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

Abstract

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.

Treating the Different Phenotypes of Behçet's Syndrome

“…In four Italian multicenter observational studies, treatment with either ADA or IFX proved effective for the treatment of refractory retinal vasculitis (45,(94)(95)(96). In another recent observational study on 106 patients with uveitis, ADA was associated with high rates of ocular control, effective steroid tapering, and good preservation of visual acuity, also in the absence of concomitant DMARDs treatment (46). Similarly, increasing observational evidence supports the use of ADA or IFX in neuro-BS (41).…”

“…Correspondence analysis; male, eye disease, HLA-B51 (+), neurologic involvement Azathioprine Clinical trial: (11,36) Observational evidence (for azathioprine alone or in combination): (37,38) Anti TNF-α Interventional study (for infliximab): (39,40) Observational studies (for infliximab): (41,42) Clinical trials (for adalimumab): (43,44) Observational studies (for adalimumab): (41,45,46) Cyclophosphamide Observational study: (47-49)…”

Adalimumab effectively controls both anterior and posterior noninfectious uveitis associated with systemic inflammatory diseases: focus on Behçet’s syndrome

“…In a previous study, we specifically addressed this issue and evaluated the long-term effectiveness of ADA in a large and heterogeneous cohort of patients with non-infectious uveitis treated in real clinical practice. Our results showed the long-term effective control of ADA, either combined with disease-modifying anti-rheumatic drugs (DMARDs) or as monotherapy, in patients with noninfectious primary or secondary uveitis in the real-world setting (Bitossi et al 2019). Of note, this cohort also included patients with anterior uveitis (AU), in which the use of ADA is off-label.…”

Behçet’s syndrome: focus on pathogenetic background, clinical phenotypes and specific treatments

“…For the ocular involvement, AZA is the treatment of choice after an induction treatment with high-dose corticosteroids. In patients refractory to AZA, or with a severe presentation, and/or negative prognostic factor (male gender), anti-TNF-α (mainly infliximab and adalimumab) or IFN α should be used [49][50][51][52][53][54][55][56][57][58]. Recently, a potential role for the anti-IL agents (namely anakinra and canakinumab) has been suggested, despite with a lower effect size than anti-TNF-α [59][60][61][62][63][64].…”