Comparative study of adalimumab versus conventional therapy in sight-threatening refractory Behcet's uveitis with vasculitis

Background: Anti-tumor necrosis factor-alpha was regarded as an option in treatment of non-infectious uveitis. However, few studies in the far easter region have concentrated on this therapy and current studies have not emphasized the elimination of retinal vasculitis. To compare the effectiveness of adalimumab (ADA) plus con-ventional therapy (CT) versus CT alone in treating patients with retinal vasculitis (RV) due to refractory Behcet's uveitis (BU). Design: Retrospective cohort study. Methods: Clinical records of BU patients with previously treated but poorly controlled RV were analyzed. Patients were allocated into two groups depending on ADA use. Each group was treated for no less than 6 months between February 2015 and September 2020. The primary outcome parameter was the RV score. Best-corrected visual acuity (BCVA), number of relapses, macular thickness and ocular complications were considered concomitantly. Results: Forty-two patients (72 eyes) were included; 21 patients were in CT group, and 21 patients were in ADA group. Inflammatory parameters improved in both groups. The improvement in the fluorescein angiography (FA) score and anterior chamber inflammation were significantly better in ADA group than in CT group (P < 0.05). The relapse time was significantly lower in ADA group than in CT group (P = 0.01). Daily glucocorticoid dose tapers were more evident in ADA group than in CT group (P < 0.05). Adverse events were detected in 7 patients (5 had upper respiratory tract infection and 2 had gastrointestinal discomfort) in ADA group; in CT group, upper respiratory infection and recurrent gum swelling were observed in 1 patient each. Conclusion: Our results indicate that ADA plus CT outperforms CT alone in patients with RV due to refractory BU. More agile ADA use in these patients should be considered to achieve optimal treatment.

Automated summary

The study compared the effectiveness of adalimumab plus conventional therapy versus conventional therapy alone in treating patients with retinal vasculitis due to refractory Behcet's uveitis. Results showed that adalimumab plus conventional therapy outperformed conventional therapy alone in improving inflammatory parameters, reducing relapse time, and tapering daily glucocorticoid doses. Adverse events were mainly upper respiratory tract infection and gastrointestinal discomfort in the adalimumab group, while fewer adverse events were observed in the conventional therapy group.