Long Term Follow-up and Optimization of Infliximab in Refractory Uveitis of Behçet’s Disease. Multicenter Study of 103 Cases

Belén Atienza-Mateo¹, José Luis Martín-Varillas¹, Lucia C. Domínguez-Casas¹, Nuria Vegas-Revenga¹, Vanesa Calvo-Río¹, Emma Beltrán², Juan Sánchez-Burson³, Marina Mesquida⁴, Alfredo Adán⁴, M Victoria Hernández⁴, Javier López-Longo⁵, Marisa Hernández Garfella², Elia Valls Pascual⁶, Lucía Martínez Costa⁶, Agustí Sellas-Fernandez⁷, José L. García-Serrano⁸, José-Luis Callejas-Rubio⁸, Norberto Ortego⁸, José M. Herreras⁹, Alejandro Fonollosa¹⁰, Olga Maíz¹¹, Ana Blanco¹², Ignacio Torre¹³, C. Fernandez-Espartero¹⁴, V. Jovani¹⁵, D. Peiteado Lopez¹⁶, David Díaz Valle¹⁷, Esperanza Pato¹⁷, J. Cruz¹⁸, C. Fernandez-Cid¹⁸, Elena Aurrecoechea¹⁹, M. García²⁰, Miguel A. Caracuel²¹, Antonio Atanes²², F. Francisco²³, Santos Insúa²⁴, S. Gonzalez-Suárez²⁵, A. Sánchez-Andrade²⁶, L. Linares²⁷, F. Romero-Bueno²⁸, A. J. García²⁹, R. Almodovar³⁰, Enrique Mínguez³¹, Carmen Carrasco Cubero³², E. Raya Álvarez⁸, M. Alcalde-Villar³³, C. Fernández-Carbadillo³⁴, FA. Pagés³⁵, MC Gonzalez-Vela³⁶, Rosalia Demetrio³⁷, Enar Pons³⁷, Jose L. Hernández³⁸, Miguel Angel González-Gay³⁹ and Ricardo Blanco⁴⁰, ¹Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ²Hospital General Universitario de Valencia, Valencia, Spain, ³Hospital de Valme, Sevilla, Spain, ⁴Hospital Clinic, Barcelona, Spain, ⁵Hospital Gregorio Marañón, Madrid, Spain, ⁶Hospital Peset, Valencia, Spain, ⁷Hospital Vall d´Hebron, Barcelona, Spain, ⁸Hospital San Cecilio, Granada, Spain, ⁹Hospital Universitario IOBA, Valladolid, Spain, ¹⁰Hospital de Cruces, Bilbao, Spain, ¹¹Hospital Donosti, San Sebastian, Spain, ¹²Ophthalmology, Hospital Universitario Donostia. San Sebastian. Spain, San Sebastián, Spain, ¹³Hospital Basurto, Bilbao, Spain, ¹⁴Hospital Universitario de Móstoles, Madrid, Spain, ¹⁵Hospital General Alicante, Alicante, Spain, ¹⁶Hospital Universitario La Paz, Madrid, Spain, ¹⁷Hospital Clínico San Carlos, Madrid, Spain, ¹⁸Hospital Pontevedra, Pontevedra, Spain, ¹⁹Hospital Sierrallana, Torrelavega, Spain, ²⁰Hospital La Princesa, Madrid, Spain, ²¹Hospital Córdoba, Córdoba, Spain, ²²Hospital Universitario de A Coruña, A Coruña, Spain, ²³Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain, ²⁴Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain, ²⁵Hospital Cabueñes, Gijón, Spain, ²⁶Hospital Lucus Augusti, Lugo, Spain, ²⁷Hospital Arrixaca, Murcia, Spain, ²⁸Fundación Jiménez Díaz, Madrid, Spain, ²⁹Hospital 12 de Octubre, Madrid, Spain, ³⁰Hospital Universitario Fundación Alcorcón, Madrid, Spain, ³¹Hospital Clínico Zaragoza, Zaragoza, Spain, ³²Hospital Universitari Germans Trias i Pujol, Barcelona, Spain, ³³Hospital Severo Ochoa, Madrid, Spain, ³⁴Hospital General Universitario de Elda, Alicante, Spain, ³⁵Complejo Asistencial de Palencia, Palencia, Spain, ³⁶Pathology Anatomy, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ³⁷Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria., Santander, Spain, ³⁸Internal Medicine, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ³⁹Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Johannesburg, South Africa, ⁴⁰Hospital Universitario Marqués de Valdecilla, Santander, Spain

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Behcet's syndrome, infliximab and uveitis

Session Information

Date: Tuesday, November 7, 2017

Title: Vasculitis Poster III: Other Vasculitis Syndromes

Session Type: ACR Poster Session C

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

Background/Purpose: Uveitis is a severe manifestation of Behçet Disease (BD). The treatment is based on corticosteroids and conventional immunosuppressive drugs. In refractory cases, anti-TNFα had demonstrated efficacy. Our aim was to study the efficacy in long-term treatment with Infliximab (IFX) and its optimization.

Methods: Multicenter study of 178 patients diagnosed with Uveitis associated with BD refractory to high-dose of corticosteroids and at least one conventional immunosuppressive drug. IFX was used in 103 of these patients. The degree of ocular inflammation was evaluated with “the SUN working Group” (Am J Ophthalmol 2005; 140: 509-516) and the macular thickening with the optical coherence tomography (OCT). A comparison between baseline, 1st and 2nd week, 1st, 3rd and 6th month and 1st, 2nd, 3th and 4th year was performed. The statistical analysis was performed with the software STATISTICA Statsoft Inc. Tulsa, Oklahoma, USA). Results are expressed in mean±SD for variables with a normal distribution, or median [25-75 IQR] when distribution is not normal. The comparison of continuous variables was performed with the Wilcoxon test.

