Efficacy and safety of rituximab in peripheral ulcerative keratitis associated with rheumatoid arthritis

Bonnet, I; Rousseau, Antoine; Duraffour, Pierre; Pouchot, J.; Nguyen, Chi; Gabison, Éric; Séror, Raphaèle; Marotte, Hubert; Mariette, Xavier; Nocturne, Gaëtane

doi:10.1136/rmdopen-2020-001472

Cited by 11 publications

(8 citation statements)

References 17 publications

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“…However, we include RTX in Figure 3 based on previous reports. 9 , 26 , 33 – 36 Ocular manifestations in RA not only may be related to the underlying disease but also it may be due to the adverse ocular reactions secondary to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and DMARDs, both synthetic and biological, in patients with RA. 37 …”

Section: Discussionmentioning

confidence: 99%

Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review

Calvo-Río

Sánchez-Bilbao

Álvarez-Reguera

et al. 2022

Therapeutic Advances in Musculoskeletal

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Ocular disease, such as scleritis and peripheral ulcerative keratitis (PUK), may be a serious ocular complication. We present a patient with severe and refractory PUK treated with baricitinib. A review of the literature on Janus kinase inhibitors (JAKINIB) in refractory ocular surface pathology was also performed. For the literature review, the search in PubMed, Embase, and the Cochrane library was carried out from inception until 31 May 2021, including conference proceedings from four major rheumatology congresses. All original research articles studying JAKINIB treatment in patients with inflammatory eye disease were included. We present an 85-year-old woman with rheumatoid arthritis (RA) and secondary Sjögren’s syndrome refractory to methotrexate, leflunomide, certolizumab pegol, adalimumab, and tocilizumab (TCZ). However, 10 months after starting TCZ, the patient suffered a perforation secondary to PUK, requiring urgent surgical intervention. In the absence of infection, she was treated with boluses of intravenous methylprednisolone followed by oral prednisone at high doses in a decreasing pattern together with baricitinib at a dose of 2 mg/day with a very rapid and persistent favorable response to eye and joint symptoms. After 18 months of treatment, the patient had not presented serious side effects or signs of reactivation of her disease. In addition to this report, three other studies including one PUK associated with RA and two non-infectious scleritis treated with tofacitinib were included in this literature review. All three patients had experienced an insufficient response to conventional treatment, including biologic agents, before being switched to JAKINIB, leading to a complete or partial recovery in all of them without significant adverse effects so far. JAKINIBs (baricitinib and tofacitinib) may be an effective and safe therapy in patients with severe autoimmune and refractory ocular surface pathology, such as scleritis and PUK.

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Section: Discussionmentioning

confidence: 99%

Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review

Calvo-Río

Sánchez-Bilbao

Álvarez-Reguera

et al. 2022

Therapeutic Advances in Musculoskeletal

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“…Patients who fail combination corticosteroid and cytotoxic therapy can be started on one of the biologics. 16,31,33,88,121,125,126,127 Geetha et al 128 compared rituximab with oral CyP in ANCAassociated vasculitis, and found that it was non-inferior to CyP and possibly better at preventing relapsing disease. 128 A recent study showed greater efficacy of the non-TNFα agents in the management of PUK.…”

Section: Systemicmentioning

confidence: 99%

“…Corneal perforation is a severe complication of PUK, which can be managed by several ways, including corneal glue, multi-layer amniotic membrane or a corneal patch graft (full thickness or lamellar). 11,125,126 Corneal glue is a simple office procedure to seal a small corneal perforation. 20 This is often a temporising procedure before definitive surgery; however, this occasionally may allow for healing without further surgery.…”

Section: Tectonicmentioning

confidence: 99%

“…11,12,122,135 Fortunately, with the increased use of biological agents, the need for patch grafts has reduced to 12% -14% with good tissue survival and improved visual outcomes. 15,126 Patients with GPA seem to have a more severe course of disease, with 50% -60% of patients requiring patch grafts to maintain globe integrity despite the use of CTT and biologics. 26,125 Various techniques have been described to assist the surgeon in fashioning these crescentic grafts.…”

