In patients with noninfectious, treatment-resistant uveitis, monoclonal tumor necrosis factor inhibitors (TNFi) adalimumab and infliximab displayed comparable efficacy and safety profiles, with no statistically significant difference in retention rates. Various therapeutic, clinical, and demographic variables appeared to have no significant effect on long-term drug retention, according to a study published in Clinical Rheumatology.

Proper medical management of uveitis is crucial for maintenance of ocular function and prevention of complications. In patients with refractory uveitis or for patients in whom steroids or conventional disease-modifying anti-rheumatic drugs (cDMARDs) are not an option, TNFis such as adalimumab and infliximab have become major components of available therapeutic regimens, revolutionizing treatment of uveitis. This was the first study to compare long-term drug survival of adalimumab and infliximab in patients with noninfectious uveitis.

A total of 108 patients (59.3% men; 188 eyes with uveitis) who had taken adalimumab (n=62) or infliximab (n=46) to treat uveitis were enrolled in a retrospective analysis. The majority (74.1%) of patients presented with bilateral manifestations and most cases (80.6%) were related to systemic disease, with Behçet disease by far the most common associated disorder. Participants had diagnoses of intermediate uveitis (2.8%), posterior uveitis (42.6%), or panuveitis (54.6%).


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No significant difference (log-rank P =.22) was detected between the drug retention rates of adalimumab and infliximab, and this lack of significance was consistent in separate analyses of participants with posterior uveitis (log-rank P =.42), panuveitis (log-rank P = .92), and retinal vasculitis (log-rank P =.53). Subgroup analysis of participants with Behcet disease also yielded no significant difference (log-rank P =.07) between treatment groups.

Secondary outcomes demonstrated a similar lack of statistical significance between groups.  Retention rates did not change significantly when evaluating gender (P =.09 for women; P =.61 for men) or therapeutic differences (P =.08 for monotherapy; log-rank P =.63 for combination therapy with cDMARDs; P =.79 for biologic-naive participants; P =.81 for prior biologic exposure).

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The safety profiles of adalimumab and infliximab were both acceptable. There were 2 adverse events reported in the adalimumab group, both of which involved urticarial rashes. In the infliximab cohort, there were 4 adverse events detailed, including dyspnea, dizziness, asthenia, and leukocytosis.

The investigators noted that the only study limitation was the retrospective nature of the investigation.

Both adalimumab and infliximab demonstrated excellent drug retention rates and comparable safety and efficacy in the treatment of refractory noninfectious uveitis variants, with no evidence of significant effects from a range of clinical, pharmacologic, and demographic variables. They should be considered essential well-tolerated second-line therapies in the treatment of resistant disease.

Reference

Fabiani C, Vitale A, Emmi G, et al. Long-term retention rates of adalimumab and infliximab in non-infectious intermediate, posterior, and panuveitis [published online April 3, 2018]. Clin Rheumatol. doi:10.1007/s10067-018-4069-3