Efficacy of golimumab on recurrent uveitis in HLA-B27-positive ankylosing spondylitis

Abstract

To evaluate the efficacy of golimumab on severe and frequent recurrent anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis. In this study, 15 eyes of 12 HLA-B27-positive AS patients with resistant anterior uveitis who received 50 mg of subcutaneous golimumab (Gol) per month due to frequent uveitis recurrences were analyzed retrospectively between May 2013 and October 2015. Assessment criteria were uveitis activity, the number of recurrence of uveitis, visual acuity, systemic corticosteroid, or other drug requirement for maintenance of remission of AU. Twelve patients (15 eyes) with HLA-B27-positive ankylosing spondylitis and anterior uveitis have been treated with golimumab 50 mg/month. Remission of uveitis was observed in 12 eyes out of 15. Malign hypertension developed in one subject after the second dose of golimumab therefore the treatment was stopped and this subject was excluded from the study. Median follow-up time was 11 months (interquartile range: 8-18). No uveitic reaction was seen except in the patient who stopped treatment. No topical or systemic steroid necessity was needed except in two cases with oral 4 mg systemic maintenance. Visual acuity was significantly increased (p = 0.002). Golimumab may be a new and effective choice for maintaining remission and the prevention of recurrences of severe, resistant anterior uveitis in patients with HLA-B27-positive ankylosing spondylitis.

The use of biologic agents in the management of uveitis

“…These studies demonstrate successful control of severe, complicated and recalcitrant uveitis associated with JIA, BD, HLA‐B27 positivity and idiopathic retinitis . The largest data come from four retrospective interventional case series involving 12–17 patients with recalcitrant uveitis, which show that monthly golimumab achieved rapid and complete control of ocular inflammation in >80% of patients, allowed significant tapering of concurrent immunosuppression and maintained remission for >6 months . The profile of adverse events, while theoretically predicted to be similar to other TNF‐α inhibitors, was less severe with golimumab, though this may be due to small study sizes.…”

“…[67][68][69][70] The largest data come from four retrospective interventional case series involving 12-17 patients with recalcitrant uveitis, which show that monthly golimumab achieved rapid and complete control of ocular inflammation in >80% of patients, allowed significant tapering of concurrent immunosuppression and maintained remission for >6 months. [71][72][73][74] The profile of adverse events, while theoretically predicted to be similar to other TNF-α inhibitors, was less severe with golimumab, though this may be due to small study sizes. Isolated case reports showed no remarkable adverse events at all, with most patients having only mild localised cutaneous reactions.…”

“…Isolated case reports showed no remarkable adverse events at all, with most patients having only mild localised cutaneous reactions. However, there was one reported case of renal adenocarcinoma, malignant hypertension, bacterial pneumonia, and desquamative skin eruption across the case series. An advantage of golimumab over the other TNF‐α inhibitors is its s.c. monthly dosing that eliminates the expense and time‐commitment for infusions such as infliximab.…”

Advances in the treatment of uveitis in patients with spondyloarthritis - is it the time for biologic therapy?

“…Recently, a study carried out on 15 eyes of 12 HLA-B27 positive AS patients with resistant AU who received golimumab 50 mg per week showed that remission on AU was observed in 12 eyes of 15 and the visual acuity was significantly increased [ 38 ].…”

Occurrence of anterior uveitis in patients with spondyloarthritis treated with tumor necrosis factor inhibitors: comparing the soluble receptor to monoclonal antibodies in a large observational cohort

“…In patients receiving adalimumab, the reduction in incidence as compared with placebo was estimated at 51% [8]. Golimumab has been found effective in uveitis resistant to local treatments, general first-line treatments, and in some cases, other TNF-α inhibitors (TNFi) [9]. Data provided by the randomized study RAPID-Ax-Spa, evaluating uveitis in both ankylosing spondylitis (AS) and non-radiographic axial SpA, also showed a marked decrease in the incidence of acute anterior uveitis with certolizumab versus placebo [10].…”