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Manfred Zierhut, Albert O Edwards, Michal Kramer, Alan G Palestine, Ivan R Schwab, Ehud Zamir, Deshka Doycheva, Bianka Sobolewska; Biologicals inducing or reactivating uveitis. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1864.
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© ARVO (1962-2015); The Authors (2016-present)
To characterize first time uveitis or reactivated uveitis after treatment with biologic drugs.
Retrospective case controlled multicenter study from 6 sites. Patients under biologic therapy were included if they developed uveitis for the first time or experienced severe recurrences or more recurrences than before treatment with this agent. The clinical pattern of the new or recurrent uveitis, also available laboratory and imaging data, were analysed
Seventeen subjects in 6 sites were included, 9 female, 16 Caucasians and 1 African-American. Age at onset of uveitis ranged from 4-68 years(mean 32.1 years). Underlying disorders included Behçet’s Disease (2), ankylosing spondylitis (5), rheumatoid arthritis (2), anterior uveitis (4), and juvenile idiopathic arthritis (JIA) associated uveitis (4). Biologic agents inducing a first uveitis or recurrences of a known uveitis were etanercept (10), adalimumab (4), abatacept (2) and golimumab (1). Ten patients experienced severe recurrences, while a first episode of uveitis was induced in 7 patients (all under etanercept). Further analysis disclosed signs of sarcoidosis in 7 patients, which consisted of: sarcoidosis grad 1 on lung CT-scan along with anterior and posterior synechiae (1); bihilar lymphadenopathy in chest X-ray with serum lysozyme elevation and evolution from anterior to intermediate uveitis with snowballs (1); granulomatous keratic precipitates (KP)(5) of whom 2 patients had a change in the pattern from non-granulomatous to granulomatous KP, in another patient the typical unilateral HLA-B27 pattern developed into bilateral granulomatous anterior uveitis). Treatment mostly consisted of additional corticosteroid application, in stopping the initiating biological, and change to another biological.
We hereby report patients treated with biologic agents who developed severe recurrences of a previously known uveitis (10) or experienced a first uveitis episode (7). While it cannot be ruled out that the development of the uveitis may be independent of the used biologic agents, the pattern of sarcoidosis found in some of the patients may suggest a causative role, since it is known that biologic agents can induce sarcoidosis.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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