Anti–Interleukin‐6 Receptor Tocilizumab for Severe Juvenile Idiopathic Arthritis–Associated Uveitis Refractory to Anti–Tumor Necrosis Factor Therapy: A Multicenter Study of Twenty‐Five Patients
Objective To assess the efficacy of tocilizumab (TCZ) for the treatment of juvenile idiopathic arthritis (JIA)–associated uveitis. Methods We conducted a multicenter study of patients with JIA‐associated uveitis that was refractory to conventional immunosuppressive drugs and anti–tumor necrosis fact...
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| Veröffentlicht in: | Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2017-03, Vol.69 (3), p.668-675 |
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| creator | Calvo‐Río, Vanesa Santos‐Gómez, Montserrat Calvo, Inmaculada González‐Fernández, M. Isabel López‐Montesinos, Berta Mesquida, Marina Adán, Alfredo Hernández, María Victoria Maíz, Olga Atanes, Antonio Bravo, Beatriz Modesto, Consuelo Díaz‐Cordovés, Gisela Palmou‐Fontana, Natalia Loricera, Javier González‐Vela, M. C. Demetrio‐Pablo, Rosalía Hernández, J. L. González‐Gay, Miguel A. Blanco, Ricardo |
| description | Objective
To assess the efficacy of tocilizumab (TCZ) for the treatment of juvenile idiopathic arthritis (JIA)–associated uveitis.
Methods
We conducted a multicenter study of patients with JIA‐associated uveitis that was refractory to conventional immunosuppressive drugs and anti–tumor necrosis factor (anti‐TNF) agents.
Results
We assessed 25 patients (21 female; 47 affected eyes) with a mean ± SD age of 18.5 ± 8.3 years. Uveitis was bilateral in 22 patients. Cystoid macular edema was present in 9 patients. Ocular sequelae found at initiation of TCZ included cataracts (n = 13), glaucoma (n = 7), synechiae (n = 10), band keratopathy (n = 12), maculopathy (n = 9), and amblyopia (n = 5). Before TCZ, patients had received corticosteroids, conventional immunosuppressive drugs, and biologic agents (median 2 [range 1–5]), including adalimumab (n = 24), etanercept (n = 8), infliximab (n = 7), abatacept (n = 6), rituximab (n = 2), anakinra (n = 1), and golimumab (n = 1). Patients received 8 mg/kg TCZ intravenously every 4 weeks in most cases. TCZ yielded rapid and maintained improvement in all ocular parameters. After 6 months of therapy, 79.2% of patients showed improvement in anterior chamber cell numbers, and 88.2% showed improvement after 1 year. Central macular thickness measured by optical coherence tomography in patients with cystoid macular edema decreased from a mean ± SD of 401.7 ± 86.8 μm to 259.1 ± 39.5 μm after 6 months of TCZ (P = 0.012). The best‐corrected visual acuity increased from 0.56 ± 0.35 to 0.64 ± 0.32 (P |
| doi_str_mv | 10.1002/art.39940 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1877848943</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4317200511</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5150-db43d2cd52bf12463e18c7d93859e1cfff4df3585d391d34358e3c05f6b896123</originalsourceid><addsrcrecordid>eNqNks1u1DAQxyMEolXpgRdAlrjAYVt_xE7MLapYuqh8qE3PUWKPtS7ZZGs7W4VTH6ESj8Vb9ElwulsOSCB88czo57_Hnn-SvCT4iGBMj2sXjpiUKX6S7FNGxYxTzJ8-xkSSveTQ-yscl8ywwPx5skczIUXGxX7ys-iCvb_9segCuBaGb7a7v70T6BwUrEPvUNkr29rvw6pukIn5BWzAAfo4bKCzLaCFtv26DkurUOHC0tlgfdQrvI8H6wAaXW5gKkZJ42oVNUcUerS7txxWUfQzKNf7yMwfAFQuwdXr8R0q0KehDVbB1B66CIMeUW9QeRMLY2x0bjeAvtbBxty_SJ6ZuvVwuNsPksv5-_LkdHb25cPipDibKU44nukmZZoqzWljCE0FA5KrTEuWcwlEGWNSbRjPuWaSaJbGEJjC3Igml4JQdpC82equXX89gA_VynoFbVt30A--InmW5WkuU_YfKONMpFRO6Os_0Kt-cF18SKSkoDSOWP6byighcchTh2-31PSt3oGp1s6uajdWBFeTa6romurBNZF9tVMcmhXo3-SjRyJwvAVu4rzHvytVxXm5lfwFghHSuw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1872110972</pqid></control><display><type>article</type><title>Anti–Interleukin‐6 