Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Abatacept IN Refractory ANTI-TNF Resistant Juvenile Idiopathic ARTHRITIS-RELATED Uveitis

Zulian1,  Francesco, Balzarin1,  Marta, Falcini2,  F., Fiori3,  Ginevra, Alessio4,  Maria, Cimaz5,  Rolando, Zannin1,  Maria Elisabetta

University of Padua, Padua, Italy,
Italy, Italy, Italy,
University of Florence, Italy, Florence, Italy,
Dpt of Pediatrics, Rheumatology Unit, University of Naples Federico II, Naples, Italy,
University of Florence and Anna Meyer Children's Hospital. Florence, Italy, Florence, Italy

Purpose:

Anterior uveitis is a serious complication of Juvenile Idiopathic Arthritis (JIA) with the potential for significant ocular damage and eventually blindness. Recently, Abatacept, a selective T-cell co-stimulation modulator, has been used in children with JIA who had failed previous treatments, including anti-TNF agents.

We report the short-term results on safety and efficacy of Abatacept in a cohort of patients with severe JIA-related uveitis refractory or intolerant to other anti-TNF agents.

Method:

Patients with JIA-related uveitis refractory to previous immunosuppressive treatments (MTX, CyA, MMF) and to anti-TNF agents, Infliximab (IFX) and Adalimumab (ADM), have been treated with Abatacept (ABT) at a monthly dosage of 10 mg/kg (up to 750 mg), administered intravenously. Uveitis course and side effects have been carefully monitored. Absolute frequencies of flares before and after ABT treatment and/or new ocular complications have been reported.

Results:

Six patients (5 female, 1 male), aged 9–24 years, have been treated, with a mean follow-up of 7.2 months (range: 6–9 months). The mean uveitis duration, at the beginning of Abatacept treatment, was 11 years (range: 3–17 years). All patients failed previous immunosuppressive (MTX, CyA, MMF) and anti-TNF agents (Infliximab and Adalimumab) treatment. Two patients shifted from IFX to ABT for systemic reactions. Four patients shifted from IFX and ADM for inefficacy. No side effects were reported in all but one patient, who developed serious oral mucous reaction after 3 months of treatment. The mean frequency of uveitis flares went down from 3.3 (range: 2–5) during the six months before ABT to 0.6 (range: 0–2) post ABT. At the end of the follow-up no new ocular complications appeared and the pre-existing ones remained stable in all patients.

Conclusion:

Abatacept induced a rapid and sustained improvement of refractory JIA-related uveitis and was well tolerated in 5/6 patients. Abatacept represents a treatment of choice for patients failing both immunosuppressive and anti-TNF agents and a possible candidate for the early treatment of severe course JIA-related uveitis.

To cite this abstract, please use the following information:
Zulian, Francesco, Balzarin, Marta, Falcini, F., Fiori, Ginevra, Alessio, Maria, Cimaz, Rolando, et al; Abatacept IN Refractory ANTI-TNF Resistant Juvenile Idiopathic ARTHRITIS-RELATED Uveitis [abstract]. Arthritis Rheum 2009;60 Suppl 10 :2052
DOI: 10.1002/art.27124

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