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Efficacy and safety of biological therapy compared to synthetic immunomodulatory drugs or placebo in the treatment of Behçet’s disease associated uveitis: a systematic review

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Abstract

The aim of this study is to compare the efficacy and safety of biological therapy with cyclosporin A (CsA), azathioprine (AZA), or placebo in uveitis flares and other ocular outcomes in patients with Behçet disease. A comprehensive and sensitive search in MEDLINE, EMBASE, and the Cochrane Library was performed. We selected articles including: (1) adult patients with Behçet’s and uveitis; (2) on biological therapies; (3) placebo or active control with CsA or AZA; (4) analyzing efficacy (number of uveitis flares, macular edema, etc.) and/or safety outcomes. Meta-analyses, systematic reviews, clinical trials, and observational studies with > 10 patients were included. The selection, data collection and quality assessment (Oxford scale) was carried out by 2 reviewers independently. Nine articles of moderate quality were included (6 randomized clinical trials and 3 retrospective studies) involving 378 patients. Most of them, apart from the study drugs received systemic corticosteroids and other immunosuppressant drugs. Infliximab was more effective than CsA in reducing short-term uveitis flares and severe complications of retinal vasculitis in the long term. Rituximab was similar to a combination of cytotoxic drugs in improving inflammatory activity. In patients with active uveitis adalimumab was associated with a lower risk of uveitic flare or visual impairment, and in patients with inactive uveitis to a significantly lowered the risk of flare upon corticosteroid withdrawal. Secukinumab and daclizumab were not superior to placebo in reducing uveitis flares, like interferonα compared to other drugs. Our results highlight the need for better designed comparative studies on Behçet’s uveitis.

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Funding

There was no specific funding for this work but for medical writing assistance that was provided by a grant from Merck Sharp & Dohme of Spain.

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Authors and Affiliations

  1. Rheumatology Department, Can Misses Hospital, Ibiza, Spain

    Ana Urruticoechea-Arana

  2. Rheumatology Department, University Hospital Infanta Sofía, Madrid, Spain

    Tatiana Cobo-Ibáñez

  3. Universidad Europea, Madrid, Spain

    Tatiana Cobo-Ibáñez

  4. Rheumatology Department, University Hospital of Mostoles, Madrid, Spain

    Virginia Villaverde-García

  5. Rheumatology Department, Sierrallana Hospital, Torrelavega, Spain

    Montserrat Santos Gómez

  6. Instituto de Salud Musculoesquelética, InMusc, Madrid, Spain

    Estíbaliz Loza

  7. Family and Community Medicine, Can Misses Hospital, Ibiza, Spain

    Kelly Vargas-Osorio & Leslie Fariñas Padrón

  8. Rheumatology Department, University Hospital of the Canary Islands, Tenerife, Spain

    Federico Diaz-Gonzalez

  9. University Hospital Marques of Valdecilla, Santander, Spain

    Vanesa Calvo-Río & Ricardo Blanco

Authors
  1. Ana Urruticoechea-Arana
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  2. Tatiana Cobo-Ibáñez
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  3. Virginia Villaverde-García
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  4. Montserrat Santos Gómez
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  5. Estíbaliz Loza
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  6. Kelly Vargas-Osorio
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  8. Federico Diaz-Gonzalez
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  9. Vanesa Calvo-Río
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Contributions

AU-A, RB and EL participated in the study design. MSG, KV-O, LFP and AU-A participates in the study selection and data collection. All of the authors took part in the rest of the study phases, contributed in this article discussion and reviewed the final version.

Corresponding author

Correspondence to Estíbaliz Loza.

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Conflict of interest

RB has received grants/research supports from Abbvie, MSD, and Roche; Consultation fees/participation in company sponsored speaker´s bureau from AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD. EL has received grants/research supports from Abbvie, MSD, Roche, Pfizer, Bristol-Myers, MSD, Novartis, Astellas, Sanofi.

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Urruticoechea-Arana, A., Cobo-Ibáñez, T., Villaverde-García, V. et al. Efficacy and safety of biological therapy compared to synthetic immunomodulatory drugs or placebo in the treatment of Behçet’s disease associated uveitis: a systematic review. Rheumatol Int 39, 47–58 (2019). https://doi.org/10.1007/s00296-018-4193-z

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  • DOI: https://doi.org/10.1007/s00296-018-4193-z

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