Receptor Tocilizumab for Severe Juvenile Idiopathic Arthritis–Associated Uveitis Refractory to Anti–Tumor Necrosis Factor Therapy: A Multicenter Study of Twenty‐Five Patients</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Calvo‐Río, Vanesa ; Santos‐Gómez, Montserrat ; Calvo, Inmaculada ; González‐Fernández, M. Isabel ; López‐Montesinos, Berta ; Mesquida, Marina ; Adán, Alfredo ; Hernández, María Victoria ; Maíz, Olga ; Atanes, Antonio ; Bravo, Beatriz ; Modesto, Consuelo ; Díaz‐Cordovés, Gisela ; Palmou‐Fontana, Natalia ; Loricera, Javier ; González‐Vela, M. C. ; Demetrio‐Pablo, Rosalía ; Hernández, J. L. ; González‐Gay, Miguel A. ; Blanco, Ricardo</creator><creatorcontrib>Calvo‐Río, Vanesa ; Santos‐Gómez, Montserrat ; Calvo, Inmaculada ; González‐Fernández, M. Isabel ; López‐Montesinos, Berta ; Mesquida, Marina ; Adán, Alfredo ; Hernández, María Victoria ; Maíz, Olga ; Atanes, Antonio ; Bravo, Beatriz ; Modesto, Consuelo ; Díaz‐Cordovés, Gisela ; Palmou‐Fontana, Natalia ; Loricera, Javier ; González‐Vela, M. C. ; Demetrio‐Pablo, Rosalía ; Hernández, J. L. ; González‐Gay, Miguel A. ; Blanco, Ricardo</creatorcontrib><description>Objective
To assess the efficacy of tocilizumab (TCZ) for the treatment of juvenile idiopathic arthritis (JIA)–associated uveitis.
Methods
We conducted a multicenter study of patients with JIA‐associated uveitis that was refractory to conventional immunosuppressive drugs and anti–tumor necrosis factor (anti‐TNF) agents.
Results
We assessed 25 patients (21 female; 47 affected eyes) with a mean ± SD age of 18.5 ± 8.3 years. Uveitis was bilateral in 22 patients. Cystoid macular edema was present in 9 patients. Ocular sequelae found at initiation of TCZ included cataracts (n = 13), glaucoma (n = 7), synechiae (n = 10), band keratopathy (n = 12), maculopathy (n = 9), and amblyopia (n = 5). Before TCZ, patients had received corticosteroids, conventional immunosuppressive drugs, and biologic agents (median 2 [range 1–5]), including adalimumab (n = 24), etanercept (n = 8), infliximab (n = 7), abatacept (n = 6), rituximab (n = 2), anakinra (n = 1), and golimumab (n = 1). Patients received 8 mg/kg TCZ intravenously every 4 weeks in most cases. TCZ yielded rapid and maintained improvement in all ocular parameters. After 6 months of therapy, 79.2% of patients showed improvement in anterior chamber cell numbers, and 88.2% showed improvement after 1 year. Central macular thickness measured by optical coherence tomography in patients with cystoid macular edema decreased from a mean ± SD of 401.7 ± 86.8 μm to 259.1 ± 39.5 μm after 6 months of TCZ (P = 0.012). The best‐corrected visual acuity increased from 0.56 ± 0.35 to 0.64 ± 0.32 (P < 0.01). After a median follow‐up of 12 months, visual improvement persisted, and complete remission of uveitis was observed in 19 of 25 patients. Significant reduction in the prednisone dosage was also achieved. The main adverse effects were severe autoimmune thrombocytopenia in 1 patient, pneumonia and then autoimmune anemia and thrombocytopenia in 1 patient, and viral conjunctivitis and bullous impetigo in 1 patient.
