Optimization of Adalimumab on Refractory Uveitis of Behcet's Syndrome. Multicenter Study of 23 Patients

Carlos Fernández-Díaz¹, Ricardo Blanco¹, Vanesa Calvo-Río¹, Javier Loricera¹, J. Sanchez-bursón², Norberto Ortego Centeno³, Jose L. García Serrano⁴, Miguel Cordero⁵, J. Vazquez⁶, Emma Beltran⁷, Elia Valls⁸, O. Maiz Alonso⁹, Ana Blanco¹⁰, Ignacio Torre¹¹, Angel García-Aparicio¹², F.j Toyos-saénz¹³, L. Martinez-Costa¹⁴, Lucia C. Domínguez-Casas¹, Natalia Palmou¹ and Miguel Angel Gonzalez-Gay¹, ¹Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Santander, Spain, ²Rheumatology, Hospital Valme, Hospital Valme, Sevilla, Spain, ³Medicine Department, Hospital Universitario San Cecilio, Granada, Spain, ⁴Ophthalmology, Hospital Universitario San Cecilio, Granada, Spain, ⁵Ophthalmology, Hospital de León, León, Spain, ⁶Rheumatology, Hospital de Ferrol, Ferrol, Spain, ⁷Rheumatology, Hospital General Universitario de Valencia, Valencia, Spain, ⁸Rheumatology, Hospital Dr. Peset., Valencia, Spain, ⁹Rheumatology, Hospital Donostia, San Sebastian, Spain, ¹⁰Ophthalmology Department. Donostia University Hospital, Donostia, Spain, ¹¹Rheumatology, Hospital de Basurto, Bilbao, Spain, ¹²Rheumatology, Ophthalmology and rheumatology, Hospital de Ferrol, Ferrol, Ferrol, Spain, ¹³Rheumatology,, Hospital Virgen de la Macarena, Sevilla, Spain, ¹⁴Hospital Dr. Peset., Valencia, Spain

Meeting: ACR/ARHP Annual Meeting 2016

Date of first publication: September 28, 2016

Keywords: Adalimumab, Behcet's syndrome, optimism and uveitis

Session Information

Date: Tuesday, November 15, 2016

Title: Vasculitis - Poster III: Rarer Vasculitides

Session Type: ACR Poster Session C

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

Background/Purpose: In non-infectious no anterior uveitis, adalimumab (ADA) is the only biologic drug that has shown efficacy in phase III randomized, double blind studies, such as VISUAL I and VISUAL II. After 80 mg loading dose, maintenance dose is the standard for other indications, 40 mg/sc/2 weeks. Our aim was to asses in patients with Behcet’s syndrome with uveitis if once remission was obtained, it was possible to optimize the maintenance ADA dose.

Methods: Multicenter study of 71 uveitis related to Behcet’s syndrome and refractory to at least one standard synthetic immunosuppressive drug in which ADA was started at standard dose. In 23 of 71 (32,39%) once remission was achieved, ADA dose was optimized. The degree of ocular inflammation was assessed by “the Standardization of Uveitis Nomenclature (SUN) Working Group” (Am J Ophthalmol 2005; 140: 509-516), and macular thickness by optical coherence tomography (OCT). A comparison was made between the first visit when ADA was started at standard dose, the onset of ADA optimization, and the final visit.

Results:

We studied 23 patients/42 affected eyes (15 men/ 8 women) that had an optimization in ADA dose, the median age was 37.2±13.4 years (range 10-62). Prior to ADA, and as systemic treatment besides oral steroids, they had received intravenous methylprednisolone boluses (n=7), cyclosporine A (CyA) (n=20), methotrexate (MTX) (n=11) and azathioprine (AZA) (n =11). ADA was used in monotherapy (n=5) and in combination with CyA (n=12), MTX (n=4) and AZA (n=2). The average interval from ADA onset to optimization was 15.3±9 months. Of the 23 patients the interval dose of ADA was progressively increased to 3 weeks (n =6), 4 weeks (n =13), 5 weeks (n =1), 6 weeks (n =1) and 8 weeks (n =2).

Only 2 patients had to return to the standard dose of ADA due to reactivation after optimizing, achieving again remission of uveitis. It was also possible to suspend ADA in 4 patients after 35.2±9.3 months in remission, not presenting a new reactivation after a mean of 20±6.9 months following the suspension.

Conclusion: Optimizing ADA therapy, once remission is achieved, seems feasible in Behcet’s syndrome with uveitis. However, this data should be verified again in prospective and randomized studies. TABLE

	At onset of ADA	At ADA Optimization	At Last Visit
VA (median [IQR])	0,8 [0,3-1]	1 [0,8-1] *	1 [0,9-1] *
Anterior chamber cells (median [IQR])	0 [0-2]	0 [0-0] *	0 [0-0] *
Vitritis (median [IQR])	1 [0-2]	0 [0-0] *	0 [0-0] *
Retinal vasculitis (% affected eyes)	41.8%	10.8% *	0% *
OCT (µ) (mean±SD)	306.7±122.9	253±20 *	250.5±17.9 *

* p< 0,05 Between at onset of ADA, At onset of ADA optimization and last visit (Wilcoxon test)

Disclosure: C. Fernández-Díaz, None; R. Blanco, None; V. Calvo-Río, None; J. Loricera, None; J. Sanchez-bursón, None; N. Ortego Centeno, None; J. L. García Serrano, None; M. Cordero, None; J. Vazquez, None; E. Beltran, None; E. Valls, None; O. Maiz Alonso, None; A. Blanco, None; I. Torre, None; A. García-Aparicio, None; F. J. Toyos-saénz, None; L. Martinez-Costa, None; L. C. Domínguez-Casas, None; N. Palmou, None; M. A. Gonzalez-Gay, None.

To cite this abstract in AMA style:

Fernández-Díaz C, Blanco R, Calvo-Río V, Loricera J, Sanchez-bursón J, Ortego Centeno N, García Serrano JL, Cordero M, Vazquez J, Beltran E, Valls E, Maiz Alonso O, Blanco A, Torre I, García-Aparicio A, Toyos-saénz FJ, Martinez-Costa L, Domínguez-Casas LC, Palmou N, Gonzalez-Gay MA. Optimization of Adalimumab on Refractory Uveitis of Behcet’s Syndrome. Multicenter Study of 23 Patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/optimization-of-adalimumab-on-refractory-uveitis-of-behcets-syndrome-multicenter-study-of-23-patients/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/optimization-of-adalimumab-on-refractory-uveitis-of-behcets-syndrome-multicenter-study-of-23-patients/