Longterm Safety and Efficacy of Adalimumab and Infliximab for Uveitis Associated with Juvenile Idiopathic Arthritis

Vanessa Cecchin; Maria Elisabetta Zannin; Daniele Ferrari; Irene Pontikaki; Elisabetta Miserocchi; Maria P Paroli; Claudia Bracaglia; Denise Pires Marafon; Serena Pastore; Fulvio Parentin; Gabriele Simonini; Cinzia De Libero; Fernanda Falcini; Antonella Petaccia; Giovanni Filocamo; Riccardo De Marco; Francesco La Torre; Silvana Guerriero; Silvana Martino; Francesco Comacchio; Valentina Muratore; Giorgia Martini; Fabio Vittadello; Francesco Zulian

doi:10.3899/jrheum.171006

Longterm Safety and Efficacy of Adalimumab and Infliximab for Uveitis Associated with Juvenile Idiopathic Arthritis

J Rheumatol. 2018 Aug;45(8):1167-1172. doi: 10.3899/jrheum.171006. Epub 2018 Apr 15.

Authors

Vanessa Cecchin^{1

2}, Maria Elisabetta Zannin^{1

2}, Daniele Ferrari^{1

2}, Irene Pontikaki^{1

2}, Elisabetta Miserocchi^{1

2}, Maria P Paroli^{1

2}, Claudia Bracaglia^{1

2}, Denise Pires Marafon^{1

2}, Serena Pastore^{1

2}, Fulvio Parentin^{1

2}, Gabriele Simonini^{1

2}, Cinzia De Libero^{1

2}, Fernanda Falcini^{1

2}, Antonella Petaccia^{1

2}, Giovanni Filocamo^{1

2}, Riccardo De Marco^{1

2}, Francesco La Torre^{1

2}, Silvana Guerriero^{1

2}, Silvana Martino^{1

2}, Francesco Comacchio^{1

2}, Valentina Muratore^{1

2}, Giorgia Martini^{1

2}, Fabio Vittadello^{1

2}, Francesco Zulian^{3

4}

Affiliations

¹ From the Department of Woman and Child Health, University of Padua, Padua; G. Pini Institute for Rheumatology; Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda, Ospedale Maggiore Policlinico, Milan; Department of Ophthalmology, Sapienza University; Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome; Institute for Maternal and Child Health IRCCS "Burlo Garofolo," Trieste; Anna Meyer Children's Hospital, and Department of Internal Medicine, Rheumatology, Transition Clinic, University of Florence, Florence; G. Gaslini Children's Hospital, Genoa; Department of Pediatrics, A. Perrino Hospital, Brindisi; Department of Neurosciences and Sense Organs, University of Bari, Bari; Ospedale Infantile Regina Margherita, University of Torino, Torino; Ophthalmology Unit, University Hospital Borgo Trento, Verona; IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
² V. Cecchin, MD, Assistant Professor, Department of Woman and Child Health, University of Padua; M.E. Zannin, MD, Department of Woman and Child Health, University of Padua; D. Ferrari, MD, Assistant Professor, Department of Woman and Child Health, University of Padua; I. Pontikaki, MD, Assistant Professor, G. Pini Institute for Rheumatology, Milan; E. Miserocchi, MD, Assistant Professor, G. Pini Institute for Rheumatology; M.P. Paroli, MD, Assistant Professor, Department of Ophthalmology, Sapienza University; C. Bracaglia, MD, Assistant Professor, Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù; D.P. Marafon, MD, Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù; S. Pastore, MD, Rheumatology Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo"; F. Parentin, MD, Assistant Professor, Ophthalmology Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo"; G. Simonini, MD, Associate Professor, Rheumatology Unit, Anna Meyer Children's Hospital, University of Florence; C. De Libero, MD, Ophthalmology Unit, Anna Meyer Children's Hospital, University of Florence; F. Falcini, MD, Associate Professor, Rheumatology Unit, Transition Clinic, University of Florence; A. Petaccia, MD, Assistant Professor, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico; G. Filocamo, MD, Assistant Professor, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico; R. De Marco, MD, Assistant Professor, Ophthalmology Unit, G. Gaslini Children's Hospital; F. La Torre, MD, Assistant Professor, Department of Pediatrics, A. Perrino Hospital; S. Guerriero, MD, Associate Professor, Department of Neurosciences and Sense Organs, University of Bari; S. Martino, MD, Associate Professor, Ospedale Infantile Regina Margherita, University of Torino; F. Comacchio, MD, Assistant Professor, Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Verona University Medical School, and University Hospital Borgo Trento; V. Muratore, MD, Assistant Professor, Department of Pediatrics, IRCCS Fondazione Policlinico San Matteo; G. Martini, MD, PhD, Assistant Professor, Department of Woman and Child Health, University of Padua; F. Vittadello, Department of Woman and Child Health, University of Padua; F. Zulian, MD, Associate Professor, Rheumatology Unit, Department of Woman and Child Health, University of Padua.
³ From the Department of Woman and Child Health, University of Padua, Padua; G. Pini Institute for Rheumatology; Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Cà Granda, Ospedale Maggiore Policlinico, Milan; Department of Ophthalmology, Sapienza University; Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome; Institute for Maternal and Child Health IRCCS "Burlo Garofolo," Trieste; Anna Meyer Children's Hospital, and Department of Internal Medicine, Rheumatology, Transition Clinic, University of Florence, Florence; G. Gaslini Children's Hospital, Genoa; Department of Pediatrics, A. Perrino Hospital, Brindisi; Department of Neurosciences and Sense Organs, University of Bari, Bari; Ospedale Infantile Regina Margherita, University of Torino, Torino; Ophthalmology Unit, University Hospital Borgo Trento, Verona; IRCCS Fondazione Policlinico San Matteo, Pavia, Italy. francescozulian58@gmail.com.
⁴ V. Cecchin, MD, Assistant Professor, Department of Woman and Child Health, University of Padua; M.E. Zannin, MD, Department of Woman and Child Health, University of Padua; D. Ferrari, MD, Assistant Professor, Department of Woman and Child Health, University of Padua; I. Pontikaki, MD, Assistant Professor, G. Pini Institute for Rheumatology, Milan; E. Miserocchi, MD, Assistant Professor, G. Pini Institute for Rheumatology; M.P. Paroli, MD, Assistant Professor, Department of Ophthalmology, Sapienza University; C. Bracaglia, MD, Assistant Professor, Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù; D.P. Marafon, MD, Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù; S. Pastore, MD, Rheumatology Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo"; F. Parentin, MD, Assistant Professor, Ophthalmology Unit, Institute for Maternal and Child Health IRCCS "Burlo Garofolo"; G. Simonini, MD, Associate Professor, Rheumatology Unit, Anna Meyer Children's Hospital, University of Florence; C. De Libero, MD, Ophthalmology Unit, Anna Meyer Children's Hospital, University of Florence; F. Falcini, MD, Associate Professor, Rheumatology Unit, Transition Clinic, University of Florence; A. Petaccia, MD, Assistant Professor, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico; G. Filocamo, MD, Assistant Professor, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico; R. De Marco, MD, Assistant Professor, Ophthalmology Unit, G. Gaslini Children's Hospital; F. La Torre, MD, Assistant Professor, Department of Pediatrics, A. Perrino Hospital; S. Guerriero, MD, Associate Professor, Department of Neurosciences and Sense Organs, University of Bari; S. Martino, MD, Associate Professor, Ospedale Infantile Regina Margherita, University of Torino; F. Comacchio, MD, Assistant Professor, Ophthalmology Unit, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, Verona University Medical School, and University Hospital Borgo Trento; V. Muratore, MD, Assistant Professor, Department of Pediatrics, IRCCS Fondazione Policlinico San Matteo; G. Martini, MD, PhD, Assistant Professor, Department of Woman and Child Health, University of Padua; F. Vittadello, Department of Woman and Child Health, University of Padua; F. Zulian, MD, Associate Professor, Rheumatology Unit, Department of Woman and Child Health, University of Padua. francescozulian58@gmail.com.