Conclusion
TCZ appears to be a useful therapy for severe refractory JIA‐associated uveitis.</description><identifier>ISSN: 2326-5191</identifier><identifier>EISSN: 2326-5205</identifier><identifier>DOI: 10.1002/art.39940</identifier><identifier>PMID: 27696756</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Acuity ; Adolescent ; Adult ; Anemia ; Anterior chamber ; Antibodies, Monoclonal, Humanized - therapeutic use ; Anticancer properties ; Arthritis ; Arthritis, Juvenile - complications ; Cataracts ; Child ; Complications ; Conjunctivitis ; Corticoids ; Corticosteroids ; Dosage ; Drugs ; Edema ; Etanercept ; Eye (anatomy) ; Female ; Glaucoma ; Humans ; Immunosuppressive agents ; Impetigo ; Infliximab ; Interleukin 1 receptor antagonist ; Interleukin 6 ; Interleukins ; Male ; Monoclonal antibodies ; Necrosis ; Optical Coherence Tomography ; Patients ; Prednisone ; Receptors, Interleukin-6 - antagonists & inhibitors ; Remission ; Retrospective Studies ; Rituximab ; Severity of Illness Index ; Side effects ; Therapy ; Thrombocytopenia ; Tumor necrosis factor ; Tumor Necrosis Factor-alpha - antagonists & inhibitors ; Tumor necrosis factor-TNF ; Uveitis - drug therapy ; Uveitis - etiology ; Visual acuity ; Visual observation ; Young Adult</subject><ispartof>Arthritis & rheumatology (Hoboken, N.J.), 2017-03, Vol.69 (3), p.668-675</ispartof><rights>2016, American College of Rheumatology</rights><rights>2016, American College of Rheumatology.</rights><rights>2017, American College of Rheumatology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5150-db43d2cd52bf12463e18c7d93859e1cfff4df3585d391d34358e3c05f6b896123</citedby><cites>FETCH-LOGICAL-c5150-db43d2cd52bf12463e18c7d93859e1cfff4df3585d391d34358e3c05f6b896123</cites><orcidid>0000-0001-6657-2333</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fart.39940$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fart.39940$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27696756$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Calvo‐Río, Vanesa</creatorcontrib><creatorcontrib>Santos‐Gómez, Montserrat</creatorcontrib><creatorcontrib>Calvo, Inmaculada</creatorcontrib><creatorcontrib>González‐Fernández, M. Isabel</creatorcontrib><creatorcontrib>López‐Montesinos, Berta</creatorcontrib><creatorcontrib>Mesquida, Marina</creatorcontrib><creatorcontrib>Adán, Alfredo</creatorcontrib><creatorcontrib>Hernández, María Victoria</creatorcontrib><creatorcontrib>Maíz, Olga</creatorcontrib><creatorcontrib>Atanes, Antonio</creatorcontrib><creatorcontrib>Bravo, Beatriz</creatorcontrib><creatorcontrib>Modesto, Consuelo</creatorcontrib><creatorcontrib>Díaz‐Cordovés, Gisela</creatorcontrib><creatorcontrib>Palmou‐Fontana, Natalia</creatorcontrib><creatorcontrib>Loricera, Javier</creatorcontrib><creatorcontrib>González‐Vela, M. C.</creatorcontrib><creatorcontrib>Demetrio‐Pablo, Rosalía</creatorcontrib><creatorcontrib>Hernández, J. L.</creatorcontrib><creatorcontrib>González‐Gay, Miguel A.</creatorcontrib><creatorcontrib>Blanco, Ricardo</creatorcontrib><title>Anti–Interleukin‐6 Receptor Tocilizumab for Severe Juvenile Idiopathic Arthritis–Associated Uveitis Refractory to Anti–Tumor Necrosis Factor Therapy: A Multicenter Study of Twenty‐Five Patients</title><title>Arthritis & rheumatology (Hoboken, N.J.)</title><addtitle>Arthritis Rheumatol</addtitle><description>Objective
To assess the efficacy of tocilizumab (TCZ) for the treatment of juvenile idiopathic arthritis (JIA)–associated uveitis.
Methods
We conducted a multicenter study of patients with JIA‐associated uveitis that was refractory to conventional immunosuppressive drugs and anti–tumor necrosis factor (anti‐TNF) agents.
