Golimumab in juvenile idiopathic arthritis-associated uveitis unresponsive to Adalimumab

Sofia Lanz,Andrea Skrabl-Baumgartner,Gerald Seidel

doi:10.1186/s12969-021-00630-1

Sofia Lanz, Andrea Skrabl-Baumgartner + Show 1 more

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https://doi.org/10.1186/s12969-021-00630-1

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Abstract

ObjectiveTo assess the efficacy of golimumab (GLM) as a treatment option for juvenile idiopathic arthritis (JIA)-associated uveitis refractory to adalimumab (ADA).MethodsRetrospective single-centre study including patients with JIA receiving GLM for active uveitis after failing ADA. JIA- and uveitis-related data, including intraocular inflammation, best-corrected visual acuity, corticosteroid-sparing potential, and ocular complications were evaluated at start of GLM treatment, at 1 month and 3 months, and every 3 months thereafter during GLM administration. We further investigated the association of response to GLM with primary and secondary failure of ADA treatment.ResultsTen patients were studied, all female (17 affected eyes, mean age 14.3 + 6.7 yrs., mean follow-up 25.2 + 21.7 mos). Two patients were switched to GLM because of primary non-response to ADA. Eight were switched because of loss of response (LOR).In 5 of the latter LOR was associated with neutralizing anti-ADA-antibodies. Response to GLM was observed in all 8 patients with LOR, while the 2 patients with primary non-response to ADA also did not respond to GLM. Three of the 8 responders experienced LOR. At the end of follow-up 4 of the 5 remaining responders had achieved complete response. One had achieved partial response.ConclusionGLM is an efficacious therapeutic option in patients who experience LOR to ADA. Our data indicate that patients without primary response to ADA should be rather switched to a biologic agent with a different mode of action instead of further blocking the TNF-alpha pathway.

Highlights

Uveitis is a potentially blinding complication of juvenile idiopathic arthritis (JIA) [1,2,3]
As such golimumab (GLM), another fully humanised anti-tumor necrosis factor (TNF)-α monoclonal antibody approved for the treatment of polyarticular JIA, has shown promising results in small heterogeneous case series [11,12,13]
Patients and methods We conducted a single-centre, retrospective study in patients with JIA-associated uveitis who were treated with GLM for active uveitis that had proved refractory to at least one conventional diseasemodifying anti-rheumatic drugs (cDMARDs) and to ADA

Summary

Introduction

Uveitis is a potentially blinding complication of juvenile idiopathic arthritis (JIA) [1,2,3]. In this regard data from small numbers of patients provide evidence that switching to a second anti-TNF agent may be beneficial [8, 10]. Lanz et al Pediatric Rheumatology (2021) 19:132 on the TNF- α pathway promising in these patients? As such golimumab (GLM), another fully humanised anti-TNF-α monoclonal antibody approved for the treatment of polyarticular JIA, has shown promising results in small heterogeneous case series [11,12,13]. We further determined if patients with a primary non-response to ADA fared differently than those with a loss of response (LOR) to ADA

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