Short and Long-Term Follow-up of Tocilizumab for Severe Juvenile Idiopathic Arthritis-Associated Uveitis

Nuria Vegas-Revenga¹, Vanesa Calvo-Río¹, Montserrat Santos-Gómez², Inmaculada Calvo³, Mº Isabel González- Fernández³, Berta López- Montesinos³, Marina Mesquida⁴, Alfredo Adan⁴, M. Victoria Hernández⁴, Olga Maiz⁵, Antonio Atanes⁶, Beatriz Bravo⁷, Consuelo Modesto⁸, Gisela Díaz-Cordovés⁹, Natalia Palmou-Fontana¹, Javier Loricera¹, MC Gonzalez-Vela¹⁰, Rosalia Demetrio¹¹, Carlos Fernández-Díaz¹, Lucia C. Domínguez-Casas¹, José Luis Martín-Varillas¹, Belén Atienza-Mateo¹, Jose L. Hernández¹², Miguel Angel González-Gay¹ and Ricardo Blanco¹, ¹Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ²Rheumatology, Hospital de Sierrallana. Torrelavega. Spain, Torrelavega, Spain, ³Rheumatology, Hospital Universitario i Politecnico La Fe. Valencia. Spain, Valencia, Spain, ⁴Hospital Clinic. Barcelona. Spain, Barcelona, Spain, ⁵Hospital Donostia. Spain, San Sebastian, Spain, ⁶Rheumatology, Complejo Hospitalario Universitario A Coruña (CHUAC). Spain, A Coruna, Spain, ⁷Rheumatology, HU Virgen de las Nieves. Granada. Spain, Granada, Spain, ⁸Hospital Universitari Vall d'Hebron. Barcelona. Spain, Barcenola, Spain, ⁹Rheumatology, Hospital Regional Universitario de Málaga. Spain, Málaga, Spain, ¹⁰Pathology Anatomy, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ¹¹Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain, ¹²Internal Medicine, Hospital Universitario Marqués de Valdecilla. IDIVAL. Santander. Universidad de Cantabria. Spain, Santander, Spain

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: juvenile idiopathic arthritis (JIA), tocilizumab and uveitis

Session Information

Date: Tuesday, November 7, 2017

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects II: Juvenile Arthritis

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose: Our objective was to assess the efficacy of tocilizumab (TCZ) at short and long term follow-up for severe juvenile idiopathic arthritis-associated uveitis.

Methods: A Multicentre study of 25 patients who had inadequate response or intolerance to traditional treatment with corticosteroids and at least one conventional immunosuppressive drug including biological therapy. The outcome variables were the degree of inflammation of the anterior chamber and vitreous, visual acuity and macular thickness. The results are expressed as mean ±SD for normally distributed variables, or as median [IQR] when are not. Comparison of continuous variables was performed using the Wilcoxon test.

Results: We studied 25 patients (21 women/ 4 men); mean age; 18.6±8.3. Uveitis was bilateral in 22. JIA subsets were oligoarthritis (n=17), polyarthritis (5), psoriatic (2) and enthesitis-related arthritis (1). Ocular sequelae found at initiation of TCZ included cataracts (13), glaucoma (7), synechiae (10), band keratopathy (12), maculopathy (9), and amblyopia (5). Pattern of uveitis was: anterior (17), panuveitis (4), intermediate (2) and posterior (2). Before TCZ, patients had received corticosteroids, conventional immunosuppressive drugs (Methotrexate (MTX) 24) and biologic agents, including adalimumab (24), etanercept (8), infliximab (7), abatacept (6), rituximab (2), anakinra (1), and golimumab (1). TCZ dosage regimen was 8 mg/kg IV every 4 weeks (21), every 2 weeks (2), every 8 weeks (1), or 2.9 mg/kg subcutaneously every week (1). It was used in combination with conventional immunosuppressive drugs in 22 patients. All of the outcome variables showed rapid and maintained improvement in all ocular parameters (TABLE) after a follow up of one year (n=21), 2 years (n=11), and 3 years (n=5). A reduction in the daily median dose of prednisone from 10 mg [0-15 mg] to 0 mg [0-0 mg] in 3 years, (p<0.05) was observed. After a median follow-up of 20.5±11.7 months in 4 patients, the interval between TCZ doses was increased to 5 weeks (n=2), 6 weeks (1) and 7 weeks (1) because of sustained clinical remission. TCZ had to be withdrawn due to articular inefficiency (1) or articular and ocular inefficiency (1). The main adverse effects were severe autoimmune thrombocytopenia, autoimmune anemia and thrombocytopenia, pneumonia, viral conjunctivitis and bullous impetigo in 1 patient each.

Conclusion:

TCZ is useful at short and long term follow-up for severe Juvenile Idiopathic Arthritis-associated uveitis. It is possible to optimize the TCZ dose.

TABLE.

	Baseline	1st week	2nd week	1st month	3rd month	6th month	1st year	2nd year	3rd year
Visual acuity mean ± SD	0.57±0.35	0.55±0.35	0.56±0.35	0.59±0.33	0.6±0.32*	0.63±0.32*	0.63±0.35*	0.59±0.32*	0.45±0.34*
Anterior chamber cells [median (IQR)]	1 [0-1]	0.75 [0-1]*	0.5 [0-1]*	0 [0-0.5]*	0 [0-0]*	0 [0-0]*	0 [0-0]*	0 [0-0]*	0 [0-0]*
Vitritis [median (IQR)]	0 [0-0]	0 [0-1]	0 [0-0]	0 [0-0]	0 [0-0]*	0 [0-0]*	0 [0-0]*	0 [0-0]*	0 [0-0]
OCT (microns) mean ± SD	358.69±92.17	351.4±108.29	336.5±100.9*	313.4±91.28*	280.7±35.03*	274.9±101.33*	245.4±29.4*	239.6±33.5	ND

*p <0.05 compared with basal data

Disclosure: N. Vegas-Revenga, None; V. Calvo-Río, None; M. Santos-Gómez, None; I. Calvo, Novartis Pharmaceutical Corporation, 2,AbbVie, Roche, Novartis, Sobi, 8; M. I. González- Fernández, None; B. López- Montesinos, None; M. Mesquida, None; A. Adan, AbbVie, Santen and Allergan, 9; M. V. Hernández, None; O. Maiz, None; A. Atanes, None; B. Bravo, None; C. Modesto, None; G. Díaz-Cordovés, None; N. Palmou-Fontana, None; J. Loricera, None; M. Gonzalez-Vela, None; R. Demetrio, None; C. Fernández-Díaz, None; L. C. Domínguez-Casas, None; J. L. Martín-Varillas, None; B. Atienza-Mateo, None; J. L. Hernández, None; M. A. González-Gay, None; R. Blanco, None.

To cite this abstract in AMA style:

Vegas-Revenga N, Calvo-Río V, Santos-Gómez M, Calvo I, González- Fernández MI, López- Montesinos B, Mesquida M, Adan A, Hernández MV, Maiz O, Atanes A, Bravo B, Modesto C, Díaz-Cordovés G, Palmou-Fontana N, Loricera J, Gonzalez-Vela M, Demetrio R, Fernández-Díaz C, Domínguez-Casas LC, Martín-Varillas JL, Atienza-Mateo B, Hernández JL, González-Gay MA, Blanco R. Short and Long-Term Follow-up of Tocilizumab for Severe Juvenile Idiopathic Arthritis-Associated Uveitis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/short-and-long-term-follow-up-of-tocilizumab-for-severe-juvenile-idiopathic-arthritis-associated-uveitis/. Accessed .

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