Results
We assessed 25 patients (21 female; 47 affected eyes) with a mean ± SD age of 18.5 ± 8.3 years. Uveitis was bilateral in 22 patients. Cystoid macular edema was present in 9 patients. Ocular sequelae found at initiation of TCZ included cataracts (n = 13), glaucoma (n = 7), synechiae (n = 10), band keratopathy (n = 12), maculopathy (n = 9), and amblyopia (n = 5). Before TCZ, patients had received corticosteroids, conventional immunosuppressive drugs, and biologic agents (median 2 [range 1–5]), including adalimumab (n = 24), etanercept (n = 8), infliximab (n = 7), abatacept (n = 6), rituximab (n = 2), anakinra (n = 1), and golimumab (n = 1). Patients received 8 mg/kg TCZ intravenously every 4 weeks in most cases. TCZ yielded rapid and maintained improvement in all ocular parameters. After 6 months of therapy, 79.2% of patients showed improvement in anterior chamber cell numbers, and 88.2% showed improvement after 1 year. Central macular thickness measured by optical coherence tomography in patients with cystoid macular edema decreased from a mean ± SD of 401.7 ± 86.8 μm to 259.1 ± 39.5 μm after 6 months of TCZ (P = 0.012). The best‐corrected visual acuity increased from 0.56 ± 0.35 to 0.64 ± 0.32 (P < 0.01). After a median follow‐up of 12 months, visual improvement persisted, and complete remission of uveitis was observed in 19 of 25 patients. Significant reduction in the prednisone dosage was also achieved. The main adverse effects were severe autoimmune thrombocytopenia in 1 patient, pneumonia and then autoimmune anemia and thrombocytopenia in 1 patient, and viral conjunctivitis and bullous impetigo in 1 patient.
Conclusion
TCZ appears to be a useful therapy for severe refractory JIA‐associated uveitis.</description><subject>Acuity</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Anemia</subject><subject>Anterior chamber</subject><subject>Antibodies, Monoclonal, Humanized - therapeutic use</subject><subject>Anticancer properties</subject><subject>Arthritis</subject><subject>Arthritis, Juvenile - complications</subject><subject>Cataracts</subject><subject>Child</subject><subject>Complications</subject><subject>Conjunctivitis</subject><subject>Corticoids</subject><subject>Corticosteroids</subject><subject>Dosage</subject><subject>Drugs</subject><subject>Edema</subject><subject>Etanercept</subject><subject>Eye (anatomy)</subject><subject>Female</subject><subject>Glaucoma</subject><subject>Humans</subject><subject>Immunosuppressive agents</subject><subject>Impetigo</subject><subject>Infliximab</subject><subject>Interleukin 1 receptor antagonist</subject><subject>Interleukin 6</subject><subject>Interleukins</subject><subject>Male</subject><subject>Monoclonal antibodies</subject><subject>Necrosis</subject><subject>Optical Coherence Tomography</subject><subject>Patients</subject><subject>Prednisone</subject><subject>Receptors, Interleukin-6 - antagonists & inhibitors</subject><subject>Remission</subject><subject>Retrospective Studies</subject><subject>Rituximab</subject><subject>Severity of Illness Index</subject><subject>Side effects</subject><subject>Therapy</subject><subject>Thrombocytopenia</subject><subject>Tumor necrosis factor</subject><subject>Tumor Necrosis Factor-alpha - antagonists & inhibitors</subject><subject>Tumor necrosis factor-TNF</subject><subject>Uveitis - drug