Infliximab Versus Adalimumab in the Treatment of Refractory Inflammatory Uveitis: A Multicenter Study From the French Uveitis Network

Abstract

Objective. To analyze the factors associated with response to anti-tumor necrosis factor (anti-TNF) treatment and compare the efficacy and safety of infliximab (IFX) and adalimumab (ADA) in patients with refractory noninfectious uveitis.Methods. This was a multicenter observational study of 160 patients (39% men and 61% women; median age 31 years [interquartile range 21-42]) with uveitis that had been refractory to other therapies, who were treated with anti-TNF (IFX 5 mg/kg at weeks 0, 2, 6, and then every 5-6 weeks [n 5 98] or ADA 40 mg every 2 weeks [n 5 62]). Factors associated with complete response were assessed by multivariate analysis. Efficacy and safety of IFX versus ADA were compared using a propensity score approach with baseline characteristics taken into account. Subdistribution hazard ratios (SHRs) and 95% confidence intervals (95% CIs) were calculated.Results. The main etiologies of uveitis included Behçet's disease (BD) (36%), juvenile idiopathic arthritis (22%), spondyloarthropathy (10%), and sarcoidosis (6%). The overall response rate at 6 and 12 months was 87% (26% with complete response) and 93% (28% with complete response), respectively. The median time to complete response was 2 months. In multivariate analysis, BD and occurrence of >5 uveitis flares before anti-TNF initiation were associated with complete response to anti-TNF (SHR 2.52 [95% CI 1.35-4.71], P 5 0.004 and SHR 1.97 [95% CI 1.02-3.84], P 5 0.045, respectively). Side effects were reported in 28% of patients, including serious adverse events in 13%. IFX and ADA did not differ significantly in terms of occurrence of complete response (SHR 0.65 [95% CI 0.25-1.71], P 5 0.39), serious side effects (SHR 0.22 [95% CI

Adalimumab in Active and Inactive, Non-Infectious Uveitis: Global Results from the VISUAL I and VISUAL II Trials

“…The participants had an overall response rate of 93% at 12 months. 23 Most recently, the main study data from VISUAL I and VISUAL II studies also demonstrated the efficacy and safety of adalimumab (anti-TNFα) to treat uveitis. 13,14 Low adalimumab immunogenicity was observed in both VISUAL I and VISUAL II studies and was in the range of rates observed in other disease states.…”

Efficacy and safety of intravitreal anti‐tumour necrosis factor drugs in adults with non‐infectious uveitis – a systematic review

“…; Vallet et al. ; Durrani et al ) and the capability to rapidly reach therapeutic drug levels in the eye when used intravitreally (Modorati & Miserocchi ). One reason that may explain the lack of efficacy or long‐term efficacy in some of the studies is that their mechanisms of action may not be effective when administered locally in the eye, given the systemic nature of the diseases underlying the inflammatory process (Suhler et al.…”

“…Although not formally approved for NIU, there are an important number of studies with infliximab specifically in two underlying conditions: Behc ßet disease and juvenile idiopathic arthritis (Levy-Clarke et al 2014;Cordero-Coma & Sobrin 2015). Moreover, evidence of the efficacy and safety of adalimumab and infliximab in adult NIU may also be found in case reports (Leccese et al 2011;Takase et al 2011;Zmuda et al 2013;Capote et al 2014;Ermetcan et al 2014;Achille et al 2016;Sakurai et al 2016), retrospective case series (Mushtaq et al 2007;Sobrin et al 2007;Handa et al 2011;Okada et al 2012;Al Rashidi et al 2013;Dobner et al 2013;Alfawaz et al 2014;van Denderen et al 2014;Interlandi et al 2014;Kruh et al 2014;Takeuchi et al 2014;Kim et al 2016;Vallet et al 2016;Durrani et al 2017) and prospective case series (Joseph et al 2003;Diaz-Llopis et al 2008;Rudwaleit et al 2009;Suhler et al 2009Suhler et al , 2013D ıaz-Llopis et al 2012;Erckens et al 2012).…”

“…Also, high levels of the cytokine TNF in the aqueous humour of patients with NIU have been described in literature (Sijssens et al 2007;Kuiper et al 2011). Thus, the inceptive rational for the intravitreal use of anti-TNF drugs is based on the efficacy of these drugs in NIU when used systemically (Suhler et al 2005;Interlandi et al 2014;Lin et al 2014;Vallet et al 2016;Durrani et al 2017) and the capability to rapidly reach therapeutic drug levels in the eye when used intravitreally (Modorati & Miserocchi 2012). One reason that may explain the lack of efficacy or long-term efficacy in some of the studies is that their mechanisms of action may not be effective when administered locally in the eye, given the systemic nature of the diseases underlying the inflammatory process (Suhler et al 2005;Tempest-Roe et al 2013;Jaffe et al 2016a,b;Nguyen et al 2016a,b).…”

An update on the use of biologic therapies in the management of uveitis in Behçet’s disease: a comprehensive review

“…A 2016 study found 28% of patients experienced side effects with 13% deemed ‘serious’, such as hypersensitivity reactions ( n  = 10), autoimmune disease ( n  = 6) and neoplasia ( n  = 4) [64]. These adverse effects are most likely due to the murine origin of the variable region of the molecule, and can be attenuated by concomitant anti-histamine and pain-relief medication.…”