title: Anti-TNF-α therapy in refractory uveitis associated with sarcoidosis: Multicenter study of 17 patients.
abstract: OBJECTIVE
  To assess anti-TNF-α therapy response in uveitis associated with sarcoidosis refractory to conventional immunosuppressive therapy.
  
  
  METHODS
  Open-label, multicenter, retrospective study on patients with sarcoid uveitis who underwent anti-TNF-α therapy because of inadequate response to conventional therapy including corticosteroids and at least 1 systemic synthetic immunosuppressive drug. The main outcome measurements were degree of anterior and posterior chamber inflammation, visual acuity, macular thickness, and immunosuppression load.
  
  
  RESULTS
  A total of 17 patients (8 men; 29 affected eyes; mean ± standard deviation age 38.4 ± 16.8; range: 13-76 years) were studied. The patients had bilateral hilar lymphadenopathy (58.8%), lung parenchyma involvement (47.1%), peripheral lymph nodes (41.2%), and involvement of other organs (52.9%). Angiotensin-converting enzyme was elevated in 58.8%. The most frequent ocular pattern was bilateral chronic relapsing panuveitis. The first biologic agent used was adalimumab in 10 (58.8%) and infliximab in 7 (41.2%) cases. Infliximab 5mg/kg intravenously every 4-8 weeks and adalimumab 40mg subcutaneously every 2 weeks were the most common administration patterns. In most cases anti-TNF-α therapy was given in combination with immunosuppressive drugs. The mean duration of follow-up was 33.9 ± 17.1 months. Significant improvement was observed following anti-TNF-α therapy. Baseline results versus results at 2 years from the onset of biologic therapy were the following: the median of cells in the ocular anterior chamber (interquartile range-IQR) 0.5 (0-2) versus 0 (0-0) (p = 0.003), vitritis 0 (0-1.25) versus 0 (0-0) (p = 0.008), macular thickness (391.1 ± 58.8 versus 247 ± 40.5µm) (p = 0.028), and visual acuity 0.60 ± 0.33 versus 0.74 ± 0.27; p = 0.009. The median daily (interquartile range) dose of prednisone was also reduced from 10 (0-30)mg at the onset of the anti-TNF-α therapy to 0 (0-0)mg at 2 years (p = 0.02). Significant reduction was also achieved in the immunosuppressive load.
  
  
  CONCLUSIONS
  Anti-TNF-α therapy is effective in sarcoid uveitis patients refractory to conventional immunosuppressive therapy. Infliximab and adalimumab allowed a substantial reduction in prednisone dose despite having failed standard therapy.
authors.affiliation: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain.
authors.forename: Leyre
authors.initials: L
authors.lastname: Riancho-Zarrabeitia
authors.affiliation: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Calvo-Río
authors.affiliation: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.affiliation: Division of Ophthalmology, Hospital Clínic of Barcelona, Barcelona, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Mesquida
authors.affiliation: Division of Ophthalmology, Hospital Clínic of Barcelona, Barcelona, Spain.
authors.forename: Alfredo M
authors.initials: AM
authors.lastname: Adan
authors.affiliation: Division of Ophthalmology, Hospital Universitario, IOBA, Valladolid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Herreras
authors.affiliation: Division of Rheumatology, Hospital de Toledo, Toledo, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Aparicio
authors.affiliation: Division of Rheumatology, Hospital Universitario La Paz Madrid, Spain.
authors.forename: Diana
authors.initials: D
authors.lastname: Peiteado-Lopez
authors.affiliation: Division of Ophthalmology, Hospital de León. Instituto Biomedicina (IBIOMED), University of León, León, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Cordero-Coma
authors.affiliation: Division of Ophthalmology and Internal Medicine, Hospital San Cecilio, Granada, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: García Serrano
authors.affiliation: Division of Ophthalmology and Internal Medicine, Hospital San Cecilio, Granada, Spain.
authors.forename: Norberto
authors.initials: N
authors.lastname: Ortego-Centeno
authors.affiliation: Division of Rheumatology and Ophthalmology, Hospital Donostia San, Sebastian, Spain.
authors.forename: Olga
authors.initials: O
authors.lastname: Maíz
authors.affiliation: Division of Rheumatology and Ophthalmology, Hospital Donostia San, Sebastian, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Blanco
authors.affiliation: Division of Rheumatology, Hospital de Valme, Sevilla, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sánchez-Bursón
authors.affiliation: Division of Rheumatology, Hospital Cabueñes, Gijón, Spain.
authors.forename: Senén
authors.initials: S
authors.lastname: González-Suárez
authors.affiliation: Division of Ophthalmology, Hospital de Cruces, Bilbao, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Fonollosa
authors.affiliation: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Santos-Gómez
authors.affiliation: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: González-Vela
authors.affiliation: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Loricera
authors.affiliation: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain.
authors.forename: Trinitario
authors.initials: T
authors.lastname: Pina
authors.affiliation: Division of Rheumatology, Hospital Universitario Marqués de Valdecilla. IDIVAL, Avda. Valdecilla s/n., Santander ES-39008, Spain. Electronic address: miguelaggay@hotmail.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Gay
mesh_terms: D000068879:Adalimumab / Q000627:therapeutic use*; D000293:Adolescent; D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000069285:Infliximab / Q000627:therapeutic use*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D019233:Retreatment; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D014605:Uveitis / Q000150:complications / Q000188:drug therapy*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D016572:Cyclosporine; D000069285:Infliximab; D000068879:Adalimumab; D011241:Prednisone; D008727:Methotrexate
keywords: Biologic therapy; Sarcoidosis; Uveitis