ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1750

Short and Long-Term Biological Therapy In Refractory Uveitis Of Behcet’s Syndrome. Multicenter Study Of 124 Patients

Francisco Ortiz-Sanjuan1, Vanesa Calvo-Río2, Ricardo Blanco3, Emma Beltrán4, Juan Sánchez-Bursón5, Marina Mesquida6, Alfredo M. Adan6, M Hernandez Grafella7, E Valls Pascual8, L Martínez-Costa9, Agustí Sellas-Fernàndez10, Miguel Cordero-Coma11, Manuel Diaz-llopis12, David Salom12, Jl García Serrano13, Norberto Ortego13, JM Herreras14, Alejandro Fonollosa15, A Aparicio16, O Maíz17, A Blanco18, I Torre19, Cruz Fernández-Espartero20, V Jovani21, D Peitado-Lopez22, Esperanza Pato23, J Cruz24, J. Carlos Fernandez-Cid25, E. Aurrecoechea26, M García27, M Caracuel28, Carlos Montilla29, A Atanes30, F Francisco31, S Insua32, S González-Suárez33, A Sánchez-Andrade34, F Gamero35, Luis Linares36, F Romero-Bueno37, AJ García González38, Raquel Almodovar39, E Minguez40, C Carrasco Cubero41, Alejandro Olive Marques42, J Vázquez43, O Ruiz Moreno44, F Jimenez-Zorzo44, J Manero44, Javier Loricera1 and Miguel Angel González-Gay1, 1Rheumatology, Hospital Universitario Marqués de Valdecilla. IFIMAV. Santander. Spain, Santander, Spain, 2Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Spain, Santander, Spain, 3Hospital Marques de Valdecilla, Santander, Spain, 4Rheumatology, Hospital General Universitario de Valencia. Spain, Valencia, Spain, 5Hospital de Valme. Sevilla, Sevilla, Spain, 6Ophthalmology, Hospital Clínic of Barcelona, Barcelona, Spain, 7Ophthalmology, Hospital General Universitario, Valencia, Valencia, Spain, 8Rheumatology, Hospital Peset Valencia, Valencia, Spain, 9Ophthalmology, Hospital Peset Valencia, Valencia, Spain, 10Rheumatology, Hospital Val d´Hebron. Barcelona, Barcelona, Spain, 11Departament of Ophthalmology, Hospital de León, León, Spain, 12Department of Ophthalmology, Hospital Universitario La Fe de Valencia, Valencia, Spain, 13Hospital San Cecilio. Granada, Granada, Spain, 14Hospital Universitario, IOBA. Valladolid, Valladolid, Spain, 15Ophtalmology Service, Hospital de Cruces. Bilbao, Bilbao, Spain, 16Rheumatology., Hospital de Toledo., Toledo, Spain, 17Rheumatology, Hospital Donosti San Sebastian, San Sebastián, Spain, 18Ophthalmology., Hospital Donosti San Sebastian, San Sebastián, Spain, 19Rheumatology., Hospital Basurto. Bilbao, Bilbao, Spain, 20Servicio de Reumatología, Hospital Universitario de Móstoles, Madrid, Spain, 21Rheumatology., Hospital General de Alicante., Alicante, Spain, 22Rheumatology, Hospital Universitario La Paz Madrid, Madrid, Spain, 23Rheumatology, Hospital Clínico San Carlos. Madrid, Madrid, Spain, 24Rheumatology, Hospital de Pontevedra, Pontevedra, Spain, 25Departament of Ophthalmology, Hospital de Pontevedra, Pontevedra, Spain, 26Hospital Sierrallana. Torrelavega, Torrelavega, Spain, 27Rheumatology., Hospital La Princesa. Madrid, Madrid, Spain, 28Rheumatology., Hospital de Córdoba., Córdoba, Spain, 29Unit Rheumatology, Hospital Universitario de Salamanca, Salamanca, Spain, 30Rheumatology., HUCA La Coruña., A Coruña, Spain, 31Rheumatology., Hospital Doctor Negrín Canarias., Canarias, Spain, 32Rheumatology., Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain, 33Rheumatology., Hospital Cabueñes, Gijón, Gijón, Spain, 34Rheumatology., Hospital Lucus Augusti Lugo, Lugo, Spain, 35Rheumatology., Hospital San Pedro Alcantara Caceres, Caceres, Spain, 36Rheumatology, Hospital Universitario Virgen de la Arrixaca. Murcia, Murcia, Spain, 37Rheumatology., Fundación Jimenez Díaz. Madrid, Madrid, Spain, 38Rheumatology., Hospital 12 de Octubre. Madrid, Madrid, Spain, 39Rheumatology Unit, Hospital Universitario Fundación Alcorcón. Madrid, Alcorcon. Madrid, Spain, 40Ophthalmology, Hospital Clínico de Zaragoza, Zaragoza, Spain, 41Rheumatology., Hospital de Mérida, Mérida, Spain, 42Hospital Germans Trias i Pujol. Badalona, Barcelona, Spain, 43Rheumatology, Hospital de Ferrol. A Coruña, A Coruña, Spain, 44Hospital Universitario Miguel Servet. Zaragoza, Zaragoza, Spain

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: , , ,

Session Information

Title: Vasculitis II

Session Type: Abstract Submissions (ACR)

Background/Purpose:

To evaluate short and long-term response to biological therapy in uveitis associated to Behçet´s syndrome refractory to standard systemic treatment.

Methods:

Multicenter study of 124 patients followed in uveitis units from 38 hospitals. All of them presented inadequate response to conventional therapy with corticosteroids and at least 1 systemic immunosuppressive drug.

