Treatment of Refractory Cystoid Macular Edema to Conventional Immunosuppressive Therapy: Tocilizumab Vs Anti-TNF-Alpha. Multicenter Study of 59 Patients

José Luis Martín-Varillas¹, Belén Atienza-Mateo¹, Vanesa Calvo-Río², Monica Calderón Goercke², Diana Prieto Peña², Rosalía Demetrio-Pablo³, Javier Loricera³, Eva Peña Sainz-Pardo³, M. Victoria Hernández⁴, Alfredo Adan⁵, Marina Mesquida⁵, Santos Insua⁶, Jose M Herreras⁷, Olga Maíz⁸, Ana Blanco⁹, Myriam Gandía¹⁰, David Diaz-Valle¹¹, Lucía Martínez-Costa¹², Elia Valls-Pascual¹², Gisela Díaz-Cordovés¹³, Manuel Díaz-Llopis¹⁴, Inmaculada Calvo¹⁵, Ignacio Torre-Salaberri¹⁶, Antonio Atanes¹⁷, Luis Francisco Linares¹⁸, Marisa Hernández¹⁹, Emma Beltrán²⁰, Miguel Cordero-Coma²¹, Elena Aurrecoechea²², Félix Francisco²³, Raquel Almodóvar González²⁴, Oscar Ruiz Moreno²⁵, Fernando Jiménez-Zorzo²⁶, Joan Miquel Nolla²⁷, Consuelo Modesto²⁸, Enar Pons¹, 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 Clinic. Barcelona. Spain, Barcelona, Spain, ⁵Hospital Clinic. Barcelona. Spain, Barcelona, Spain, ⁶Rheumatology, Hospital Universitario Santiago de Compostela. La Coruña. Spain, La Coruña, Spain, ⁷Ophthalmology, Hospital Universitario, IOBA. Valladolid. Spain, Valladolid, Spain, ⁸Hospital Universitario Donostia. San Sebastian. Spain, San Sebastián, Spain, ⁹Ophtamology, Hospital Universitario Donostia. San Sebastian. Spain, San Sebastian, Spain, ¹⁰Rheumatology, Hospital Puerta del Mar. Cádiz. Spain, Cádiz, Spain, ¹¹Hospital Clínico San Carlos. Madrid. Spain, Madrid, Spain, ¹²Hospital Universitario Doctor Peset. Valencia. Spain, Valencia, Spain, ¹³Rheumatology, Hospital Regional Universitario de Málaga. Spain, Málaga, Spain, ¹⁴Hospital Universitario La Fe. Valencia. Spain, Valencia, Spain, ¹⁵Hospital Universitario La Fe, Valencia, Spain, ¹⁶Rheumatology, Hospital Universitario de Basurto. Bilbao. Spain, Bilbao, Spain, ¹⁷Complejo Hospitalario Universitario A Coruña. Spain, A Coruna, Spain, ¹⁸Rheumatology, Hospital Virgen de la Arrixaca. Murcia. Spain, Murcia, Spain, ¹⁹Ophthalmology, Hospital General Universitario de Valencia. Spain, Valencia, Spain, ²⁰Rheumatology, Hospital del Mar. Barcelona. Spain, Barcelona, Spain, ²¹Ophthalmology, Hospital de León. Spain, León, Spain, ²²Rheumatology, Hospital de Sierrallana, Torrelavega. Cantabria. Spain, Torrelavega, Spain, ²³Rheumatology, Hospital Doctor Negrín. Las Palmas de Gran Canaria. Spain, Las Palmas de Gran Canaria, Spain, ²⁴Rheumatology, Hospital Universitario Fundación Alcorcón. Madrid. Spain, Madrid, Spain, ²⁵Ophthalmology and Rheumatology, Hospital Miguel Servet. Zaragoza. Spain, Zaragoza, Spain, ²⁶Hospital Miguel Servet. Zaragoza. Spain, Zaragoza, Spain, ²⁷Rheumatology, Hospital Universitario de Bellvitge, Barcelona, Spain, ²⁸Hospital Universitari Vall d'Hebron. Barcelona. Spain, Barcenola, Spain

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Adalimumab, anti-TNF therapy, infliximab, tocilizumab and uveitis

Session Information

Date: Tuesday, October 23, 2018

Title: Miscellaneous Rheumatic and Inflammatory Diseases Poster III: Sarcoid, Inflammatory Eye Disease, and Autoinflammatory Disease

Session Type: ACR Poster Session C

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

Background/Purpose:

Cystoid macular edema (CME) is the main cause of irreversible visual loss in patients with uveitis. Our aim objective was to determine the efficacy of Tocilizumab (TCZ) in Immunomediated Inflammatory Diseases (IMIDs) with EMQ and to compare with Anti-TNF drugs in refractory patients to conventional immunosuppressive therapy.

Methods:

We set up a multicenter study of patients with refractory CME to traditional treatment with glucocorticoids and at least 1 conventional immunosuppressant. All patients presented OCT> 300μ at the study onset. The main objective was the improvement of macular thickness. Results were expressed as mean±S.D. for variables with a normal distribution, or as median [IQR] [25th, 75th] for those not normally distributed. The Wilcoxon signed-rank test was used to compare continuous variables and Student’s t-test was used to compare both groups.

