Adalimumab for the treatment of refractory active and inactive non-infectious uveitis

Lee, Jonathan Tl; Yates, William B.; Rogers, Sophie; Wakefield, Denis; McCluskey, Peter; Lim, Lyndell L

doi:10.1136/bjophthalmol-2017-311234

Cited by 29 publications

(36 citation statements)

References 24 publications

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“…Notably, our study showed that ADA is effective also in the long-term follow-up, with more than 90% of the patients with ocular control over a median follow-up of 36 months. Our findings on the long-term ADA control is of importance for clinicians, considering that all other studies had a significantly shorter follow-up [1, 6, 8, 11–13, 16].…”

Section: Discussionmentioning

confidence: 76%

“…Compared with other retrospective studies, our work included a considerably larger cohort of cases. In particular, Dobner et al [11] evaluated ADA treatment in 60 patients, Durrani et al [12] in 32 patients, and Lee et al [13] in 22 patients. Studies with a larger population were the trials [1, 8], but as compared to the VISUAL-1 and 2 populations, our cohort was mainly composed of subjects with a concomitant systemic inflammatory disorder.…”

Section: Discussionmentioning

confidence: 99%

“…What is more, the real contribution of DMARDs in the response to and drug retention rate on ADA treatment, particularly in secondary uveitis, is still unclear. Furthermore, only a small number of studies have evaluated ADA efficacy for the treatment of noninfectious primary or secondary uveitis in a real-world setting [11–13].…”

Section: Introductionmentioning

confidence: 99%

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Adalimumab Accounts for Long-Term Control of Noninfectious Uveitis Also in the Absence of Concomitant DMARD Treatment: A Multicenter Retrospective Study

Bitossi

Bettiol

Silvestri

et al. 2019

Mediators of Inflammation

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Objective. This study was aimed at assessing the long-term ocular control of adalimumab (ADA) in a large real-world population with noninfectious primary or secondary uveitis, focusing on the steroid-sparing effect and on disease-modifying antirheumatic drug (DMARD) cotreatment. Methods. In this retrospective, multicenter study, the efficacy of ADA was evaluated in terms of ocular control, changes in best-corrected visual acuity (BCVA), corticosteroid-sparing effect, and drug retention rate, overall and stratified according to DMARD cotreatment. Results. 106 patients were included. 88.7% had an associated systemic disease. After 6 and 12 months, proportions of patients with effective ocular control were 83.7% and 83.3%, respectively. At last the follow-up, 94.6% of patients had satisfactory ocular control. No difference in terms of ocular control at all time points emerged among patients starting ADA for ocular vs. systemic involvements. Patients with poor baseline BCVA remained stable or improved, while those with good BCVA hardly worsened. At 6 and 12 months, the median dose of prednisone significantly reduced to 5 mg/day (0-5) and 2.5 mg/day (0-5) (p<0.001). Over a median follow-up of 36 months, 38 subjects discontinued ADA treatment. Mild to moderate side effects were reported in 7 patients (6.6%). ADA ocular control, corticosteroid-sparing effect, and drug retention rate were not influenced by the concomitant use of DMARDs. Conclusion. The long-term ocular control of ADA in noninfectious primary or secondary uveitis is confirmed, also for BCVA preservation. Concomitant use of DMARDs does not provide additional benefits to ADA alone in terms of ocular control, steroid spare, and drug retention rate.

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Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Adalimumab Accounts for Long-Term Control of Noninfectious Uveitis Also in the Absence of Concomitant DMARD Treatment: A Multicenter Retrospective Study

Bitossi

Bettiol

Silvestri

et al. 2019

Mediators of Inflammation

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“…However, no TNFi are currently licensed to treat AAU in adults, although adalimumab is licensed to treat non-infectious intermediate, posterior and panuveitis. 6 In a post hoc analysis of randomised controlled trials for axSpA and other conditions, as well as in many observational studies, it has been shown that monoclonal TNFi are efficacious in AAU, with monoclonal antibody TNFi showing superior efficacy over etanercept. 7– 9…”

Section: Introductionmentioning

confidence: 99%

Predictors of extra-articular manifestations in axial spondyloarthritis and their influence on TNF-inhibitor prescribing patterns: results from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis

et al. 2020

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ObjectivesExtra-articular manifestations (EAMs) are important systemic features of axial spondyloarthritis (axSpA), which may influence the choice of tumour necrosis factor-inhibitor (TNFi). We examined the cumulative incidence and predictors of EAMs and the influence of these on first TNFi choice in a ‘real-world’ cohort of patients with axSpA.MethodsClinical and patient-reported outcomes of 2420 patients with axSpA from 83 centres were collected by the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis. Lifestyle factors for EAMs (acute anterior uveitis (AAU), inflammatory bowel diseases (IBD), psoriasis) were compared with those without EAMs. Also, the association between pretreatment EAMs and choice of first TNFi (adalimumab, etanercept, certolizumab) was analysed.ResultsAAU was directly associated with human leukocyte antigen (HLA)-B27 (incidence rate ratio (IRR) 1.95, 95% CI 1.40 to 2.73) and inversely associated with ever-smoking (IRR=0.71, 95% CI 0.55 to 0.92). For both psoriasis and IBD, there was an inverse relationship with HLA-B27 (IRR 0.54, 95% CI 0.36 to 0.79 and IRR 0.63, 95% CI 0.43 to 0.91, respectively). A diagnosis of either AAU (OR 3.79, 95% CI 2.11 to 6.80) or IBD (OR 5.50, 95% CI 2.09 to 14.46) was associated with preference for adalimumab versus others. In contrast, a diagnosis of either AAU (OR 0.14, 95% CI 0.06 to 0.33) or IBD (OR 0.17, 95% CI 0.05 to 0.57) was associated with less preference for etanercept over other TNFi.ConclusionThe higher occurrence of AAU and lower occurrence of psoriasis and IBD in HLA-B27-positive patients with axSpA are consistent with current pathophysiology. Patients with previous AAU and IBD are more likely to be prescribed adalimumab and less likely to receive etanercept, consistent with the superior efficacy of monoclonal TNFi for these indications. Future work will determine whether EAMs influence TNFi survival, or effectiveness, and whether this varies between agents.

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“…Their outcomes are excellent and similar to those reported previously by our group and others. 6,7 Castle and Gale refer to another article in the November issue by Olver et al, that discusses ethical decision-making in healthcare resource allocation. 8 We have no argument with the sound principles espoused and agree completely on the importance of an ethical, inclusive, accountable and transparent process for healthcare resource allocation.…”

Section: Author Replymentioning

confidence: 99%

Author reply

Zagora

McCluskey

2020

Internal Medicine Journal

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Adalimumab for the treatment of refractory active and inactive non-infectious uveitis

Abstract: Adalimumab appears to reduce the corticosteroid burden in active and inactive non-infectious uveitis in the real-world setting. Inflammatory activity at the time of adalimumab commencement may determine long-term treatment success.

Cited by 29 publications

References 24 publications

Adalimumab Accounts for Long-Term Control of Noninfectious Uveitis Also in the Absence of Concomitant DMARD Treatment: A Multicenter Retrospective Study

Adalimumab Accounts for Long-Term Control of Noninfectious Uveitis Also in the Absence of Concomitant DMARD Treatment: A Multicenter Retrospective Study

Predictors of extra-articular manifestations in axial spondyloarthritis and their influence on TNF-inhibitor prescribing patterns: results from the British Society for Rheumatology Biologics Register in Ankylosing Spondylitis

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