The degree of ocular inflammation was evaluated according to “The Standardization of Uveitis Nomenclature (SUN)” (Am J Ophthalmol 2005; 140: 509-516) and macular thickness by optical coherence tomography (OCT). Comparisons were made between baseline and 1st week, 1st month, 6th month, 1st year, 2nd year, 3rd year and 4thyear. Statistical analysis was performed using the software STATISTICA (StatSoft Inc. Tulsa, Oklahoma, USA). Results were expressed as mean±SD for variables with a normal distribution, or as median [25th-75th interquartile range (IQR)] when they were not normally distributed. The comparison of continuous variables was performed using the Wilcoxon test.

Results:

We studied 124 patients/221 affected eyes (68 men/56 women) with a mean age of 38.6±10.4 years (range 10-67). HLA-B51 was positive in 66.1%. Besides oral steroids and before biologic therapy onset patients had received methylprednisolone i.v. boluses (34 patients), cyclosporine A (CyA) (102), methotrexate (MTX) (62) or azathioprine (AZA) (66). Anti-TNF drugs were the first choice biological agents; Infliximab (IFX) in 77 cases (62%) and adalimumab (ADA) in the remaining 47 cases (38%). They were used in 25 cases as monotherapy or in combination with: CyA (52 cases), MTX (27), AZA (17), mycophenolate (1), tacrolimus (1) or cyclophosphamide (1). The IFX regimen more frequently used were 5 mg/kg /i.v./every 4-8 weeks and ADA 40 mg/sc/EOW. In cases of refractory uveitis or intolerance to a 1stbiologic other agents were used; namely: Golimumab (4 cases), Tocilizumab (1 case), rituximab (1 case) and etanercept (1 case). The mean follow-up of anti-TNF therapy was 35.9±20.3 months. Visual acuity (VA), Tyndall, vitritis and OCT showed a rapid and statistically significant improvement at the 1ª week. From biological onset to 2 years mean improvement was observed in VA from 0.5±0.3 to 0.7±0.3 (p<0.01); tyndall from a median [IQR] of 1 [0-2] to 0 [0-0] (p<0.01) and vitritis, from a median [IQR] of 1 [0-2] to 0 [0-0] (p<0.01). At baseline, 50 patients, (80 eyes) had macular thickening (OCT>250μ) and 35 patients (49 eyes) had cystoid macular edema (CME) (OCT>300μ). The CME improved from 420±119.5 microns to 282.5±55 microns at 2 years (p<0.01).

The more severe side-effects observed were milliary tuberculosis and fatal lymphoma (in one case each).

Conclusion:

Biological therapy, especially IFX and ADA, yields short and long-term efficacy and has a relatively safety profile in uveitis refractory to standard systemic treatment of Behcet’s syndrome.

 

Basal

active patients,N /active eyes (%)
1 week
active eyes (%)
1 month
active eyes (%)
6 months
active eyes (%)
1   year
active eyes (%)
2 years
active eyes (%)
3 years
active eyes (%)
4 years
active eyes (%)
Anterior inflammation (Tyndall) 
80 / 57%
51%
32.3%
19.3%
9.2%
11.7% 
5.7%
6.1%
Vitritis
96 / 64.4%
58.4%
42.8%
24.6%
16.9%
13.9%
9.4%
5.8%
Choroiditis
28 / 17.6%
15.1%
12.1%
4.1%
2.5%
1.7%
0%
0%
Retinitis
45 / 30.7%
24.5%
14.3%
2.8%
0.5%
0.6%
1.1%
0%
Retinal vasculitis
89 / 61.1%
56.5%
34.8%
15.7%
7.1%
9.7%
8.2%
2.3%
Macular thickness ≥ 250 microns
55 / 61.4%
62.2%
56.5%
48.3%
43.5%
50%
27.3%
37.5%

Disclosure:

F. Ortiz-Sanjuan,
None;

V. Calvo-Río,
None;

R. Blanco,
None;

E. Beltrán,
None;

J. Sánchez-Bursón,
None;

M. Mesquida,
None;

A. M. Adan,
None;

M. Hernandez Grafella,
None;

E. Valls Pascual,
None;

L. Martínez-Costa,
None;

A. Sellas-Fernàndez,
None;

M. Cordero-Coma,
None;

M. Diaz-llopis,
None;

D. Salom,
None;

J. García Serrano,
None;

N. Ortego,
None;

J. Herreras,
None;

A. Fonollosa,
None;

A. Aparicio,
None;

O. Maíz,
None;

A. Blanco,
None;

I. Torre,
None;

C. Fernández-Espartero,
None;

V. Jovani,
None;

D. Peitado-Lopez,
None;

E. Pato,
None;

J. Cruz,
None;

J. C. Fernandez-Cid,
None;

E. Aurrecoechea,
None;

M. García,
None;

M. Caracuel,
None;

C. Montilla,
None;

A. Atanes,
None;

F. Francisco,
None;

S. Insua,
None;

S. González-Suárez,
None;

A. Sánchez-Andrade,
None;

F. Gamero,
None;

L. Linares,
None;

F. Romero-Bueno,
None;

A. García González,
None;

R. Almodovar,
None;

E. Minguez,
None;

C. Carrasco Cubero,
None;

A. Olive Marques,
None;

J. Vázquez,
None;

O. Ruiz Moreno,
None;

F. Jimenez-Zorzo,
None;

J. Manero,
None;

J. Loricera,
None;

M. A. González-Gay,
None.

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