Badalona, Spain, 46Rheumatology., Hospital de Ferrol, La Coruña, Spain, 47Ophthalmology and Rheumatology., Hospital Miguel Servet, Zaragoza, Spain, 48Ophthalmology and Rheumatology, Hospital Miguel Servet, Zaragoza, Spain, 49Rheumatology, Hospital Infanta Sofía, Madrid, Spain, 50Rheumatology, Hospital General Universitario de Elda, Elda (Alicante), Spain, 51Rheumatology Department,, Hospital Universitario Virgen del Rocío, Sevilla, Spain, 52Rheumatology, Hospital de Palencia, Palencia, Spain, 53Rheumatology, Hospital Virgen de la Macarena, Seville, Spain, 54Department of Autoimmune Diseases, IDIBAPS, Hospital Clínic, Barcelona, Spain, 55Pathology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, 56Rheumatology, Hospital Universitario San Cecilio, Granada, Spain

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: ,

Session Information

Date: Tuesday, November 10, 2015

Title: Vasculitis Poster III

Session Type: ACR Poster Session C

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

Background/Purpose:

Conventional management of uveitis due to Behçet’s disease (UBD) consists on conventional immunosuppressive drugs. However, UBD is often refractory requiring more intensive therapy.Our aim was to assess long-term response in UBD patients refractory to conventional therapy.

Methods:

Multicenter study of 165 patients with UBD followed-up in the uveitis units of 45 hospitals. All of them had inadequate response or intolerance to traditional treatment with corticosteroids and at least 1 systemic immunosuppressive drug. The degree of ocular inflammation was assessed as “the Standardization of Uveitis Nomenclature (SUN) working Group” (Am J Ophthalmol 2005; 140: 509-516), and macular thickness was assessed by optical coherence tomography (OCT). Comparisons were made between baseline and the 1st week, 2nd week, 1st month, 6th month, 1st, 2nd, 3rd,4th and 5th year.

Results:

165 patients (89 men/76 women/297 affected eyes) with a mean age of 39.3±10.5 years (range 10-67) were studied. HLA-B51 was positive in 64.8%. Prior to biologic therapy and in addition to oral corticosteroids, patients had received the following drugs: Intravenous pulses of methylprednisolone (50 patients), cyclosporine A (CyA) (134), methotrexate (MTX) (72) and azathioprine (AZA) (87). Infliximab (IFX) was the first biologic used in 96 cases (58.2%) and adalimumab (ADA) in the remaining 69 (41.8%) patients. These agents were used as a monotherapy in 46 cases or in combination with immunosuppressive drugs::CsA (58 cases), MTX (34), AZA (24), mycophenolate (1), cyclophosphamide (1) and tacrolimus (1). The most common regimens were IFX 5 mg/kg/i.v. every 4-8 weeks and ADA 40 mg sc/2 weeks. In the course of the diseases, in cases of refractory uveitis to these drugs switching to other biologic agents was performed: golimumab (n = 6), tocilizumab (5), rituximab (2), certolizumab (1) and etanercept (1). Nevertheless, in 30 cases the biologic agents were discontinued because of maintained clinical remission. Significant improvement observed since the 1sr week was observed in the visual acuity (VA), Tyndall and vitritis. OCT improvement was observed since the 2nd week (TABLE). At baseline, 57 patients (95 eyes) had macular thickening (OCT> 250μ) and 33 patients (50 eyes) had cystoid macular edema (CME) (OCT> 300μ). The OCT improved from 344.5 ± 137.3 microns to 254.2 ± 60.8 microns (p <0.01). After a mean follow-up of 38.3±22.4 months the most serious side effects were miliary TB (n=1), Mycobacterium avium pneumonia (n=1), melanoma (n=1), and fatal lymphoma (n=1).

Conclusion:

Biological treatment with IFX or ADA are effective and relatively safe in UBD refractory to conventional therapy.

