Efficacy of infliximab in refractory Behçet’s disease-associated and idiopathic posterior segment uveitis: a prospective, follow-up study of 50 patients

Abstract

PurposeTo evaluate the long-term efficacy of infliximab in patients with refractory Behçet’s disease (BD)-associated and idiopathic posterior uveitis (PU).MethodsSingle center, prospective, 6-year duration, follow-up study on 50 consecutive patients (20 [40%] males and 30 [60%] females with a mean age of 37.5 ± 12.3 years) with refractory BD-associated PU (36 patients) and idiopathic PU (14 patients) who had failed at least one immunosuppressive drug. At baseline, patients received prednisone 1 mg/kg/day with rapid tapering and infliximab infusions (5 mg/kg) at weeks 0, 2, 6, and every 8 weeks thereafter. Nonresponders after the third infusion withdrew from the study. Primary outcome measures were visual acuity (VA) value improvement compared to baseline. Secondary outcome measures were proportion of patients with VA improvement from baseline; proportion of patients achieving disease remission; number of PU flare-ups; and incidence of adverse events.ResultsAt the final follow-up, mean right and left eye VA respectively increased from 0.57 ± 0.31 at baseline to 0.68 ± 0.33 (P = 0.048) and from 0.67 ± 0.28 to 0.76 ± 0.27 (P = 0.047). None of the patients had VA worsening and new onset ocular complications. A complete response of PU was recorded in 34/50 (68%) patients and partial response in 11/50 (22%). Five patients were nonresponders and withdrew from the study after the third infusion. A significant reduction of ocular attacks and of the proportion of patients with cystoid macular edema was observed. No differences in infliximab efficacy was recorded between patients with BD-associated and idiopathic PU. No serious adverse events occurred. The mean follow-up duration was 36.8 months.ConclusionLong-term infliximab therapy was equally effective and safe with a significant VA gain in refractory BD-associated and idiopathic PU.

Efficacy of anti-TNF alpha in severe and/or refractory Behçet's disease: Multicenter study of 124 patients

“…In agreement with the literature, 96% of patients were complete or partial responders. An open-label study of 36 patients with BD and posterior refractory uveitis treated with IFX concluded that 91% of patients had complete or partial response after 37.3 months of follow-up [27]. A recent literature review regarding the use of anti-TNF agents in 369 BD patients, showed that 89% of patients with uveitis treated with IFX presented a sustained response [8].…”

Successful Treatment with Infliximab for Refractory Uveitis in a Hemodialysis Patient with Behçet's Disease and a Review of the Literature for Infliximab Use in Patients on Hemodialysis

“…The administration of TNF-α inhibitors is considered in BD patients who exhibit an inadequate response to topical and/or conventional systemic therapies, such as corticosteroids, CsA and colchicine, or those with refractory ocular involvement. Although there are no controlled trials, several open-label clinical trials and nonrandomized comparative studies have reported the efficacy of intravenous infliximab for BD-associated uveitis (17)(18)(19)(20)(21), among TNF-α inhibitors, only infliximab is approved for the treatment of BD-associated uveitis in Japan. However, little is known about the efficacy of infliximab in ESRD patients on hemodialysis.…”

Use of Anti TNF-α Therapy in Systemic Vasculitis

“…High-quality level of evidence is warranted to assist the practicing rheumatologist in toward difficult-to-treat cases of BD. Table 4 shows a summary of studies that addressed the use of anti TNF-α agents in patients with BD [43]. -More patients remained free of nodular skin lesions (85% versus 25%).…”