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Efficacy of adalimumab and infliximab in recalcitrant retinal vasculitis inadequately responsive to other immunomodulatory therapies

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Abstract

The primary aim of the study was to evaluate the efficacy of tumor necrosis factor (TNF)-α blockers adalimumab (ADA) and infliximab (IFX) in refractory sight-threatening retinal vasculitis (RV) during a 12-month follow-up period. Secondary aims were to evaluate (i) any impact of concomitant conventional disease-modifying anti-rheumatic drugs (cDMARDs) and different lines of biologic therapy; (ii) any difference in terms of efficacy between ADA and IFX; (iii) consequences of biotherapies on the best-corrected visual acuity (BCVA); (iv) corticosteroid-sparing effect; and (vi) ocular complications during anti-TNF-α treatment. Demographic, clinical, and therapeutic data were retrospectively collected from the medical records and statistically analyzed. Forty-eight patients (82 eyes) were recruited, 22 (45.8%) of which received IFX and 26 (54.2%) ADA. The percentages of patients achieving RV remission within 3 and 12 months were 54 and 86%, respectively. A significant decrease in RV detection was identified from baseline to 3-month (p < 0.0001) and 12-month (p < 0.0001) assessments and between 3-month and 12-month visits (p = 0.004). No differences were identified in terms of RV resolution between (i) patients undergoing monotherapy and those co-administered with cDMARDs at 3-month (p = 0.560) and 12-month (p = 0.611) follow-up; (ii) biologic-naïve patients and those already exposed to other biologics at 3-month (p = 0.497) and 12-month (p > 0.99) visits; and (iii) patients treated with ADA and those treated with IFX (p = 0.357). During the study period, a statistically significant corticosteroid-sparing effect was observed (p = 0.0002), while BCVA values did not significantly change (p = 0.950). Anti-TNF-α monoclonal antibodies have proved excellent results in patients with recalcitrant sight-threatening RV.

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References

  1. Androudi S, Dastiridou A, Symeonidis C, Kump L, Praidou A, Brazitikos P, Kurup SK (2013) Retinal vasculitis in rheumatic diseases: an unseen burden. Clin Rheumatol 32:7–13

    Article  PubMed  Google Scholar 

  2. Talat L, Lightman S, Tomkins-Netzer O (2014) Ischemic retinal vasculitis and its management. J Ophthalmol 2014:197675

    Article  PubMed  PubMed Central  Google Scholar 

  3. Rosenbaum JT, Sibley CH, Lin P (2016) Retinal vasculitis. Curr Opin Rheumatol 28:228–235

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Hatemi G, Silman A, Bang D, Bodaghi B, Chamberlain AM, Gul A, Houman MH, Kötter I, Olivieri I, Salvarani C, Sfikakis PP, Siva A, Stanford MR, Stübiger N, Yurdakul S, Yazici H, EULAR Expert Committee (2008) EULAR recommendations for the management of Behçet disease. Ann Rheum Dis 67:1656–1662

    Article  PubMed  CAS  Google Scholar 

  5. Tabbara KF, Al-Hemidan AI (2008) Infliximab effects compared to conventional therapy in the management of retinal vasculitis in Behçet disease. Am J Ophthalmol 146:845–50.e1

    Article  PubMed  CAS  Google Scholar 

  6. Fabiani C, Vitale A, Emmi G, Vannozzi L, Lopalco G, Guerriero S, Orlando I, Franceschini R, Bacherini D, Cimino L, Soriano A, Frediani B, Galeazzi M, Iannone F, Tosi GM, Salvarani C, Cantarini L (2017) Efficacy and safety of adalimumab in Behçet’s disease-related uveitis: a multicenter retrospective observational study. Clin Rheumatol 36:183–189

    Article  PubMed  Google Scholar 

  7. Calvo-Río V, Blanco R, Beltrán E, Sánchez-Bursón J, Mesquida M, Adán A, Hernandez MV, Hernandez Garfella M, Valls Pascual E, Martínez-Costa L, Sellas-Fernández A, Cordero Coma M, Díaz-Llopis M, Gallego R, Salom D, 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 (2014) Anti-TNF-α therapy in patients with refractory uveitis due to Behçet’s disease: a 1-year follow-up study of 124 patients. Rheumatology (Oxford) 53:2223–2231

