EFFICACY AND SAFETY OF THE OPTIMISATION OF BIOLOGICAL THERAPY IN NON-INFECTIOUS UVEITIS: SYSTEMATIC REVIEW

BackgroundIn other rheumatic diseases it is possible to optimize biological therapy, maintaining its effectiveness and without risk in its safety. But this aspect has not been studied in the field of non-infectious uveitis.ObjectivesIn other rheumatic diseases it is possible to optimize biological therapy, maintaining its effectiveness and without risk in its safety. But this aspect has not been studied in the field of non-infectious uveitis.MethodsA search strategy (Pubmed, Embase and Cochrane) was carried out on UNI up to Jan-22 with Mesh vocabulary and free text (human beings, English or Spanish). Review last 2 years of International Congresses Rheumat/Oft. We included meta-analyses, systematic reviews, clinical trials, prospective and retrospective longitudinal observational studies (OA). Secondary manual search and quality assessment with the Oxford scale by 2 independent researchers. The population included were UNI in ophthalmological remission after TB use. Articles with TB optimization strategies and whether there is a comparison with those that maintain the smPC dose are examined. The main measures being evaluated are efficacy and safety. Data are collected on eye activity, number of outbreaks, GC (glucorticoid) doses and adverse effects.Results11 articles of low or moderate quality. They were mostly retrospective EO (n=7), and to a lesser extent prospective (n=4), and included 513 patients. With a variable follow-up from a minimum of 12 months, up to 17 years of evolution. There was a predominance of males, of average age of 36 years, the most represented disease was Bechet’s disease. There was no homogeneous criterion when trying to optimize, since the minimum required time of remission maintained with TB, varied from 3 to 12 months. The use of FAME and GC was allowed. The intervention is described in 7 articles with Infliximab, 2 with Adalimumab and 2 with Etanercept. Other TB other than anti-TNF, have not performed optimization so they are not included in this systematic review. They included patients treated with DMARD and even with previous anti-TNF. Many articles did not have a comparison group. Studies suggest that after 3-6 months in remission, it could be a time to assess optimization. The remission maintained after discontinuation of the drug, is maintained from 7.5 months, up to 2 years. GC reduction and suspension up to 74% and even 40% FAME are described. But there are also relapses in 25-50%, but they are controlled in general with the increase in doses and in some cases with change of TB. There were no relevant security issues.Conclusion1. Low quality of the evidence. 2. Great variability in patients, pathologies, definitions or outcome variables. 3. There is no consensus at the time of starting the optimization, the data suggest that after 3-6 months in remission it could be assessed. 4. Articles with a limited number of cases (some without a control group) or retrospective are included. There is great heterogeneity in the optimization and protocols used. But despite all this, these results suggest that optimization and/or suspension (in selected cases) can be carried out safely and planned for anti-TNF TB, with a low probability of short-term recurrences. 5. In case of reactivation of uveitis, it seems that it is usually controlled in most cases, using again the standard doses. 6. There were no relevant security issues. 7. More studies with homogeneous criteria and established protocols are needed to determine the duration of the ideal treatment and see if there are differences in the etiology of uveitis or TB used.References[1]Al-Janabi A, El Nokrashy A, Sharief L, Nagendran V, Lightman S, Tomkins-Netzer O. Long-Term Outcomes of Treatment with Biological Agents in Eyes with Refractory, Active, Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis. Ophthalmology 2020;127(3):410-416.AcknowledgementsThe authors would like to thank the Spanish Rheumatology Society for their support for the publication of this paper.Disclosure of InterestsNone declared