Abstract
Purpose :
Behçet’s disease (BD) is a recurrent multisystem vasculitis associated with a blinding uveitis. The advent of TNF-α inhibitors have significantly improved treatment, however comparative studies between conventional disease-modifying antirheumatic drugs (DMARDs) and biologic DMARDs in BD are limited. As retention time is a measure of drug effectiveness and tolerability, we compared this in patients with BD uveitis.
Methods :
Retrospective case review of patients who met the revised International Criteria for Behçet’s Disease (ICBD) treated at the Royal Victorian Eye and Ear Hospital, Australia, between 1985–2021. Demographic, ophthalmic and systemic features, DMARD use and reasons for discontinuation were recorded. Retention time was calculated as total days on drug and number of days per person within each DMARD group.
Results :
Forty-eight patients (37 males) with a median age of 28.6 years (IQR 25.4–35.0) were followed-up for a median of 7.8 years (IQR 2.6–13.9). At initial presentation, exactly half had bilateral disease (N=24), and of the 62 eyes with uveitis (16 anterior uveitis, 11 intermediate, 2 posterior and 33 panuveitis) the median logMAR visual acuity was 0.176. During the first visit, 33 patients met ICBD criteria, and the systemic manifestations were oral ulcers (N=33), genital ulcers (N=11), skin (N=7), joint (N=6), and vascular (N=1). Corticosteroid sparing agents used were Cyclosporin (CSA, N=24), Mycophenolate (N=22), Azathioprine (N=21), Methotrexate (N=15), Adalimumab (ADA, N=15), Infliximab (IFX, N=2), and Rituximab (RTX, N=1). Total median drug retention time was 1064, 704, 231, 623, and 917 days, respectively, and 44.3, 32.0, 11.0, 41.5, and 61.1 days per person after adjusting for number of patients per drug (not calculated for IFX and RTX due to low use). DMARDs were discontinued 119 times and the reasons for cessation were adverse reaction (N=34), failure of treatment (N=28), poor adherence (N=25), sustained quiescence (N=15), loss to follow-up (N=14), and unclear documentation (N=3).
Conclusions :
Our data suggests that the tolerability and efficacy, as measured with retention time, of ADA is at least comparable to, and possibly better than cDMARDs in young males with BD, who often suffer from vision threatening disease at first presentation. Median drug retention time for CSA was longer than ADA but not after adjusting for patients in each DMARD group.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.