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Anti-TNF-α therapy in patients with refractory uveitis due to Behçet's disease: a 1-year follow-up study of 124

Vanesa Calvo-Río¹, Ricardo Blanco¹, Emma Beltrán¹

¹Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Rheumatology, Hospital General Universitario de Valencia, Valencia, Rheumatology, Hospital de Valme, Sevilla, Ophthalmology and Rheumatology, Hospital Clinic, Barcelona, Ophthalmology, Hospital General Universitario de Valencia, Rheumatology and Ophthalmology, Hospital Peset Valencia, Valencia, Rheumatology Hospital Val d'Hebron, Barcelona, Ophthalmology Division, Hospital de León, Ophthalmology, Hospital Universitario La Fe, Valencia, Ophthalmology and Autoimmune Diseases, Hospital San Cecilio, Granada, Ophthalmology, Hospital Universitario, IOBA, Valladolid, Ophthalmology, Hospital de Cruces, Bilbao, Rheumatology, Hospital de Toledo, Rheumatology and Ophthalmology, Hospital Donosti San Sebastian, Rheumatology, Hospital Basurto, Bilbao, Rheumatology, Hospital Universitario de Móstoles, Rheumatology, Hospital General de Alicante, Rheumatology, Hospital Universitario La Paz Madrid, Rheumatology, Hospital Clínico San Carlos, Madrid, Rheumatology and Ophthalmology, Hospital de Pontevedra, Rheumatology, Hospital Sierrallana, Torrelavega, Rheumatology, Hospital La Princesa, Madrid, Rheumatology, Hospital de Córdoba, Rheumatology, Hospital Universitario de Salamanca, Rheumatology, HUCA La Coruña, Rheumatology, Hospital Doctor Negrín Canarias, Rheumatology, Hospital Universitario Santiago de Compostela, A Coruña, Rheumatology, Hospital Cabueñes, Gijón, Rheumatology, Hospital Lucus Augusti, Lugo, Rheumatology, Hospital San Pedro Alcantara, Caceres, Rheumatology, Hospital Arrixaca, Murcia, Rheumatology, Fundación Jiménez Díaz, Rheumatology, Hospital 12 de Octubre, Madrid, Rheumatology, Hospital Universitario Fundación Alcorcon, Ophthalmology, Hospital Clínico de Zaragoza, Rheumatology, Hospital de Merida, Rheumatology, Hospital Universitari Germans Trias i Pujol, Badalona, Rheumatology, Hospital de Ferrol, A Coruña, Ophthalmology, Rheumatology Hospital Miguel Servet, Zaragoza, and

Rheumatology (Oxford, England)

|July 6, 2014

Objective:

The aim of this study was to assess the efficacy of anti-TNF-α therapy in refractory uveitis due to Behçet's disease (BD).

Methods:

We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load.

Results:

Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (s.d. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-α drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-α therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 μm] and 35 (49 eyes) had cystoid macular oedema (OCT>300 μm) that improved from 420 μm (s.d. 119.5) at baseline to 271 μm (s.d. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases.

Conclusion:

Anti-TNF-α therapy is effective and relatively safe in refractory BD uveitis.

Keywords:

Behçet’s disease anti-TNF therapy uveitis

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