Adalimumab Accounts for Long-Term Control of Noninfectious Uveitis Also in the Absence of Concomitant DMARD Treatment: A Multicenter Retrospective Study.

Alice Bitossi,Claudia Fabiani,Domenico Prisco,Gerardo Di Scala,Lorenzo Vannozzi,Gian Marco Tosi,Gianni Virgili,Alessandra Bettiol,Antonio Vitale,Giacomo Emmi,Stanislao Rizzo,Luca Cantarini,Daniela Bacherini,Giuseppe Lopalco,Florenzo Iannone,Elena Silvestri,Vincenzo Venerito

doi:10.1155/2019/1623847

Abstract

Objective This study was aimed at assessing the long-term ocular control of adalimumab (ADA) in a large real-world population with noninfectious primary or secondary uveitis, focusing on the steroid-sparing effect and on disease-modifying antirheumatic drug (DMARD) cotreatment. Methods In this retrospective, multicenter study, the efficacy of ADA was evaluated in terms of ocular control, changes in best-corrected visual acuity (BCVA), corticosteroid-sparing effect, and drug retention rate, overall and stratified according to DMARD cotreatment. Results 106 patients were included. 88.7% had an associated systemic disease. After 6 and 12 months, proportions of patients with effective ocular control were 83.7% and 83.3%, respectively. At last the follow-up, 94.6% of patients had satisfactory ocular control. No difference in terms of ocular control at all time points emerged among patients starting ADA for ocular vs. systemic involvements. Patients with poor baseline BCVA remained stable or improved, while those with good BCVA hardly worsened. At 6 and 12 months, the median dose of prednisone significantly reduced to 5 mg/day (0-5) and 2.5 mg/day (0-5) (p < 0.001). Over a median follow-up of 36 months, 38 subjects discontinued ADA treatment. Mild to moderate side effects were reported in 7 patients (6.6%). ADA ocular control, corticosteroid-sparing effect, and drug retention rate were not influenced by the concomitant use of DMARDs. Conclusion The long-term ocular control of ADA in noninfectious primary or secondary uveitis is confirmed, also for BCVA preservation. Concomitant use of DMARDs does not provide additional benefits to ADA alone in terms of ocular control, steroid spare, and drug retention rate.

Highlights

Noninfectious primary or secondary uveitis is a group of vision-threatening diseases characterized by intraocular inflammation
It can occur as an isolated involvement of the eyes or associated with a systemic condition, including Behçet’s syndrome (BS), juvenile idiopathic arthritis (JIA), rheumatoid arthritis (RA), Vogt-Koyanagi-Harada (VKH), sarcoidosis (SAR), ankylosing spondylitis (AS), psoriatic arthritis (PsA), inflammatory bowel disease (IBD), and multiple sclerosis [1, 2]
One hundred and six patients treated with ADA for noninfectious primary or secondary uveitis were included

Summary

Introduction

Noninfectious primary or secondary uveitis is a group of vision-threatening diseases characterized by intraocular inflammation. It can occur as an isolated involvement of the eyes or associated with a systemic condition, including Behçet’s syndrome (BS), juvenile idiopathic arthritis (JIA), rheumatoid arthritis (RA), Vogt-Koyanagi-Harada (VKH), sarcoidosis (SAR), ankylosing spondylitis (AS), psoriatic arthritis (PsA), inflammatory bowel disease (IBD), and multiple sclerosis [1, 2]. Uveitis can affect people of any age, Mediators of Inflammation but it most commonly develops in people between the ages of 20 and 59 years and is a major cause of visual morbidity in the working age group [2]. Long-term use of moderate to high doses of corticosteroids can result in serious adverse events, including both ocular morbidity, such as glaucoma and cataract, and systemic adverse events, including impaired glucose tolerance, hypertension, osteoporosis, and infection susceptibility [2]

Methods

Discussion

Conclusion