Top

Journal of Ophthalmic Inflammation and Infection

Published in:

Open Access 01-12-2019 | Vasculitis | Brief report

Experience of using adalimumab in treating sight-threatening paediatric or adolescent Behcet’s disease-related uveitis

Authors: Mary Ho, Li Jia Chen, Helena P. Y. Sin, Lawrence P. L. Iu, Marten Brelen, Assunta C. H. Ho, Timothy Y. Y. Lai, Alvin L. Young

Published in: Journal of Ophthalmic Inflammation and Infection | Issue 1/2019

Abstract

Purpose

To report the clinical outcomes of adalimumab in treating refractory Behcet’s disease (BD)-related uveitis in paediatric or adolescent patients.

Methods

Retrospective review of five paediatric or adolescent patients with BD-related uveitis with a minimum follow-up of 24 months.

Results

Disease quiescence was observed in 9 (90%) of 10 eyes at 12 months. The mean number of relapses per year per patient was 5 (range, 3–7) before initiation of adalimumab treatment. This was reduced to 0.2 relapse per patient per year among the five patients during the first 24 months after starting adalimumab treatment. At baseline, 5 eyes had active retinal vasculitis. Retinal vasculitis resolved in all cases (100%) after starting adalimumab. The mean time to complete resolution of inflammation was 3.4 weeks. The mean ± standard deviation logMAR best-corrected visual acuity was 0.711 ± 0.63 at baseline and improved to 0.172 ± 1.04 at 12 months (P < 0.001). None of the patients developed any adverse events associated with adalimumab treatment.

Conclusion

Adalimumab was effective in preventing irreversible sight-threatening BD-related uveitis in paediatric or adolescent patients. Adalimumab appears to be a promising treatment option for young patients with recalcitrant BD-related uveitis and has a favourable safety profile.

Acharya NR, Tham VM, Esterberg E, Borkar DS, Parker JV, Vinoya AC, Uchida A (2013) Incidence and prevalence of uveitis: results from the Pacific Ocular Inflammation Study. JAMA Ophthalmol 131:1405–1412. https://doi.org/10.1001/jamaophthalmol.2013.4237 CrossRefPubMed

Ardoin SP, Kredich D, Rabinovich E, Schanberg LE, Jaffe GJ (2007) Infliximab to treat chronic noninfectious uveitis in children: retrospective case series with long-term follow-up. Am J Ophthalmol 144:844–849. https://doi.org/10.1016/j.ajo.2007.08.018 CrossRefPubMedPubMedCentral

Arida A, Fragiadaki K, Giavri E, Sfikakis PP (2011) Anti-TNF agents for Behcet’s disease: analysis of published data on 369 patients. Semin Arthritis Rheum 41:61–70. https://doi.org/10.1016/j.semarthrit.2010.09.002 CrossRefPubMed

Bartelds GM et al (2011) Development of antidrug antibodies against adalimumab and association with disease activity and treatment failure during long-term follow-up. JAMA 305:1460–1468. https://doi.org/10.1001/jama.2011.406 CrossRefPubMed

Biester S, Deuter C, Michels H, Haefner R, Kuemmerle-Deschner J, Doycheva D, Zierhut M (2007) Adalimumab in the therapy of uveitis in childhood. Br J Ophthalmol 91:319–324. https://doi.org/10.1136/bjo.2006.103721 CrossRefPubMed

Bravo-Ljubetic L, Peralta-Calvo J, Noval S, Pastora-Salvador N, Abelairas-Gomez J, Merino R (2013) Adalimumab therapy for refractory childhood uveitis. J AAPOS 17:456–459. https://doi.org/10.1016/j.jaapos.2013.06.009 CrossRefPubMed

Castiblanco C, Meese H, Foster CS (2016) Treatment of pediatric uveitis with adalimumab: the MERSI experience. J AAPOS 20:145–147. https://doi.org/10.1016/j.jaapos.2015.12.006 CrossRefPubMed

Diaz-Llopis M et al (2012) Treatment of refractory uveitis with adalimumab: a prospective multicenter study of 131 patients. Ophthalmology 119:1575–1581. https://doi.org/10.1016/j.ophtha.2012.02.018 CrossRefPubMed

Evereklioglu C (2005) Current concepts in the etiology and treatment of Behcet disease. Surv Ophthalmol 50:297–350. https://doi.org/10.1016/j.survophthal.2005.04.009 CrossRefPubMed

10.

Evereklioglu C, Er H, Turkoz Y, Cekmen M (2002) Serum levels of TNF-alpha, sIL-2R, IL-6, and IL-8 are increased and associated with elevated lipid peroxidation in patients with Behcet’s disease. Mediators Inflamm 11:87–93. https://doi.org/10.1080/09629350220131935 CrossRefPubMedPubMedCentral

11.

Garcia-De-Vicuna C et al (2013) Usefulness of adalimumab in the treatment of refractory uveitis associated with juvenile idiopathic arthritis. Mediators Inflamm 2013:560632. https://doi.org/10.1155/2013/560632 CrossRefPubMedPubMedCentral

12.

