Efficacy of infliximab in the treatment of uveitis that is resistant to treatment with the combination of azathioprine, cyclosporine, and corticosteroids in behçet's disease: An open‐label trial

Abstract

Objective. To investigate the effect of infliximab on the frequency of uveitis attacks and the visual prognosis in male patients with Behçet's disease in whom uveitis was resistant to combination therapy with corticosteroids, azathioprine, and cyclosporine.Methods. The study group comprised patients who were receiving combination therapy but experienced at least 2 attacks of posterior uveitis/panuveitis or retinal vasculitis during the 6-month period prior to enrollment. Infliximab infusions (5 mg/kg) were administered at weeks 0, 2, 6, and 14. Weeks 0-22 were defined as the infusion period, and weeks 23-54 were defined as the observation period. Patients continued to receive azathioprine and corticosteroids, but cyclosporine was discontinued after the screening visit. The primary outcome measures were the absence of uveitis attacks during the infusion period (remission), and the absence of uveitis attacks throughout the study period (sustained remission).Results. Thirteen patients were enrolled in the study. Thirty-two uveitis attacks involving the posterior segment occurred during the previous-treatment period. During the infusion period, 4 patients (30.8%) remained attack-free, and 9 patients had a total of 13 uveitis attacks. Ten of these attacks (76.9%) occurred at either week 14 or week 22. One of 13 patients fulfilled the definition of sustained remission, and the remaining 12 patients had a total of 36 uveitis attacks during the observation period. The mean number of uveitis attacks and daily corticosteroid doses were significantly lower during the infusion period than during the previoustreatment period or the observation period. Although potential visual acuity was regained following infliximab infusion, this beneficial effect was not preserved until week 54. None of the patients experienced a serious adverse event.Conclusion. The results of this trial suggest that infliximab is effective in suppressing the occurrence of uveitis attacks, has a corticosteroid-sparing effect, and has favorable implications for the visual prognosis of patients with resistant Behçet's uveitis.Behçet's disease (BD) is a multisystem inflammatory disorder with a chronic, relapsing course. Patients with ocular involvement typically have bilateral nongranulomatous panuveitis and retinal vasculitis that involves all elements of the retinal vasculature (1). The course of the disease is characterized by recurrent, explosive attacks of uveitis followed by spontaneous remissions. The severity and frequency of these inflammatory episodes determine the extent of permanent damage to the intraocular structures and resultant visual loss. Permanent sequelae of posterior segment involvement include optic atrophy, maculopathy, sheathing and occlusion of retinal vessels, and diffuse atrophy and gliosis of the retina. Although the course of the disease shows individual variability, male patients have a younger age at disease onset, more severe disease, and

Efficacy of Infliximab in Patients with Refractory Uveitis Associated with Behcet Disease

“…In the present study, isoniazid prophylaxis was given to patients with positive PPD tests for 9 months. The common side effects of IFX reported in other studies included frequent respiratory and urinary infections, infusion reactions, headache, malaise, diarrhea and dizziness [3,11,20]. During follow-up period, IFX infusions were well-tolerated and no patient reported serious or life-threatening adverse effects.…”

“…Relapsing course of ocular inflammation leads to permanent damage of intraocular structures such as maculopaty, retinal vessel occlusions, and optic atrophy. It also leads to sight threatening disease [3].…”

Pseudotumor cerebri como una manifestación excepcional de la enfermedad de Behçet: Caso clínico

“…Sin embargo, en casos más severos lo recomendado es usar ciclosporina o la combinación de ambas 16 . En casos refractarios se ha usado interferón alfa con buena respuesta, pero dado que se basa en un solo estudio 1 y que tiene frecuentes efectos adversos, actualmente se prefiere el uso de antagonistas del TNF-α basado en series clínicas y trabajos retrospectivos, la mayoría con infliximab 16,19,20 . Estos fármacos también actúan Pseudotumor cerebrii como una manifestación excepcional de la enfermedad de Behçet -J. Durán et al a nivel de las manifestaciones mucocutáneas y articulares.…”

UVEITIS INA RHEUMATOLOGISTS PRACTICE: A ROLE OF TUMOR NECROSIS FACTOR-а INHIBITORS

“…После 1 инфузии инфликсимаба у всех пациентов отмечено уменьшение воспалительных изменений (через 24 ч) и улучшение остроты зрения (в течение 7 дней). В другое небольшое открытое исследование были вклю-чены 13 мужчин с болезнью Бехчета, у которых увеит оказался устойчивым к комбинированной иммуносу-прессивной терапии [19]. У всех пациентов в течение 6 мес до начала исследования отмечалось по крайней мере 2 обострения увеита на фоне лечения ГК, азати-оприном и циклоспорином.…”