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To conduct a systematic critical review of the literature on the efficacy and safety of biological therapy (BT) optimisation in non-infectious uveitis (NIU).Searches were conducted (PubMed, Embase, Cochrane and conference abstracts) up to March 2021. The study population comprised patients with NIU in remission after BT. We analysed BT optimisation strategies. The main outcome measures were efficacy and safety. To assess the risk of bias, the ROBINS-1 tool was used. A qualitative review of the data was performed to assess heterogeneity and bias. Evidence tables (study characteristics and outcomes) were generated, and quantitative synthesis was performed if data were homogeneous.We selected 11 studies (prospective and retrospective) including 513 patients. The studies were at moderate/high risk of bias and there was considerable variability between studies in sample size, underlying diseases, definitions and outcome variables. Criteria for starting optimisation were not uniform. All BTs optimised were TNF inhibitors. Optimisation could be attempted after 3-6 months in remission. Relapse occurred in 25-50% of patients but was controlled after dose re-escalation or BT switching. No safety issues were identified.The optimization of BT (with TNF inhibitors) has been applied in patients with NIU in remission. There is no consensus on criteria for attempting BT optimisation and protocols are heterogeneous. There is a least moderate risk of bias, so no robust conclusions on efficacy and safety of optimization can be reached. Preliminary evidence suggests that relapses might be controlled using standard doses. Larger studies using uniform criteria are needed.

Background and objectives Influenza vaccine is recommended for patients with autoimmune inflammatory rheumatic diseases who receive biological therapy. To evaluate if biological therapy impairs immunization after seasonal influenza vaccine. Material and methods Patients with inflammatory arthopathies, psoriasis, inflammatory bowel disease or connective tissue diseases who were receiving or were going to initiate biological therapy were included and vaccinated during 2014–2015 influenza season. ELISA was used to measure influenza antigen A and B antibodies, before and after vaccination. Demographic parameters, diagnosis and kind of treatment were recorded and their influence on the final serological status against influenza was studied. Results 253 subjects were analyzed. After vaccination, 77% of participants presented detectable antibodies against antigen A and 50.6% of them had detectable antibodies against antigen B. Final seropositivity rate against antigen B antibodies increased from baseline (50.6% vs 43.5%, p

Patients with different autoimmune inflammatory diseases (AIID) on biological therapy are at risk of pneumococcal disease. Adults with inflammatory arthropathies, connective tissue diseases, psoriasis, or inflammatory bowel disease on biological therapy such as anti-TNFα, rituximab, tocilizumab, abatacept, or anakinra were included in this study. Patients completed a protocol combining the pneumococcal vaccines PCV13 and PPV23. Immune response against pneumococcal serotypes 1, 3, 7F, 14, 19A, and 19F were assessed evaluating functional antibodies by an opsonophagocytosis killing assay (OPKA). In this study, 182 patients with AIID completed the sequential vaccination protocol. Patients on etanercept tended to achieve OPKA titers against a larger number of serotypes than the rest of patients on other biological therapies, while adalimumab was associated to a lower number of serotypes with OPKA titers. Rituximab was not associated with a worse response when compared with the rest of biological agents. Not glucocorticoids, nor synthetic disease-modifying antirheumatic drugs, interfered with the immune response. OPKA titers against serotype 3 which is one of the most prevalent, was obtained in 44% of patients, increasing up to 58% in those on etanercept. Hence, almost 50% of patients on biological therapy achieved functional antibodies after the administration of a complete pneumococcal vaccination protocol. Ministerio de Economía, Industria y Competitividad, Gobierno de España (SAF2017-83388) Sociedad de Reumatología de la Comunidad de Madrid (SORCOM)/ MSD (204151) Pfizer (14151) 4.961 JCR (2021) Q2, 77/161 Immunology 1.004 SJR (2021) Q1, 26/153 Drug Discovery No data IDR 2021 UEM

To evaluate the response to hepatitis B virus (HBV) vaccine in patients on biological therapy. Adults with autoimmune inflammatory diseases on biological therapy such as anti-TNFα, rituximab, tocilizumab, abatacept, or anakinra were included. Hepatitis B surface antibody (anti-HBs) was measured by ELISA before and after vaccination. Seroconversion was considered when an anti-HBs titer 10 mIU/mL was achieved. The effect of treatment on the immunoprotective state was studied. The response was compared with that obtained in patients on synthetic disease modifying anti-rheumatic drugs (DMARDs) and healthy controls. A total of 187 patients on biologicals, 48 on synthetic DMARDs, and 49 on healthy controls were analyzed. More than 80% of patients on biologics responded to the vaccine but required more boosters and second vaccine series. Patients who achieved seroconversion were younger than those who did not (47.10 ± 12.99 vs. 53.18 ± 10.54 years, p = 0.012). Being on etanercept or golimumab was associated with seroconversion, while being on rituximab was not. Seroconversion was achieved in 93.75% of patients on synthetic DMARDs and 97.96% of healthy controls. The seroconversion rate in the biologics group was lower than in the synthetic DMARD group (p = 0.043) and tended to be lower than in the healthy group (p = 0.056). In patients on biological therapy, a high rate of HBV vaccine response can be achieved when a complete vaccination schedule is administered. Vaccination while not on biological agents reduces the requirement for boosters and revaccination. Key points: • Patients on biological therapy can achieve high rates of immune response to HBV vaccine when complete vaccination schedules are administered. • However, to achieve such a high seroconversion rate, more boosters and second vaccination series are required. • This supports the proposal already made to provide HBV vaccination to all patients with an autoimmune inflammatory disease after the diagnosis is made and not when the use of a biological treatment is under consideration.

