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POS1350 (2022)
UVEITIS DUE TO IMMUNE-MEDIATED INFLAMMATORY DISEASES TREATED WITH CERTOLIZUMAB PEGOL. MULTICENTER STUDY OF 80 PATIENTS.
J. L. Martín-Varillas1, L. Sanchez-Bilbao2, V. Calvo-Río2, A. Adan3, I. Hernanz Rodriguez3, E. Beltrán4, S. Castro5, P. Fanlo Mateo6, A. García Martos7, I. Torre-Salaberri8, M. Cordero-Coma9, J. De Dios-Jiménez Aberásturi10, Á. García-Aparicio11, M. Hernández-Garfella12, A. Sanchez-Andrade13, A. García-Valle14, R. Miguélez15, O. Maiz16, S. Rodríguez Montero17, A. Urruticoechea-Arana18, R. Veroz Gonzalez19, A. Conesa20, C. Fernández-Carballido21, V. Jovani22, O. Martínez González23, P. Moya24, S. Romero-Yuste25, P. Rubio Muñoz26, E. Peña Sainz-Pardo27, M. Garijo Bufort28, J. L. Hernández29, R. Blanco2
1Hospital de Laredo, Rheumatology, Laredo, Spain
2Hospital Universitario Marqués de Valdecilla, Rheumatology, Santander, Spain
3Hospital Clinic, Ophthalmology, Barcelona, Spain
4Hospital del Mar, Rheumatology, Barcelona, Spain
5HU Joan XXIII, Rheumatology, Tarragona, Spain
6Complejo Hospitalario de Navarra, Internal Medicine, Navarra, Spain
7Hospital Universitario del Tajo, Rheumatology, Madrid, Spain
8Hospital de Basurto, Rheumatology, Bilbao, Spain
9Complejo Asistencial de León, Ophthalmology, León, Spain
10Hospital Universitario de Alava, Rheumatology, Alava, Spain
11Complejo Hospitalario Universitario de Toledo, Rheumatology, Toledo, Spain
12Hospital General Universitario de Valencia, Rheumatology, Valencia, Spain
13Hospital Lucus Augusti, Rheumatology, Lugo, Spain
14Complejo Asistencial Universitario de Palencia, Rheumatology, Palencia, Spain
15Hospital de Móstoles, Rheumatology, Madrid, Spain
16Hospital Universitario de Donostia, Rheumatology, San Sebastian, Spain
17Hospital Universitario Virgen de Valme, Rheumatology, Sevilla, Spain
18Hospital Can Misses, Rheumatology, Ibiza, Spain
19Hospital de Mérida, Rheumatology, Merida, Spain
20Hospital General Universitario de Castellon, Rheumatology, Castellón, Spain
21Hospital de San Juan, Rheumatology, Alicante, Spain
22Hospital General Universitario de Alicante, Rheumatology, Alicante, Spain
23Hospital Clínico de Salamanca, Rheumatology, Salamanca, Spain
24Hospital Sant Pau, Rheumatology, Barcelona, Spain
25Complexo Hospitalario Universitario de Pontevedra, Rheumatology, Pontevedra, Spain
26Hospital Esperit Sant, Rheumatology, Barcelona, Spain
27Hospital 12 de Octubre, Pediatrics, Madrid, Spain
28Hospital de Sagunto, Rheumatology, Valencia, Spain
29Hospital Universitario Marqués de Valdecilla, Internal Medicine, Santander, Spain

Background: Adalimumab remains the only biologic approved by the EMA and FDA for the treatment of non-infectious uveitis [1-6]. The reports on efficacy of other anti-TNF drugs such as Certolizumab Pegol (CZP) are scarce.


Objectives: to determine the efficacy and safety of CZP in refractory uveitis secondary to Immune-mediated Inflammatory Diseases (IMIDs).


Methods: national multicenter study of 80 patients with uveitis due to IMID refractory to glucocorticoids and conventional immunosuppressants treated with CZP. Efficacy was assessed with the following ocular parameters: best corrected visual acuity (BCVA), anterior chamber cells, vitritis, macular thickness and presence of retinal vasculitis. The efficacy of CZP was compared between the baseline visit, 1 st week, 1 st and 6 th month, and 1 st year. Statistical analysis was performed with IBM SPSS Statistics v.23.


