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Anti-TNF- therapy in patients with refractory uveitis due to Behcet's disease: a 1-year follow-up study of 124 patients

2014; Oxford University Press; Volume: 53; Issue: 12 Linguagem: Inglês

10.1093/rheumatology/keu266

1462-0332

V. Calvo-Río, Ricardo Blanco, E. Beltrán, Juan Sánchez‐Bursón, Marina Mesquida, Alfredo Adán, M.V. Hernández, M. Hernández Garfella, Elia Valls Pascual, Lucía Martínez‐Costa, A. Sellas, Miguel Cordero Coma, Manuel Díaz-Llopis, Roberto Gallego, David Salom, José Luis García Serrano, N. Ortego, José M. Herreras, Alex Fonollosa, Á. García-Aparicio, O. Maíz, A. Blanco, I. Torre, Cruz Fernández-Espartero, Vega Jovaní, D. Peiteado-Lόpez, E. Pato, Javier de la Cruz, Carlos Marras, Elena Aurrecoechea, ME Cárdaba García, Miguel A. Caracuel, Carlos Montilla, A. Atanes, Félix Francisco Hernández, S. Insúa, Senén González-Suárez, A Sánchez-Andrade, Fernando Gamero, L. Linares, Fredeswinda Romero-Bueno, Alvarado García, Raquel Almodóvar, E Mínguez, Carmen Carrasco Cubero, Alejandro Olivé, J Vázquez, Oscar Ruíz Moreno, Fernando Jiménez‐Zorzo, Javier Manero, S. Muñoz Fernández, Javier Rueda‐Gotor, Miguel Á. González‐Gay,

Systemic Lupus Erythematosus Research

Objective. The aim of this study was to assess the efficacy of anti-TNF-α therapy in refractory uveitis due to Behçet’s disease (BD). Methods. We performed a multicentre study of 124 patients with BD uveitis refractory to conventional treatment including high-dose corticosteroids and at least one standard immunosuppressive agent. Patients were treated for at least 12 months with infliximab (IFX) (3–5 mg/kg at 0, 2 and 6 weeks and then every 4–8 weeks) or adalimumab (ADA) (usually 40 mg every 2 weeks). The main outcome measures were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness and immunosuppression load. Results. Sixty-eight men and 56 women (221 affected eyes) were studied. The mean age was 38.6 years (s.d. 10.4). HLA-B51 was positive in 66.1% of patients and uveitis was bilateral in 78.2%. IFX was the first biologic agent in 77 cases (62%) and ADA was first in 47 (38%). In most cases anti-TNF-α drugs were used in combination with conventional immunosuppressive drugs. At the onset of anti-TNF-α therapy, anterior chamber and vitreous inflammation was observed in 57% and 64.4% of patients, respectively. In both conditions the damage decreased significantly after 1 year. At baseline, 50 patients (80 eyes) had macular thickening [optical coherence tomography (OCT) >250 μm] and 35 (49 eyes) had cystoid macular oedema (OCT>300 μm) that improved from 420 μm (s.d. 119.5) at baseline to 271 μm (s.d. 45.6) at month 12 (P < 0.01). The best-corrected visual acuity and the suppression load also showed significant improvement. After 1 year of follow-up, 67.7% of patients were inactive. Biologic therapy was well tolerated in most cases. Conclusion. Anti-TNF-α therapy is effective and relatively safe in refractory BD uveitis.