Biotherapies in Uveitis
Abstract
:1. Introduction
2. Pathophysiological Rationale
3. Anti-TNF-α Agents
3.1. Adalimumab
3.2. Infliximab
3.3. Other Anti-TNF-α Agents
3.4. Recommendations and Outstanding Questions
3.4.1. What Are the Recommendations for the Use of Anti-TNF-α Agents in Uveitis?
3.4.2. What Is the Long-Term Efficacy of Anti-TNF-α Agents?
3.4.3. How to Manage the Failure of an Anti-TNF-α Agent
3.4.4. Is It Interesting to Add Conventional Immunosuppressive Drugs to Anti-TNF-α Agents?
3.4.5. What Is the Duration of Therapy with Anti-TNF-α Agents?
3.4.6. How to Discontinue an Anti-TNF-α Agent
3.4.7. Which Anti-TNF-α Agent, ADA or IFX, Is Recommended in Uveitis?
3.4.8. What Is the Efficacy of Anti-TNF-α Agents in Sight Threatening Uveitis?
3.4.9. How to Manage Corticosteroids and Conventional Immunosuppressive Drugs in the Era of Anti-TNF-α Agents?
4. Anti-IL6 Agents
5. Anti-IL1 Agents
6. Anti-IL17 Agents
7. Rituximab
8. Abatacept
9. Janus Associated Kinase (JAK) Inhibitors
10. Other Biotherapies
11. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Authors | Type of Study | Treatment | Population | Primary end Point | Num. of Patients | Results |
---|---|---|---|---|---|---|
Díaz-Llopis et al., 2012 | Multicentric, open-label | ADA | Refractory uveitis to DMARDs | Efficacy of ADA on intraocular inflammation at 6 months | 131 |
|
Dobner et al., 2013 | Multicentric, retrospective | ADA | Refractory uveitis to DMARDs, mostly anterior (83%) | Efficacy | 60 |
|
Suhler et al., 2013 | Multicentric, open-label | ADA | Refractory uveitis to DMARDs | Composite endpoint: visual acuity, inflammatory control, medication tapering and reduction of inflammatory signs at week 10 | 31 |
|
Jaffe et al., 2016 | Multicentric, randomized, placebo-controlled | ADA | Active NINAU despite corticosteroid | Time to treatment failure | 217: 110 ADA and 107 placebo |
|
Nguyen et al., 2016 | Multicentric, randomized, placebo-controlled | ADA | Inactive cortico-dependent NINAU | Time to treatment failure | 229: 115 ADA and 114 placebo |
|
Fabiani et al., 2017 | Multicentric, retrospective | ADA | Refractory Behçet’s uveitis to DMARDs | Reduction of ocular inflammatory flares at 12 months | 40 |
|
Mackensen et al., 2017 | Multicentric, randomized, placebo-controlled | ADA | Refractory uveitis to DMARDs | Change in visual acuity (3 lines improvement) at 3 months | 25: 15 ADA and 10 placebo |
|
Ramanan et al., 2017 | Multicentric, randomized, placebo-controlled | ADA | Active JIA uveitis, despite MTX | Time to treatment failure | 90: 60 ADA and 30 placebo |
|
Lee et al., 2018 | Multicentric, retrospective | ADA | Refractory active or inactive uveitis to DMARDs | Reduction of prednisolone dose, ability to taper immunosuppressive drugs, treatment failure | 22 |
|
Quartier et al., 2018 | Multicentric, randomized, placebo-controlled | ADA | Active JIA uveitis, despite MTX | Response to treatment at month 2 | 32: 16 ADA and 16 placebo |
|
Suhler et al., 2018 | Multicentric, open-label | ADA | Active and inactive NINAU | Quiescence at week 78 | 371 |
|
Bitossi et al., 2019 | Multicentric, retrospective | ADA | Refractory uveitis to DMARDs | Control of ocular inflammation (i.e., absence of ocular flare in both eyes and reduction of the daily prednisone dose to ≤10 mg/day) at 6 months, 12 months and at the end of follow-up | 105 |
|
Tugal-Tutkun et al., 2005 | Monocentric, prospective | IFX | Refractory Behçet’s uveitis to DMARDs in male patients | Remission at weeks 22 (infusion period) and at weeks 54 (observation period) | 13 |
|
Al-Rayes et al., 2008 | Monocentric, open-label | IFX | Refractory Behçet’s uveitis to DMARDs | Remission: absence of uveitis attacks involving the posterior segment during the follow-up periods (3 years) | 10 | Remission: 30% with only 2 perfusions, 50% with a regimen of one perfusion every 8 weeks, 20% with a regimen of one perfusion every6 weeks
