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Background: Biologic therapy has improved prognosis of Behçet Disease (BD) uveitis (1-5). Although infliximab (IFX) is approved in Japan, most data in Caucasian patients comes from small series. No data on optimization has been published
Objectives: In a large series of Caucasian patients with refractory uveitis of BD, we assess: a ) long-term efficacy and safety; b ) IFX optimization when ocular remission was achieved
Methods: Multicenter study of IFX-treated patients with BD uveitis refractory to conventional immunosuppressants.103 patients were treated with IFX as 1st biologic as follows: 3-5 mg/kg i.v. at 0, 2, 6 and every 4-8 weeks. The main outcomes were anterior chamber cells, vitritis, retinal vasculitis, macular thickness, visual acuity, and glucocorticoids sparing effect; analysed at baseline, 1st week, 1st and 6th months and 1st and 2nd years. After remission, IFX optimization was performed
Results: In whole series (n=103), main outcomes showed a rapid and maintained improvement, reaching remission in 78 patients after a mean IFX duration of 31.5 months. Severe side-effects were observed in 9 patients.
Comparative study between optimized and non-optimized groups showed: a ) no differences in clinical baseline characteristics; b ) similar maintained improvement in most ocular outcomes; c ) lower severe adverse events and d ) lower IFX cost in optimized group (4826.52 vs 9854.13 euros/patient/year) (Table )
Conclusion: IFX seems effective and safe in Caucasian patients with refractory BD uveitis. IFX optimization is effective, safe, and cost-effective
REFERENCES:
[1]Martín-Varillas JL. Ophthalmology 2018;125:1444-1451.
[2]Atienza-Mateo B: Arthritis Rheumatol. 2019;71:2081-2089
[3]Santos-Gómez M. Clin Exp Rheumatol. 2016;34 (6 Suppl 102): S34-S40
[4]Urruticoechea-Arana A. Rheumatol Int. 2019;39:47-58.
[5]Atienza-Mateo B. Rheumatology (Oxford). 2018 1;57:856-864
|
Optimized
|
Non Optimized
| P | |
|---|---|---|---|
| Patients/eyes affected, n/n | 18/34 | 42/77 | |
| Age, mean (SD), years | 39.5 (9.8) | 38.8 (10.5) | 0.82 |
| Men, % | 55.6 | 59.5 | 0.78 |
| Duration of uveitis before IFX, median [IQR] months | 38 [18-119] | 35 [10-48] | 0.11 |
| Ocular features at time of IFX onset | |||
| -AC cells count, median [IQR] | 2 [1-4] | 2 [1-2] | 0.29 |
| -Vitritis, median [IQR] | 2 [1.5-3] | 2 [1-2] | 0.02 |
| -BCVA, mean (SD) | 0.32 (0.21) | 0.37 (0.26) | 0.51 |
| -OCT, mean (SD) | 303.5 (23.3) | 397.7 (155.7) | 0.12 |
| -Retinal vasculitis, n (%) | 9 (50) | 26 (66.7) | 0.23 |
| Uveitis pattern, n (% ) | |||
| -Bilateral/unilateral | 16/2 (88.9/11.1) | 35/7 (83.3/16.7) | 0.71 |
| -Anterior | 0 (0) | 6 (14.3) | 0.17 |
| -Posterior | 5 (27.8) | 8 (19.0) | 0.50 |
| -Panuveitis | 13 (72.2) | 28 (66.7) | 0.67 |
| Prednisone dose at IFX onset, mean (SD), mg/d | 40.3 (20.6) | 41.4 (15.5) | 0.81 |
| IFX therapy | |||
| Monotherapy/combined treatment, n (%) | 15 (83.3) | 30 (71.4) | 0.33 |
| -AZA | 5 (27.8) | 4 (9.5) | 0.11 |
| -CsA | 9 (33.3) | 8 (19.0) | 0.32 |
| -MTX | 4 (22.2) | 15 (35.7) | 0.30 |
| Follow-up on IFX therapy, median [IQR], months | 48 [33-60] | 24 [6-60] | 0.007 |
| - Relapses, median (IQR ) | 0 [0-1] | 0 [0-2] | |
| - Remission, % | 100 | 75.6 | 0.46 |
| - Severe side effects, n (per 100 patients/year ) | 0 (0) | 3 (0.78) | 0.02 |
| - Cost (mean), euros per year | 4826.52 | 9854.13 | 0.55– |
Disclosure of Interests: José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Belén Atienza-Mateo: None declared, Vanesa Calvo-Río Grant/research support from: MSD and Roche, Speakers bureau: AbbVie, Lilly, Celgene, Grünenthal, UCB Pharma, Emma Beltrán: None declared, Alfredo Adan: None declared, Elena Aurrecoechea: None declared, Santos Castañeda: None declared, Miguel A González-Gay Grant/research support from: Pfizer, Abbvie, MSD, Speakers bureau: Pfizer, Abbvie, MSD, J. Luis Hernández: None declared, Ricardo Blanco Grant/research support from: AbbVie, MSD, and Roche, Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, and MSD