PMID: 29657140
DOI: 10.3899/jrheum.171006

Abstract

Objective: Anti-TNF-α agents have significantly changed the management of juvenile idiopathic arthritis (JIA). We evaluated the safety and efficacy of adalimumab (ADA) and infliximab (IFX) for the treatment of JIA-associated uveitis in patients treated for ≥ 2 years.

Methods: Patients with JIA-associated uveitis treated with IFX and ADA were managed by a standardized protocol and data were entered in the ORCHIDEA registry. At baseline, all patients were refractory to standard immunosuppressive treatment or were corticosteroid-dependent. Data recorded every 3 months were uveitis course, number/type of ocular flares and complications, drug-related adverse events (AE), and treatment switch or withdrawal. Data of patients treated for ≥ 2 years were analyzed by descriptive statistics.

Results: Up to December 2014, 154 patients with ≥ 24 months followup were included in the study. Fifty-nine patients were treated with IFX and 95 with ADA. Clinical remission, defined as the absence of flares for > 6 months on treatment, was achieved in 69 patients (44.8%), with a better remission rate for ADA (60.0%) as compared to IFX (20.3%; p < 0.001). A significant reduction of flares was observed in all patients without difference between the 2 treatment modalities. The number of new ocular complications decreased in both groups but was lower for ADA (p = 0.015). No serious AE were recorded; 16.4% of patients experienced 35 minor AE and the incidence rate was lower with ADA than with IFX.

Conclusion: At the 2-year followup, ADA showed a better efficacy and safety profile than IFX for the treatment of refractory JIA-associated uveitis.

Keywords: ANTI-TNF AGENTS; JUVENILE IDIOPATHIC ARTHRITIS; TREATMENT; UVEITIS.

MeSH terms

Adalimumab / adverse effects
Adalimumab / therapeutic use*
Adolescent
Antirheumatic Agents / adverse effects
Antirheumatic Agents / therapeutic use*
Arthritis, Juvenile / complications
Arthritis, Juvenile / drug therapy*
Child
Child, Preschool
Female
Humans
Immunosuppressive Agents / adverse effects
Immunosuppressive Agents / therapeutic use*
Infliximab / adverse effects
Infliximab / therapeutic use*
Male
Treatment Outcome
Uveitis / drug therapy*
Uveitis / etiology

Substances

Antirheumatic Agents
Immunosuppressive Agents
Infliximab
Adalimumab