Results: we studied 80 patients/111 affected eyes (33 men/47 women) with a mean age of 41.6±11.7 years. The IMIDs included were: spondyloarthritis (n=43), Behçet’s disease (10), psoriatic arthritis (8), Crohn’s disease (4), sarcoidosis (2), JIA (1), reactive arthritis (1), rheumatoid arthritis (1), relapsing polychondritis (1), TINU (1), pars planitis (1), Birdshot (1) and idiopathic uveitis (6). Anterior was the most frequent uveitis pattern (n=61).

In 20 patients, besides the presence of refractory uveitis, desire of pregnancy was the reason for CZP initiation.

Prior to CZP, patients had received: methotrexate (n=38), sulfasalazine (28), azathioprine (14), cyclosporine (10), leflunomide (3), mycophenolate mofetil (4), and cyclophosphamide (1). Previous biologic therapy was administered in 52 patients (63%), with a median [IQR] of 2 [1-3] drugs per patient. The most used biologic was adalimumab (n=48), followed by infliximab (32), golimumab (15), tocilizumab (5), etanercept (7), rituximab (1), anakinra (1) and secukinumab (1). CZP was administered as monotherapy in 39 patients.

After 24 [12-36] months of follow-up, all parameters analyzed showed a rapid and maintained improvement ( Table 1 ). A decrease in the mean number of uveitis flares was observed before and after CZP, (2.6±2.3 vs. 0.6±0.4, p<0.001). CZP was discontinued in 16 patients due to: ocular remission (n=3), insufficient ocular response (4) and incomplete response of extraocular manifestations (9). No serious adverse effects were found.

main ocular parameters analyzed in 80 patients with uveitis due to IMID and treated with CZP.

Baseline 1st week 1st month 3rd month 6th month 1st year
BCVA (mean±SD) 0.68±0.27 0.73±0.26* 0.79±0.26* 0.82±0.25* 0.85±0.24* 0.86±0.23*
Tyndall improvement , n (%) Patients with Tyndall + at baseline (n=57 ) - 23 (40.3) 45 (78.9) 47 (82.4) 57 (100) 57 (100)
Vitritis improvement , n (%) Patients with Vitritis at baseline (n=14 ) - 5 (35.7) 8 (57.1) 13 (92.8) 14 (100) 14 (100)
OCT (µm) (mean±SD) 297.5±48.1 297.1±45.5 286.5±39.8* 277.6±43.3* 271.5±38.6* 269.0±38.8*
Choroiditis, affected eyes , n (%) 3 (2.4) 3 (2.4) 2 (1.6) 2 (1.6) 1 (0.8) 1 (0.8)
Retinal vasculitis, affected eyes , n (%) 3 (2.4) 2 (1.6) 1 (0.8) 0 (0) 0 (0) 0 (0)

*p<0.01


Conclusion: CZP seems to be effective and safe in the control of uveitis associated to different IMIDs.


REFERENCES:

[1]Jaffe GJ, et al. N Engl J Med 2016;375:932-43. doi: 10.1056/NEJMoa1509852.

[2]Nguyen QD, et al. Lancet 2016;388:1183-92. doi: 10.1016/S0140-6736(16)31339-3.

[3]Martín-Varillas JL, et al. Ophthalmology 2018; 125:1444-1451 doi: 10.1016/j.ophtha.2018.02.020

[4]Martín-Varillas JL, et al. J Rheumatol. 2021;48:741-750. doi: 10.3899/jrheum.200300

[5]Atienza-Mateo B. Arthritis Rheumatol. 2019;71:2081-2089. doi: 10.1002/art.41026.

[6]Vegas-Revenga N et al Am J Ophthalmol. 2019;200:85-94. doi: 10.1016/j.ajo.2018.12.019


Disclosure of Interests: None declared


Citation: , volume 81, supplement 1, year 2022, page 1013
Session: Other orphan diseases (POSTERS only)