THU0277 Tocilizumab in Uveitis Associated with Behçet's Disease. Multicenter Study of 7 Patients. (9th June 2015)

• Record Type: Journal Article
• Authors: Beltrán, E.; Calvo-Río, V.; Blanco, R.; Atanes, A.; Loricera, J.; González-Gay, M. Ά.; Pena, C.E.
• Is Part Of: Annals of the rheumatic diseases. Volume 74(2015)Supplement 2
• Page Start: 296
• Page End: 297
• Publication Date: 2015-06-09
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2015-eular.3292
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Treatment recommended in severe and/or refractory uveitis of Behçet disease is anti-TNF-α therapy, usually infliximab (IFX) or adalimumab (ADA) (Levy-Clarke et al Ophthalmology 2014;121:785-796). However, in some cases these biologic agents are not effective, may be contraindicated or they are not well tolerated. IL-6 is a key cytokine in the pathogenesis of uveitis, including Behçet's syndrome. Objectives: Our aim was to evaluate the response to tocilizumab (TCZ) in uveitis associated with Behçet syndrome refractory to standard systemic treatment. Methods: Multicenter study on 7 patients with uveitis associated to Behçet disease. Patients had previously been treated with at least one conventional immunosuppressive drug and in most cases with anti-TNF-α agents. The main parameters assessed were the visual acuity (VA) and the degree of inflammation of the anterior and posterior chamber. Results: 4 men and 3 women were studied; mean age 39.1±15.4 years (range 22-67). Uveitis was bilateral (n=6) and unilateral (n=1) (Table ). The pattern of ocular involvement was posterior uveitis (n=1), panuveitis (n=2), panuveitis + papilitis (n=1) and panuveitis + vasculitis (n=3). The clinical course was chronic (n=3) or recurrent (n=4). Besides oral corticosteroids and before TCZ onset they had received: intraocular corticosteroids (n=7), i.v. methylprednisolone pulses (n=7), methotrexate (MTX) (n=7), (cyclosporin A) CsA (n=7), azathioprine (n=2), cyclophosphamide (n=2) daclizumab and mycophenolate (n=1), Adalimumab (n=5), infliximab (n=2) and golimumab (n=2). In all patients TCZ was prescribed at the standard dose (8 mg/kg/i.v. month). Treatment was administered as a monotherapy in 5 cases and combined with conventional immunosuppressive drugs in 2 cases (1 MTX, 1 CsA). After a mean follow up of 5.36±5.1 months, from the onset of TCZ improvement was observed in the following items: a) median VA (0.2 [0.05-0.7] to 0.95 [0, 4-1]; p<0.01); b) Median cells in the anterior chamber (1 [0-2] to 0 [0-0]; p=0.01); c) average vitritis (1.4±1.1 at 0±0; p<0.01); d) retinal vasculitis (n=8 eyes, 57.1%) that disappeared in all cases (p<0.01); e) OCT mean (μ) (from 335.7±82.3 to 246.4±32.6; p<0.01); f) 5 patients achieved remission, g) reduction in median dose of prednisone (30 [30-30] to 3.75 [0-7.5] mg/day; p=0.18). TCZ was withdrawn in 1 case due to an infusion reaction. No other side effects were observed. Conclusions: Treatment with TCZ seems to be effective in patients with refractory uveitis due to Behçet's disease. References: Levy-Clarke et al Ophthalmology 2014;121:785-796 Acknowledgements: This study was supported by a grant from "Fondo de Investigaciones Sanitarias" PI12/00193 (Spain). This work was also partially supported by RETICS Programs, RD08/0075 (RIER) and RD12/0009/0013 from "Instituto de Salud Carlos III" (ISCIII) (Spain). Disclosure of Interest: None declared