Background/Purpose: Uveitis are inflammatory processes of the vascular layer of the eye, the uvea, which is divided into iris (anterior uvea), ciliary body (intermediate) and choroid (posterior uvea). Many of these uveitis will have severe repercussions on the visual function and quality of life of the patients. We propose a clinical trial that allows us to evaluate the presence of differences in disease control (frequency and severity of relapses, and need for addition of another drug over time of the study) between biological therapy with adalimumab (ADA) and conventional disease-modifying antirheumatic drugs.

Methods: Prospective interventional study at 2 years of follow-up, type III clinical trial, with a sequential randomization of treatments. A sample size of 92 outpatients from a multidisciplinary autoimmune unit with one rheumatologist and one ophthalmologist, were assigned to ADA, methrotexate (MTX) or cyclosporine (CyA). Inclusion criteria for study selection were: non infectious uveitis, recurrent uveitis (≥ 3 relapses) and 1 episode of previous uveitis with severity criteria. Indicators of inflammation were: decreased visual acuity, tyndall effect, flare, par planitis and cells in vitreous. Severity indicators were: onset of synechiae, band-keratophaty, cataract, cystic macular edema, retinitis, choroyditis and vasculitis. Clinical response was defined as the improvement of one inflammation indicator without worsening of the rest, from 6 months to the end of study. The patients were assessed at 0, 2, 6, 12, 18 and 24 months.

Results: A total of 92 patients were reviewed, 57.6% males. The mean age at initiation of the study was 40.9 ± 14.9 years. The most frequent diagnosis was idiopathic uveitis (66.3%), uveitis associated with autoimmune disease (22.8%) (ankylosing spondylitis 5, psoriatic arthritis 4, juvenile idiopathic arthritis 3, inflammatory bowel disease 3) and primary uveitis due to juvenile idiopathic arthritis “like” (7.6%). Granulomatous uveitis were 68 (73.9%) vs non-granulomatous 24 (26.1%).

Data analyzed showed the 3 drugs groups achieved clinical response maintained in 100% of the cases. Outcome measures to evaluate effectiveness as number of recurrence of uveitis showed significant differences (x²_{kruskall-wallis}= 7.146; p=0.028), with more patients without relapse in ADA group. There was not significative difference in severity uveitis relapse (x²_k-w= 1.408; p=0.495) (table 1) or addition of another drug (21 patients, x²_K-W=0.651; p =0,722).

Conclusion: In our study we show such as ADA, MTX and CyA therapy are effective in non-infectious uveitis control in the disease inflammation, severity relapse and need for another drug, without statistical difference between groups. A total of 52 patients had at least one relapse over time the study, with better result in ADA group. This fact is very important due to the relation between number of relapse and the structural damage in uveitis.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-of-non-infectious-uveitis-a-comparative-long-term-study-between-biologic-therapy-with-adalimumab-and-two-conventional-disease-modifying-antirheumatic-drugs/