The Efficacy of Adalimumab as an Initial Treatment in Patients with Behçet’s Retinal Vasculitis

Shizhao Yang,Xiuxing Liu,Lihui Xie,Feng Wen,Wenru Su,Yunwei Hu,Jian Zhang,Dan Liang,He Li,Zhaohao Huang

doi:10.3389/fphar.2021.609148

Abstract

Background: No study has evaluated the effectiveness of Adalimumab (ADA) as first-line in treatment-naïve patients with retinal vasculitis due to Behçet’s Uveitis (BU). Objective: To compare the efficacy of ADA plus conventional therapy and conventional therapy alone as initial treatments in naïve BU patients characterized by retinal vasculitis. Methods: Medical records of BU patients characterized by retinal vasculitis treated with conventional therapy (CT, refers to glucocorticoid and immunosuppressive agents) alone or ADA plus conventional therapy with at least 6 months of follow-up between February 2015 and June 2020 were analyzed. Only patients who were first diagnosed with BU without previous systemic treatment were reviewed. The retinal vasculitis score based on fluorescein angiography (FA), best-corrected visual acuity, glucocorticoid-sparing effect, the number of relapses and ocular complications were evaluated. Results: A total of 45 patients (87 eyes) were included. Twenty-four patients (55.33%) in the CT group were treated with conventional therapy and 21 patients (46.67%) in the ADA group were treated with ADA plus conventional therapy. The inflammatory parameters improved in both groups. FA scores showed significantly greater improvement in ADA group than CT group (p < 0.001). The median number of relapses was significantly lower, and the duration of remission was longer in ADA group than CT group (p < 0.001). At the last visit, a significantly better BCVA improvement (p = 0.024), better inflammation control (anterior chamber inflammation p = 0.017 and vitritis p < 0.001) and lower daily glucocorticoid dosage (p = 0.005) were identified in patients received ADA therapy. In CT group, 1 patient suffered hepatitis B and tuberculosis, 1 had growth retardation, 1 patient had with osteoporosis, then followed by other mild AEs (mostly respiratory upper tract infections); while in ADA group, 1 patient experienced a mild pneumonia (n = 1) while milder AEs were represented mostly by respiratory upper tract infections followed by gastrointestinal discomfort. Conclusion: ADA plus conventional therapy achieved superiority over conventional therapy as initial treatment in naïve BU patients with retinal vasculitis.

Highlights

Behçet’s disease (BD) is a multisystem vasculitis disorder of uncertain aetiology with a series of manifestations, including recurrent oral ulcers, genital ulcers, dermic lesions and uveitis
No study has evaluated the effectiveness of Adalimumab (ADA) as first-line in treatment-naïve patients with retinal vasculitis due to Behçet’s Uveitis (BU)
We retrieved 158 medical records of Behçet’s uveitis (BU) patients with retinal vasculitis who were admitted to our clinic at Zhongshan Ophthalmic Center between February 2015 and June 2021

Summary

Introduction

Behçet’s disease (BD) is a multisystem vasculitis disorder of uncertain aetiology with a series of manifestations, including recurrent oral ulcers, genital ulcers, dermic lesions and uveitis. Behçet’s uveitis (BU) is treated systemically with high doses of corticosteroids in conjunction with at least one immunosuppressive agent, including cyclosporine (CsA), azathioprine (AZA), methotrexate (MTX) and mycophenolate mofetil (MMF), while topical corticosteroids and mydriatic drops are used when inflammation of the ocular anterior segment is present (Jabs et al, 2000). Approximately 25% of those patients become blind even with consecutive conventional treatment. No study has evaluated the effectiveness of Adalimumab (ADA) as first-line in treatment-naïve patients with retinal vasculitis due to Behçet’s Uveitis (BU)

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Results

Conclusion