Letter to the Editor
Resolution of Refractory Uveitis, Switching Anti-TNF Treatment
Resolución de uveítis refractaria, cambiando el tratamiento anti-TNF
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class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oftalmología, Hospital de Cabueñes, Gijón, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Resolución de uveítis refractaria, cambiando el tratamiento anti-TNF" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1440 "Ancho" => 1301 "Tamanyo" => 327942 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Optical coherence (left) and retinal tomography (right) of the patient's right eye at 7 months after treatment with infliximab (A) and 2 (B) and 4 (C) months after switching anti-TNF -α treatment to adalimumab.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">TNF-α plays a role in the induction and maintenance of inflammation in autoimmune disease, hence the TNF-α inhibitors are used successfully in the control of certain systemic diseases or autoinmunitarias.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Uveitis is an intraocular inflammation-associated to autoimmune systemic diseases, in which effectively blocking TNF-α<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> constitutes one of the most important advances in recent years in the treatment of non-infectious uveitis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The different anti-TNF-α agents do not have the same efficacy on ocular<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> inflammation and 3 major questions remain to be resolved (when to initiate therapy with an agent, at what dose, duration, etc.).<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Changing biologic therapy works in some cases.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a patient with idiopathic uveitis, papillitis, and EMQ, who after 1 year of treatment with prednisone, cyclosporine, azathioprine, and infliximab had no improvement and underwent a change in anti-TNF-α treatment to adalimumab, achieving a major clinical response within 2 months.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In July 2009, a 58-year-old male came to the office complaining of pain in the right eye. Ophthalmologic examination showed Tyndall sign (+), vitritis (++), papillitis with periphlebitis around the papilla, and cystoid emerging macular edema (CME) with visual acuity (VA) of 0.5. The anamnesis for connective tissue disease and spondyloarthritis was negative and the analytical studies had not relevant findings, with negative HLA-B27. The first treatment was transeptal infiltration with triamcinolone acetonide, cyclosporine (5<span class="elsevierStyleHsp" style=""></span>mg/kg/day), and prednisone (60<span class="elsevierStyleHsp" style=""></span>mg/day). In August the patient presented a respiratory infection that required hospitalization, so we discontinued cyclosporine and prednisone was reduced (30<span class="elsevierStyleHsp" style=""></span>mg/day).</p><p id="par0030" class="elsevierStylePara elsevierViewall">In January 2010 the treatment was changed to azathioprine (100<span class="elsevierStyleHsp" style=""></span>mg/day), prednisone (40<span class="elsevierStyleHsp" style=""></span>mg/day), and infliximab (5<span class="elsevierStyleHsp" style=""></span>mg/kg/day, weeks 0, 2, 6, and then every 8 weeks). No improvement was seen and by April 2010 treatment with infliximab was reduced to a dose every 4 weeks, and azathioprine was increased to 150<span class="elsevierStyleHsp" style=""></span>mg/day.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In August 2010, the patient still had pain, papillitis, and EMQ (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A) and 0.2 of VA, so we switched the anti-TNF-α to adalimumab (40<span class="elsevierStyleHsp" style=""></span>mg/s every 2 weeks) maintaining azathioprine. After a month with this treatment the VA improved to 0.4 and the pain disappeared. At 2 months, papillitis decreased (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B), and AV reached 0.5. In December 2010 the patient remained stable (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C) with adalimumab treatment and azathioprine (100<span class="elsevierStyleHsp" style=""></span>mg/day).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">There is some evidence that not all anti-TNF-α have the same efficacy in the treatment of uveítis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Etanercept (a p75 TNF-α receptor and human IgG Fc fusion protein) has demonstrated efficacy in treating uveítis<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3,5</span></a>; however, infliximab (chimeric monoclonal antibody) and adalimumab (monoclonal human antibody) may be effective in the treatment of refractary<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–9</span></a> uveitis. There is no comparative data to support the superiority of one antibody over the other, and influencing this choice we find, among others, the route of administration and patient<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> preference. In case of an absence of response to anti-TNF, which can be seen, among others, with infliximab due to antichimeric antibodies, switching to a second anti-TNF antibody may be effective as has been observed in other inflammatory diseases.