Biologic therapy in severe and refractory peripheral ulcerative keratitis (PUK). Multicenter study of 34 patients
Por:
Dominguez-Casas LC, Sánchez-Bilbao L, Calvo-Río V, Maíz O, Blanco A, Beltrán E, Martínez-Costa L, Demetrío-Pablo R, Del Buergo MÁ, Rubio-Romero E, Díaz-Valle D, Lopez-Gonzalez R, García-Aparicio ÁM, Mas AJ, Vegas-Revenga N, Castañeda S, Hernández JL, González-Gay MA and Blanco R
Publicada:
1 ago 2020
Ahead of Print:
15 may 2020
Resumen:
Purpose: We assessed the efficacy and safety of biologic therapy in severe and refractory Peripheral Ulcerative Keratitis (PUK).
Design: Open-label multicenter study of biologic-treated patients with severe PUK refractory to conventional immunosuppressive drugs.
Subjects: We studied 34 patients (44 affected eyes) (24 women/10 men; mean age, 55.26 +/- 17.4 years). PUK was associated with a well-defined condition in 29 of them (rheumatoid arthritis [n = 20], psoriatic arthritis [n = 2], inflammatory bowel disease [n = 2], Beh,cet disease [n = 1], granulomatosis with polyangiitis [n = 1], microscopic polyangiitis [n = 1], systemic lupus erythematosus [n = 1] and axial spondyloarthritis [n = 1]). Besides topical and oral systemic glucocorticoids, patients had received: methylprednisolone pulses [n = 9], and conventional immunosuppressive drugs, mainly methotrexate [n = 18], and leflunomide [n = 7]. Eleven patients had required ocular surgery prior to biologic therapy.
Methods: Following biologic therapy, baseline main outcomes were compared with those found at 1st week, 1st and 6th months and 1st year.
Main outcome measures: Efficacy and safety of biologic therapy. Efficacy was analyzed by the assessment of corneal inflammation (corneal thinning, central keratolysis and ocular perforation); other causes of ocular surface inflammation (scleritis, episcleritis); intraocular inflammation (uveitis); visual acuity and glucocorticoid sparing effect.
Results: The first biologic agents used were anti-TNFa drugs (n = 25); adalimumab (n = 16), infliximab (n = 8), etanercept (n = 1), and non-TNFa agents (n = 9); rituximab (n = 7), tocilizumab (n = 1) belimumab (n = 1) and abatacept (n = 1). During the follow-up, switching to a second biologic agent was required in 12 of the 25 (48%) patients treated with anti-TNF alpha drugs. However, no switching was required in those undergoing biologic therapy different from anti-TNF alpha agents. The main outcome variables showed a rapid and maintained improvement after a mean follow-up of 23.7 +/- 20 months. Major adverse effects were tachyphylaxis, relapsing respiratory infections, supraventricular tachycardia, pulmonary tuberculosis and death, one each.
Conclusions: Biologic therapy is effective and relatively safe in patients with severe and refractory PUK. Nonanti-TNF alpha agents appear to be effective in these patients. (C) 2020 Elsevier Inc. All rights reserved.
Filiaciones:
Dominguez-Casas LC:
Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
Sánchez-Bilbao L:
Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
Calvo-Río V:
Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
Maíz O:
Rheumatology and Ophthalmology, Hospital Donosti, San Sebastian, Spain
Blanco A:
Rheumatology and Ophthalmology, Hospital Donosti, San Sebastian, Spain
Beltrán E:
Rheumatology, Hospital del Mar, Barcelona, Spain
:
Ophthalmology, Hospital Peset Valencia, Spain
Demetrío-Pablo R:
Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
Del Buergo MÁ:
Rheumatology, Hospital Río Carrión, Palencia, Spain
Rubio-Romero E:
Rheumatology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Díaz-Valle D:
Ophthalmology, Hospital Clínico San Carlos, Madrid, Spain
Lopez-Gonzalez R:
Rheumatology, Complejo Hospitalario de Zamora, Spain
García-Aparicio ÁM:
Rheumatology, Hospital de Toledo, Spain
Mas AJ:
Rheumatology, Hospital Son Llàtzer, Palma de Mallorca, Spain
Vegas-Revenga N:
Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
Castañeda S:
Rheumatology, Hospital La Princesa, IIS-Princesa, Madrid, Spain
Hernández JL:
Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
González-Gay MA:
Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
Blanco R:
Rheumatology, Ophthalmology and Internal medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
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