Christoph Tappeiner1,2, Marina Mesquida3,4, Alfredo Adán3,4, Jordi Anton3,4, Athimalaipet V Ramanan3,4, Ester Carreno3,4, Friederike Mackensen3,4, Kaisu Kotaniemi3,4, Joke H de Boer3,4, Rosa Bou3,4, Carmen García de Vicuña3,4, Arnd Heiligenhaus3,4. 1. From the Department of Ophthalmology, St. Franziskus Hospital, Münster; Department of Ophthalmology and Interdisciplinary Uveitis Center, University of Heidelberg, Heidelberg; University of Duisburg-Essen, Essen, Germany; Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland; Institut Clinic d'Oftalmologia, Hospital Clínic de Barcelona, University of Barcelona; Pediatric Rheumatology Unit, and Ophthalmology Department, Hospital Sant Joan de Déu, University of Barcelona, Esplugues, Barcelona, Spain; Department of Paediatric Rheumatology, Bristol Royal Hospital for Children; Clinical Research Unit, Bristol Eye Hospital, Bristol, UK; Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland; Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands. christoph.tappeiner@insel.ch. 2. C. Tappeiner, MD, FEBO, Department of Ophthalmology, St. Franziskus Hospital, and Department of Ophthalmology, Inselspital, University of Bern; M. Mesquida, MD, PhD, Institut Clinic d'Oftalmologia, Hospital Clínic de Barcelona, University of Barcelona; A. Adán, MD, PhD, Institut Clinic d'Oftalmologia, Hospital Clínic de Barcelona, University of Barcelona; J. Anton, MD, PhD, Pediatric Rheumatology Unit, Hospital Sant Joan de Déu, University of Barcelona; A.V. Ramanan, MD, Department of Paediatric Rheumatology, Bristol Royal Hospital for Children; E. Carreno, MD, PhD, Clinical Research Unit, Bristol Eye Hospital; F. Mackensen, MD, Department of Ophthalmology and Interdisciplinary Uveitis Center, University of Heidelberg; K. Kotaniemi, MD, PhD, Department of Ophthalmology, Helsinki University Hospital; J.H. de Boer, MD, PhD, Department of Ophthalmology, University Medical Center Utrecht; R. Bou, MD, Pediatric Rheumatology Unit, Hospital Sant Joan de Déu, University of Barcelona; C.G. de Vicuña, MD, Ophthalmology Department, Hospital Sant Joan de Déu, University of Barcelona; A. Heiligenhaus, MD, Department of Ophthalmology, St. Franziskus Hospital, and University of Duisburg-Essen. christoph.tappeiner@insel.ch. 3. From the Department of Ophthalmology, St. Franziskus Hospital, Münster; Department of Ophthalmology and Interdisciplinary Uveitis Center, University of Heidelberg, Heidelberg; University of Duisburg-Essen, Essen, Germany; Department of Ophthalmology, Inselspital, University of Bern, Bern, Switzerland; Institut Clinic d'Oftalmologia, Hospital Clínic de Barcelona, University of Barcelona; Pediatric Rheumatology Unit, and Ophthalmology Department, Hospital Sant Joan de Déu, University of Barcelona, Esplugues, Barcelona, Spain; Department of Paediatric Rheumatology, Bristol Royal Hospital for Children; Clinical Research Unit, Bristol Eye Hospital, Bristol, UK; Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland; Department of Ophthalmology, University Medical Center Utrecht, Utrecht, the Netherlands. 4. C. Tappeiner, MD, FEBO, Department of Ophthalmology, St. Franziskus Hospital, and Department of Ophthalmology, Inselspital, University of Bern; M. Mesquida, MD, PhD, Institut Clinic d'Oftalmologia, Hospital Clínic de Barcelona, University of Barcelona; A. Adán, MD, PhD, Institut Clinic d'Oftalmologia, Hospital Clínic de Barcelona, University of Barcelona; J. Anton, MD, PhD, Pediatric Rheumatology Unit, Hospital Sant Joan de Déu, University of Barcelona; A.V. Ramanan, MD, Department of Paediatric Rheumatology, Bristol Royal Hospital for Children; E. Carreno, MD, PhD, Clinical Research Unit, Bristol Eye Hospital; F. Mackensen, MD, Department of Ophthalmology and Interdisciplinary Uveitis Center, University of Heidelberg; K. Kotaniemi, MD, PhD, Department of Ophthalmology, Helsinki University Hospital; J.H. de Boer, MD, PhD, Department of Ophthalmology, University Medical Center Utrecht; R. Bou, MD, Pediatric Rheumatology Unit, Hospital Sant Joan de Déu, University of Barcelona; C.G. de Vicuña, MD, Ophthalmology Department, Hospital Sant Joan de Déu, University of Barcelona; A. Heiligenhaus, MD, Department of Ophthalmology, St. Franziskus Hospital, and University of Duisburg-Essen.
