Leyre Riancho-Zarrabeitia1, Vanesa Calvo-Río1, Ricardo Blanco1, Marina Mesquida2, Alfredo M Adan2, José M Herreras3, Ángel Aparicio4, Diana Peiteado-Lopez5, Miguel Cordero-Coma6, José Luis García Serrano7, Norberto Ortego-Centeno7, Olga Maíz8, Ana Blanco8, Juan Sánchez-Bursón9, Senén González-Suárez10, Alejandro Fonollosa11, Montserrat Santos-Gómez1, Carmen González-Vela1, Javier Loricera1, Trinitario Pina1, Miguel A González-Gay12. 1. Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain. 2. Division of Ophthalmology, Hospital Clínic of Barcelona, Barcelona, Spain. 3. Division of Ophthalmology, Hospital Universitario, IOBA, Valladolid, Spain. 4. Division of Rheumatology, Hospital de Toledo, Toledo, Spain. 5. Division of Rheumatology, Hospital Universitario La Paz Madrid, Spain. 6. Division of Ophthalmology, Hospital de León. Instituto Biomedicina (IBIOMED), University of León, León, Spain. 7. Division of Ophthalmology and Internal Medicine, Hospital San Cecilio, Granada, Spain. 8. Division of Rheumatology and Ophthalmology, Hospital Donostia San, Sebastian, Spain. 9. Division of Rheumatology, Hospital de Valme, Sevilla, Spain. 10. Division of Rheumatology, Hospital Cabueñes, Gijón, Spain. 11. Division of Ophthalmology, Hospital de Cruces, Bilbao, Spain. 12. Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain. Electronic address: miguelaggay@hotmail.com.
Abstract
OBJECTIVES: To assess anti-TNF-α therapy response in uveitis associated with sarcoidosis refractory to conventional immunosuppressive therapy. METHODS: Open-label, multicenter, retrospective study on patients with sarcoid uveitis who underwent anti-TNF-α therapy because of inadequate response to conventional therapy including corticosteroids and at least 1 systemic synthetic immunosuppressive drug. The main outcome measurements were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness, and immunosuppression load. RESULTS: A total of 17 patients (8 men; 29 affected eyes; mean ± standard deviation age 38.4 ± 16.8; range: 13-76 years) were studied. The patients had bilateral hilar lymphadenopathy (58.8%), lung parenchyma involvement (47.1%), peripheral lymph nodes (41.2%), and involvement of other organs (52.9%). Angiotensin-converting enzyme was elevated in 58.8%. The most frequent ocular pattern was bilateral chronic relapsing panuveitis. The first biologic agent used was adalimumab in 10 (58.8%) and infliximab in 7 (41.2%) cases. Infliximab 5mg/kg intravenously every 4-8 weeks and adalimumab 40mg subcutaneously every 2 weeks were the most common administration patterns. In most cases anti-TNF-α therapy was given in combination with immunosuppressive drugs. The mean duration of follow-up was 33.9 ± 17.1 months. Significant improvement was observed following anti-TNF-α therapy. Baseline results versus results at 2 years from the onset of biologic therapy were the following: the median of cells in the ocular anterior chamber (interquartile range-IQR) 0.5 (0-2) versus 0 (0-0) (p = 0.003), vitritis 0 (0-1.25) versus 0 (0-0) (p = 0.008), macular thickness (391.1 ± 58.8 versus 247 ± 40.5µm) (p = 0.028), and visual acuity 0.60 ± 0.33 versus 0.74 ± 0.27; p = 0.009. The median daily (interquartile range) dose of prednisone was also reduced from 10 (0-30)mg at the onset of the anti-TNF-α therapy to 0 (0-0)mg at 2 years (p = 0.02). Significant reduction was also achieved in the immunosuppressive load. CONCLUSION: Anti-TNF-α therapy is effective in sarcoid uveitis patients refractory to conventional immunosuppressive therapy. Infliximab and adalimumab allowed a substantial reduction in prednisone dose despite having failed standard therapy.
OBJECTIVES: To assess anti-TNF-α therapy response in uveitis associated with sarcoidosis refractory to conventional immunosuppressive therapy. METHODS: Open-label, multicenter, retrospective study on patients with sarcoid uveitis who underwent anti-TNF-α therapy because of inadequate response to conventional therapy including corticosteroids and at least 1 systemic synthetic immunosuppressive drug. The main outcome measurements were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness, and immunosuppression load. RESULTS: A total of 17 patients (8 men; 29 affected eyes; mean ± standard deviation age 38.4 ± 16.8; range: 13-76 years) were studied. The patients had bilateral hilar lymphadenopathy (58.8%), lung parenchyma involvement (47.1%), peripheral lymph nodes (41.2%), and involvement of other organs (52.9%). Angiotensin-converting enzyme was elevated in 58.8%. The most frequent ocular pattern was bilateral chronic relapsing panuveitis. The first biologic agent used was adalimumab in 10 (58.8%) and infliximab in 7 (41.2%) cases. Infliximab 5mg/kg intravenously every 4-8 weeks and adalimumab 40mg subcutaneously every 2 weeks were the most common administration patterns. In most cases anti-TNF-α therapy was given in combination with immunosuppressive drugs. The mean duration of follow-up was 33.9 ± 17.1 months. Significant improvement was observed following anti-TNF-α therapy. Baseline results versus results at 2 years from the onset of biologic therapy were the following: the median of cells in the ocular anterior chamber (interquartile range-IQR) 0.5 (0-2) versus 0 (0-0) (p = 0.003), vitritis 0 (0-1.25) versus 0 (0-0) (p = 0.008), macular thickness (391.1 ± 58.8 versus 247 ± 40.5µm) (p = 0.028), and visual acuity 0.60 ± 0.33 versus 0.74 ± 0.27; p = 0.009. The median daily (interquartile range) dose of prednisone was also reduced from 10 (0-30)mg at the onset of the anti-TNF-α therapy to 0 (0-0)mg at 2 years (p = 0.02). Significant reduction was also achieved in the immunosuppressive load. CONCLUSION: Anti-TNF-α therapy is effective in sarcoid uveitispatients refractory to conventional immunosuppressive therapy. Infliximab and adalimumab allowed a substantial reduction in prednisone dose despite having failed standard therapy.
Authors: Julien Stievenart; Guillaume Le Guenno; Marc Ruivard; Virginie Rieu; Marc André; Vincent Grobost Journal: Front Cardiovasc Med Date: 2021-06-11