    Article  Google Scholar 

  8. Sharma PK, Markov GT, Bajwa A, Foster CS (2015) Long-term efficacy of systemic infliximab in recalcitrant retinal vasculitis. Retina 35:2641–2646

    Article  PubMed  CAS  Google Scholar 

  9. Fabiani C, Vitale A, Emmi G, Lopalco G, Vannozzi L, Guerriero S, Gentileschi S, Bacherini D, Franceschini R, Frediani B, Galeazzi M, Iannone F, Tosi GM, Cantarini L (2017) Interleukin (IL)-1 inhibition with anakinra and canakinumab in Behçet’s disease-related uveitis: a multicenter retrospective observational study. Clin Rheumatol 36:191–197

    Article  PubMed  Google Scholar 

  10. Vallet H, Seve P, Biard L, Baptiste Fraison J, Bielefeld P, Perard L, Bienvenu B, Abad S, Rigolet A, Deroux A, Sene D, Perlat A, Marie I, Feurer E, Hachulla E, Fain O, Clavel G, Riviere S, Bouche PA, Gueudry J, Pugnet G, Le Hoang P, Resche Rigon M, Cacoub P, Bodaghi B, Saadoun D, Network FU (2016) Infliximab versus adalimumab in the treatment of refractory inflammatory uveitis: a multicenter study from the French Uveitis Network. Arthritis Rheumatol 68:1522–1530

    Article  PubMed  CAS  Google Scholar 

  11. Borrás-Blasco J, Casterá DE, Cortes X, Abad FJ, Rosique-Robles JD, Mallench LG (2015) Effectiveness of infliximab, adalimumab and golimumab for non-infectious refractory uveitis in adults. Int J Clin Pharmacol Ther 53:377–390

    Article  PubMed  CAS  Google Scholar 

  12. Fabiani C, Sota J, Vitale A, Emmi G, Vannozzi L, Bacherini D, Lopalco G, Guerriero S, Venerito V, Orlando I, Franceschini R, Fusco F, Frediani B, Galeazzi M, Iannone F, Tosi GM, Cantarini L (2017) Ten-year retention rate of infliximab in patients with Behçet’s disease-related uveitis. Ocul Immunol Inflamm 3:1–6

    Google Scholar 

  13. Keino H, Okada AA, Watanabe T, Taki W (2014) Long-term efficacy of infliximab on background vascular leakage in patients with Behçet’s disease. Eye (Lond) 28:1100–1106

    Article  CAS  Google Scholar 

  14. Suhler EB, Adán A, Brézin AP, Fortin E, Goto H, Jaffe GJ, Kaburaki T, Kramer M, Lim LL, Muccioli C, Nguyen QD, Van Calster J, Cimino L, Kron M, Song AP, Liu J, Pathai S, Camez A, Schlaen A, van Velthoven MEJ, Vitale AT, Zierhut M, Tari S, Dick AD (2018) Safety and efficacy of adalimumab in patients with noninfectious uveitis in an ongoing open-label study: VISUAL III. Ophthalmology. https://doi.org/10.1016/j.ophtha.2017.12.039

  15. Vallet H, Riviere S, Sanna A, Deroux A, Moulis G, Addimanda O, Salvarani C, Lambert M, Bielefeld P, Seve P, Sibilia J, Pasquali J, Fraison J, Marie I, Perard L, Bouillet L, Cohen F, Sene D, Schoindre Y, Lidove O, Le Hoang P, Hachulla E, Fain O, Mariette X, Papo T, Wechsler B, Bodaghi B, Rigon MR, Cacoub P, Saadoun D, French Behçet Network (2015) Efficacy of anti-TNF alpha in severe and/or refractory Behçet’s disease: multicenter study of 124 patients. J Autoimmun 62:67–74

    Article  PubMed  CAS  Google Scholar 

  16. Perra D, Alba MA, Callejas JL, Mesquida M, Ríos-Fernández R, Adán A, Ortego N, Cervera R, Espinosa G (2012) Adalimumab for the treatment of Behçet’s disease: experience in 19 patients. Rheumatology (Oxford) 51:1825–1831

