Impact of systemic treatments on the course of HLA-B27-associated uveitis: A retrospective study of 101 patients

Abstract

To investigate the efficacy and tolerance of systemic treatments for the prevention of HLA-B27-associated acute uveitis (AU) recurrence. Methods Retrospective review of patients with HLA-B27-associated uveitis followed in our tertiary center over a 15-year period. Systemic treatments were prescribed to patients with frequent (more than 2 flares per year) or severe uveitis, according to a step-up strategy Results 101 patients (51.5% of men, 88.1% of white Europeans) with a median age of 37 years. AU was mostly recurrent (68.3%) and associated with spondyloarthritis (60.4%). After a median follow-up duration of 22 months (3-73), 37.6% of the patients have received systemic treatment. 88.5% of the patients have been treated with sulfasalazine (SSZ) for ophthalmologic purposes (23/26). Methotrexate (MTX) and anti-TNFα agents have been initiated for a rheumatologic indication in 81.8% (9/11) and 100% of the patients (13/13), respectively. The annual uveitis relapse rate significantly decreased on SSZ (0.37 recurrences/year versus baseline 2.46 recurrences/year; p<0.001) and MTX (1.54 recurrences/year versus 4.17/year; p = 0.008). Patients under ADA for ophthalmologic purposes (n = 2) did not experience any recurrence. Conclusion We report an open-label strategy to prevent the recurrences of HLA-B27-associated AU. First-line sulfasalazine reduced uveitis relapses. The use of anti-TNFα agents for ophthalmologic purposes was unnecessary with rare exceptions.

Immunopathophysiology and clinical impact of uveitis in inflammatory rheumatic diseases: An update

“…The prognosis of HLA‐B27‐associated uveitis is usually good in the long term, but complications and recurrences may occur. 78 Particularly, pupil occlusion caused by a fibrinous inflammatory membrane may cause pupil block, elevated intraocular pressure and secondary glaucoma. Macular and optic nerve head involvement may also be observed.…”

Uveitis as an Open Window to Systemic Inflammatory Diseases

“…We recently reported an open-label strategy to prevent the recurrences of HLA-B27-associated AU in 61 of 101 patients (60.4%) with Spa-associated uveitis [ 109 ]. The use of SSZ as a first-line treatment for the ophthalmologic indication reduced uveitis recurrences in 82% (23/26) of patients.…”

Secukinumab in HLA‐B27 associated uveitis

“…Chiara Giuffre MD FEBO 1 Roberto Caporali MD 2 Ennio G. Favalli MD 3 1 Department of Ophthalmology, San Raffaele Scientific…”

“…These diseases share many clinical features and an association with HLA-B27. 1 HLA-B27 associated uveitis is an acute, unilateral, recurrent inflammation of the anterior segment of the eye that may occur in association with other HLA-B27 related diseases. Recurrence of HLA-B27 uveitis often involves the fellow eye and can cause complications including synechiae and cataract in milder forms, and retinal vasculitis and macular oedema as more severe manifestations.…”

“…Most patients respond to short courses of local or oral corticosteroids, but patients with recurrent or severe attacks of HLA-B27 associated uveitis may require long-term treatment with systemic immunosuppressive drugs. 1 Three multicenter, randomised, double-masked, phase III studies (SHIELD, INSURE, ENDURE) found no difference in the number of noninfectious uveitis recurrences when comparing secukinumab to placebo. However, these studies were limited by the potentially confounding effects of concomitant immunosuppressive medications and different types of uveitis enrolled.…”