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This case shows that adalimumab is an effective drug in the treatment of uveitis refractory to conventional treatment, even in cases that did not respond to other anti-TNF-α. Therefore, the first choice of anti-TNF-α did not produce satisfactory effects after a few months, and the best option was to change the anti-TNF-α.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: González-Suárez S, et al. Resolución de uveítis refractaria, cambiando el tratamiento anti-TNF. Reumatol Clin. 2012. <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2012.02.005">http://dx.doi.org/10.1016/j.reuma.2012.02.005</span>.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1440 "Ancho" => 1301 "Tamanyo" => 327942 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Optical coherence (left) and retinal tomography (right) of the patient's right eye at 7 months after treatment with infliximab (A) and 2 (B) and 4 (C) months after switching anti-TNF -α treatment to adalimumab.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TNFa blockade in human diseases: an overview of efficacy and safety" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 13 | 24 |
| 2024 October | 30 | 24 | 54 |
| 2024 September | 47 | 22 | 69 |
| 2024 August | 62 | 36 | 98 |
| 2024 July | 54 | 32 | 86 |
| 2024 June | 55 | 30 | 85 |
| 2024 May | 64 | 31 | 95 |
| 2024 April | 52 | 22 | 74 |
| 2024 March | 75 | 35 | 110 |
| 2024 February | 71 | 27 | 98 |
| 2024 January | 51 | 30 | 81 |
| 2023 December | 55 | 37 | 92 |
| 2023 November | 68 | 44 | 112 |
| 2023 October | 65 | 31 | 96 |
| 2023 September | 50 | 39 | 89 |
| 2023 August | 32 | 11 | 43 |
| 2023 July | 35 | 25 | 60 |
| 2023 June | 28 | 22 | 50 |
| 2023 May | 40 | 16 | 56 |
| 2023 April | 35 | 7 | 42 |
| 2023 March | 40 | 25 | 65 |
| 2023 February | 46 | 29 | 75 |
| 2023 January | 29 | 16 | 45 |
| 2022 December | 51 | 26 | 77 |
| 2022 November | 59 | 33 | 92 |
| 2022 October | 45 | 31 | 76 |
| 2022 September | 47 | 34 | 81 |
| 2022 August | 37 | 35 | 72 |
| 2022 July | 34 | 43 | 77 |
| 2022 June | 29 | 30 | 59 |
| 2022 May | 40 | 33 | 73 |
| 2022 April | 44 | 53 | 97 |
| 2022 March | 50 | 34 | 84 |
| 2022 February | 37 | 22 | 59 |
| 2022 January | 32 | 37 | 69 |
| 2021 December | 26 | 34 | 60 |
| 2021 November | 38 | 37 | 75 |
| 2021 October | 44 | 45 | 89 |
| 2021 September | 34 | 41 | 75 |
| 2021 August | 22 | 49 | 71 |
| 2021 July | 28 | 30 | 58 |
| 2021 June | 35 | 36 | 71 |
| 2021 May | 36 | 33 | 69 |
| 2021 April | 75 | 78 | 153 |
| 2021 March | 52 | 29 | 81 |
| 2021 February | 30 | 29 | 59 |
| 2021 January | 23 | 18 | 41 |
| 2020 December | 25 | 21 | 46 |
| 2020 November | 20 | 16 | 36 |
| 2020 October | 19 | 14 | 33 |
| 2020 September | 34 | 26 | 60 |
| 2020 August | 21 | 13 | 34 |
| 2020 July | 18 | 12 | 30 |
| 2020 June | 41 | 18 | 59 |
| 2020 May | 21 | 10 | 31 |
| 2020 April | 19 | 16 | 35 |
| 2020 March | 27 | 13 | 40 |
| 2020 February | 1 | 0 | 1 |
| 2020 January | 5 | 0 | 5 |
| 2019 September | 4 | 0 | 4 |
| 2019 June | 1 | 0 | 1 |
| 2019 March | 1 | 0 | 1 |
| 2019 January | 1 | 0 | 1 |
| 2018 May | 3 | 1 | 4 |
| 2018 April | 40 | 9 | 49 |
| 2018 March | 67 | 9 | 76 |
| 2018 February | 39 | 5 | 44 |
| 2018 January | 56 | 8 | 64 |
| 2017 December | 26 | 7 | 33 |
| 2017 November | 31 | 7 | 38 |
| 2017 October | 23 | 5 | 28 |
| 2017 September | 32 | 9 | 41 |
| 2017 August | 51 | 6 | 57 |
| 2017 July | 47 | 6 | 53 |
| 2017 June | 72 | 11 | 83 |
| 2017 May | 68 | 10 | 78 |
| 2017 April | 62 | 5 | 67 |
| 2017 March | 51 | 13 | 64 |
| 2017 February | 28 | 5 | 33 |
| 2017 January | 27 | 6 | 33 |
| 2016 December | 76 | 19 | 95 |
| 2016 November | 52 | 17 | 69 |
| 2016 October | 78 | 16 | 94 |
| 2016 September | 78 | 14 | 92 |
| 2016 August | 91 | 23 | 114 |
| 2016 July | 59 | 32 | 91 |
| 2015 December | 1 | 0 | 1 |
| 2015 November | 1 | 0 | 1 |
| 2015 October | 0 | 15 | 15 |
| 2015 September | 4 | 0 | 4 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 19 | 4 | 23 |
| 2015 June | 39 | 10 | 49 |
| 2015 May | 64 | 25 | 89 |
| 2015 April | 37 | 18 | 55 |
| 2015 March | 37 | 10 | 47 |
| 2015 February | 37 | 20 | 57 |
| 2015 January | 43 | 25 | 68 |
| 2014 December | 40 | 14 | 54 |
| 2014 November | 36 | 20 | 56 |
| 2014 October | 35 | 15 | 50 |
| 2014 September | 34 | 15 | 49 |
| 2014 August | 29 | 15 | 44 |
| 2014 July | 42 | 21 | 63 |
| 2014 June | 58 | 17 | 75 |
| 2014 May | 50 | 13 | 63 |
| 2014 April | 56 | 20 | 76 |
| 2014 March | 53 | 16 | 69 |
| 2014 February | 49 | 7 | 56 |
| 2014 January | 42 | 13 | 55 |
| 2013 December | 44 | 10 | 54 |
| 2013 November | 28 | 10 | 38 |
| 2013 October | 61 | 12 | 73 |
| 2013 September | 49 | 12 | 61 |
| 2013 August | 56 | 12 | 68 |
| 2013 July | 45 | 6 | 51 |
| 2013 June | 46 | 10 | 56 |
| 2013 May | 44 | 12 | 56 |
| 2013 April | 62 | 10 | 72 |
| 2013 March | 52 | 16 | 68 |
| 2013 February | 50 | 9 | 59 |
| 2013 January | 56 | 23 | 79 |
| 2012 December | 55 | 20 | 75 |
| 2012 November | 7 | 4 | 11 |
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