Adalimumab yields superior outcomes vs. infliximab in Behçet’s-related uveitis
Adalimumab yielded better outcomes than infliximab in best-corrected visual acuity, retention and other areas among patients with uveitis related to Behçet’s disease, according to findings published in Arthritis & Rheumatology.
“According to the ‘Expert panel recommendations for the use of anti-TNF-alpha drugs in patients with ocular inflammatory disorders,’ published in 2014, anti-TNF therapy with infliximab (good-quality evidence) or adalimumab (moderate-quality evidence) may be considered as the first- or second-line corticosteroid-sparing therapy for patients with ophthalmic manifestations of Behçet’s disease, and infliximab may be considered as the first- or second-line treatment for acute exacerbations of pre-existing Behçet’s disease,” Belén Atienza-Mateo, MD, of Marqués de Valdecilla University Hospital, and colleagues wrote.
“In 2016, adalimumab was reported to be the only biologic drug that demonstrated efficacy in randomized double-blind phase 3 studies in non-infectious intermediate, posterior uveitis and panuveitis,” they added. “Consequently, adalimumab was approved by the EMA and the FDA in non-infectious non-anterior uveitis. [However], little is known of differences in the outcome of Behçet’s disease uveitis treated with infliximab or adalimumab.”
To analyze and compare the efficacy of infliximab (Remicade, Janssen) and adalimumab (Humira, AbbVie) as a first biologic in patients with refractory uveitis due to Behçet's disease, Atienza-Mateo and colleagues conducted an open-label multicenter study of 177 participants with 316 affected eyes. Among the participants, 103 patients received infliximab, while 74 were treated with adalimumab.
Dosing regimens for infliximab included 3 mg to 5 mg per kg intravenously at 0, 2 and 6 weeks, and every 4 to 8 weeks thereafter. For adalimumab, patients received 40 mg subcutaneously every other week, without a loading dose. The researchers compared efficacy, safety and retention rates between the two groups over a period of 1 year.
According to the researchers, participants in both groups demonstrated improvements in all ocular parameters. However, patients who received adalimumab saw significantly better outcomes in anterior chamber inflammation — 92.31% compared with 78.18% for infliximab (P = .06) — vitritis — 78.95% for infliximab compared with 93.33% for adalimumab (P = .04) — retinal vasculitis — 97% for infliximab compared with 95% for adalimumab — macular thickness and bestcorrected visual acuity (P = .001). Further, drug retention rates were 84.95% for infliximab and 95.24% for adalimumab (P = .042).
“Although our study showed a rapid and maintained improvement of all ocular parameters with both anti-TNF-alpha drugs, significant differences were observed regarding BCVA improvement mediated by adalimumab therapy,” Atienza-Mateo and colleagues wrote.
“Retention drug was also higher in the adalimumab group,” they noted. “This in part could be explained because of the route of administration since adalimumab is given subcutaneously in a rapid and comfortable way. Moreover, infusional reactions occur more frequently with infliximab due to its chimeric nature and, probably, the occurrence of anti-drug antibodies may also be higher with infliximab.” – by Jason Laday
Disclosure: Atienza-Mateo reports grant or research support from Celgene, GSK and Roche. Please see the full study for additional authors’ disclosures.