therapy</subject><subject>Uveitis - etiology</subject><subject>Visual acuity</subject><subject>Visual observation</subject><subject>Young Adult</subject><issn>2326-5191</issn><issn>2326-5205</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNks1u1DAQxyMEolXpgRdAlrjAYVt_xE7MLapYuqh8qE3PUWKPtS7ZZGs7W4VTH6ESj8Vb9ElwulsOSCB88czo57_Hnn-SvCT4iGBMj2sXjpiUKX6S7FNGxYxTzJ8-xkSSveTQ-yscl8ywwPx5skczIUXGxX7ys-iCvb_9segCuBaGb7a7v70T6BwUrEPvUNkr29rvw6pukIn5BWzAAfo4bKCzLaCFtv26DkurUOHC0tlgfdQrvI8H6wAaXW5gKkZJ42oVNUcUerS7txxWUfQzKNf7yMwfAFQuwdXr8R0q0KehDVbB1B66CIMeUW9QeRMLY2x0bjeAvtbBxty_SJ6ZuvVwuNsPksv5-_LkdHb25cPipDibKU44nukmZZoqzWljCE0FA5KrTEuWcwlEGWNSbRjPuWaSaJbGEJjC3Igml4JQdpC82equXX89gA_VynoFbVt30A--InmW5WkuU_YfKONMpFRO6Os_0Kt-cF18SKSkoDSOWP6byighcchTh2-31PSt3oGp1s6uajdWBFeTa6romurBNZF9tVMcmhXo3-SjRyJwvAVu4rzHvytVxXm5lfwFghHSuw</recordid><startdate>201703</startdate><enddate>201703</enddate><creator>Calvo‐Río, Vanesa</creator><creator>Santos‐Gómez, Montserrat</creator><creator>Calvo, Inmaculada</creator><creator>González‐Fernández, M. Isabel</creator><creator>López‐Montesinos, Berta</creator><creator>Mesquida, Marina</creator><creator>Adán, Alfredo</creator><creator>Hernández, María Victoria</creator><creator>Maíz, Olga</creator><creator>Atanes, Antonio</creator><creator>Bravo, Beatriz</creator><creator>Modesto, Consuelo</creator><creator>Díaz‐Cordovés, Gisela</creator><creator>Palmou‐Fontana, Natalia</creator><creator>Loricera, Javier</creator><creator>González‐Vela, M. C.</creator><creator>Demetrio‐Pablo, Rosalía</creator><creator>Hernández, J. L.</creator><creator>González‐Gay, Miguel A.</creator><creator>Blanco, Ricardo</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-6657-2333</orcidid></search><sort><creationdate>201703</creationdate><title>Anti–Interleukin‐6 Receptor Tocilizumab for Severe Juvenile Idiopathic Arthritis–Associated Uveitis Refractory to Anti–Tumor Necrosis Factor Therapy: A Multicenter Study of Twenty‐Five Patients</title><author>Calvo‐Río, Vanesa ; Santos‐Gómez, Montserrat ; Calvo, Inmaculada ; González‐Fernández, M. Isabel ; López‐Montesinos, Berta ; Mesquida, Marina ; Adán, Alfredo ; Hernández, María Victoria ; Maíz, Olga ; Atanes, Antonio ; Bravo, Beatriz ; Modesto, Consuelo ; Díaz‐Cordovés, Gisela ; Palmou‐Fontana, Natalia ; Loricera, Javier ; González‐Vela, M. C. ; Demetrio‐Pablo, Rosalía ; Hernández, J. L. ; González‐Gay, Miguel A. ; Blanco, Ricardo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5150-db43d2cd52bf12463e18c7d93859e1cfff4df3585d391d34358e3c05f6b896123</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acuity</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Anemia</topic><topic>Anterior chamber</topic><topic>Antibodies, Monoclonal, Humanized - therapeutic use</topic><topic>Anticancer properties</topic><topic>Arthritis</topic><topic>Arthritis, Juvenile - complications</topic><topic>Cataracts</topic><topic>Child</topic><topic>Complications</topic><topic>Conjunctivitis</topic><topic>Corticoids</topic><topic>Corticosteroids</topic><topic>Dosage</topic><topic>Drugs</topic><topic>Edema</topic><topic>Etanercept</topic><topic>Eye (anatomy)</topic><topic>Female</topic><topic>Glaucoma</topic><topic>Humans</topic><topic>Immunosuppressive agents</topic><topic>Impetigo</topic><topic>Infliximab</topic><topic>Interleukin 1 receptor antagonist</topic><topic>Interleukin 