Comparable Efficacy of Abatacept Used as First-line or Second-line Biological Agent for Severe Juvenile Idiopathic Arthritis-related Uveitis

Carolina Birolo; Maria Elisabetta Zannin; Svetlana Arsenyeva; Rolando Cimaz; Elisabetta Miserocchi; Margarita Dubko; Chantal Job Deslandre; Fernanda Falcini; Maria Alessio; Francesco La Torre; Ekaterina Denisova; Giorgia Martini; Irina Nikishina; Francesco Zulian

doi:10.3899/jrheum.151389

Comparable Efficacy of Abatacept Used as First-line or Second-line Biological Agent for Severe Juvenile Idiopathic Arthritis-related Uveitis

J Rheumatol. 2016 Nov;43(11):2068-2073. doi: 10.3899/jrheum.151389. Epub 2016 Sep 15.

Authors

Carolina Birolo^{1

2}, Maria Elisabetta Zannin^{1

2}, Svetlana Arsenyeva^{1

2}, Rolando Cimaz^{1

2}, Elisabetta Miserocchi^{1

2}, Margarita Dubko^{1

2}, Chantal Job Deslandre^{1

2}, Fernanda Falcini^{1

2}, Maria Alessio^{1

2}, Francesco La Torre^{1

2}, Ekaterina Denisova^{1

2}, Giorgia Martini^{1

2}, Irina Nikishina^{1

2}, Francesco Zulian^{3

4}

Affiliations

¹ From the Department of Pediatrics, Rheumatology Unit, University of Padua, Padua, Italy; Scientific Research Institute of Rheumatology RAMS, Moscow, Russian Federation; A. Meyer Children's Hospital, Rheumatology Unit, and Department of Internal Medicine, Section of Rheumatology, University of Florence, Florence, Italy; Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy; Saint-Petersburg Pediatric Medical Academy, Saint-Petersburg, Russian Federation; Rheumatology Service, Cochin Hospital, Paris, France; Department of Pediatrics, Rheumatology Unit, University of Naples Federico II, Naples, Italy; Department of Pediatrics, Antonio Perrino Hospital, Brindisi, Italy; Helmgoltz Moscow Research Institute of Eye Diseases, Moscow, Russian Federation.
² C. Birolo, MD, Resident in Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua; M.E. Zannin, MD, PhD, Assistant Professor of Ophthalmology, Department of Pediatrics, Rheumatology Unit, University of Padua; S. Arsenyeva, MD, PhD, Associate Professor of Ophthalmology, Scientific Research Institute of Rheumatology RAMS; R. Cimaz, MD, Professor of Pediatrics, A. Meyer Children's Hospital, Rheumatology Unit, University of Florence; E. Miserocchi, MD, PhD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Scientific Institute San Raffaele; M. Dubko, MD, Associate Professor of Pediatrics, Saint-Petersburg Pediatric Medical Academy; C.J. Deslandre, MD, Associate Professor of Pediatrics, Rheumatology Service, Cochin Hospital; F. Falcini, MD, Associate Professor of Pediatrics, Department of Internal Medicine, Section of Rheumatology, University of Florence; M. Alessio, MD, Associate Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Naples Federico II; F. La Torre, MD, Assistant Professor of Pediatrics, Department of Pediatrics, Antonio Perrino Hospital; E. Denisova, MD, Assistant Professor of Ophthalmology, Helmgoltz Moscow Research Institute of Eye Diseases; G. Martini, MD, PhD, Assistant Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua; I. Nikishina, MD, Associate Professor of Pediatrics, Scientific Research Institute of Rheumatology RAMS; F. Zulian, MD, Associate Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua.
³ From the Department of Pediatrics, Rheumatology Unit, University of Padua, Padua, Italy; Scientific Research Institute of Rheumatology RAMS, Moscow, Russian Federation; A. Meyer Children's Hospital, Rheumatology Unit, and Department of Internal Medicine, Section of Rheumatology, University of Florence, Florence, Italy; Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy; Saint-Petersburg Pediatric Medical Academy, Saint-Petersburg, Russian Federation; Rheumatology Service, Cochin Hospital, Paris, France; Department of Pediatrics, Rheumatology Unit, University of Naples Federico II, Naples, Italy; Department of Pediatrics, Antonio Perrino Hospital, Brindisi, Italy; Helmgoltz Moscow Research Institute of Eye Diseases, Moscow, Russian Federation. zulian@pediatria.unipd.it.
⁴ C. Birolo, MD, Resident in Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua; M.E. Zannin, MD, PhD, Assistant Professor of Ophthalmology, Department of Pediatrics, Rheumatology Unit, University of Padua; S. Arsenyeva, MD, PhD, Associate Professor of Ophthalmology, Scientific Research Institute of Rheumatology RAMS; R. Cimaz, MD, Professor of Pediatrics, A. Meyer Children's Hospital, Rheumatology Unit, University of Florence; E. Miserocchi, MD, PhD, Assistant Professor of Ophthalmology, Department of Ophthalmology, Scientific Institute San Raffaele; M. Dubko, MD, Associate Professor of Pediatrics, Saint-Petersburg Pediatric Medical Academy; C.J. Deslandre, MD, Associate Professor of Pediatrics, Rheumatology Service, Cochin Hospital; F. Falcini, MD, Associate Professor of Pediatrics, Department of Internal Medicine, Section of Rheumatology, University of Florence; M. Alessio, MD, Associate Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Naples Federico II; F. La Torre, MD, Assistant Professor of Pediatrics, Department of Pediatrics, Antonio Perrino Hospital; E. Denisova, MD, Assistant Professor of Ophthalmology, Helmgoltz Moscow Research Institute of Eye Diseases; G. Martini, MD, PhD, Assistant Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua; I. Nikishina, MD, Associate Professor of Pediatrics, Scientific Research Institute of Rheumatology RAMS; F. Zulian, MD, Associate Professor of Pediatrics, Department of Pediatrics, Rheumatology Unit, University of Padua. zulian@pediatria.unipd.it.

