Hélène Vallet1, Pascal Seve2, Lucie Biard3, Jean Baptiste Fraison4, Philip Bielefeld5, Laurent Perard6, Boris Bienvenu7, Sébastien Abad8, Aude Rigolet1, Alban Deroux9, Damien Sene10, Antoinette Perlat11, Isabelle Marie12, Elodie Feurer2, Eric Hachulla13, Olivier Fain14, Gaëlle Clavel15, Sophie Riviere16, Pierre-Alban Bouche3, Julie Gueudry12, Gregory Pugnet17, Phuc Le Hoang18, Matthieu Resche Rigon3, Patrice Cacoub1, Bahram Bodaghi18, David Saadoun1. 1. Hôpital Pitié-Salpêtrière, AP-HP, Centre National de Référence Maladies Systémiques et Autoimmunes Rares, and Université Paris VI, Paris, France. 2. Hôpital Croix Rousse, Lyon, France. 3. Hôpital Saint Louis and Le Centre de Recherche INSERM, Paris Sorbonne Cité, UMR 1153, Paris, France. 4. Hôpital Jean Verdier, Bondy, France. 5. Centre Hospitalier Universitaire (CHU) de Dijon, Dijon, France. 6. Hôpital Edouard Herriot, Lyon, France. 7. CHU de Caen, Caen, France. 8. Hôpital Avicenne, Bobigny, France. 9. CHU de Grenoble-Hôpital Michallon, Grenoble, France. 10. Hôpital Lariboisière, AP-HP, Paris, France. 11. CHU de Rennes, Rennes, France. 12. CHU de Rouen, Rouen, France. 13. Eric Hachulla, MD, PhD: Centre Hospitalier Régional Universitaire de Lille, Lille, France. 14. Hôpital Saint Antoine, AP-HP, Paris, France. 15. A. Rothschild Foundation, Paris, France. 16. CHU de Montpellier, Montpellier, France. 17. CHU de Toulouse-Hôpital Purpan, INSERM UMR 1027, Toulouse, France. 18. Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
Abstract
OBJECTIVE: To analyze the factors associated with response to anti-tumor necrosis factor (anti-TNF) treatment and compare the efficacy and safety of infliximab (IFX) and adalimumab (ADA) in patients with refractory noninfectious uveitis. METHODS: This was a multicenter observational study of 160 patients (39% men and 61% women; median age 31 years [interquartile range 21-42]) with uveitis that had been refractory to other therapies, who were treated with anti-TNF (IFX 5 mg/kg at weeks 0, 2, 6, and then every 5-6 weeks [n = 98] or ADA 40 mg every 2 weeks [n = 62]). Factors associated with complete response were assessed by multivariate analysis. Efficacy and safety of IFX versus ADA were compared using a propensity score approach with baseline characteristics taken into account. Subdistribution hazard ratios (SHRs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: The main etiologies of uveitis included Behçet's disease (BD) (36%), juvenile idiopathic arthritis (22%), spondyloarthropathy (10%), and sarcoidosis (6%). The overall response rate at 6 and 12 months was 87% (26% with complete response) and 93% (28% with complete response), respectively. The median time to complete response was 2 months. In multivariate analysis, BD and occurrence of >5 uveitis flares before anti-TNF initiation were associated with complete response to anti-TNF (SHR 2.52 [95% CI 1.35-4.71], P = 0.004 and SHR 1.97 [95% CI 1.02-3.84], P = 0.045, respectively). Side effects were reported in 28% of patients, including serious adverse events in 13%. IFX and ADA did not differ significantly in terms of occurrence of complete response (SHR 0.65 [95% CI 0.25-1.71], P = 0.39), serious side effects (SHR 0.22 [95% CI 0.04-1.25], P = 0.089), or event-free survival (SHR 0.55 [95% CI 0.28-1.08], P = 0.083). CONCLUSION: Anti-TNF treatment is highly effective in refractory inflammatory uveitis. BD is associated with increased odds of response. IFX and ADA appear to be equivalent in terms of efficacy.
OBJECTIVE: To analyze the factors associated with response to anti-tumornecrosis factor (anti-TNF) treatment and compare the efficacy and safety of infliximab (IFX) and adalimumab (ADA) in patients with refractory noninfectious uveitis. METHODS: This was a multicenter observational study of 160 patients (39% men and 61% women; median age 31 years [interquartile range 21-42]) with uveitis that had been refractory to other therapies, who were treated with anti-TNF (IFX 5 mg/kg at weeks 0, 2, 6, and then every 5-6 weeks [n = 98] or ADA 40 mg every 2 weeks [n = 62]). Factors associated with complete response were assessed by multivariate analysis. Efficacy and safety of IFX versus ADA were compared using a propensity score approach with baseline characteristics taken into account. Subdistribution hazard ratios (SHRs) and 95% confidence intervals (95% CIs) were calculated. RESULTS: The main etiologies of uveitis included Behçet's disease (BD) (36%), juvenile idiopathic arthritis (22%), spondyloarthropathy (10%), and sarcoidosis (6%). The overall response rate at 6 and 12 months was 87% (26% with complete response) and 93% (28% with complete response), respectively. The median time to complete response was 2 months. In multivariate analysis, BD and occurrence of >5 uveitis flares before anti-TNF initiation were associated with complete response to anti-TNF (SHR 2.52 [95% CI 1.35-4.71], P = 0.004 and SHR 1.97 [95% CI 1.02-3.84], P = 0.045, respectively). Side effects were reported in 28% of patients, including serious adverse events in 13%. IFX and ADA did not differ significantly in terms of occurrence of complete response (SHR 0.65 [95% CI 0.25-1.71], P = 0.39), serious side effects (SHR 0.22 [95% CI 0.04-1.25], P = 0.089), or event-free survival (SHR 0.55 [95% CI 0.28-1.08], P = 0.083). CONCLUSION: Anti-TNF treatment is highly effective in refractory inflammatory uveitis. BD is associated with increased odds of response. IFX and ADA appear to be equivalent in terms of efficacy.
Authors: M D Becker; R Max; A Dimitriou; T Saurenmann; H-M Lorenz; A Jansen; S Lortz; J Grulich-Henn; M Weber Journal: Z Rheumatol Date: 2018-08 Impact factor: 1.372