1559: Comparison of Treatment with Adalimumab, Infliximab and Certolizumab in Refractory Cystoid Macular Edema Due to Behçet Disease

Nuria Barroso-Garcia¹, Jose Luis Martin-Varillas², Lara Sanchez-Bilbao³, Ivan Ferraz Amaro⁴, Vanesa Calvo Río⁵, Alfredo Adán⁶, Inés Hernanz-Rodriguez⁷, Emma Beltran-Catalan⁸, David Diaz-Valle⁹, Marisa Hernandez-Garfella¹⁰, Lucia Martinez-Costa¹¹, Manuel Diaz-Llopis¹², Jose M Herreras¹³, Olga Maiz-Alonso¹⁴, Ignacio Torre-Salaberri¹⁵, Antonio Atanes Sandoval¹⁶, Santos Insua-Vilariño¹⁷, Raquel Almodovar¹⁸, Patricia Fanlo-Mateo¹⁹, Juan Ramon De Dios²⁰, Angel Garcia-Aparicio²¹, Sergio rodriguez-Montero²², Vega Jovani²³, Patricia Moya²⁴, Eva Peña Sainz-Pardo²⁵, Jose Luis Hernandez²⁶ and Ricardo Blanco²⁷, ¹Hospital Universitario Puerta del Mar, Cadiz, Spain, ²Hospital de Laredo, Laredo, Spain, ³Hospital Universitario Marques de Valdecilla, Santander, Spain, ⁴Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain, ⁵Valdecilla Hospital, Santander, Spain, ⁶Oftalmology, Hospital Clinic de Barcelona, Barcelona, Spain, ⁷Ophthalmology, Hospital Clinic de Barcelona, Barcelona, Spain, ⁸HOSPITAL DEL MAR, Barcelona, Spain, ⁹Hospital Clinico San Carlos, Madrid, Spain, ¹⁰Ophthalmology, Hospital Universitario General Valencia, Valencia, Spain, ¹¹Ophthalmology, Hospital Universitario Doctor Peset, Valencia, Spain, ¹²Ophthalmology, Hospital Universitario La Fe, Valencia, Spain, ¹³Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain, ¹⁴University Hospital Donostia, San Sebastian, Spain, ¹⁵Hospital Universitario de Basurto, Bilbao, Spain, ¹⁶Rheumatology department, Complexo Hospitalario Universitario A Coruña (CHUAC). Instituto de Investigación Biomédica A Coruña (INIBIC)., A Coruña, Spain, ¹⁷Rheumatology, Hospital Universitario de Santiago de Compostela, Santiago Compostela, Spain, ¹⁸Alcorcón Foundation University Hospital, Madrid, Spain, ¹⁹Internal Medicine, Complejo Hospitalario Universitario de Navarra, Pamplona, Spain, ²⁰Osakidetza, Vitoria, Spain, ²¹Hospital Universitario de Toledo, Toledo, Spain, ²²Rheumatology, Hospital Universitario Virgen de Valme, Sevilla, Spain, ²³Department of Rheumatology, Hospital General Universitario Dr. Balmis, Alicante, Spain, ²⁴Hospital de Santa Creu i Sant Pau, Barcelona, Spain, ²⁵Pediatric, Hospital 12 de Octubre, Madrid, Spain, ²⁶Rheumatology, Ophthalmology and Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain, ²⁷Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain

Background/Purpose: Cystoid macular edema (CME) is the leading cause of blindness in non-infectious uveitis. One of the most frequently associated conditions is Behçet's disease (BD) (1-3). The objective is to compare efficacy and safety of Adalimumab (ADA), Infliximab (IFX) and Certolizumab (CZP) in CME refractory due to BD.

Methods: Multicenter study of patients with CME secondary to BD refractory to glucocorticoids (GC) and at least 1 conventional immunosuppressant. All patients had CME (OCT >300µ) at baseline. From baseline up to 2 years of follow-up, the evolution of macular thickness (µm), visual acuity (BCVA), anterior chamber (AC) cells, vitritis and GC-sparing effect was analyzed to assess the efficacy of ADA, IFX and CZP. Statistical analysis was performed with IBM SPSS Statistics v.23.

Results: Fifty patients (78 eyes) were evaluated. Twenty-five patients were treated with ADA, 15 with IFX and 10 patients received CZP. No significant differences in demographic parameters were identified in all groups. However, patients in the CZP group had a significantly longer time from diagnosis to drug initiation (75 [36-120] vs 30 [12-82] vs 15 [8-60] months; p=0.04) and had received a greater median [IQR] number of biological treatments (2 [0.75-3] vs 0 [0-0] vs 0 [0-0]) than the ADA and IFX groups. In CZP group, ADA and IFX were used previously in 7 patients. ADA was used in combined therapy in 64%, IFX in 66.7% and CZP in 70% of patients (p=0.94) (TABLE).
Concerning efficacy outcomes, a rapid and maintained improvement in macular thickness was observed after 2 years of follow-up in three groups with no statistically significant differences between them (FIGURE). Improvement in BCVA, AC cells, vitritis and a GC-sparing effect was also noted. No serious adverse events were observed in IFX and CZP group. One case of pyelonephritis was reported in the ADA group.

Conclusion: ADA, IFX and CZP are effective and safe in refractory CME due to BD. CZP appears effective even in patients with inadequate response to ADA and/or IFX.






N. Barroso-Garcia: None; J. Martin-Varillas: None; L. Sanchez-Bilbao: None; I. Ferraz Amaro: AbbVie/Abbott, 5, 6, Amgen, 5, 6, Bristol-Myers Squibb(BMS), 6; V. Calvo Río: None; A. Adán: None; I. Hernanz-Rodriguez: None; E. Beltran-Catalan: None; D. Diaz-Valle: None; M. Hernandez-Garfella: None; L. Martinez-Costa: None; M. Diaz-Llopis: None; J. Herreras: None; O. Maiz-Alonso: None; I. Torre-Salaberri: None; A. Atanes Sandoval: None; S. Insua-Vilariño: None; R. Almodovar: None; P. Fanlo-Mateo: None; J. De Dios: None; A. Garcia-Aparicio: None; S. rodriguez-Montero: None; V. Jovani: None; P. Moya: None; E. Peña Sainz-Pardo: None; J. Hernandez: None; R. Blanco: AbbVie, 5, 6, Amgen, 6, AstraZeneca, 2, BMS, 6, Eli Lilly, 6, Galapagos, 2, 6, Janssen, 2, 6, MSD, 6, Novartis, 2, 6, Pfizer, 2, 6, Roche, 5, 6, Sanofi, 6.