Basal

(165/315)

1 week

(163/310)

2 weeks

(162/309)

1 month

(162/302)

6 months

(152/290)

1 year

(145/279)

2 years

(131/247)

3 years

(89/161)

4 years

(63/110)

5 years

(44/74)

VA (mean±SD)

0.53 ± 0.3

0.56±0.3 *

0.59±0.3 *

0.66±0.3 *

0.7±0.3 *

0.75±0.7 *

0.72±0.3 *

0.7±0.3 *

0.72±0.3 *

0.73±0.3 *

Anterior chamber cells (median [IQR])

1 [0-2]

0 [0-2] *

0 [0-1] *

0 [0-0.5] *

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 [0-1] *

0 [0-1] *

0 [0-0] *

0 [0-0] *

0 [0-0] *

0 [0-0] *

0 [0-0] *

0 [0-0] *

Retinal Vasculitis (% affected eyes)

58.4%

53.22% *

43.36% *

32.2% *

11.76% *

5% *

4.8% *

3.1%

0,9%

1.3%

OCT (μ) (mean±SD)

344.5 ± 137.3

349±134.6

333.6±114.2 *

307.2±95 *

266.3±50.8 *

258.6±48.6 *

267.5±56.8 *

249.4±37.8 *

246.6±40.1 *

254.2±60.8 *

TABLE. Evolution of the main ophthalmological parameters

In brackets is the number of patient/number of eyes with the data available.

* p <0.05, the comparative study is done for each variable in each period compared to baseline.

Disclosure: M. Santos-Gómez, None; V. Calvo-Río, None; R. Blanco, None; E. Beltran, None; J. Sánchez Bursón Sr., None; M. Mesquida, None; A. Adan, None; M. V. Hernández, None; F. J. López-Longo, None; M. Hernandez Grafella, None; E. Valls Pascual, None; L. Martinez-Costa, None; A. Sellas-Fernandez, None; M. Cordero, None; M. Díaz-Llopis, None; R. Gallego, None; J. L. García Serrano, None; J. Callejas Rubio, None; N. Ortego-Centeno, None; J. M. Herreras, None; A. Fonollosa, None; A. M. Garcia-Aparicio, None; O. Maiz Alonso, None; A. Blanco, None; I. Torre, None; C. Fernández- Espartero, None; V. Jovani, None; D. Peiteado, None; D. Diaz Valle, None; E. Pato, None; J. Cruz, None; C. Férnandez Cid, None; E. Aurrecoechea, None; M. García-Arias, None; M. A. Caracuel-Ruiz, None; C. A. Montilla Morales, None; A. Atanes-Sandoval, None; F. Francisco, None; S. Insua, None; S. González-Suárez, None; A. Sánchez-Andrade, None; F. Gamero, None; L. F. Linares, None; F. Romero, None; A. J. García-González, None; R. Almodóvar González, None; E. Minguez, None; C. Carrasco Cubero, None; A. Olivé, None; J. Vázquez, None; O. Ruiz Moreno, None; F. Jiménez-Zorzo, None; J. Manero, None; S. MuÑoz Fernandez, None; C. Fernández-Carballido, None; E. Rubio Romero, None; F. Antón Pagés, None; J. Toyos-Saenz de Miera, None; M. Gandía, None; C. Gonzalez-Vela, None; E. Raya, None; N. Palmou, None; L. Riancho-Zarrabeitia, None; M. A. Gonzalez-Gay, None.

To cite this abstract in AMA style:

Santos-Gómez M, Calvo-Río V, Blanco R, Beltran E, Sánchez Bursón J Sr., Mesquida M, Adan A, Hernández MV, López-Longo FJ, Hernandez Grafella M, Valls Pascual E, Martinez-Costa L, Sellas-Fernandez A, Cordero M, Díaz-Llopis M, Gallego R, García Serrano JL, Callejas Rubio J, Ortego-Centeno N, Herreras JM, Fonollosa A, Garcia-Aparicio AM, Maiz Alonso O, Blanco A, Torre I, Fernández- Espartero C, Jovani V, Peiteado D, Diaz Valle D, Pato E, Cruz J, Férnandez Cid C, Aurrecoechea E, García-Arias M, Caracuel-Ruiz MA, Montilla Morales CA, Atanes-Sandoval A, Francisco F, Insua S, González-Suárez S, Sánchez-Andrade A, Gamero F, Linares LF, Romero F, García-González AJ, Almodóvar González R, Minguez E, Carrasco Cubero C, Olivé A, Vázquez J, Ruiz Moreno O, Jiménez-Zorzo F, Manero J, MuÑoz Fernandez S, Fernández-Carballido C, Rubio Romero E, Antón Pagés F, Toyos-Saenz de Miera J, Gandía M, Gonzalez-Vela C, Raya E, Palmou N, Riancho-Zarrabeitia L, Gonzalez-Gay MA. Long Term Biological Therapy in Uveitis Refractory Due to Behçet’s Disease. Multicenter Study of 165 Patients.  [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/long-term-biological-therapy-in-uveitis-refractory-due-to-behcets-disease-multicenter-study-of-165-patients/. Accessed .

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