Optimization Protocol for Adalimumab Treatment in Refractory Uveitis Due to Behçet’s Disease

José Luis Martín-Varillas¹, Belén Atienza-Mateo¹, Vanesa Calvo-Río², Diana Prieto Peña², Monica Calderón Goercke², Eva Peña Sainz-Pardo³, Emma Beltrán⁴, Juan Sánchez Bursón Sr.⁵, M. Victoria Hernández⁶, Alfredo Adan⁷, Marina Mesquida⁷, Marisa Hernández⁸, Elia Valls-Pascual⁹, Lucía Martínez-Costa⁹, Agusti Sellas-Fernandez¹⁰, Miguel Cordero-Coma¹¹, Manuel Díaz-Llopis¹², Roberto Gallego¹², David Salom¹², Norberto Ortego Centeno¹³, Jose L. García Serrano¹⁴, José-Luis Callejas-Rubio¹⁵, Jose M Herreras¹⁶, Angel Garcia-Aparicio¹⁷, Olga Maíz¹⁸, Ana Blanco¹⁹, Ignacio Torre-Salaberri²⁰, David Diaz-Valle²¹, Esperanza Pato Cour²², Elena Aurrecoechea²³, Miguel A. Caracuel²⁴, Fernando Gamero²⁵, Enrique Minguez²⁶, Carmen Carrasco-Cubero²⁷, Alejandro Olivé-Marqués²⁸, Oscar Ruiz Moreno²⁹, Javier Manero²⁹, Julio Vázquez³⁰, Santiago Muñoz Fernandez³¹, Myriam Gandía³², Esteban Rubio-Romero³³, Francisco Toyos³⁴, Francisco Javier López Longo³⁵, Joan Miquel Nolla³⁶, Marcelino Revenga Martínez³⁷, Javier Loricera³, Rosalía Demetrio-Pablo³, Enar Pons¹, José Luis Hernández³, 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 del Mar. Barcelona. Spain, Barcelona, Spain, ⁵Rheumatology, Hospital de Valme. Sevilla. Spain, Sevilla, Spain, ⁶Rheumatology, Hospital Clinic. Barcelona. Spain, Barcelona, Spain, ⁷Hospital Clinic. Barcelona. Spain, Barcelona, Spain, ⁸Ophthalmology, Hospital General Universitario de Valencia. Spain, Valencia, Spain, ⁹Hospital Universitario Doctor Peset. Valencia. Spain, Valencia, Spain, ¹⁰Vall d'Hebron Hospital Research Institute, Barcelona, Spain, ¹¹Ophthalmology, Hospital de León. Spain, León, Spain, ¹²Hospital Universitario La Fe. Valencia. Spain, Valencia, Spain, ¹³Medicine Department, Hospital Universitario San Cecilio. Granada. Spain, Granada, Spain, ¹⁴Ophthalmology, Hospital Universitario San Cecilio. Granada. Spain, Granada, Spain, ¹⁵Hospital Universitario San Cecilio. Granada. Spain, Granada, Spain, ¹⁶Ophthalmology, Hospital Universitario, IOBA. Valladolid. Spain, Valladolid, Spain, ¹⁷Rheumatology, Hospital de Toledo. Toledo. Spain, Toledo, Spain, ¹⁸Hospital Universitario Donostia. San Sebastian. Spain, San Sebastián, Spain, ¹⁹Ophtamology, Hospital Universitario Donostia. San Sebastian. Spain, San Sebastian, Spain, ²⁰Rheumatology, Hospital Universitario de Basurto. Bilbao. Spain, Bilbao, Spain, ²¹Hospital Clínico San Carlos. Madrid. Spain, Madrid, Spain, ²²Rheumatology, Hospital Clínico San Carlos, Madrid, Spain, ²³Rheumatology, Hospital de Sierrallana, Torrelavega. Cantabria. Spain, Torrelavega, Spain, ²⁴Hospital de Córdoba, Córdoba, Spain., Córdoba, Spain, ²⁵Rheumatology, Hospital San Pedro Alcántara. Cáceres. Spain, Cáceres, Spain, ²⁶Ophthalmology, Hospital Clínico de Zaragoza. Spain, Zaragoza, Spain, ²⁷Hospital de Mérida. Spain, Mérida, Spain, ²⁸Rheumatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, ²⁹Ophthalmology and Rheumatology, Hospital Miguel Servet. Zaragoza. Spain, Zaragoza, Spain, ³⁰Rheumatology, Hospital de Ferrol. La Coruña. Spain, La Coruña, Spain, ³¹Hospital Universitario Infanta Sofía. Madrid. Spain, San Sebastián de los Reyes (Madrid), Spain, ³²Rheumatology, Hospital Puerta del Mar. Cádiz. Spain, Cádiz, Spain, ³³Hospital Universitario Virgen del Rocío. Sevilla. Spain, Sevilla, Spain, ³⁴Rheumatology, Hospital Universitario Virgen de la Macarena, Sevilla, Spain, ³⁵Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain, ³⁶Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain, ³⁷Hospital Universitario Ramón y Cajal. Madrid. Spain, Madrid, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

