medwireNews: The tumor necrosis factor (TNF)α inhibitors adalimumab and infliximab both show good efficacy when used as first biologic agents in patients with refractory uveitis due to Behçet's disease, Spanish research shows.
Treatment with adalimumab, however, resulted in a higher drug retention rate and significantly greater improvements in visual acuity, report Ricardo Blanco (Hospital Universitario Marqués de Valdecilla, Santander) and colleagues in Arthritis & Rheumatology.
The open‐label multicenter study included 177 patients with Behçet's disease‐associated uveitis (316 affected eyes) refractory to conventional non‐biologic treatment who were treated with intravenous infliximab 3–5 mg/kg at weeks 0, 2, and 6, and every 4–8 weeks thereafter (n=103) or with subcutaneous adalimumab 40 mg every 2 weeks with no loading dose (n=74) according to physician and patient preference.
After 1 year of therapy, patients in both groups had significant improvements in all six ocular parameters measured by the researchers, but the degree of improvement in some outcomes differed between the two treatments.
For example, patients receiving adalimumab had significantly greater improvements in best Snellen corrected visual acuity (mean 0.81 vs 0.67 logMAR equivalents) and a significantly greater drug retention rate (95.2 vs 85.0%) than those who received infliximab.
But the proportion of patients with vitritis at 1 year was significantly higher with adalimumab than with infliximab (93.3 vs 79.0%) and the proportion with anterior chamber inflammation was nonsignificantly higher (92.3 vs 78.2%).
Blanco and team suggest this difference could be due in part to the fact that patients in the adalimumab group “did not receive the loading dose of 80 mg along with the next dose of 40 mg at one week as performed in the VISUAL trials since our study was carried out before these studies had been published.”
There was no significant difference between the adalimumab- and infliximab-treated patients in the rate of retinal vasculitis (95 vs 97%) and macular thickness (mean 250.6 vs 264.9 µm) at 1 year, however.
Furthermore, the median daily dose of prednisone fell from 20 mg and 30 mg in the adalimumab and infliximab groups, respectively, at baseline, to 5 mg/day at 1 year in both groups.
After mean follow-up periods of 26.5 months in the adalimumab group and 31.5 months in the infliximab group, 87.8% and 76.5% of patients, respectively, achieved ocular remission (defined as the absence of signs of intraocular inflammation 3 months or more), a nonsignificant difference.
Four patients in the adalimumab group and eight in the in the infliximab group withdrew treatment due to severe side effects or toxicity, including lymphoma, injection site reactions, and infections in the former group, and infusion reactions, infections, severe oral ulcers, and skin reactions in the latter. Withdrawal due to inefficacy was reported in 14.9% and 17.5%, respectively.
Blanco et al accept that the study is limited by its observational nature. “Because of that, further randomized, controlled trials comparing head to head both anti-TNF-α agents are required,” they conclude.
By Laura Cowen
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Arthritis Rheumatol 2019; doi:10.1002/art.41026
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