Anti-TNF-alpha therapy in patients with refractory uveitis due to Behcet's disease: a 1-year follow-up study of 124 patients

Autores de IIS La Fe

• Eduardo Beltran Beleña

  Autor

• Elia Valls Pascual

  Autor

• Manuel Díaz Llopis

  Autor

• Roberto Gallego Pinazo

  Autor

• David Salom Alonso

  Autor

Participantes ajenos a IIS La Fe

• Calvo-Río V
• Blanco R
• Sánchez-Bursón J
• Mesquida M
• Adán A
• Hernandez MV
• Hernandez Garfella M
• Martínez-Costa L
• Sellas-Fernández A
• Cordero Coma M
• García Serrano JL
• Ortego N
• Herreras JM
• Fonollosa A
• García-Aparicio AM
• Maíz O
• Blanco A
• Torre I
• Fernández-Espartero C
• Jovani V
• Peiteado-Lopez D
• Pato E
• Cruz J
• Fernández-Cid C
• Aurrecoechea E
• García M
• Caracuel MA
• Montilla C
• Atanes A
• Hernandez FF
• Insua S
• González-Suárez S
• Sánchez-Andrade A
• Gamero F
• Linares L
• Romero-Bueno F
• García AJ
• Almodovar R
• Minguez E
• Carrasco Cubero C
• Olive A
• Vázquez J
• Ruiz Moreno O
• Jiménez-Zorzo F
• Manero J
• Muñoz Fernández S
• Rueda-Gotor J
• González-Gay MA

Grupos

• 

  Biomedicina Molecular, Celular y Genómica

Abstract

Objective. The aim of this study was to assess the efficacy of anti-TNF-alpha therapy in refractory uveitis due to Behcet's disease (BD). Methods. We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3-5 mg/kg at 0, 2 and 6 weeks and then every 4-8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load. Results. Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (S.D. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-alpha drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-alpha therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 mu m] and 35 (49 eyes) had cystoid macular oedema (OCT > 300 mu m) that improved from 420 mm (S.D. 119.5) at baseline to 271 mu m (S.D. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases. Conclusion. Anti-TNF-alpha therapy is effective and relatively safe in refractory BD uveitis.

Keywords

• Behcet's disease; uveitis; anti-TNF therapy