Annual rate of ocular inflammatory flares fell from 200 to 49 per 100 patients.
Behçet’s disease (BD) is a systemic inflammatory disorder that affects a wide range of organs including the eyes. Although BD had been classified as a form of vasculitis, it is now considered a cross between an autoimmune and an auto-inflammatory syndrome.
The auto-inflammatory nature of BD was proposed based on its inflammatory effects, relapsing-remitting course, and lack of autoantibodies or autoreactive antigen-specific T cells, much like monogenic auto-inflammatory syndromes (MAIS). Because inhibition of interleukin-1β is the cornerstone of therapy for these syndromes, the use of IL-1 inhibitors such as the IL-1 receptor antagonist anakinra (Kineret/Sobi) and the anti-IL-1β monoclonal antibody canakinumab (Ilaris/Novartis) has recently been investigated for BD resistant to standard treatment.
Claudia Fabiani, MD, in the Department of Ophthalmology of Humanitas Clinical and Research Hospital in Milan, Italy, and colleagues at the Universities of Bari, Florence, and Siena retrospectively studied the results of Kineret or Ilaris treatment of uveitis in 19 consecutive BD patients who together had 31 eyes with uveitis. The Italian team analyzed the data collected at baseline and three and 12 months after treatment.
The study’s primary endpoint was the reduction in the annual rate of ocular inflammatory flares. Secondary endpoints included reduction in retinal vasculitis assessed by fluorescein angiography.
After 12 months of treatment, the annual rate of ocular inflammatory flares decreased from 200 to 49 episodes/100 patients (P < 0.0001), and the frequency of retinal vasculitis also decreased (P = 0.001).
In addition, the Italian team evaluated differences between patients who received IL-1 inhibitors as monotherapy and those who received disease modifying anti-rheumatic drugs (DMARDs), corticosteroids, or both in addition to IL-1 inhibitors. They also evaluated differences between patients who received IL-1 inhibitors as first-line biologic treatment and patients previously treated with tumor necrosis factor-α (TNF-α) inhibitors.
Regarding combination therapy with IL-1 inhibitors and other classes of agents, the team found that the annual rate of ocular inflammatory flares was greater in patients who took DMARDs with IL-1 inhibitors (82 episodes/100 patients) that in those who took IL-1 inhibitors alone (0 episodes/100 patients) (P = 0.03). However, the team found no differences between those who took IL-1 inhibitors as first-line therapy and those who took them after taking TNF-α inhibitors.
Similarly, they found no differences between patients who took corticosteroids with IL-1 inhibitors and those who took IL-1 inhibitors alone. However, in those taking corticosteroids, the corticosteroid dosage required was lower after 12 months of IL-1 inhibitor therapy than it was at baseline (P = 0.02).
These findings led the Italian team to conclude, “Treatment with IL-1 inhibitors is effective in the management of BD-related uveitis and provides long-term control of ocular inflammation in refractory and long-lasting cases.”
The study report, “Interleukin (IL)-1 inhibition with anakinra and canakinumab in Behçet’s disease-related uveitis: a multicenter retrospective observational study,” was published online on December 16, 2016, in Clinical Rheumatology.