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Anti-TNF-a therapy in refractory uveitis associated with sarcoidosis: Multicenter study of 17 patients

Abstract: OBJECTIVES: To assess anti-TNF-a therapy response in uveitis associated with sarcoidosis refractory to conventional immunosuppressive therapy. METHODS: Open-label, multicenter, retrospective study on patients with sarcoid uveitis who underwent anti-TNF-a therapy because of inadequate response to conventional therapy including corticosteroids and at least 1 systemic synthetic immunosuppressive drug. The main outcome measurements were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness, and immunosuppression load. RESULTS: A total of 17 patients (8 men; 29 affected eyes; mean ± standard deviation age 38.4 ± 16.8; range: 13-76 years) were studied. The patients had bilateral hilar lymphadenopathy (58.8%), lung parenchyma involvement (47.1%), peripheral lymph nodes (41.2%), and involvement of other organs (52.9%). Angiotensin-converting enzyme was elevated in 58.8%. The most frequent ocular pattern was bilateral chronic relapsing panuveitis. The first biologic agent used was adalimumab in 10 (58.8%) and infliximab in 7 (41.2%) cases. Infliximab 5mg/kg intravenously every 4-8 weeks and adalimumab 40mg subcutaneously every 2 weeks were the most common administration patterns. In most cases anti-TNF-a therapy was given in combination with immunosuppressive drugs. The mean duration of follow-up was 33.9 ± 17.1 months. Significant improvement was observed following anti-TNF-a therapy. Baseline results versus results at 2 years from the onset of biologic therapy were the following: the median of cells in the ocular anterior chamber (interquartile range-IQR) 0.5 (0-2) versus 0 (0-0) (p = 0.003), vitritis 0 (0-1.25) versus 0 (0-0) (p = 0.008), macular thickness (391.1 ± 58.8 versus 247 ± 40.5µm) (p = 0.028), and visual acuity 0.60 ± 0.33 versus 0.74 ± 0.27; p = 0.009. The median daily (interquartile range) dose of prednisone was also reduced from 10 (0-30)mg at the onset of the anti-TNF-a therapy to 0 (0-0)mg at 2 years (p = 0.02). Significant reduction was also achieved in the immunosuppressive load. CONCLUSION: Anti-TNF-a therapy is effective in sarcoid uveitis patients refractory to conventional immunosuppressive therapy. Infliximab and adalimumab allowed a substantial reduction in prednisone dose despite having failed standard therapy.

Otras publicaciones de la misma revista o congreso con autores/as de la Universidad de Cantabria

 Fuente: Semin Arthritis Rheum. 2015 Dec;45(3):361-8

Editorial: W.B. Saunders

 Año de publicación: 2015

Nº de páginas: 8

Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.semarthrit.2015.05.010

ISSN: 0049-0172,1532-866X

Proyecto español: RD12/0009/0013

Autores/as

LEYRE RIANCHO ZARRABEITIA

CALVO RÍO, VANESA

RICARDO BLANCO ALONSO

MESQUIDA, MARINA

ADAN, ALFREDO M.

HERRERAS, JOSÉ M.

APARICIO, ÁNGEL

PEITEADO LÓPEZ, DIANA

CORDERO COMA, MIGUEL

GARCÍA SERRANO, JOSÉ LUIS

ORTEGO CENTENO, NORBERTO

MAÍZ, OLGA

BLANCO, ANA

SÁNCHEZ BURSÓN, JUAN

GONZÁLEZ SUÁREZ, SENÉN

FONOLLOSA, ALEJANDRO

SANTOS GÓMEZ, MONTSERRAT

LORICERA, JAVIER

PINA MURCIA, TRINITARIO