title: The effect of biologic therapy different from infliximab or adalimumab in patients with refractory uveitis due to Behçet's disease: results of a multicentre open-label study.
abstract: To assess the efficacy of other biologic therapies, different from infliximab (IFX) and adalimumab (ADA), in patients with Behçet's disease uveitis (BU).
  
  
  
  Multicenter study of 124 patients with BU refractory to at least one standard immunosuppressive agent that required IFX or ADA therapy. Patients who had to be switched to another biologic agent due to inefficacy or intolerance to IFX or ADA or patient's decision were assessed. The main outcome measures were the degree of anterior and posterior chamber inflammation and macular thickness.
  
  
  
  Seven (5.6%) of 124 cases (4 women/3 men; mean age, 43 (range 28- 67) years; 12 affected eyes) were studied. Five of them had been initially treated with ADA and 2 with IFX. The other biologic agents used were golimumab (n=4), tocilizumab (n=2) and rituximab (n=1). The ocular pattern was panuveitis (n=4) or posterior uveitis (n=3). Uveitis was bilateral in 5 patients (71.4%). At baseline, anterior chamber and vitreous inflammation were present in 6 (50%) and 7 (58.3%) of the eyes. All the patients (12 eyes) had macular thickening (OCT>250μm) and 4 of them (7 eyes), cystoid macular edema (OCT>300 μm). Besides reduction anterior chamber and vitreous inflammation, we observed a reduction of OCT values, from 330.4±58.5 μm at the onset of the biological agent to 273±50 μm at month 12 (p=0.06). Six patients achieved a complete remission of uveitis.
  
  
  
  The vast majority of patients with BU refractory to standard immunosuppressive drugs are successfully controlled with ADA and/or IFX. Other biologic agents appear to be also useful.
authors.affiliation: Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Santos-Gómez
authors.affiliation: Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Vanesa
authors.initials: V
authors.lastname: Calvo-Río
authors.affiliation: Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain. rblanco@humv.es.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.affiliation: Rheumatology and Ophthalmology, Hospital General Universitario de Valencia, Spain.
authors.forename: Emma
authors.initials: E
authors.lastname: Beltrán
authors.affiliation: Ophthalmology and Rheumatology, Hospital Clinic, Barcelona, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Mesquida
authors.affiliation: Ophthalmology and Rheumatology, Hospital Clinic, Barcelona, Spain.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Adán
authors.affiliation: Ophthalmology, Hospital de León, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Cordero-Coma
authors.affiliation: Rheumatology, Hospital de Toledo, Spain.
authors.forename: Ángel M
authors.initials: ÁM
authors.lastname: García-Aparicio
authors.affiliation: Rheumatology and Ophthalmology, Hospital Peset Valencia, Spain.
authors.forename: Elia
authors.initials: E
authors.lastname: Valls Pascual
authors.affiliation: Rheumatology and Ophthalmology, Hospital Peset Valencia, Spain.
authors.forename: Lucía
authors.initials: L
authors.lastname: Martínez-Costa
authors.affiliation: Ophthalmology and Rheumatology, Hospital Clinic, Barcelona, Spain.
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Hernández
authors.affiliation: Rheumatology and Ophthalmology, Hospital General Universitario de Valencia, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Hernandez Garfella
authors.affiliation: Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: María C
authors.initials: MC
authors.lastname: González-Vela
authors.affiliation: Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Trinitario
authors.initials: T
authors.lastname: Pina
authors.affiliation: Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: Palmou-Fontana
authors.affiliation: Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Loricera
authors.affiliation: Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
authors.forename: José L
authors.initials: JL
authors.lastname: Hernández
authors.affiliation: Rheumatology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain. miguelaggay@hotmail.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: González-Gay
mesh_terms: D000068879:Adalimumab / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D001528:Behcet Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001688:Biological Products / Q000009:adverse effects / Q000627:therapeutic use*; D004351:Drug Resistance; D057915:Drug Substitution; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014605:Uveitis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology
chemical_list: D001688:Biological Products; D007166:Immunosuppressive Agents; D000069285:Infliximab; D000068879:Adalimumab