Objetivo Conocer las variables sociodemograficas, clinicas y laborales que se relacionan con procesos de incapacidad temporal (IT) en pacientes con fibromialgia (FM). Pacientes y metodo Se incluyo a los pacientes diagnosticados de FM, segun los criterios de ACR, que acudieron a consulta durante un periodo de 3 meses. Se realizo un protocolo clinico estandar con datos sociodemograficos, clinicos y laborales y los procesos de IT del ultimo ano. Todos los pacientes completaron un cuestionario con 40 items (cuestionario de impacto de la FM [FIQ] incluido). Resultados Participaron 51 mujeres con FM, 32 de ellas necesitaron en una o mas ocasiones baja laboral durante el ultimo ano. La duracion media ± desviacion estandar (DE) fue de 83,73 ± 98 dias. En el estudio bivariable no encontramos asociacion entre IT y las caracteristicas sociodemograficas, pero si una tendencia no significativa con profesiones que requieren esfuerzo fisico y presencia de factores desencadenantes. Hay relacion estadisticamente significativa entre IT y ausencia de respuesta a inhibidores selectivos de la recaptacion de serotonina (ISRS). Observamos que los valores de FIQ mas altos mantenian una relacion directa con pacientes en situacion de IT. Conclusiones La ausencia de respuesta a ISRS se relaciona con procesos de IT. Las personas en situacion de IT tienen FIQ mas altos. Parece que hay una tendencia al incremento de IT en profesiones que requieren esfuerzo fisico.

Objective To know the sociodemographic, clinical and working conditions characteristics related with temporary disability (TWD) in patients with fibromyalgia syndrome (FS). Patients and method Patients diagnosed with FS who met the American College of Rheumatology's criteria, attending an outpatient clinic for at least 3 months prior were included. We performed a standard clinical protocol with sociodemographic, clinical and working conditions, dates and number of TWD during the last year. All patients were asked to complete a questionnaire with 40 items (Fibromyalgia Impact Questionnaire [FIQ] inclusive). Results The participants were 51 women with FS, 32 of whom needed one or more TWD during the last year. The mean TWD was 83.73 days (SD, 98). There was not a statistically significant relationship between the TWD and sociodemographic characteristics in a bivariate analysis. There is a significant trend with hard physical work and with the presence of triggering factors. There was evidence of a significant statistical relationship between TWD with a lack of response to selective serotonin re-uptake inhibitors (SSRIs). We noticed that the highest marks in the FIQ have a direct relationship with patients in a TWD situation. Conclusions The lack of response to SSRIs was related with TWD process. The patients in TWD situation scored the highest FIQ. There is a trend towards an increase in the TWD with jobs that required physical effort.

Objective To determine whether major histocompatibility complex (MHC) polymorphisms are associated with a good or poor response to infliximab therapy in patients with rheumatoid arthritis (RA). Methods Seventy-eight infliximab-treated patients with RA were genotyped for HLA–DRB1, HLA–DQA1, HLA–DQB1, MHC class I chain–related gene A (MICA) transmembrane polymorphism alleles, and tumor necrosis factor a (TNFa), TNFb, TNFc, TNFd, TNFe, D6S273, HLA–B–associated transcript 2 (BAT2), and D6S2223 microsatellites. Chi-square tests were performed to compare allele proportions between responder and nonresponder patients. A control sample of 342 healthy individuals was also included to detect linkage disequilibrium between pairs of markers. Results Among responders, the frequency of the TNFa11;b4 minihaplotype was increased (41% versus 16% in nonresponders; P = 0.01) and that of the D6S273_3 allele was decreased (32% versus 56% in nonresponders; P = 0.04). The D6S273_4/BAT2_2 pair was much more frequently observed among responders (46% versus 11% in nonresponders; P = 0.001). When compared with controls, this pair of alleles was found to be associated only with the group of responder patients (46% in responders versus 17% in controls; P = 0.00002). Most of the time, these markers are present in a DRB1*0404/D6S273_4/BAT2_2/TNFa11;b4 context. No statistically significant differences were observed for MICA and D6S2223 polymorphisms and for shared epitope status. Conclusion The data suggest that genetic determinants of response to infliximab therapy exist in the HLA complex.