OP0060 COMPARATIVE STUDY ON ANTI-TNF VS TOCILIZUMAB FOR TREATMENT OF REFRACTORY UVEITIC CYSTOID MACULAR EDEMA DUE TO BEHCET'S DISEASE. MULTICENTER STUDY OF 49 PATIENTS

Abstract

Background: Posterior segment involvement is the most serious affection of uveitis in Behçet’s disease (BD), with cystoid macular edema (CME) being the leading cause of blindness. Anti-TNF, especially adalimumab (ADA) and infliximab (IFX), have demonstrated efficacy as first-line biologic agents in BD-related uveitis [1,2] . Moreover, the anti-IL6R tocilizumab (TCZ) has shown excellent results in highly refractory BD-uveitis and noninfectious uveitic CME [3-6] . Objectives: To compare the efficacy of ADA vs IFX vs TCZ in patients with refractory CME due to BD. Methods: Observational multicenter study of patients with BD-associated CME refractory to conventional and/or biological immunosuppressive drugs. From a cohort of 177 patients treated with anti-TNF and 14 patients treated with TCZ, we selected those with CME at baseline. CME was defined as macular thickness > 300μm (measured by optic coherence tomography). We analyzed in the 3 groups of treatment (ADA, IFX, TCZ) from baseline up to 4 years the evolution of macular thickness (main outcome) and best-corrected visual acuity (BCVA). Differences between basal and final follow-up were evaluated. Multivariable linear regression was used to assess the differences between the 3 groups. Results: A total of 49 patients were included. ADA was used in 25 patients (40 eyes with CME), IFX in 15 (21 eyes with CME) and TCZ in 9 (11 eyes with CME). No statistically significant baseline differences were observed between the 3 groups ([Table][1]) except for previous anti-TNF therapy, which was used only in patients treated with TCZ (5 patients received ADA, 1 received IFX and 2 received both ADA and IFX, in different times). Most patients from all groups had received several conventional immunosuppressive drugs. Biological therapy was used in monotherapy or combined with azathioprine (n=10, 5 and 1 in ADA, IFX and TCZ group, respectively), cyclosporine A (n=10, 5 and 1) or methotrexate (n=4, 2 and 3). Macular thickness progressively decreased in the 3 groups, with no signs of CME after 1 year of treatment. Similarly, BCVA improvement and inflammatory ocular remission was reached in all groups ([Figure][2]). View this table: Table 1. Demographic and clinical characteristics of 49 patients with cystoid macular edema due to Behçet’s disease receiving ADA, IFX or TCZ. ![Figure 1.][3] Figure 1. Evolution of ocular parameters in 49 patients with cystoid macular edema due to Behçet’s disease receiving ADA, IFX or TCZ. Conclusion: Refractory CME associated to BD’s uveitis can be effectively treated with ADA, IFX or TCZ. Moreover, TCZ is effective in patients resistant to anti-TNF therapy. References: [1] Arthritis Rheumatol. 2019;71(12):2081-2089. doi: 10.1002/art.41026 [2] Ophthalmology. 2018;125(9):1444-1451. doi: 10.1016/j.ophtha.2018.02.020 [3] Rheumatology (Oxford). 2018;57(5):856-864. doi: 10.1093/rheumatology/kex480 [4] Am J Ophthalmol. 2019;200:85-94. doi: 10.1016/j.ajo.2018.12.019 [5] Clin Exp Rheumatol. 2014;32(4 Suppl 84): S54-7. PMID: 25005576 [6] Clin Exp Rheumatol. 2016;34(6 Suppl 102): S34-S40. PMID:27054359 Disclosure of Interests: None declared [1]: #T1 [2]: #F1 [3]: pending:yes