Abstract
OBJECTIVE: To report on experience using the anti-interleukin 6 receptor antibody tocilizumab (TCZ) to treat severe and therapy-refractory uveitis associated with juvenile idiopathic arthritis (JIA). METHODS: Retrospective data were gathered from patients with JIA receiving TCZ treatment for uveitis. JIA and related uveitis data (disease onset, activity, structural complications, and topical and systemic antiinflammatory treatment) were evaluated at the start of TCZ (baseline) and every 3 months during TCZ therapy. RESULTS: A total of 17 patients (14 women) with active uveitis were included (mean age 15.3 ± 6.9 yrs, mean followup time 8.5 mos). In all patients, uveitis had been refractory to previous topical and systemic corticosteroids, methotrexate (MTX), and other synthetic and biological disease-modifying antirheumatic drugs, including ≥ 1 tumor necrosis factor-α (TNF-α) inhibitor. Uveitis inactivity was achieved in 10 patients after a mean of 5.7 months of TCZ treatment (in 3 of them, it recurred during followup) and persisted in the remaining 7 patients. By using TCZ, systemic corticosteroids or immunosuppressives could be spared in 7 patients. Macular edema was present in 5 patients at baseline and improved in all of them under TCZ treatment. Arthritis was active in 11 patients at the initial and in 6 at the final followup visit. CONCLUSION: TCZ appears to represent a therapeutic option for severe JIA-associated uveitis that has been refractory to MTX and TNF-α inhibitors in selected patients. The present data indicate that inflammatory macular edema responds well to TCZ in patients with JIA-associated uveitis.
OBJECTIVE: To report on experience using the anti-interleukin 6 receptor antibody tocilizumab (TCZ) to treat severe and therapy-refractory uveitis associated with juvenile idiopathic arthritis (JIA). METHODS: Retrospective data were gathered from patients with JIA receiving TCZ treatment for uveitis. JIA and related uveitis data (disease onset, activity, structural complications, and topical and systemic antiinflammatory treatment) were evaluated at the start of TCZ (baseline) and every 3 months during TCZ therapy. RESULTS: A total of 17 patients (14 women) with active uveitis were included (mean age 15.3 ± 6.9 yrs, mean followup time 8.5 mos). In all patients, uveitis had been refractory to previous topical and systemic corticosteroids, methotrexate (MTX), and other synthetic and biological disease-modifying antirheumatic drugs, including ≥ 1 tumor necrosis factor-α (TNF-α) inhibitor. Uveitis inactivity was achieved in 10 patients after a mean of 5.7 months of TCZ treatment (in 3 of them, it recurred during followup) and persisted in the remaining 7 patients. By using TCZ, systemic corticosteroids or immunosuppressives could be spared in 7 patients. Macular edema was present in 5 patients at baseline and improved in all of them under TCZ treatment. Arthritis was active in 11 patients at the initial and in 6 at the final followup visit. CONCLUSION:TCZ appears to represent a therapeutic option for severe JIA-associated uveitis that has been refractory to MTX and TNF-α inhibitors in selected patients. The present data indicate that inflammatory macular edema responds well to TCZ in patients with JIA-associated uveitis.
Authors: Sheila T Angeles-Han; Sarah Ringold; Timothy Beukelman; Daniel Lovell; Carlos A Cuello; Mara L Becker; Robert A Colbert; Brian M Feldman; Gary N Holland; Polly J Ferguson; Harry Gewanter; Jaime Guzman; Jennifer Horonjeff; Peter A Nigrovic; Michael J Ombrello; Murray H Passo; Matthew L Stoll; C Egla Rabinovich; H Nida Sen; Rayfel Schneider; Olha Halyabar; Kimberly Hays; Amit Aakash Shah; Nancy Sullivan; Ann Marie Szymanski; Marat Turgunbaev; Amy Turner; James Reston Journal: Arthritis Care Res (Hoboken) Date: 2019-04-25 Impact factor: 4.794
Authors: Sheila T Angeles-Han; Sarah Ringold; Timothy Beukelman; Daniel Lovell; Carlos A Cuello; Mara L Becker; Robert A Colbert; Brian M Feldman; Gary N Holland; Polly J Ferguson; Harry Gewanter; Jaime Guzman; Jennifer Horonjeff; Peter A Nigrovic; Michael J Ombrello; Murray H Passo; Matthew L Stoll; C Egla Rabinovich; H Nida Sen; Rayfel Schneider; Olha Halyabar; Kimberly Hays; Amit Aakash Shah; Nancy Sullivan; Ann Marie Szymanski; Marat Turgunbaev; Amy Turner; James Reston Journal: Arthritis Rheumatol Date: 2019-04-25 Impact factor: 10.995