PMID: 27633826
DOI: 10.3899/jrheum.151389

Abstract

Objective: Abatacept (ABA) has recently been proposed as second-line treatment in patients with juvenile idiopathic arthritis (JIA)-associated uveitis refractory to anti-tumor necrosis factor-α (anti-TNF) agents, but little is known about its efficacy as a first-line approach. The aim of the present study was to compare the safety and efficacy of ABA as a first-line biological agent (ABA-1) with that of ABA as a second-line treatment after 1 or more anti-TNF agents (ABA-2), in patients with severe JIA-related uveitis.

Methods: In this multicenter study, we collected data on patients with severe JIA-related uveitis treated with ABA as a first-line or second-line biological agent. Changes in frequency of uveitis flares/year and ocular complications before and after ABA treatment, clinical remission, and side effects were recorded.

Results: Thirty-five patients with a mean age of 10.8 years were treated with ABA for a mean period of 19.6 months. In 4 patients, ABA administration was discontinued, owing to inefficacy on arthritis in 3 cases and allergic reaction in 1. Thirty-one patients, 14 in the ABA-1 group and 17 in the ABA-2 group, completed the 12-month followup period; of these, 17 (54.8%) had clinical remission. The mean frequency of uveitis flares decreased from 4.1 to 1.2 in the ABA-1 group (p = 0.002) and from 3.7 to 1.2 in the ABA-2 group (p = 0.004). Preexisting ocular complications improved or remained stable in all but 5 patients, all in the ABA-2 group. No significant difference was found between the efficacy of the 2 treatment modalities. ABA confirmed its good safety profile.

Conclusion: ABA, used as first-line biological treatment or after 1 or more anti-TNF agents, induces a comparable improvement in severe refractory JIA-related uveitis.

Keywords: ABATACEPT; ANTI-TUMOR NECROSIS FACTOR AGENTS; JUVENILE IDIOPATHIC ARTHRITIS; UVEITIS.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Abatacept / therapeutic use*
Adolescent
Antirheumatic Agents / therapeutic use*
Arthritis, Juvenile / drug therapy*
Child
Child, Preschool
Female
Humans
Immunosuppressive Agents / therapeutic use*
Male
Retreatment
Treatment Outcome
Uveitis / drug therapy*
Young Adult

Substances

Antirheumatic Agents
Immunosuppressive Agents
Abatacept