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Ophthalmology. 2018 Sep;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020. Epub 2018 Mar 27.

Successful Optimization of Adalimumab Therapy in Refractory Uveitis Due to Behçet's Disease.

Author information

1
Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
2
Rheumatology and Ophthalmology, Hospital General Universitario de Valencia, Valencia, Spain.
3
Rheumatology Hospital de Valme, Sevilla, Spain.
4
Rheumatology, Hospital Clinic, Barcelona, Spain.
5
Rheumatology and Ophthalmology, Hospital Peset, Valencia, Spain.
6
Rheumatology Hospital Vall d'Hebron, Barcelona, Spain.
7
Ophthalmology, Hospital de León, Léon, Spain.
8
Ophthalmology, Hospital Universitario La Fe, Valencia, Spain.
9
Ophthalmology and Autoinmune Disease, Hospital San Cecilio, Granada, Spain.
10
Ophthalmology, Hospital Universitario, IOBA, Valladolid, Spain.
11
Rheumatology, Hospital de Toledo, Toledo, Spain.
12
Rheumatology and Ophthalmology, Hospital Donosti San Sebastian, Spain.
13
Rheumatology, Hospital Basurto, Bilbao, Spain.
14
Rheumatology, Hospital Clínico San Carlos, Madrid, Spain.
15
Rheumatology, Hospital Sierrallana, Torrelavega, Spain.
16
Rheumatology, Hospital de Córdoba, Córdoba, Spain.
17
Rheumatology, Hospital San Pedro Alcántara, Caceres, Spain.
18
Ophthalmology, Hospital Clínico de Zaragoza, Zaragoza, Spain.
19
Rheumatology, Hospital de Mérida, Mérida, Spain.
20
Rheumatology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
21
Rheumatology, Hospital de Ferrol, A Coruña, Spain.
22
Rheumatology and Ophthalmology, Hospital Miguel Servet Zaragoza, Zaragoza, Spain.
23
Rheumatology, Hospital Universitario Infanta Sofía, en San Sebastián de los Reyes (Madrid), Madrid, Spain.
24
Rheumatology, Hospital Puerta del Mar, Cádiz, Spain.
25
Rheumatology, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
26
Rheumatology, Hospital Universitario Virgen Macarena, Sevilla, Spain.
27
Rheumatology, Hospital Gregorio Marañón, Madrid, Spain.
28
Rheumatology, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain.
29
Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
30
Rheumatology and Ophthalmology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain. Electronic address: miguelaggay@hotmail.com.

Erratum in

Abstract

PURPOSE:

To assess efficacy, safety, and cost-effectiveness of adalimumab (ADA) therapy optimization in a large series of patients with uveitis due to Behçet disease (BD) who achieved remission after the use of this biologic agent.

DESIGN:

Open-label multicenter study of ADA-treated patients with BD uveitis refractory to conventional immunosuppressants.

SUBJECTS:

Sixty-five of 74 patients with uveitis due to BD, who achieved remission after a median ADA duration of 6 (range, 3-12) months. ADA was optimized in 23 (35.4%) of them. This biologic agent was maintained at a dose of 40 mg/subcutaneously/2 weeks in the remaining 42 patients.

METHODS:

After remission, based on a shared decision between the patient and the treating physician, ADA was optimized. When agreement between patient and physician was reached, optimization was performed by prolonging the ADA dosing interval progressively. Comparison between optimized and nonoptimized patients was performed.

MAIN OUTCOME MEASURES:

Efficacy, safety, and cost-effectiveness in optimized and nonoptimized groups. To determine efficacy, intraocular inflammation (anterior chamber cells, vitritis, and retinal vasculitis), macular thickness, visual acuity, and the sparing effect of glucocorticoids were assessed.

RESULTS:

No demographic or ocular differences were found at the time of ADA onset between the optimized and the nonoptimized groups. Most ocular outcomes were similar after a mean ± standard deviation follow-up of 34.7±13.3 and 26±21.3 months in the optimized and nonoptimized groups, respectively. However, relevant adverse effects were only seen in the nonoptimized group (lymphoma, pneumonia, severe local reaction at the injection site, and bacteremia by Escherichia coli, 1 each). Moreover, the mean ADA treatment costs were lower in the optimized group than in the nonoptimized group (6101.25 euros/patient/year vs. 12 339.48; P < 0.01).

CONCLUSION:

ADA optimization in BD uveitis refractory to conventional therapy is effective, safe, and cost-effective.

PMID:
29602570
DOI:
10.1016/j.ophtha.2018.02.020
[Indexed for MEDLINE]

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