6</topic><topic>Interleukins</topic><topic>Male</topic><topic>Monoclonal antibodies</topic><topic>Necrosis</topic><topic>Optical Coherence Tomography</topic><topic>Patients</topic><topic>Prednisone</topic><topic>Receptors, Interleukin-6 - antagonists & inhibitors</topic><topic>Remission</topic><topic>Retrospective Studies</topic><topic>Rituximab</topic><topic>Severity of Illness Index</topic><topic>Side effects</topic><topic>Therapy</topic><topic>Thrombocytopenia</topic><topic>Tumor necrosis factor</topic><topic>Tumor Necrosis Factor-alpha - antagonists & inhibitors</topic><topic>Tumor necrosis factor-TNF</topic><topic>Uveitis - drug therapy</topic><topic>Uveitis - etiology</topic><topic>Visual acuity</topic><topic>Visual observation</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Calvo‐Río, Vanesa</creatorcontrib><creatorcontrib>Santos‐Gómez, Montserrat</creatorcontrib><creatorcontrib>Calvo, Inmaculada</creatorcontrib><creatorcontrib>González‐Fernández, M. Isabel</creatorcontrib><creatorcontrib>López‐Montesinos, Berta</creatorcontrib><creatorcontrib>Mesquida, Marina</creatorcontrib><creatorcontrib>Adán, Alfredo</creatorcontrib><creatorcontrib>Hernández, María Victoria</creatorcontrib><creatorcontrib>Maíz, Olga</creatorcontrib><creatorcontrib>Atanes, Antonio</creatorcontrib><creatorcontrib>Bravo, Beatriz</creatorcontrib><creatorcontrib>Modesto, Consuelo</creatorcontrib><creatorcontrib>Díaz‐Cordovés, Gisela</creatorcontrib><creatorcontrib>Palmou‐Fontana, Natalia</creatorcontrib><creatorcontrib>Loricera, Javier</creatorcontrib><creatorcontrib>González‐Vela, M. C.</creatorcontrib><creatorcontrib>Demetrio‐Pablo, Rosalía</creatorcontrib><creatorcontrib>Hernández, J. L.</creatorcontrib><creatorcontrib>González‐Gay, Miguel A.</creatorcontrib><creatorcontrib>Blanco, Ricardo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Arthritis & rheumatology (Hoboken, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Calvo‐Río, Vanesa</au><au>Santos‐Gómez, Montserrat</au><au>Calvo, Inmaculada</au><au>González‐Fernández, M. Isabel</au><au>López‐Montesinos, Berta</au><au>Mesquida, Marina</au><au>Adán, Alfredo</au><au>Hernández, María Victoria</au><au>Maíz, Olga</au><au>Atanes, Antonio</au><au>Bravo, Beatriz</au><au>Modesto, Consuelo</au><au>Díaz‐Cordovés, Gisela</au><au>Palmou‐Fontana, Natalia</au><au>Loricera, Javier</au><au>González‐Vela, M. C.</au><au>Demetrio‐Pablo, Rosalía</au><au>Hernández, J. L.</au><au>González‐Gay, Miguel A.</au><au>Blanco, Ricardo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anti–Interleukin‐6 Receptor Tocilizumab for Severe Juvenile Idiopathic Arthritis–Associated Uveitis Refractory to Anti–Tumor Necrosis Factor Therapy: A Multicenter Study of Twenty‐Five Patients</atitle><jtitle>Arthritis & rheumatology (Hoboken, N.J.)</jtitle><addtitle>Arthritis Rheumatol</addtitle><date>2017-03</date><risdate>2017</risdate><volume>69</volume><issue>3</issue><spage>668</spage><epage>675</epage><pages>668-675</pages><issn>2326-5191</issn><eissn>2326-5205</eissn><abstract>Objective
To assess the efficacy of tocilizumab (TCZ) for the treatment of juvenile idiopathic arthritis (JIA)–associated uveitis.
Methods
We conducted a multicenter study of patients with JIA‐associated uveitis that was refractory to conventional immunosuppressive drugs and anti–tumor necrosis factor (anti‐TNF) agents.