Gritz DC, Wong IG (2004) Incidence and prevalence of uveitis in Northern California; the Northern California Epidemiology of Uveitis Study. Ophthalmology 111:491–500; discussion 500. https://doi.org/10.1016/j.ophtha.2003.06.014 CrossRefPubMed

13.

Jabs DA, Nussenblatt RB, Rosenbaum JT, Standardization of Uveitis Nomenclature Working G (2005) Standardization of uveitis nomenclature for reporting clinical data. Results of the First International Workshop. Am J Ophthalmol 140:509-516

14.

Jeroudi A, Angeles-Han ST, Yeh S (2014) Efficacy of adalimumab for pediatric Vogt-Koyanagi-Harada syndrome. Ophthalmic Surg Lasers Imaging Retina 45:332–334. https://doi.org/10.3928/23258160-20140709-09 CrossRefPubMedPubMedCentral

15.

Kahn P, Weiss M, Imundo LF, Levy DM (2006) Favorable response to high-dose infliximab for refractory childhood uveitis. Ophthalmology 113:860–864 e862. https://doi.org/10.1016/j.ophtha.2006.01.005 CrossRefPubMed

16.

Kone-Paut I, Yurdakul S, Bahabri SA, Shafae N, Ozen S, Ozdogan H, Bernard JL (1998) Clinical features of Behcet’s disease in children: an international collaborative study of 86 cases. J Pediatr 132:721–725CrossRef

17.

Lee JT, Yates WB, Rogers S, Wakefield D, McCluskey P, Lim LL (2018) Adalimumab for the treatment of refractory active and inactive non-infectious uveitis. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2017-311234

18.

Levy-Clarke G, Jabs DA, Read RW, Rosenbaum JT, Vitale A, Van Gelder RN (2014) Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders. Ophthalmology 121:785–796 e783. https://doi.org/10.1016/j.ophtha.2013.09.048 CrossRefPubMed

19.

Lindstedt EW, Baarsma GS, Kuijpers RW, van Hagen PM (2005) Anti-TNF-alpha therapy for sight threatening uveitis. Br J Ophthalmol 89:533–536. https://doi.org/10.1136/bjo.2003.037192 CrossRefPubMedPubMedCentral

20.

Martel JN, Esterberg E, Nagpal A, Acharya NR (2012) Infliximab and adalimumab for uveitis. Ocul Immunol Inflamm 20:18–26. https://doi.org/10.3109/09273948.2011.633205 CrossRefPubMed

21.

Matsuo T, Itami M, Nakagawa H, Nagayama M (2002) The incidence and pathology of conjunctival ulceration in Behcet’s syndrome. Br J Ophthalmol 86:140–143CrossRef

22.

Mercier AE, Ribeiro E, Korobelnik JF, Delyfer MN, Rougier MB (2016) Efficacy of anti-TNF-alpha therapy for the treatment of non-infectious uveitis: a retrospective study of 21 patients. Ocul Immunol Inflamm:1–8. https://doi.org/10.1080/09273948.2016.1236968

23.

Munoz-Gallego A, Barral E, Enriquez E, Tejada P, Barcelo A, de Inocencio J (2017) Adalimumab for the treatment of refractory noninfectious paediatric uveitis. Int Ophthalmol 37:719–725. https://doi.org/10.1007/s10792-016-0293-5 CrossRefPubMed

24.

Mushtaq B, Saeed T, Situnayake RD, Murray PI (2007) Adalimumab for sight-threatening uveitis in Behcet’s disease. Eye 21:824–825. https://doi.org/10.1038/sj.eye.6702352 CrossRefPubMed

25.

Olivieri I et al (2011) Efficacy of adalimumab in patients with Behcet’s disease unsuccessfully treated with infliximab. Clin Exp Rheumatol 29:S54–S57PubMed

26.

Perra D et al (2012) Adalimumab for the treatment of Behcet's disease: experience in 19 patients. Rheumatology (Oxford) 51:1825–1831. https://doi.org/10.1093/rheumatology/kes130 CrossRef

27.

Pipitone N, Olivieri I, Cantini F, Triolo G, Salvarani C (2006) New approaches in the treatment of Adamantiades-Behcet’s disease. Curr Opin Rheumatol 18:3–9CrossRef

28.

Ramanan AV et al (2014) A randomised controlled trial of the clinical effectiveness, safety and cost-effectiveness of adalimumab in combination with methotrexate for the treatment of juvenile idiopathic arthritis associated uveitis (SYCAMORE Trial). Trials 15:14. https://doi.org/10.1186/1745-6215-15-14 CrossRefPubMedPubMedCentral

29.

Ramanan AV et al (2017) Adalimumab plus methotrexate for uveitis in juvenile idiopathic arthritis. N Engl J Med 376:1637–1646. https://doi.org/10.1056/NEJMoa1614160 CrossRefPubMed

30.

Sfikakis PP et al (2007) Anti-TNF therapy in the management of Behcet’s disease--review and basis for recommendations. Rheumatology (Oxford) 46:736–741. https://doi.org/10.1093/rheumatology/kem034 CrossRef

31.