|
Suhler et al., 2009 | Multicentric, open-label | IFX | Refractory NINAU to DMARDs | Composite endpoint: visual acuity, inflammatory control, medication tapering at week 10 | 31 |
|
Takeuchi et al., 2014 | Multicentric, retrospective | IFX | Refractory Behçet’s uveitis to DMARDs | Efficacy and relapse rate during follow-up (from 12 months to ≥ 48 months) | 164 |
|
Fabiani et al., 2017 | Monocentric, retrospective | IFX | Refractory Behçet’s uveitis to DMARDs | Cumulative IFX drug retention rate during a 10-year follow- up period | 40 |
|
Maleki et al., 2017 | Monocentric, retrospective | IFX | Refractory intermediate uveitis to DMARDs | Remission at 6 months | 23 |
|
Ohno et al., 2019 | Multicentric, retrospective | IFX | Refractory uveoretinitis to DMARDs in Behcet’s disease | Clinical response based on physician global assessment and number of ocular attacks | 650 |
|
Martel et al., 2012 | Monocentric, retrospective | ADA/IFX | Refractory uveitis to DMARDs | Sustained, corticosteroid-sparing control of inflammation at 3, 6 and 12 months | 41: 12 ADA and 31 IFX |
|
Calvo-Río et al., 2014 | Multicentric, open-label | ADA/IFX | Refractory Behçet’s uveitis to DMARDs | Efficacy at 12 months | 124: 47 ADA and 77 IFX |
|
Vallet et al., 2016 | Multicentric, retrospective | ADA/IFX | Refractory uveitis to DMARDs | Efficacy of anti-TNF-α and the factors associated with complete response | 160: 62 ADA and 98 IFX |
|
Fabiani et al., 2018 | Monocentric, retrospective | ADA/IFX | Refractory NINAU to DMARDs | Efficacy of ADA and IFX at 12 months | 107: 66 ADA and 41 IFX |
|
Fabiani et al., 2018 | Monocentric, retrospective | ADA/IFX | Refractory NINAU to DMARDs | Long-term retention rates of ADA and IFX | 108: 62 ADA and 46 IFX |
|
Atienza-Mateo et al., 2019 | Multicentric, open-label | ADA/IFX | Behçet’s uveitis refractory to DMARDs | Efficacy, safety and drug retention rate | 177: 74 ADA and 103 IFX |
|
Sharma et al., 2019 | Multicentric, open-label | ADA/IFX | Refractory uveitis and scleritis to DMARDs | Rate of sustained remission: anterior chamber inflammation and vitreous haze scores of ≤0.5 + on two successive visits, absence of retinal vasculitis or worsening CME at 8 years | 43, including 4 scleritis |
|
Miserocchi et al., 2013 | Monocentric, retrospective | GOL | Refractory uveitis to ADA/IFX | Long-term efficacy | 17 |
|
Cordero-Coma et al., 2014 | Multicentric, retrospective | GOL | Refractory uveitis to DMARDs | Efficacy at 6 months | 13 |
|
Calvo-Río et al., 2016 | Multicentric, open-label | GOL | Refractory uveitis to DMARDs in SA | Efficacy at 24 months | 15 |
|
Fabiani et al., 2017 | Monocentric, retrospective | GOL | Behçet’s uveitis refractory to DMARDs and ADA/IFX | Efficacy at 12 months | 5 |
|
Llorenç et al., 2014 | Multicentric, retrospective | CTZ | Refractory uveitis to ADA/IFX | Ocular quiescence | 7 |
|
Rudwaleit et al., 2016 | Multicentric, randomized, placebo-controlled | CTZ | Axial SA | Relapse rate | 69 |
|
Tosi et al., 2019 | Multicentric, retrospective | CTZ/GOL | Refractory uveitis to DMARDs | Efficacy at 12 months | 21: 11 CTZ and 10 GOL |
|
Uveitis Localization | Diseases | Recommendations |
---|---|---|
Anterior | JIA |
|
Anterior | SA |
|
NINAU | Behçet |
|
NINAU | All |
|
Authors | Type of Study | Treatment | Population | Primary End Point | Num. of Patients | Results |
---|---|---|---|---|---|---|
Calvo-Río et al., 2017 | Multicentric, retrospective | TCZ 8 mg/kg IV | Refractory JIA to DMARDs and anti-TNF-α agents | Efficacy at 6 months | 25 |
|
Sepah et al., 2017 | Multicentric, randomized, open-label | TCZ 8 mg/kg IV or TCZ 4 mg/kg IV | Active NINAU naive or resistant to corticosteroid or DMARDs | Incidence and severity of systemic and ocular adverse events at month 6 | 37: 18 (4 mg/kg) and 19 (8 mg/kg) |