Results
We assessed 25 patients (21 female; 47 affected eyes) with a mean ± SD age of 18.5 ± 8.3 years. Uveitis was bilateral in 22 patients. Cystoid macular edema was present in 9 patients. Ocular sequelae found at initiation of TCZ included cataracts (n = 13), glaucoma (n = 7), synechiae (n = 10), band keratopathy (n = 12), maculopathy (n = 9), and amblyopia (n = 5). Before TCZ, patients had received corticosteroids, conventional immunosuppressive drugs, and biologic agents (median 2 [range 1–5]), including adalimumab (n = 24), etanercept (n = 8), infliximab (n = 7), abatacept (n = 6), rituximab (n = 2), anakinra (n = 1), and golimumab (n = 1). Patients received 8 mg/kg TCZ intravenously every 4 weeks in most cases. TCZ yielded rapid and maintained improvement in all ocular parameters. After 6 months of therapy, 79.2% of patients showed improvement in anterior chamber cell numbers, and 88.2% showed improvement after 1 year. Central macular thickness measured by optical coherence tomography in patients with cystoid macular edema decreased from a mean ± SD of 401.7 ± 86.8 μm to 259.1 ± 39.5 μm after 6 months of TCZ (P = 0.012). The best‐corrected visual acuity increased from 0.56 ± 0.35 to 0.64 ± 0.32 (P < 0.01). After a median follow‐up of 12 months, visual improvement persisted, and complete remission of uveitis was observed in 19 of 25 patients. Significant reduction in the prednisone dosage was also achieved. The main adverse effects were severe autoimmune thrombocytopenia in 1 patient, pneumonia and then autoimmune anemia and thrombocytopenia in 1 patient, and viral conjunctivitis and bullous impetigo in 1 patient.
Conclusion
TCZ appears to be a useful therapy for severe refractory JIA‐associated uveitis.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>27696756</pmid><doi>10.1002/art.39940</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-6657-2333</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2326-5191 |
| ispartof | Arthritis & rheumatology (Hoboken, N.J.), 2017-03, Vol.69 (3), p.668-675 |
| issn | 2326-5191 2326-5205 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1877848943 |
| source | Wiley Online Library - AutoHoldings Journals; MEDLINE; Alma/SFX Local Collection |
| subjects | Acuity Adolescent Adult Anemia Anterior chamber Antibodies, Monoclonal, Humanized - therapeutic use Anticancer properties Arthritis Arthritis, Juvenile - complications Cataracts Child Complications Conjunctivitis Corticoids Corticosteroids Dosage Drugs Edema Etanercept Eye (anatomy) Female Glaucoma Humans Immunosuppressive agents Impetigo Infliximab Interleukin 1 receptor antagonist Interleukin 6 Interleukins Male Monoclonal antibodies Necrosis Optical Coherence Tomography Patients Prednisone Receptors, Interleukin-6 - antagonists & inhibitors Remission Retrospective Studies Rituximab Severity of Illness Index Side effects Therapy Thrombocytopenia Tumor necrosis factor Tumor Necrosis Factor-alpha - antagonists & inhibitors Tumor necrosis factor-TNF Uveitis - drug therapy Uveitis - etiology Visual acuity Visual observation Young Adult |
| title | Anti–Interleukin‐6 Receptor Tocilizumab for Severe Juvenile Idiopathic Arthritis–Associated Uveitis Refractory to Anti–Tumor Necrosis Factor Therapy: A Multicenter Study of Twenty‐Five Patients |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-07T15%3A10%3A02IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Anti%E2%80%93Interleukin%E2%80%906%20Receptor%20Tocilizumab%20for%20Severe%20Juvenile%20Idiopathic%20Arthritis%E2%80%93Associated%20Uveitis%20Refractory%20to%20Anti%E2%80%93Tumor%20Necrosis%20Factor%20Therapy:%20A%20Multicenter%20Study%20of%20Twenty%E2%80%90Five%20Patients&rft.jtitle=Arthritis%20&%20rheumatology%20(Hoboken,%20N.J.)&rft.au=Calvo%E2%80%90R%C3%ADo,%20Vanesa&rft.date=2017-03&rft.volume=69&rft.issue=3&rft.spage=668&rft.epage=675&rft.pages=668-675&rft.issn=2326-5191&rft.eissn=2326-5205&rft_id=info:doi/10.1002/art.39940&rft_dat=%3Cproquest_cross%3E4317200511%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1872110972&rft_id=info:pmid/27696756&rfr_iscdi=true |