    Article  CAS  Google Scholar 

  17. Fabiani C, Sota J, Rigante D, Vitale A, Emmi G, Vannozzi L, Franceschini R, Bacherini D, Frediani B, Galeazzi M, Tosi GM, Cantarini L (2017) Rapid and sustained efficacy of golimumab in the treatment of multirefractory uveitis associated with Behçet’s disease. Ocul Immunol Inflamm 5:1–6

    Google Scholar 

  18. Adler S, Baumgartner I, Villiger PM (2012) Behçet’s disease: successful treatment with infliximab in 7 patients with severe vascular manifestations. A retrospective analysis. Arthritis Care Res (Hoboken) 64:607–611

    Article  CAS  Google Scholar 

  19. Ali A, Ku JH, Suhler EB, Choi D, Rosenbaum JT (2014) The course of retinal vasculitis. Br J Ophthalmol 98:785–789

    Article  PubMed  Google Scholar 

  20. Lopez-Gonzalez R, Loza E, Jover JA, Benitez Del Castillo JM, Mendez R, Hernandez-Garcia C, Pato E (2009) Treatment of refractory posterior uveitis with infliximab: a 7-year follow-up study. Scand J Rheumatol 38:58–62

    Article  PubMed  CAS  Google Scholar 

  21. Lee JT, Yates WB, Rogers S, Wakefield D, McCluskey P, Lim LL (2018) Adalimumab for the treatment of refractory active and inactive non-infectious uveitis. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2017-311234

  22. Kruh JN, Yang P, Suelves AM, Foster CS (2014) Infliximab for the treatment of refractory noninfectious uveitis: a study of 88 patients with long-term follow-up. Ophthalmology 121:358–364

    Article  PubMed  Google Scholar 

  23. Díaz-Llopis M, Salom D, Garcia-de-Vicuña C, Cordero-Coma M, Ortega G, Ortego N, Suarez-de-Figueroa M, Rio-Pardo MJ, Fernandez-Cid C, Fonollosa A, Blanco R, Garcia-Aparicio AM, Benitez-Del-Castillo JM, Olea JL, Arevalo JF (2012) Treatment of refractory uveitis with adalimumab: a prospective multicenter study of 131 patients. Ophthalmology 119:1575–1581

    Article  PubMed  Google Scholar 

Download references

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Author notes

  1. Claudia Fabiani and Jurgen Sota contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, Humanitas Clinical and Research Center, via Manzoni 56, 20089, Rozzano, MI, Italy

    Claudia Fabiani

  2. Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy

    Claudia Fabiani, Rossella Franceschini & Gian Marco Tosi

  3. Research Center of Systemic Autoinflammatory Diseases and Behçet’s Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, viale Bracci 1, 53100, Siena, Italy

    Jurgen Sota, Antonio Vitale, Ida Orlando, Bruno Frediani, Mauro Galeazzi & Luca Cantarini

  4. Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario “A. Gemelli”, Rome, Italy

    Donato Rigante

  5. Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy

    Giacomo Emmi

  6. Interdisciplinary Department of Medicine, Rheumatology Unit, University of Bari, Bari, Italy

    Giuseppe Lopalco & Florenzo Iannone

  7. Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy

    Lorenzo Vannozzi & Alice Bitossi

  8. Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy

    Silvana Guerriero

Authors
  1. Claudia Fabiani
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  2. Jurgen Sota
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  3. Donato Rigante
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  4. Antonio Vitale
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  5. Giacomo Emmi
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  6. Giuseppe Lopalco
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  7. Lorenzo Vannozzi
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  8. Silvana Guerriero
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  9. Alice Bitossi
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  10. Ida Orlando
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  11. Rossella Franceschini
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  12. Bruno Frediani
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  13. Mauro Galeazzi
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  14. Florenzo Iannone
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  15. Gian Marco Tosi
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  16. Luca Cantarini
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Corresponding authors

Correspondence to Claudia Fabiani or Luca Cantarini.

Ethics declarations

The study was conducted according to the Declaration of Helsinki and all recruited patients had provided a written informed consent for critical evaluation of their clinical histories and medical charts.

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Fabiani, C., Sota, J., Rigante, D. et al. Efficacy of adalimumab and infliximab in recalcitrant retinal vasculitis inadequately responsive to other immunomodulatory therapies. Clin Rheumatol 37, 2805–2809 (2018). https://doi.org/10.1007/s10067-018-4133-z

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  • DOI: https://doi.org/10.1007/s10067-018-4133-z

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