Results: We studied 103 patients/185 affected eyes (55 men/48 women), mean age 40.4±10.1. The ocular pattern was panuveitis (n=64), posterior uveitis (n=28) and anterior (n=11). Before IFX and besides oral corticosteroids, patients received: iv metilprednisolone (n=30), cyclosporine A (CyA) (n=77), azathioprine (AZA) (n=58), metotrexate (MTX) (n=45) and other treatments (n=34). IFX was administrated in monotherapy (n=24) or combinated with other drugs (n=78): CyA (n=32), MTX (26), AZA (17), Cyclophosphamide (1), tacrolimus (1) and mycophenolate (1). The maintenance dose of IFX ranged between 3-5 mg/kg every/4 or 8 weeks. The evolution of the main ocular parameters is summarized in TABLE. Once achieved the remission we optimized treatment with IFX in 28 patients. a) In 23, the interval of dose was increased. b) In the other 5 patients the dose was reduced. After a mean follow-up of 32.29±23.35 months, IFX was stopped in 56 patients for the following reasons: remission (n=20), preference for other way of administration (n=11), inefficacy (n=15), infusional reaction (n=5), TBC (n=1), cutaneous reaction (n=1), oral ulcers (n=1), colon carcinoma (n=1) and desire of pregnancy (n=1).

Conclusion: IFX is effective in short and long term treatment of refractory uveitis associated to BD. Optimization and even discontinuation of IFX after remission is possible.

Table.

	BCVA (mean±S.D.)	AC cells (median [IQR])	Vitritis (median [IQR])	OCT (µ) (mean±S.D.)	Retinal Vasculitis (% affected eyes)
Baseline	0.50±0.35	1 [0-2]	1 [0-2]	331.7±134.0	53.84%
1^st week	0.53±0.34	0 [0-1]	0.25 [0-1.5]	325.8±124.2	42.30%
2^nd week	0.58±0.33	0 [0-1]	0 [0-1]	319.6±115.3	33.17%
1^st month	0.63±0.33	0 [0-0]	0 [0-0]	301.4±103.7	22.11%
3^rd month	0.68±0.34	0 [0-0]	0 [0-0]	283.2±83.5	10.57%
6^th month	0.68±0.34	0 [0-0]	0 [0-0]	265.7±66.5	7.21%
1^st year	0.66±0.33	0 [0-0]	0 [0-0]	264.1±61.3	2.40%
2^nd year	0.66±0.33	0 [0-0]	0 [0-0]	263.6±65.1	1.92%
3^rd year	0.66±0.33	0 [0-0]	0 [0-0]	239.8±26.8	0.48%
4^th year	0.67±0.32	0 [0-0]	0 [0-0]	231.2±35.6	0.48%

Disclosure: B. Atienza-Mateo, None; J. L. Martín-Varillas, None; L. C. Domínguez-Casas, None; N. Vegas-Revenga, None; V. Calvo-Río, None; E. Beltrán, None; J. Sánchez-Burson, None; M. Mesquida, None; A. Adán, None; M. V. Hernández, None; J. López-Longo, None; M. Hernández Garfella, None; E. Valls Pascual, None; L. Martínez Costa, None; A. Sellas-Fernandez, None; J. L. García-Serrano, None; J. L. Callejas-Rubio, None; N. Ortego, None; J. M. Herreras, None; A. Fonollosa, None; O. Maíz, None; A. Blanco, None; I. Torre, None; C. Fernandez-Espartero, None; V. Jovani, None; D. Peiteado Lopez, None; D. Díaz Valle, None; E. Pato, None; J. Cruz, None; C. Fernandez-Cid, None; E. Aurrecoechea, None; M. García, None; M. A. Caracuel, None; A. Atanes, None; F. Francisco, None; S. Insúa, None; S. Gonzalez-Suárez, None; A. Sánchez-Andrade, None; L. Linares, None; F. Romero-Bueno, None; A. J. García, None; R. Almodovar, None; E. Mínguez, None; C. Carrasco Cubero, None; E. Raya Álvarez, None; M. Alcalde-Villar, None; C. Fernández-Carbadillo, None; F. Pagés, None; M. Gonzalez-Vela, None; R. Demetrio, None; E. Pons, None; J. L. Hernández, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Atienza-Mateo B, Martín-Varillas JL, Domínguez-Casas LC, Vegas-Revenga N, Calvo-Río V, Beltrán E, Sánchez-Burson J, Mesquida M, Adán A, Hernández MV, López-Longo J, Hernández Garfella M, Valls Pascual E, Martínez Costa L, Sellas-Fernandez A, García-Serrano JL, Callejas-Rubio JL, Ortego N, Herreras JM, Fonollosa A, Maíz O, Blanco A, Torre I, Fernandez-Espartero C, Jovani V, Peiteado Lopez D, Díaz Valle D, Pato E, Cruz J, Fernandez-Cid C, Aurrecoechea E, García M, Caracuel MA, Atanes A, Francisco F, Insúa S, Gonzalez-Suárez S, Sánchez-Andrade A, Linares L, Romero-Bueno F, García AJ, Almodovar R, Mínguez E, Carrasco Cubero C, Raya Álvarez E, Alcalde-Villar M, Fernández-Carbadillo C, Pagés F, Gonzalez-Vela M, Demetrio R, Pons E, Hernández JL, González-Gay MA, Blanco R. Long Term Follow-up and Optimization of Infliximab in Refractory Uveitis of Behçet’s Disease. Multicenter Study of 103 Cases [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/long-term-follow-up-and-optimization-of-infliximab-in-refractory-uveitis-of-behcets-disease-multicenter-study-of-103-cases/. Accessed .

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