Efficacy and safety of biological therapy compared to synthetic immunomodulatory drugs or placebo in the treatment of Behçet’s disease associated uveitis: a systematic review
The aim of this study is to compare the efficacy and safety of biological therapy with cyclosporin A (CsA), azathioprine (AZA), or placebo in uveitis flares and other ocular outcomes in patients with Behçet disease. A comprehensive and sensitive search in MEDLINE, EMBASE, and the Cochrane Library was performed. We selected articles including: (1) adult patients with Behçet’s and uveitis; (2) on biological therapies; (3) placebo or active control with CsA or AZA; (4) analyzing efficacy (number of uveitis flares, macular edema, etc.) and/or safety outcomes. Meta-analyses, systematic reviews, clinical trials, and observational studies with > 10 patients were included. The selection, data collection and quality assessment (Oxford scale) was carried out by 2 reviewers independently. Nine articles of moderate quality were included (6 randomized clinical trials and 3 retrospective studies) involving 378 patients. Most of them, apart from the study drugs received systemic corticosteroids and other immunosuppressant drugs. Infliximab was more effective than CsA in reducing short-term uveitis flares and severe complications of retinal vasculitis in the long term. Rituximab was similar to a combination of cytotoxic drugs in improving inflammatory activity. In patients with active uveitis adalimumab was associated with a lower risk of uveitic flare or visual impairment, and in patients with inactive uveitis to a significantly lowered the risk of flare upon corticosteroid withdrawal. Secukinumab and daclizumab were not superior to placebo in reducing uveitis flares, like interferonα compared to other drugs. Our results highlight the need for better designed comparative studies on Behçet’s uveitis.
KeywordsSystematic literature review Uveitis Biologic therapy Behçet’s disease
AU-A, RB and EL participated in the study design. MSG, KV-O, LFP and AU-A participates in the study selection and data collection. All of the authors took part in the rest of the study phases, contributed in this article discussion and reviewed the final version.
There was no specific funding for this work but for medical writing assistance that was provided by a grant from Merck Sharp & Dohme of Spain.
Compliance with ethical standards
Conflict of interest
RB has received grants/research supports from Abbvie, MSD, and Roche; Consultation fees/participation in company sponsored speaker´s bureau from AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD. EL has received grants/research supports from Abbvie, MSD, Roche, Pfizer, Bristol-Myers, MSD, Novartis, Astellas, Sanofi.
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