Infliximab versus adalimumab in the treatment of refractory inflammatory uveitis: Multicenter study from the french uveitis network

Hélène Vallet (1) , Pascal Seve (2, 3) , Lucie Biard (4, 5) , Jean-Baptiste Fraison (6) , Philip Bielefeld (7) , Laurent Perard (8) , Boris Bienvenu (9) , Sébastien Abad (10) , Aude Rigolet (1, 11, 12) , Alban Deroux (13, 14) , Damien Sène (15) , Antoinette Perlat (16, 17) , Isabelle Marie (18) , Elodie Feurer (19, 2) , Eric Hachulla (20) , Olivier Fain (21) , Gaëlle Clavel (22) , Sophie Riviere (23) , Pierre-Alban Bouche (5, 4) , Julie Gueudry (18) , Gregory Pugnet (24, 25) , Phuc Le Hoang (1) , Matthieu Resche Rigon (5, 4) , Patrice Cacoub (26, 27) , Bahram Bodaghi (28) , David Saadoun (26, 27)

1 CHU Pitié-Salpêtrière [AP-HP]
2 Hôpital de la Croix-Rousse [CHU - HCL]
3 UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon
4 AP-HP - Hopital Saint-Louis [AP-HP]
5 CRESS (U1153 / UMR_A_1125 / UMR_S_1153) - Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité
6 Hôpital Jean Verdier [AP-HP]
7 CHU Dijon - Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand
8 Hôpital Edouard Herriot [CHU - HCL]
9 Service de médecine interne [CHU Caen]
10 Hôpital Avicenne [AP-HP]
11 Centre de recherche en myologie
12 DHU - I2B - Departement Hospitalo- Universitaire - Inflammation, Immunopathologie, Biothérapie [Paris]
13 Hôpital Michallon
14 UGA UFRM - Université Grenoble Alpes - UFR Médecine
15 Hôpital Lariboisière
16 Service de Médecine interne et immunologie clinique [Rennes] = internal medicine and clinical immunology [Rennes]
17 CHU Pontchaillou [Rennes]
18 Service de Médecine Interne [CHU Rouen]
19 LYOS - Physiopathologie, diagnostic et traitements des maladies osseuses / Pathophysiology, Diagnosis & Treatments of Bone Diseases
20 Service de médecine interne [Lille]
21 CHU Saint-Antoine [AP-HP]
22 ROTHSCHILD FOUNDATION
23 CHU de Montpellier
24 Service Médecine Interne et immunologie clinique [CHU Toulouse]
25 Service Médecine interne et immunopathologie clinique [CHU Toulouse]
26 I3 - Immunologie - Immunopathologie - Immunothérapie
27 Service d'Immunologie [CHU Pitié-Salpétrière]
28 Service d'Ophtalmologie [CHU Pitié-Salpêtrière]

OBJECTIVES: To analyze the factors associated with response to anti-TNFα and to compare the efficacy and safety of infliximab (IFX) and adalimumab (ADA) in patients with refractory non infectious uveitis. METHODS: Observational multicenter study including 160 patients [median age of 31 [21-42] years with 39% of men] with refractory uveitis treated with anti-TNFα [IFX 5mg/kg at weeks 0, 2, 6 and every 5-6 weeks (n=98) and ADA 40mg/14days (n=62)]. Factors associated to complete response were assessed in multivariate analysis. Comparison between efficacy and safety of IFX and ADA was performed using a propensity score approach accounting for baseline characteristics. RESULTS: Main etiologies of uveitis included Behçet's disease (36%), juvenile idiopathic arthritis (22%), spondylarthropathies (10%) and sarcoidosis (6%). The overall response rate at 6 and 12 months was of 87% (26% of complete response) and 93% (28% of complete response), respectively. The median time to complete response was 2 (0-12) months. In multivariate analysis, Behçet's disease (SHR= 2.52 [1.35-7.71], p=0.004) and a number of uveitis flares before anti-TNFα greater than 5 (HR=1.97 [1.02-3.84], p=0.045) were associated with complete response to anti-TNFα. Side effects were reported in 28% of patients, including 12% of serious adverse events. IFX and ADA did not differ significantly in terms of occurrence of complete response (SHR=0.65 [0.25;1.71], p=0.39), serious side effects (SHR= 0.22 [0.04-1.25], p=0.089) or event free survival (SHR=0.55 [0.28;1.08], p=0.083). CONCLUSIONS: Anti-TNFα are highly effective in refractory inflammatory uveitis. Behçet's disease is associated with increase odds of response. IFX and ADA seem equivalent in terms of efficacy. This article is protected by copyright. All rights reserved

Keywords: safety; anti-TNFα; efficacy; refractory inflammatory uveitis

Domains: Life Sciences [q-bio]; Immunology; Immunotherapy; Life Sciences [q-bio]; Pharmaceutical sciences; Medication; Life Sciences [q-bio]; Human health and pathology; Sensory Organs

Hélène Vallet, Pascal Seve, Lucie Biard, Jean-Baptiste Fraison, Philip Bielefeld, et al.. Infliximab versus adalimumab in the treatment of refractory inflammatory uveitis: Multicenter study from the french uveitis network. Arthritis & rheumatology, 2016, 66 (6), pp.1522-1530. ⟨10.1002/art.39667⟩. ⟨hal-01301142⟩