Comparative Study of Infliximab Versus Adalimumab in Refractory Uveitis due to Behçet's Disease: National Multicenter Study of 177 Cases
Authors: Atienza‐Mateo Belén , Martín‐Varillas José Luis , Calvo‐Río Vanesa , Demetrio‐Pablo Rosalía , Beltrán Emma , Sánchez‐Bursón Juan , Mesquida Marina , Adan Alfredo , Hernández María Victoria , Hernández‐Garfella Marisa , Valls‐Pascual Elia , Martínez‐Costa Lucía , Sellas‐Fernández Agustí , Cordero‐Coma Miguel , Díaz‐Llopis Manuel , Gallego Roberto , García‐Serrano José L. , Ortego‐Centeno Norberto , Herreras José M. , Fonollosa Alejandro , Garcia‐Aparicio Ángel M. , Maíz‐Alonso Olga , Blanco Ana , Torre‐Salaberri Ignacio , Fernandez‐Espartero Cruz , Jovaní Vega , Peiteado Diana , Pato Esperanza , Cruz Juan , Férnandez‐Cid Carlos , Aurrecoechea Elena , García‐Arias Miriam , Castañeda Santos , Caracuel‐Ruiz Miguel A. , Montilla‐Morales Carlos A. , Atanes‐Sandoval Antonio , Francisco Félix , Insua Santos , González‐Suárez Senen , Sanchez‐Andrade Amalia , Gamero Fernando , Linares Ferrando Luis F. , Romero‐Bueno F. , García‐González A. Javier , González Raquel Almodóvar , Muro Enrique Minguez , Carrasco‐Cubero Carmen , Olive Alejandro , Prior Águeda , Vázquez Julio , Ruiz‐Moreno Oscar , Jiménez‐Zorzo Fernando , Manero Javier , Muñoz Fernandez Santiago , Fernández‐Carballido Cristina , Rubio‐Romero Esteban , Pages Fred Antón , Toyos‐Sáenz de Miera Francisco J. , Martinez Myriam Gandia , Díaz‐Valle David , López Longo Francisco J. , Nolla Joan M. , Álvarez Enrique Raya , Martínez Marcelino Revenga , González‐López Julio José , Rodríguez‐Cundin Paz , Hernández José L. , González‐Gay Miguel A. , Blanco Ricardo 
Published: June 2019

Objective

To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as a first‐line biologic drug over 1 year of treatment in a large series of patients with refractory uveitis due to Behçet's disease (BD).

Methods

We conducted an open‐label multicenter study of IFX versus ADA for BD‐related uveitis refractory to conventional nonbiologic treatment. IFX or ADA was chosen as the first‐line biologic agent based on physician and patient agreement. Patients received 3–5 mg/kg intravenous IFX at 0, 2, and 6 weeks and every 4–8 weeks thereafter, or 40 mg subcutaneous ADA every other week without a loading dose. Ocular parameters were compared between the 2 groups.

Results

The study included 177 patients (316 affected eyes), of whom 103 received IFX and 74 received ADA. There were no significant baseline differences between treatment groups in main demographic features, previous therapy, or ocular sign severity. After 1 year of therapy, we observed an improvement in all ocular parameters in both groups. However, patients receiving ADA had significantly better outcomes in some parameters, including improvement in anterior chamber inflammation (92.31% versus 78.18% for IFX; P = 0.06), improvement in vitritis (93.33% versus 78.95% for IFX; P = 0.04), and best‐corrected visual acuity (mean ± SD 0.81 ± 0.26 versus 0.67 ± 0.34 for IFX; P = 0.001). A nonsignificant difference was seen for macular thickness (mean ± SD 250.62 ± 36.85 for ADA versus 264.89 ± 59.74 for IFX; P = 0.15), and improvement in retinal vasculitis was similar between the 2 groups (95% for ADA versus 97% for IFX; P = 0.28). The drug retention rate was higher in the ADA group (95.24% versus 84.95% for IFX; P = 0.042).

Conclusion

Although both IFX and ADA are efficacious in refractory BD‐related uveitis, ADA appears to be associated with better outcomes than IFX after 1 year of follow‐up.