Simonini G et al (2013) Superior efficacy of adalimumab in treating childhood refractory chronic uveitis when used as first biologic modifier drug: adalimumab as starting anti-TNF-alpha therapy in childhood chronic uveitis. Pediatr Rheumatol Online J 11:16. https://doi.org/10.1186/1546-0096-11-16 CrossRefPubMedPubMedCentral

32.

Smith JA et al (2009) Epidemiology and course of disease in childhood uveitis. Ophthalmology 116:1544–1551, e1541. https://doi.org/10.1016/j.ophtha.2009.05.002 CrossRefPubMedPubMedCentral

33.

Sood AB, Angeles-Han ST (2017) An update on treatment of pediatric chronic non-infectious uveitis. Curr Treatm Opt Rheumatol 3:1–16. https://doi.org/10.1007/s40674-017-0057-z CrossRefPubMedPubMedCentral

34.

Suhler EB et al (2013) Adalimumab therapy for refractory uveitis: results of a multicentre, open-label, prospective trial. Br J Ophthalmol 97:481–486. https://doi.org/10.1136/bjophthalmol-2012-302292 CrossRefPubMed

35.

Takase K, Ohno S, Ideguchi H, Uchio E, Takeno M, Ishigatsubo Y (2011) Successful switching to adalimumab in an infliximab-allergic patient with severe Behcet disease-related uveitis. Rheumatol Int 31:243–245. https://doi.org/10.1007/s00296-009-1178-y CrossRefPubMed

36.

Tugal-Tutkun I, Mudun A, Urgancioglu M, Kamali S, Kasapoglu E, Inanc M, Gul A (2005) Efficacy of infliximab in the treatment of uveitis that is resistant to treatment with the combination of azathioprine, cyclosporine, and corticosteroids in Behcet's disease: an open-label trial. Arthritis Rheum 52:2478–2484. https://doi.org/10.1002/art.21231 CrossRefPubMed

37.

Tugal-Tutkun I, Onal S, Altan-Yaycioglu R, Huseyin Altunbas H, Urgancioglu M (2004) Uveitis in Behcet disease: an analysis of 880 patients. Am J Ophthalmol 138:373–380. https://doi.org/10.1016/j.ajo.2004.03.022 CrossRefPubMed

38.

Tugal-Tutkun I, Urgancioglu M (2003) Childhood-onset uveitis in Behcet disease:a descriptive study of 36 cases. Am J Ophthalmol 136:1114–1119CrossRef

39.

Turan B, Gallati H, Erdi H, Gurler A, Michel BA, Villiger PM (1997) Systemic levels of the T cell regulatory cytokines IL-10 and IL-12 in Bechcet’s disease; soluble TNFR-75 as a biological marker of disease activity. J Rheumatol 24:128–132PubMed

40.

Tynjala P, Kotaniemi K, Lindahl P, Latva K, Aalto K, Honkanen V, Lahdenne P (2008) Adalimumab in juvenile idiopathic arthritis-associated chronic anterior uveitis. Rheumatology (Oxford) 47:339–344. https://doi.org/10.1093/rheumatology/kem356 CrossRef

41.

Vazquez-Cobian LB, Flynn T, Lehman TJ (2006) Adalimumab therapy for childhood uveitis. J Pediatr 149:572–575. https://doi.org/10.1016/j.jpeds.2006.04.058 CrossRefPubMed

42.

Yazici H et al (1984) Influence of age of onset and patient’s sex on the prevalence and severity of manifestations of Behcet's syndrome. Ann Rheum Dis 43:783–789CrossRef

43.

Zouboulis CC et al (1997) Epidemiological features of Adamantiades-Behcet's disease in Germany and in Europe. Yonsei Med J 38:411–422. https://doi.org/10.3349/ymj.1997.38.6.411 CrossRefPubMed

Title: Experience of using adalimumab in treating sight-threatening paediatric or adolescent Behcet’s disease-related uveitis
Authors: Mary Ho
Li Jia Chen
Helena P. Y. Sin
Lawrence P. L. Iu
Marten Brelen
Assunta C. H. Ho
Timothy Y. Y. Lai
Alvin L. Young
Publication date: 01-12-2019
Publisher: Springer Berlin Heidelberg
Keywords: Vasculitis
Vasculitis
Uveitis
Adalimumab
Published in: Journal of Ophthalmic Inflammation and Infection / Issue 1/2019
Electronic ISSN: 1869-5760
DOI: https://doi.org/10.1186/s12348-019-0181-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Experience of using adalimumab in treating sight-threatening paediatric or adolescent Behcet’s disease-related uveitis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Optical coherence tomography angiography (OCTA) as a new diagnostic tool in uveitis

Optical coherence tomography angiography in uveitis

Bilateral viral keratitis following corneal collagen crosslinking for progressive keratoconus

Topographic correlation between multifocal electroretinography, microperimetry, and spectral-domain optical coherence tomography of the macula in patients with birdshot chorioretinopathy

Evaluation of the etiology of persistent iritis after cataract surgery

Tinea corporis infection manifestating as retinochoroiditis—an unusual presentation