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Observational Study
. 2016 Jun;68(6):1522-30.
doi: 10.1002/art.39667.

Infliximab Versus Adalimumab in the Treatment of Refractory Inflammatory Uveitis: A Multicenter Study From the French Uveitis Network

Hélène Vallet  1 , Pascal Seve  2 , Lucie Biard  3 , Jean Baptiste Fraison  4 , Philip Bielefeld  5 , Laurent Perard  6 , Boris Bienvenu  7 , Sébastien Abad  8 , Aude Rigolet  1 , Alban Deroux  9 , Damien Sene  10 , Antoinette Perlat  11 , Isabelle Marie  12 , Elodie Feurer  2 , Eric Hachulla  13 , Olivier Fain  14 , Gaëlle Clavel  15 , Sophie Riviere  16 , Pierre-Alban Bouche  3 , Julie Gueudry  12 , Gregory Pugnet  17 , Phuc Le Hoang  18 , Matthieu Resche Rigon  3 , Patrice Cacoub  1 , Bahram Bodaghi  18 , David Saadoun  1 ; French Uveitis Network
Affiliations
Free article
Observational Study

Infliximab Versus Adalimumab in the Treatment of Refractory Inflammatory Uveitis: A Multicenter Study From the French Uveitis Network

Hélène Vallet et al. Arthritis Rheumatol. 2016 Jun.
Free article

Abstract

Objective: To analyze the factors associated with response to anti-tumor necrosis factor (anti-TNF) treatment and compare the efficacy and safety of infliximab (IFX) and adalimumab (ADA) in patients with refractory noninfectious uveitis.

Methods: This was a multicenter observational study of 160 patients (39% men and 61% women; median age 31 years [interquartile range 21-42]) with uveitis that had been refractory to other therapies, who were treated with anti-TNF (IFX 5 mg/kg at weeks 0, 2, 6, and then every 5-6 weeks [n = 98] or ADA 40 mg every 2 weeks [n = 62]). Factors associated with complete response were assessed by multivariate analysis. Efficacy and safety of IFX versus ADA were compared using a propensity score approach with baseline characteristics taken into account. Subdistribution hazard ratios (SHRs) and 95% confidence intervals (95% CIs) were calculated.

Results: The main etiologies of uveitis included Behçet's disease (BD) (36%), juvenile idiopathic arthritis (22%), spondyloarthropathy (10%), and sarcoidosis (6%). The overall response rate at 6 and 12 months was 87% (26% with complete response) and 93% (28% with complete response), respectively. The median time to complete response was 2 months. In multivariate analysis, BD and occurrence of >5 uveitis flares before anti-TNF initiation were associated with complete response to anti-TNF (SHR 2.52 [95% CI 1.35-4.71], P = 0.004 and SHR 1.97 [95% CI 1.02-3.84], P = 0.045, respectively). Side effects were reported in 28% of patients, including serious adverse events in 13%. IFX and ADA did not differ significantly in terms of occurrence of complete response (SHR 0.65 [95% CI 0.25-1.71], P = 0.39), serious side effects (SHR 0.22 [95% CI 0.04-1.25], P = 0.089), or event-free survival (SHR 0.55 [95% CI 0.28-1.08], P = 0.083).

Conclusion: Anti-TNF treatment is highly effective in refractory inflammatory uveitis. BD is associated with increased odds of response. IFX and ADA appear to be equivalent in terms of efficacy.

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