Results:

We studied 59 patients (87 affected eyes). Causes of uveitis were: Behçet’s disease (n=41), Birdshot’s retinochoroidopathy (n=4), Juvenile Idiopathic Arthritis (n=9), Sarcoidosis (n=1) and idiopathic (n=4).

25 patients were treated with TCZ as follows: 8 mg/kg/4 weeks (n=24) and 162 mg s.c./2 weeks (n=1). Anti-TNF-α therapy was used in the remaining 34 as follows: IFX (n=12) (5 mg/kg 0, 2 y 6 weeks and then every 4-8 weeks) y ADA (n=22) (40 mg/s.c./2 weeks).

No statistically differences were observed at baseline in both groups (TCZ vs. Anti-TNF-α) in sex (♂/♀; 8/17 vs. 15/19; p=0.34), mean age (35.6±18.9 vs. 40.0±9.1; p=0.25), and macular thickness (470.6±159.7 vs. 451.4±128.8; p=0.57). However, we found significant differences in the number of previous biological drugs (1 [1-2] vs. 0 [0]; p<0.01) and in the duration of uveitis before biological therapy onset (112 [24-198] vs. 36 [15-82]; p=0.04).

Regarding main objective, we observed a rapid and sustained improvement in macular thickness after 1 year of follow-up in both groups, without objectifying significant differences between them (TABLE).

Conclusion:

Regardless of the EIIM that causes uveitis, both therapies seem effective in CME refractory to conventional therapy. TCZ is also effective in anti-TNF failure.

TABLE

	TCZ	Anti-TNF	P
Baseline
OCT	470.6±159.7	451.4±128.8	0.57
Tyndall	1 [0-1]	1 [0-2]	0.13
Vitritis	1 [0-2]	1 [0-3]	0.07
BCVA	0.40±0.31	0.48±0.31	0.98
1st month
OCT	349.6±108.6	362.6±97.1	0.60
Tyndall	0 [0-0]	0 [0-0]	0.47
Vitritis	0 [0-0,5]	0,5 [0-1]	<0.01
BCVA	0.50±0.30	0.61±0.28	0.58
6th month
OCT	282.3±78.2	275.6±60.7	0.71
Tyndall	0 [0-0]	0 [0-0]	0.04
Vitritis	0 [0-0,5]	0 [0-0]	<0.01
BCVA	0.56±0.33	0.71±0.31	0.73
1st year
OCT	265.0±47.9	268.8±54.6	0.79
Tyndall	0 [0-0]	0 [0-0]	<0.01
Vitritis	0 [0-0,5]	0 [0-0]	0.36
BCVA	0.59±0.33	0.72±0.32	0.76

Disclosure: J. L. Martín-Varillas, None; B. Atienza-Mateo, None; V. Calvo-Río, None; M. Calderón Goercke, None; D. Prieto Peña, None; R. Demetrio-Pablo, None; J. Loricera, None; E. Peña Sainz-Pardo, None; M. V. Hernández, None; A. Adan, None; M. Mesquida, None; S. Insua, None; J. M. Herreras, None; O. Maíz, None; A. Blanco, None; M. Gandía, None; D. Diaz-Valle, None; L. Martínez-Costa, None; E. Valls-Pascual, None; G. Díaz-Cordovés, None; M. Díaz-Llopis, None; I. Calvo, None; I. Torre-Salaberri, None; A. Atanes, None; L. F. Linares, None; M. Hernández, None; E. Beltrán, None; M. Cordero-Coma, None; E. Aurrecoechea, None; F. Francisco, None; R. Almodóvar González, None; O. Ruiz Moreno, None; F. Jiménez-Zorzo, None; J. M. Nolla, None; C. Modesto, None; E. Pons, 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, Calderón Goercke M, Prieto Peña D, Demetrio-Pablo R, Loricera J, Peña Sainz-Pardo E, Hernández MV, Adan A, Mesquida M, Insua S, Herreras JM, Maíz O, Blanco A, Gandía M, Diaz-Valle D, Martínez-Costa L, Valls-Pascual E, Díaz-Cordovés G, Díaz-Llopis M, Calvo I, Torre-Salaberri I, Atanes A, Linares LF, Hernández M, Beltrán E, Cordero-Coma M, Aurrecoechea E, Francisco F, Almodóvar González R, Ruiz Moreno O, Jiménez-Zorzo F, Nolla JM, Modesto C, Pons E, González-Gay MA, Blanco R. Treatment of Refractory Cystoid Macular Edema to Conventional Immunosuppressive Therapy: Tocilizumab Vs Anti-TNF-Alpha. Multicenter Study of 59 Patients [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/treatment-of-refractory-cystoid-macular-edema-to-conventional-immunosuppressive-therapy-tocilizumab-vs-anti-tnf-alpha-multicenter-study-of-59-patients/. Accessed .

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