Lucia C Dominguez-Casas1, Lara Sánchez-Bilbao2, Vanesa Calvo-Río2, Olga Maíz3, Ana Blanco3, Emma Beltrán4, Lucía Martínez-Costa5, Rosalía Demetrío-Pablo2, María Álvarez Del Buergo6, Esteban Rubio-Romero7, David Díaz-Valle8, Ruth Lopez-Gonzalez9, Ángel M García-Aparicio10, Antonio J Mas11, Nuria Vegas-Revenga2, Santos Castañeda12, José L Hernández2, Miguel A González-Gay13, Ricardo Blanco14. 1. Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. Electronic address: luciadominguez89@gmail.com. 2. Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. 3. Rheumatology and Ophthalmology, Hospital Donosti, San Sebastian, Spain. 4. Rheumatology, Hospital del Mar, Barcelona, Spain. 5. Ophthalmology, Hospital Peset Valencia, Spain. 6. Rheumatology, Hospital Río Carrión, Palencia, Spain. 7. Rheumatology, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 8. Ophthalmology, Hospital Clínico San Carlos, Madrid, Spain. 9. Rheumatology, Complejo Hospitalario de Zamora, Spain. 10. Rheumatology, Hospital de Toledo, Spain. 11. Rheumatology, Hospital Son Llàtzer, Palma de Mallorca, Spain. 12. Rheumatology, Hospital La Princesa, IIS-Princesa, Madrid, Spain. 13. Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. Electronic address: miguelaggay@hotmail.com. 14. Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. Electronic address: rblanco@humv.es.
Abstract
PURPOSE: We assessed the efficacy and safety of biologic therapy in severe and refractory Peripheral Ulcerative Keratitis (PUK). DESIGN: Open-label multicenter study of biologic-treated patients with severe PUK refractory to conventional immunosuppressive drugs. SUBJECTS: We studied 34 patients (44 affected eyes) (24 women/10 men; mean age, 55.26±17.4 years). PUK was associated with a well-defined condition in 29 of them (rheumatoid arthritis [n = 20], psoriatic arthritis [n = 2], inflammatory bowel disease [n = 2], Behçet disease [n = 1], granulomatosis with polyangiitis [n = 1], microscopic polyangiitis [n = 1], systemic lupus erythematosus [n = 1] and axial spondyloarthritis [n = 1]). Besides topical and oral systemic glucocorticoids, patients had received: methylprednisolone pulses [n = 9], and conventional immunosuppressive drugs, mainly methotrexate [n = 18], and leflunomide [n = 7]. Eleven patients had required ocular surgery prior to biologic therapy. METHODS: Following biologic therapy, baseline main outcomes were compared with those found at 1st week, 1st and 6th months and 1st year. MAIN OUTCOME MEASURES: Efficacy and safety of biologic therapy. Efficacy was analyzed by the assessment of corneal inflammation (corneal thinning, central keratolysis and ocular perforation); other causes of ocular surface inflammation (scleritis, episcleritis); intraocular inflammation (uveitis); visual acuity and glucocorticoid sparing effect. RESULTS: The first biologic agents used were anti-TNFα drugs (n = 25); adalimumab (n = 16), infliximab (n = 8), etanercept (n = 1), and non-TNFα agents (n = 9); rituximab (n = 7), tocilizumab (n = 1) belimumab (n = 1) and abatacept (n = 1). During the follow-up, switching to a second biologic agent was required in 12 of the 25 (48%) patients treated with anti-TNFα drugs. However, no switching was required in those undergoing biologic therapy different from anti-TNFα agents. The main outcome variables showed a rapid and maintained improvement after a mean follow-up of 23.7 ± 20 months. Major adverse effects were tachyphylaxis, relapsing respiratory infections, supraventricular tachycardia, pulmonary tuberculosis and death, one each. CONCLUSIONS: Biologic therapy is effective and relatively safe in patients with severe and refractory PUK. Non-anti-TNFα agents appear to be effective in these patients.
PURPOSE: We assessed the efficacy and safety of biologic therapy in severe and refractory Peripheral Ulcerative Keratitis (PUK). DESIGN: Open-label multicenter study of biologic-treated patients with severe PUK refractory to conventional immunosuppressive drugs. SUBJECTS: We studied 34 patients (44 affected eyes) (24 women/10 men; mean age, 55.26±17.4 years). PUK was associated with a well-defined condition in 29 of them (rheumatoid arthritis [n = 20], psoriatic arthritis [n = 2], inflammatory bowel disease [n = 2], Behçet disease [n = 1], granulomatosis with polyangiitis [n = 1], microscopic polyangiitis [n = 1], systemic lupus erythematosus [n = 1] and axial spondyloarthritis [n = 1]). Besides topical and oral systemic glucocorticoids, patients had received: methylprednisolone pulses [n = 9], and conventional immunosuppressive drugs, mainly methotrexate [n = 18], and leflunomide [n = 7]. Eleven patients had required ocular surgery prior to biologic therapy. METHODS: Following biologic therapy, baseline main outcomes were compared with those found at 1st week, 1st and 6th months and 1st year. MAIN OUTCOME MEASURES: Efficacy and safety of biologic therapy. Efficacy was analyzed by the assessment of corneal inflammation (corneal thinning, central keratolysis and ocular perforation); other causes of ocular surface inflammation (scleritis, episcleritis); intraocularinflammation (uveitis); visual acuity and glucocorticoid sparing effect. RESULTS: The first biologic agents used were anti-TNFα drugs (n = 25); adalimumab (n = 16), infliximab (n = 8), etanercept (n = 1), and non-TNFα agents (n = 9); rituximab (n = 7), tocilizumab (n = 1) belimumab (n = 1) and abatacept (n = 1). During the follow-up, switching to a second biologic agent was required in 12 of the 25 (48%) patients treated with anti-TNFα drugs. However, no switching was required in those undergoing biologic therapy different from anti-TNFα agents. The main outcome variables showed a rapid and maintained improvement after a mean follow-up of 23.7 ± 20 months. Major adverse effects were tachyphylaxis, relapsing respiratory infections, supraventricular tachycardia, pulmonary tuberculosis and death, one each. CONCLUSIONS: Biologic therapy is effective and relatively safe in patients with severe and refractory PUK. Non-anti-TNFα agents appear to be effective in these patients.
Authors: Kiana Hassanpour; Reem H ElSheikh; Amir Arabi; Charles R Frank; Abdelrahman M Elhusseiny; Taher K Eleiwa; Shiva Arami; Ali R Djalilian; Ahmad Kheirkhah Journal: J Ophthalmic Vis Res Date: 2022-04-29
Authors: Isabelle Bonnet; Antoine Rousseau; Pierre Duraffour; Jacques Pouchot; Chi Duc Nguyen; Eric Gabison; Raphaele Seror; Hubert Marotte; Xavier Mariette; Gaetane Nocturne Journal: RMD Open Date: 2021-01