Effectiveness and Safety of Anti-Tumor Necrosis Factor-Alpha Agents Treatment in Behcets’ Disease-Associated Uveitis: A Systematic Review and Meta-Analysis

Abstract

Purpose: We conducted a systematic review and meta-analysis to determine the effectiveness and safety of anti-tumor necrosis factor-alpha (TNF-a) agents in the treatment of Behcets' disease (BD)-associated uveitis. Method: Three electronic databases, Embase, MEDLINE, and the Cochrane Library, were searched for eligible papers focusing on the anti-TNF-a agents treatment in BD-associated uveitis with at least 6 months follow-up time. A systematic review and meta-analysis was conducted on selected papers with appropriate clinical and methodological homogeneity. The effectiveness outcomes included inflammation remission, visual acuity (VA) improvement, central macular thickness (CMT) decrease, corticosteroid (CS)-sparing effects, and the safety outcomes included minor and severe drug-related adverse events (AEs). Result: From Jan 2010 to Dec 2019, there were 504 records produced in total, in which 18 clinical trials were selected for meta-analysis (15 trials were retrospective studies, and 3 were prospective studies). The number of patients in each study ranged from 11 to 163 and the mean follow-up time from 0.9 to 6.44 years. During the follow-up, the pooled inflammation remission rate was 68% with a 95% confidence interval (CI) of 0.59-0.79, VA improvement rate was 60% (95% CI 0.47-0.77), CMT decrease was 112.70 mm (95% CI 72.8-153.0 mm). The proportions of patients who had CS-suspended and CS-tapered reached 38% (95% CI 0.23-0.65) and 34% (95% CI 0.16-0.70), respectively. The severe AEs were reported but not common, which included severe infusion reactions, pneumonia, bacteremia, tuberculosis, melanoma, and lymphoma. Conclusion: Anti-TNF-a agents treatment has high effectiveness including efficient inflammation remission, satisfactory VA improvement, obvious CMT reduction, and significant CS-sparing effects. Although some drug-related AEs were reported, the incidence of severe AEs was acceptable. Anti-TNF-a agents treatment is a promising option for controlling BD-associated uveitis.

Epidemiology of Ocular Manifestations in Autoimmune Disease

“…Recurrent bilateral uveitis is prevalent in approximately two-thirds of Bechet’s disease patients ( 26 ), with 25% of these patients prone to developing blindness ( 27 ). In addition, serious complications can occur even in an early stage of Bechet’s disease-associated uveitis, such as retinal lesions (75 -80%) ( 28 ), cataracts (39.5%) and secondary glaucoma (17.1%) ( 29 ), leading to visual impairment.…”

Old and New Challenges in Uveitis Associated with Behçet’s Disease

“…The overall uveitis remission rate was 68% (95% CI 0.59 to 0.79), visual acuity improvement rate was 60% (95% CI 0.47 to 0.77) and central macular thickness decrease was 112.70 μm (95% CI 72.8 to 153.0) with a significant corticosteroid-sparing effect. In this review, 2.62% of patients had serious side effects [ 88 ]. Furthermore, Vallet et al retrospectively evaluated the adalimumab and infliximab efficacy in 160 refractory uveitis, including 36% of BD uveitis.…”

Recent Insights into the Management of Behçet Syndrome

“…Recently, a SR and meta-analysis evaluating the efficacy of infliximab and adalimumab in BS uveitis was published. 38 They included articles published between January 2010 and September 2019 with a minimum of 10 patients and a minimum of 6 months of follow-up. Eighteen studies with a total of 968 patients (M/F= 65%/ 35%) were included.…”