AB1139 Rituximab for scleritis and peripheral ulcerative keratitis associated with rheumatologic disease

Abstract

BackgroundSome types of ocular surface inflammatory diseases are often related to rheumatic conditions: 37% of scleritis (especially diffuse and necrotizing forms) and 60% of peripheral ulcerative keratitis (PUK). Rheumatoid arthritis (RA) and ANCA-associated vasculitis are the most frequently related conditions. Significant loss of visual acuity can be observed if these ocular diseases are not properly treated. To date, no approved therapies are available. Consequently, the management of these ocular diseases are based on published evidence coming from clinical trials (scarce and often with a low sample size), observational studies and case reports. There are positive efficacy data of rituximab (RTX) for ocular surface inflammatory disease.1–4 ObjectivesTo describe our experience with RTX as a therapy for severe ocular surface inflammatory diseases associated to rheumatic conditions.MethodsThis is a retrospective observational study. It includes patients with severe scleritis or PUK associated to rheumatic diseases diagnosed and managed at our Multidisciplinary Uveitis Clinic between January 2006 and November 2017. We recorded demographic and clinical variables. As outcome variables we used the change in visual acuity and the presence of inflammatory activity by biomicroscopy.ResultsVA: visual acuity, AE: advers events, RA: rheumatoid arthritis, GPA: granulomatosis with polyangiitis, RP: relapsing polychondritis, LTI: latent tuberculous infection, DM: diabetes mellitus, CSC: central serous choroidopathy, MPLN: metilprednisolone, PDN: prednisone, DXM: dexametasone, MTX:methotrexate, CS-A: cyclosporine, LFN: leflunomide, IFX: infliximab, ETN: etanercept, AKR: anakinra TCZ: tocilizumab.ConclusionsAs previously described we consider rituximab as an effective therapy for severe ocular surface inflammatory diseases related to rheumatic conditions when other immunosuppressant drugs fail or are contraindicated.References[1] - Albert M, Beltrán E, Martínez-Costa L. Rituximab in rheumatoid arthritis-associated peripheral ulcerative keratitis. Arch Soc Esp Oftalmol. 2011; 86(4):118–20.[2] - Sims J. Scleritis: presentations, disease associations and management. Postgrad Med J. 2012;88(1046):713–8.[3] - Jabs DA, Mudun A, Dunn JP, Mardsh MJ. Episcleritis and scleritis: clinical features and treatment results. Am J Opthalmol2000;130:469.[4] - Suhler EB, Lim LL, Beardsley RM, Giles TR, Pasadhika S, Lee ST, et al. Rituximab therapy for refractory scleritis: results of a phase I/II dose-ranging, randomized, clinical trial. Ophthalmology. 2014;121(10):1885–91.Disclosure of InterestNone declaredAbstract AB1139 – Table 1RTX for scleritis and PUKAge (ys)GenderOcular diseaseRheumatic diseaseComorbiditiesPrevious treatmentRTX cyclesΔVAInflammatory activityAEFollow up (ms) 155FPUKRAAmiloidosisMTX, CS-A, IFX, MPLN ev1+0.1NoNo132258FScleritisGPAHBV chronic carrier, LTIMPLN ev, PDN1+0.1NoNo19359FScleritisRPDMMTX, CS-A, PDN, DXM io10Diffuse nodular scleritisNo17475MScleritisRPDM, Sweet’s syndrome, myelo displasic syndromeMTX, CS-A, ETN, PDN1...