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

Session Information

Date: Monday, October 22, 2018

Title: Vasculitis Poster II: Behҫet’s Disease and IgG4-Related Disease

Session Type: ACR Poster Session B

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

Background/Purpose:

Uveitis is the most common ocular manifestation in Behçet Disease (BD), which can cause irreversible blindness. Once the efficacy, safety and cost-effectiveness of Adalimumab (ADA) have been demonstrated in a large series of patients with uveitis due to BD (Martín-Varillas et al. Ophthalmology 2018), we propose, based on this report, a treatment optimization protocol.

Methods:

Multicenter study of 65 ADA-treated patients with BD uveitis refractory to conventional immunosuppressants. Following remission, based on a shared decision between the patient and treating physician, ADA optimization was performed by increasing the ADA dosing interval progressively.

Results:

Based on our experience we propose an optimization protocol of ADA treatment as follow: after 12 months of treatment with ADA and once remission was achieved and sustained for at least 3-6 months, we recommend increase very slowly but progressively the dosing interval with regular monitoring of ocular inflammation parameters. Once the dosing interval has been increased up to every 6 weeks and there is no ocular inflammation data, we recommend discontinuing treatment but keeping close monitoring (FIGURE).

If relapse occurs, the patient should be switched to the standard dose of 40 mg/s.c./2 weeks.

Following this protocol, we perform an annual-cost analysis in which we compare the optimized and non-optimized patients, finding a statistically significant (6101.25 euros/patient/year vs.12339.48; p<0.01). In addition, no severe side effects were observed after optimization.

Conclusion:

ADA optimization in BD uveitis refractory to conventional therapy is effective, safe and cost-effective.

FIGURE

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Disclosure: J. L. Martín-Varillas, None; B. Atienza-Mateo, None; V. Calvo-Río, None; D. Prieto Peña, None; M. Calderón Goercke, None; E. Peña Sainz-Pardo, None; E. Beltrán, None; J. Sánchez Bursón Sr., None; M. V. Hernández, None; A. Adan, None; M. Mesquida, None; M. Hernández, None; E. Valls-Pascual, None; L. Martínez-Costa, None; A. Sellas-Fernandez, None; M. Cordero-Coma, None; M. Díaz-Llopis, None; R. Gallego, None; D. Salom, None; N. Ortego Centeno, None; J. L. García Serrano, None; J. L. Callejas-Rubio, None; J. M. Herreras, None; A. Garcia-Aparicio, None; O. Maíz, None; A. Blanco, None; I. Torre-Salaberri, None; D. Diaz-Valle, None; E. Pato Cour, None; E. Aurrecoechea, None; M. A. Caracuel, None; F. Gamero, None; E. Minguez, None; C. Carrasco-Cubero, None; A. Olivé-Marqués, None; O. Ruiz Moreno, None; J. Manero, None; J. Vázquez, None; S. Muñoz Fernandez, None; M. Gandía, None; E. Rubio-Romero, None; F. Toyos, None; F. J. López Longo, None; J. M. Nolla, None; M. Revenga Martínez, None; J. Loricera, None; R. Demetrio-Pablo, None; E. Pons, None; J. L. Hernández, 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, Peña Sainz-Pardo E, Beltrán E, Sánchez Bursón J Sr., Hernández MV, Adan A, Mesquida M, Hernández M, Valls-Pascual E, Martínez-Costa L, Sellas-Fernandez A, Cordero-Coma M, Díaz-Llopis M, Gallego R, Salom D, Ortego Centeno N, García Serrano JL, Callejas-Rubio JL, Herreras JM, Garcia-Aparicio A, Maíz O, Blanco A, Torre-Salaberri I, Diaz-Valle D, Pato Cour E, Aurrecoechea E, Caracuel MA, Gamero F, Minguez E, Carrasco-Cubero C, Olivé-Marqués A, Ruiz Moreno O, Manero J, Vázquez J, Muñoz Fernandez S, Gandía M, Rubio-Romero E, Toyos F, López Longo FJ, Nolla JM, Revenga Martínez M, Loricera J, Demetrio-Pablo R, Pons E, Hernández JL, González-Gay MA, Blanco R. Optimization Protocol for Adalimumab Treatment in Refractory Uveitis Due to Behçet’s Disease [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/optimization-protocol-for-adalimumab-treatment-in-refractory-uveitis-due-to-behcets-disease/. Accessed .

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