Long-term follow-up of certolizumab pegol in uveitis due to immune-mediated inflammatory diseases: multicentre study of 80 patients

Abstract

ObjectivesTo evaluate effectiveness and safety of certolizumab pegol (CZP) in uveitis due to immune-mediated inflammatory diseases (IMID).MethodsMulticentre study of CZP-treated patients with IMID uveitis refractory to conventional immunosuppressant. Effectiveness was assessed through the following ocular parameters: best-corrected visual acuity, anterior chamber cells, vitritis, macular thickness and retinal vasculitis. These variables were compared between the baseline, and first week, first, third, sixth months, first and second year.ResultsWe studied 80 (33 men/47 women) patients (111 affected eyes) with a mean age of 41.6±11.7 years. The IMID included were: spondyloarthritis (n=43), Behçet’s disease (n=10), psoriatic arthritis (n=8), Crohn’s disease (n=4), sarcoidosis (n=2), juvenile idiopathic arthritis (n=1), reactive arthritis (n=1), rheumatoid arthritis (n=1), relapsing polychondritis (n=1),ConclusionsCZP seems to be effective and safe in uveitis related to different IMID, even in patients refractory to previous biological drugs.

Management of postinfectious inflammatory arthritis

“…AZA, Azathioprine; bDMARDs, biologic DMARDs; cDMARDs, conventional DMARDs; DMARD, disease modifing antirheumatic drug; HCQ, hydroxychloroquine; IVIG, intravenous immunoglobulin; LTBI, latent tuberculosis infection; MTX, methotrexate; NSAIDs, nonsteroidal anti-inflammatory drugs; PRSA, poststreptococcal reactive arthritis; SSZ, sulfasalazine; TNFi, tumor necrosis factor inhibitor; tsDMARD, targeted synthetic DMARDs.aMTX is used first line for ocular inflammation related to reactive arthritis. Severe ocular inflammation refractory to methotrexate may require additional therapies, such as cyclosporine, etanercept, certolizumab, azathioprine, mycophenolate mofetil, cyclophosphamide, or IVIG [22,23].bIf there is evidence of cardiac involvement, then the patient should be reclassified as acute rheumatic fever and continue receiving secondary prophylaxis per American Heart Association guidelines [42].cCombination of SSZ and infliximab was used in a patient who later developed peripheral and axial psoriatic arthritis after PSRA diagnosis.dIntraarticular steroids may be effective second-line treatment in children [62,63], but intraarticular steroids delays resolution of arthritis in adults, especially if given during initial antibiotic course [49,64,65].eHCQ in contraindicated in Child–Pugh–Turcotte classification C.fSSZ is contraindicated in Child–Pugh–Turcotte classification B or C.…”

“…aMTX is used first line for ocular inflammation related to reactive arthritis. Severe ocular inflammation refractory to methotrexate may require additional therapies, such as cyclosporine, etanercept, certolizumab, azathioprine, mycophenolate mofetil, cyclophosphamide, or IVIG [22,23].…”

“…There are no randomized control trials comparing conventional or biologic DMARDs (bDMARDs) in the treatment of ReA, but sulfasalazine (SSZ) is generally used first line given its proven efficacy and favorable safety profile [19]. Methotrexate (MTX) is also effective in ReA refractory to other therapies [20][21][22][23]. Patients' refractory to SSZ and/or MTX should have their therapy escalated to bDMARDs [2].…”

Inflammatory cytokines as mediators of retinal endothelial barrier dysfunction in non‐infectious uveitis

“…Pegylated humanised Fab Yes Improved control in open-label and retrospective clinical studies 242,243 and decreased acute anterior uveitis recurrence in phase IV clinical study of treatment for spondyloarthritis. 244…”