Interleukin (IL)-1 inhibition with anakinra and canakinumab in Behçet’s disease-related uveitis: a multicenter retrospective observational study

• Published in: Clinical rheumatology Vol. 36; no. 1; pp. 191 - 197
• Main Authors: Fabiani, Claudia, Vitale, Antonio, Emmi, Giacomo, Lopalco, Giuseppe, Vannozzi, Lorenzo, Guerriero, Silvana, Gentileschi, Stefano, Bacherini, Daniela, Franceschini, Rossella, Frediani, Bruno, Galeazzi, Mauro, Iannone, Florenzo, Tosi, Gian Marco, Cantarini, Luca
• Format: Journal Article
• Language: English
• Published: London Springer London 01.01.2017; Springer Nature B.V
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Aged; Antibodies, Monoclonal - administration & dosage; Antirheumatic Agents - therapeutic use; Behcet Syndrome - complications; Behcet Syndrome - drug therapy; Drug Therapy, Combination; Female; Humans; Inflammation; Interleukin 1 Receptor Antagonist Protein - administration & dosage; Interleukin-1 - antagonists & inhibitors; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Retina - physiopathology; Retrospective Studies; Rheumatology; Treatment Outcome; Uveitis - complications; Uveitis - drug therapy; Vasculitis - complications; Treatment; Behçet’s disease; Canakinumab; Anakinra; Uveitis
• ISSN: 0770-3198; 1434-9949; 1434-9949
• DOI: 10.1007/s10067-016-3506-4

This study aimed to evaluate the role of interleukin (IL)-1 inhibitors anakinra (ANA) and canakinumab (CAN) in the treatment of Behçet’s disease (BD)-related uveitis. Multicenter retrospective observational study includes 19 consecutive BD patients (31 affected eyes) received treatment with anti-IL-1 agents. Data were analyzed at baseline and at 3 and 12 months. The primary endpoint is the reduction of ocular inflammatory flares (OIF). The secondary endpoints are improvement of best corrected visual acuity (BCVA); reduction of macular thickness defined by optical coherence tomography (OCT) and of vasculitis identified with fluorescein angiography (FA); evaluation of statistically significant differences between patients treated with IL-1 inhibitors as monotherapy, subjects also administered with disease modifying anti-rheumatic drugs (DMARDs) and/or corticosteroids as well as between patients administered with IL-1 inhibitors as first line biologic treatment and those previously treated with TNF-α inhibitors. At 12 months, OIF significantly decreased from 200 episodes/100 patients/year to 48.87 episodes/100 patients/year ( p  < 0.0001). The frequency of retinal vasculitis identified by FA significantly decreased between baseline and 3- and 12-month follow-up visits ( p  < 0.0001 and p  = 0.001, respectively). OIF rate was significantly higher in patients co-administered with DMARDs (81.8 episodes/100 patients/year) than in patients undergoing IL-1 inhibitors as monotherapy (0.0 episodes/100 patients/year) ( p  = 0.03). No differences were identified on the basis of corticosteroid use and between patients administered with IL-1 inhibitors as first line biologic approach or second line. Steroid dosage was significantly decreased at 12-month visit compared to baseline ( p  = 0.02). Treatment with IL-1 inhibitors is effective in the management of BD-related uveitis and provides a long-term control of ocular inflammation in refractory and long-lasting cases.