|
Atienza-Mateo et al., 2018 | Multicentric, retrospective | TCZ 8 mg/kg IV or SC | Refractory Behçet’s uveitis to DMARDs | Efficacy at 12 months | 11 |
|
Eser Ozturk et al., 2018 | Monocentric, retrospective | TCZ 8 mg/kg IV | Refractory Behçet’s uveitis to anti-TNF-α agents and IFN | Efficacy | 5 |
|
Vegas-Ravenga et al., 2019 | Monocentric, retrospective | TCZ 8 mg/kg IV or SC | Refractory CME to DMARDs and anti-TNF-α agents | Efficacy at 24 months | 7 |
|
Ramanan et al., 2020 | Multicentric, single-arm, open-label | TCZ SC | Refractory JIA to DMARDs and anti-TNF-α agents | Treatment response at week 12: a two-step decrease, or decrease to zero, from baseline in the level of inflammation (anterior chamber cells) | 21 |
|
Heissigerová et al., 2019 | Multicentric, randomized, placebo-controlled | SAR | Posterior uveitis refractory to corticosteroid alone or with MTX | Proportion of patients with at least a 2-step reduction in vitreous haze or with a reduction of prednisone to a dose of <10 mg/day, at week 16 | 58: 38 SAR and 20 placebo |
|
Emmi et al., 2016 | Multicentric, retrospective | ANA/CAN | Refractory Behçet’s uveitis to DMARDs | Efficacy | 30: 27 ANA and 3 CAN |
|
Fabiani et al., 2017 | Multicentric, retrospective | ANA/CAN | Refractory Behçet’s uveitis to DMARDs | Reduction of ocular inflammatory flares during the 12 months of treatment. | 19: 13 ANA and 6 CAN |
|
Tugal-Tutkun et al., 2018 | Multicentric, randomized, placebo-controlled | GEV | Refractory Behçet’s uveitis to DMARDs | Reduction of ocular inflammatory flare | 83: 40 GEV and 43 placebo |
|
Dick et al., 2013 | Multicentric, randomized, placebo-controlled | SEC SC |
|
| SHIELD: 118 INSURE: 31 ENSURE: 125 |
|
Letko et al., 2015 | Multicentric, randomized | 1/SEC SC 2/SEC 10 mg/kg IV 3/SEC 30 mg/kg IV | Refractory NINAU to DMARDs | Percentage of patients with treatment responses and percentage with complete responses (remission) at day 57 | 37: 1/12 2/13 3/12 |
|
Davatchi et al., 2010 | Multicentric, randomized |
| Retinal vasculitis and edema refractive to DMARDs in Behçet’s uveitis | TADAI score that adds the calculation of the sum of visual acuity to TIAI (total inflammatory index of both eyes) after 6 months | 20: 10 in both groups |
|
Miserocchi et al., 2016 | Monocentric, retrospective | RTX | Refractory JIA to biologic agents | Efficacy | 8 |
|
Lasave et al., 2018 | Monocentric, retrospective | RTX | Refractory posterior uveitis to DMARDs | Efficacy at 24 months | 11 |
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Zulian et al., 2010 | Monocentric, retrospective | ABA | Refractory JIA to anti-TNF-α agents | Efficacy at 6 months | 7 |
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Tappeiner et al., 2015 | Multicentric, randomized | ABA | Refractory JIA to anti-TNF-α agents | Achievement of uveitis inactivity | 21 |
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Miserocchi et al., 2020 | Monocentric, retrospective | JAK | Refractory JIA to DMARDs and anti-TNF-α agents | Efficacy | 4 |
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Leclercq, M.; Desbois, A.-C.; Domont, F.; Maalouf, G.; Touhami, S.; Cacoub, P.; Bodaghi, B.; Saadoun, D. Biotherapies in Uveitis. J. Clin. Med. 2020, 9, 3599. https://doi.org/10.3390/jcm9113599
Leclercq M, Desbois A-C, Domont F, Maalouf G, Touhami S, Cacoub P, Bodaghi B, Saadoun D. Biotherapies in Uveitis. Journal of Clinical Medicine. 2020; 9(11):3599. https://doi.org/10.3390/jcm9113599
Chicago/Turabian StyleLeclercq, Mathilde, Anne-Claire Desbois, Fanny Domont, Georgina Maalouf, Sara Touhami, Patrice Cacoub, Bahram Bodaghi, and David Saadoun. 2020. "Biotherapies in Uveitis" Journal of Clinical Medicine 9, no. 11: 3599. https://doi.org/10.3390/jcm9113599