Dirençli non-enfeksiyöz üveitli erişkin hastalarda adalimumab tedavisinin etkinliği

Amaç: Enfeksiyöz olmayan dirençli üveit hastalarında adalimumab tedavisinin etkinliğini değerlendirmek. Gereç ve Yöntem: Kronik non-enfeksiyöz üveit tanısıyla 12 aydan uzun süre adalimumab tedavisi alan hastalar retrospektif olarak değerlendirildi. Tüm hastalar adalimumab tedavisine başlamadan önce diğer immünosüpresif ajanlara dirençli olup aktif intraoküler inflamasyon bulgularına sahipti. Bulgular: Yirmi bir hasta (39 göz), ortalama 26.2 ± 13.2 ay süreyle adalimumab tedavisi aldı. Tedavi süresince 11 hastada (%52.4) nüks izlenmedi. Sadece bir hastada (%4,8) yetersiz yanıt nedeniyle adalimumab tedavisi başka bir ilaç ile değiştirildi. Beş hastada (%23.8) en az 18 aylık ataksız dönem sonunda adalimumab tedavisi sonlandırıldı. Sonuç: Adalimumab, dirençli enfeksiyöz olmayan üveit hastalarında remisyonu sağlamak ve sürdürmek için etkili ve iyi tolere edilen bir terapötik seçenektir.

Anahtar Kelimeler:

Adalimumab, enfeksiyöz olmayan üveit, dirençli üveit, non-infectious uveitis, refractory uveitis

Adalimumab treatment in adult patients with refractory non-infectious uveitis

Purpose: To assess the efficacy of adalimumab treatment in patients with refractory non-infectious uveitis. Materials and Methods: A retrospective analysis was carried out on patients with chronic non-infectious uveitis treated with adalimumab for longer than 12 months. All patients had active intraocular inflammation and were nonresponsive to other immunosuppressive agents before initiating adalimumab treatment. Results: Twenty-one patients (39 eyes) were treated with adalimumab for a mean duration of 26.2 ± 13.2 months. Eleven patients (52.4%) remained relapse-free during the treatment. In only one patient (4.8%) adalimumab was switched to another drug due to insufficient response. Adalimumab treatment was discontinued in five patients (23.8%) after an attack-free period of at least 18 months. Conclusion: Adalimumab is an effective and well-tolerated therapeutic option for patients with refractory non-infectious uveitis, to achieve and maintain disease quiescence.

Keywords:

Adalimumab, non-infectious uveitis, refractory uveitis,

PDF

___

Tsirouki T, Dastiridou A, Symeonidis C, Tounakaki O, Brazitikou I, Kalogeropoulos C et al. A Focus on the epidemiology of uveitis. Ocul Immunol Inflamm. 2018;26:2-16.
Vegas-Revenga N, Martín-Varillas JL, Calvo-Río V, González-Mazón I, Sánchez-Bilbao L, Beltrán E et al. Intravenous methylprednisolone induces rapid improvement in non-infectious uveitis: a multicentre study of 112 patients. Clin Exp Rheumatol. 2022;40:142-9.
Rosenbaum JT, Bodaghi B, Couto C, Zierhut M, Acharya N, Pavesio C et al. New observations and emerging ideas in diagnosis and management of non-infectious uveitis: A review. Semin Arthritis Rheum. 2019;49:438-45.
Hasegawa E, Takeda A, Yawata N, Sonoda KH. The effectiveness of adalimumab treatment for non-infectious uveitis. Immunol Med. 2019;42:79-83.
Robertson M, Liversidge J, Forrester JV, Dick AD. Neutralizing tumor necrosis factor-alpha activity suppresses activation of infiltrating macrophages in experimental autoimmune uveoretinitis. Invest Ophthalmol Vis Sci. 2003;44:3034-41.
Santos Lacomba M, Marcos Martín C, Gallardo Galera JM, Gómez Vidal MA, Collantes Estévez E, Ramírez Chamond R et al. Aqueous humor and serum tumor necrosis factor-alpha in clinical uveitis. Ophthalmic Res. 2001;33:251-5.
Cordero-Coma M, Sobrin L. Anti-tumor necrosis factor-α therapy in uveitis. Surv Ophthalmol. 2015;60:575-89.
Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN. Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. Ophthalmology. 2014;121:785-96.e3.
Jaffe GJ, Dick AD, Brézin AP, Nguyen QD, Thorne JE, Kestelyn P et al. Adalimumab in patients with active noninfectious uveitis. N Engl J Med. 2016;375:932-43.
Nguyen QD, Merrill PT, Jaffe GJ, Dick AD, Kurup SK, Sheppard J et al. Adalimumab for prevention of uveitic flare in patients with inactive non-infectious uveitis controlled by corticosteroids (VISUAL II): a multicentre, double-masked, randomised, placebo-controlled phase 3 trial. Lancet. 2016;388:1183-92.
Jabs DA, Nussenblatt RB, Rosenbaum JT; Standardization of Uveitis Nomenclature (SUN) Working Group. Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol. 2005;140:509-16.
Sheppard J, Joshi A, Betts KA, Hudgens S, Tari S, Chen N et al. Effect of adalimumab on visual functioning in patients with noninfectious intermediate uveitis, posterior uveitis, and panuveitis in the VISUAL-1 and VISUAL-2 trials. JAMA Ophthalmol. 2017;135:511-8.
Lee FF, Foster CS. Pharmacotherapy of uveitis. Expert Opin Pharmacother. 2010;11:1135-46.
Hiyama T, Harada Y, Kiuchi Y. Efficacy and Safety of adalimumab therapy for the treatment of non-infectious uveitis: Efficacy comparison among uveitis aetiologies. Ocul Immunol Inflamm. 2022;30:951-8.
Touhami S, Diwo E, Sève P, Trad S, Bielefeld P, Sène D et al. Expert opinion on the use of biological therapy in non-infectious uveitis. Expert Opin Biol Ther. 2019;19:477-90.
Suhler EB, Adán A, Brézin AP, Fortin E, Goto H, Jaffe GJ et al. Safety and efficacy of adalimumab in patients with noninfectious uveitis in an ongoing open-label study: VISUAL III. Ophthalmology. 2018;125:1075-87.
Mercier AE, Ribeiro E, Korobelnik JF, Delyfer MN, Rougier MB. Efficacy of anti-TNF-α therapy for the treatment of non-infectious uveitis: a retrospective study of 21 patients. Ocul Immunol Inflamm. 2018;26:477-84.
Tang Lee Say TL, Yang V, Fingret JM, Zagora S, Symes R, Younan C et al. Adalimumab in patients with vision-threatening uveitis: real-world clinical experience. BMJ Open Ophthalmol. 2021;6:e000819.
Dobner BC, Max R, Becker MD, Heinz C, Veltrup I, Heiligenhaus A et al. A three-centre experience with adalimumab for the treatment of non-infectious uveitis. Br J Ophthalmol. 2013;97:134-8.
Díaz-Llopis M, Salom D, Garcia-de-Vicuña C, Cordero-Coma M, Ortega G, Ortego N et al. Treatment of refractory uveitis with adalimumab: a prospective multicenter study of 131 patients. Ophthalmology. 2012;119:1575-81.
Suhler EB, Lowder CY, Goldstein DA, Giles T, Lauer AK, Kurz PA et al. Adalimumab therapy for refractory uveitis: results of a multicentre, open-label, prospective trial. Br J Ophthalmol. 2013;97:481-6.
Park SE, Jun JW, Lee DH, Lee SC, Kim M. The effect of adalimumab in korean patients with refractory noninfectious uveitis. Yonsei Med J. 2021;62:177-81