THU0438 Comparative study of infliximab versus adalimumab in refractory uveitis associated to cystoid macular oedemadue to behÇet’s disease. mulcitenter study of 40 cases

Abstract

ObjectivesTo compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as first biologic drug in refractory uveitis with cystoid macular oedema (CME) associated to BD.MethodsMulticenter study of 40 patients with BD-associated uveitis with CME refractory or intolerant to standard treatment (corticosteroids and at least one conventional immunosuppressive agent). CME was considered if macular thickness was greater than 300 µm. Comparative outcome measures were macular thickness, improvement of visual acuity (VA), activity of anterior chamber inflammation and vitritis. Results were expressed as mean ±SD for variables with a normal distribution, or as median [25th-75th interquartile range- IQR] when not normally distributed. The comparison of continuous variables among time-periods was performed with the Wilcoxon signed rank test.ResultsWe selected patients with CME from a cohort of 177 patients with refractory BD-related uveitis (n=40). IFX was used in 15 cases and ADA in 25. No significant differences at baseline were observed between IFX vs ADA groups in sex (♂/♀ 8/7 vs 13/12, p=0.93), mean age (38±9 vs 41±10 years, p=0.53), HLA-B51 + (10 vs 19, p=0.87), uveitis pattern (panuveitis 67% vs 80%, posterior uveitis 33% vs 20%, p=0.34), previous conventional treatment (intravenous pulses of methylprednisolone 60% vs 52%, p=0.62, oral corticosteroids 93% vs 72%, p=0.1, methotrexate 53% vs 52%, p=0.93, cyclosporin A 73% vs 88%, p=0.23, azathioprine 53% vs 56%, p=0.86, other drugs 47% vs 68%, p=0.18), and combined treatment (67% vs 64%, p=0.86). After 1 year of therapy, ocular remission was achieved in 60% of cases with IFX and in 76% of cases with ADA (p=0.28). Regarding CME, 65% of patients with IFX reached a macular thickness <250 µm vs 87% of patients with ADA, with no statistically significant differences (p=0.07). Evolution of ocular parameters is shown in the table 1. Only 2 adverse effects were observed, both in ADA group (local rash and bacteremia).ConclusionsIFX and ADA show a similar efficacy in the treatment of CME in BD-related refractory uveitis.Reference[1] Calvo-Río V, Blanco R, Beltran E, Sanchez-Burson J, Mesquida M, Adan A, et al. Anti-TNF- therapy in patients with refractory uveitis due to Behcet’s disease: a 1-year follow-up study of 124 patients. Rheumatology (Oxford)2014;53(12):2223–31.Disclosure of InterestNone declared

Long‐term efficacy, safety, and cumulative retention rate of antitumor necrosis factor‐alpha treatment for patients with Behcet's uveitis: A systematic review and meta‐analysis

“…However, when we decreased the follow‐up time criteria to include studies with a follow‐up of at least 1 year, we were able to extract data from four datasets in three articles (Figure S1). 14,16,17 The results demonstrated a significant pooled reduction in CMT of 135.72 μm (95% CI: −244.93 μm to −26.50 μm), indicating significant difference. This analysis showed substantial heterogeneity ( I 2 = 98.90%, p = .000).…”

“…Subsequently, we screened the titles and abstracts of all 1840 papers, and only 38 of them met the criteria for full‐text review and evaluation. After careful review and removal of duplicate literature and data, we ultimately included 12 articles for our analysis 10,14–24 . One of these studies provided two sets of data, each related to infliximab and adalimumab 16 .…”

“…During the follow‐up period, 715 of the 951 patients included in the nine studies maintained drug retention following anti‐TNF‐α treatment 15–20,22–24 . As shown in Figure 4, the pooled drug retention rate was 67.3% (95% CI: 53.7%–79.6%) with heterogeneity ( I 2 = 91.56%, p = .000).…”

“…A total of six studies provided data on GC dose reduction 14–16,19,21,24 . In two of these studies, which presented GC dose reduction in the form of mean ± standard deviation (SD), we conducted a meta‐analysis to assess the pooled effect.…”

“…Another contributing factor to the higher incidence of infusion or injection reactions in patients receiving infliximab could be due to its chimeric nature. Moreover, it is plausible that patients treated with infliximab have a higher likelihood of developing antidrug antibodies compared to those on adalimumab 16 . In general, anti‐TNF‐α therapy has an excellent drug retention rate in the treatment of BU.…”