The Efficacy of Adalimumab as an Initial Treatment in Patients with Behçet’s Retinal Vasculitis

Abstract

Background: No study has evaluated the effectiveness of Adalimumab (ADA) as first-line in treatment-naïve patients with retinal vasculitis due to Behçet’s Uveitis (BU).Objective: To compare the efficacy of ADA plus conventional therapy and conventional therapy alone as initial treatments in naïve BU patients characterized by retinal vasculitis.Methods: Medical records of BU patients characterized by retinal vasculitis treated with conventional therapy (CT, refers to glucocorticoid and immunosuppressive agents) alone or ADA plus conventional therapy with at least 6 months of follow-up between February 2015 and June 2020 were analyzed. Only patients who were first diagnosed with BU without previous systemic treatment were reviewed. The retinal vasculitis score based on fluorescein angiography (FA), best-corrected visual acuity, glucocorticoid-sparing effect, the number of relapses and ocular complications were evaluated.Results: A total of 45 patients (87 eyes) were included. Twenty-four patients (55.33%) in the CT group were treated with conventional therapy and 21 patients (46.67%) in the ADA group were treated with ADA plus conventional therapy. The inflammatory parameters improved in both groups. FA scores showed significantly greater improvement in ADA group than CT group (p < 0.001). The median number of relapses was significantly lower, and the duration of remission was longer in ADA group than CT group (p < 0.001). At the last visit, a significantly better BCVA improvement (p = 0.024), better inflammation control (anterior chamber inflammation p = 0.017 and vitritis p < 0.001) and lower daily glucocorticoid dosage (p = 0.005) were identified in patients received ADA therapy. In CT group, 1 patient suffered hepatitis B and tuberculosis, 1 had growth retardation, 1 patient had with osteoporosis, then followed by other mild AEs (mostly respiratory upper tract infections); while in ADA group, 1 patient experienced a mild pneumonia (n = 1) while milder AEs were represented mostly by respiratory upper tract infections followed by gastrointestinal discomfort.Conclusion: ADA plus conventional therapy achieved superiority over conventional therapy as initial treatment in naïve BU patients with retinal vasculitis.

TNF-α in Uveitis: From Bench to Clinic

“… 6) ADA seems to be associated with better outcomes after follow-up, although both IFX and ADA are efficacious for refractory BD-related uveitis ( Atienza-Mateo et al, 2019 ). 7) ADA plus conventional therapy outperforms conventional therapy alone in patients with retinal vasculitis due to refractory BD-related uveitis ( Yang et al, 2021a ; Yang et al, 2021b ). 8) In children and adolescents with active juvenile idiopathic arthritis (JIA)-related uveitis, the treatment failure rate of ADA is lower than that of the placebo ( Ramanan et al, 2017 ; Angeles-Han et al, 2019 ).…”

“…7) ADA plus conventional therapy outperforms conventional therapy alone in patients with retinal vasculitis due to refractory BD-related uveitis ( Yang et al, 2021a ; Yang et al, 2021b ).…”

Modern concept of a new group of retinal vasculitis

“…Данная патология может быть как первичной (идиопатической), так и развиваться вследствие проникновения инфекционного агента (бактериального, вирусного, паразитарного) [3]. К первичным васкулитам относятся офтальмологические проявления системных заболеваний: гигантоклеточный артериит, болезнь Бехчета, болезнь Такаясу, узелковый полиартериит, болезнь Хортона, склеродермия, саркоидоз, облитерирующий эндартериит [4][5][6][7]. Под вторичными ретиноваскулитами подразумевают изменения на фоне любой другой глазной воспалительной патологии, например при герпес-вирусной патологии, периваскулярной географической хориопатии, цитомегаловирусной инфекции [8].…”

Editorial: Introduction, Vasculitis 2021

“…39-45). Biologic agents are surely used more and more in managing BS, especially in eye disease, and there are now reports [8,9] suggesting that biologic agents may work better than traditional immunosuppressives. She then focuses on the difficulty of picking and using a disease activity tool for a condition like BS where there is multisystem involvement in most patients, and the disease severity in these make up a wide spectrum, leading to the treatment decisions being based on the most severe manifestation.…”

“…That is why we have asked Prof. Takeno, one very dedicated student of BS, both at the bench and at the bedside, to update us about HLA B Ã 51 association of BS (pp. [4][5][6][7][8][9]. He does this diligently and it turns out the meaning of this genetic association remains a mystery.…”