Section: Tectonicmentioning

confidence: 99%

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Peripheral ulcerative keratitis: A review of aetiology and management

Hӧllhumer

2022

African Vision and Eye Health

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Background: Peripheral ulcerative keratitis (PUK) is a severe inflammatory disease of the peripheral cornea that can be caused by local factors or systemic inflammatory disease.Aim: The purpose of this review is to give an overview of the pathophysiology, aetiology, clinical features, diagnosis, and management of PUK.Method: A PubMed search was conducted using the keywords, ‘peripheral ulcerative keratitis’ and ‘Mooren’s ulcer’.Results: The peripheral cornea has unique characteristics the predispose to the development of PUK. These include fine capillary arcades that allow for deposition of immune complexes and subsequent activation of an inflammatory cascade with corneal melt. Several conditions have been implicated in the aetiology of PUK. The most commonly cited causes are rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA) and various dermatoses. In patients with RA, PUK usually presents in established disease, whereas in GPA, PUK may be the presenting feature in up to 60% of cases. In RA it heralds the onset of a systemic vasculitis with significant associated morbidity and mortality. The management of PUK follows an individualised stepwise approach. All patients require supportive measures to encourage healing and halt the process of keratolysis. Systemic autoimmune conditions need a systemic corticosteroid as a fast-acting agent to halt the inflammatory process while cytotoxic therapy maintains long term disease control. Failure to achieve disease control with CTT, necessitates the use of a biologic agent.Conclusion: Peripheral ulcerative keratitis is a severe inflammatory disease of the peripheral cornea that needs a thorough diagnostic workup and stepwise management approach.

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“…[ 167 , 168 ] A recent small case series also reported success in the treatment of RA-associated PUK, with excellent control of ocular inflammation, and also improvement in the articular and vasculitic disease. [ 169 ] In addition to rituximab, tocilizumab, and belimumab are non-anti TNF antibodies to IL-6R and BAFF, respectively, that have been used sparingly but successfully in the treatment of PUK. In one case series of patients treated with rituximab, tocilizumab, or belimumab, these agents were found to be more effective than anti-TNF agents for treatment-resistant PUK.…”

Section: Introductionmentioning

confidence: 99%

Peripheral Ulcerative Keratitis: A Review

Hassanpour

ElSheikh

Arabi

et al. 2022

JOVR

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Peripheral ulcerative keratitis (PUK) is a rare but serious ocular condition that is an important clinical entity due to its ophthalmological and systemic implications. It is characterized by progressive peripheral corneal stromal thinning with an associated epithelial defect and can be associated with an underlying local or systemic pro-inflammatory condition, or present in an idiopathic form (Mooren ulcer). Associated conditions include autoimmune diseases, systemic and ocular infections, dermatologic diseases, and ocular surgery. Cell-mediated and autoantibody- mediated immune responses have been implicated in the pathogenesis of PUK, destroying peripheral corneal tissue via matrix metalloproteinases. Clinically, patients with PUK present with painful vision loss, a peripheral corneal ulcer, and often adjacent scleritis, episcleritis, iritis, or conjunctivitis. Diagnostic evaluation should be focused on identifying the underlying etiology and ruling out conditions that may mimic PUK, including marginal keratitis and Terrien marginal degeneration. Treatment should be focused on reducing local disease burden with topical lubrication, while simultaneously addressing the underlying cause with antimicrobials or anti-inflammatory when appropriate. Existing and emerging biologic immunomodulatory therapies have proven useful in PUK due to autoimmune conditions. Surgical treatment is generally reserved for cases of severe thinning or corneal perforation.

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Efficacy and safety of rituximab in peripheral ulcerative keratitis associated with rheumatoid arthritis

Cited by 11 publications

References 17 publications

Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review

Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review

Peripheral ulcerative keratitis: A review of aetiology and management

Peripheral Ulcerative Keratitis: A Review

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