A RECENT study compared the effectiveness of three immunomodulatory therapies combined with corticosteroids in preventing uveitis relapse in patients with severe Behcet’s disease. The study found that adalimumab was superior to ciclosporin, while interferon alfa-2a did not meet non-inferiority criteria compared to adalimumab. The study, conducted at a specialised uveitis centre in Chongqing, China, involved 270 patients who were already on corticosteroid therapy and had not previously received anti-TNF treatment.
The participants were randomly assigned to receive ciclosporin, interferon alfa-2a, or adalimumab, each in combination with a tapering dose of corticosteroids. The primary outcome was the annualised relapse of uveitis. Results showed that the least-squares mean relapse rate was lowest in the adalimumab group at 0.95, compared to 1.84 for ciclosporin and 1.44 for interferon alfa-2a. Adalimumab significantly outperformed ciclosporin with a mean difference of 0.90 (p=0.0054), demonstrating its superior efficacy in reducing uveitis relapse rates.
However, the trial found that interferon alfa-2a was not non-inferior to adalimumab, with a mean difference of 0.50, falling short of the non-inferiority margin. Interferon alfa-2a also did not show superiority over ciclosporin, with no significant difference in relapse rates between these two treatments.
In terms of safety, serious adverse events occurred in 13% of patients on ciclosporin, 9% on interferon alfa-2a, and 8% on adalimumab, with no treatment-related deaths reported. The study’s findings suggest that adalimumab combined with corticosteroids may offer a more effective treatment option for preventing uveitis relapse in patients with severe Behcet’s disease, while interferon alfa-2a did not demonstrate clear advantages over ciclosporin or adalimumab.
These results provide valuable insights into the treatment options for Behcet’s disease and support the use of adalimumab as a preferred therapy in clinical practice.
Aleksandra Zurowska, EMJ
Reference
Zhong Z et al. Combinations of immunomodulatory agents for prevention of uveitis relapse in patients with severe Behçet’s disease already on corticosteroid therapy: a randomised, open-label, head-to-head trial. Lancet. 2024;DOI:10.1016/S2665-9913(24)00194-2.
