Intravitreal Infliximab in Refractory Uveitis in Behcet's Disease

Anti-tumour necrosis factor (TNF) drugs have been extensively used in non-infectious uveitis (NIU), when corticosteroids or conventional immunosuppressive drugs cannot adequately control inflammation or intolerable side-effects occur. However, systemic anti-TNF therapies are also associated with a myriad of side-effects. Therefore, intravitreal administration of anti-TNF biologics has been employed to minimize patient morbidity and systemic adverse effects, while maintaining therapeutic effectivity. We undertook a systematic review to determine evidence of efficacy and safety of intravitreal administration of anti-TNF drugs in adults with NIU. We conducted this systematic review according to the PRISMA guidelines. The protocol was registered with PROSPERO (CRD42016041946). We searched CENTRAL, MEDLINE and EMBASE, from inception to April 2017, as well as clinical trial registries and grey literature. The qualitative analysis included all studies of adult patients with a diagnosis of NIU and who received intravitreal anti-TNF drugs with a 4-week minimum follow-up. A total of 4840 references were considered for title and abstract screening. Seven full texts were screened, and five studies were considered for analysis. All studies were open-label, single-centre, prospective, non-randomized, interventional case series with a follow-up between 4 and 26 weeks, employing either adalimumab in two studies and infliximab in three. Three studies showed a treatment effect of anti-TNF intravitreal injections, while one study revealed short-term improvement and one study revealed no efficacy of anti-TNF intravitreal therapy. None of the studies reported ocular adverse effects but only two studies included electrophysiological assessment in the safety analysis and no study assessed systemic human anti-drug antibodies. The available evidence is not sufficiently robust to conclude about the clinical effectivity of intravitreal anti-TNF in NIU and so no recommendation can be made. In conclusion, intravitreal injection of anti-TNF antibodies remains a possible treatment option to be explored through robust clinical investigation.

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“…) and one study published in 2016 (Hamza et al. ). We did not retrieve any unpublished studies (Fig.…”

Section: Resultsmentioning

confidence: 98%

“…One reference was retrieved by hand search (Hamza et al. ). De‐duplication generated 4840 references for screening.…”

Section: Resultsmentioning

confidence: 99%

Efficacy and safety of intravitreal anti‐tumour necrosis factor drugs in adults with non‐infectious uveitis – a systematic review

Leal

Rodrigues

Sousa

et al. 2018

Acta Ophthalmologica

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“…Infliximab has been suggested to be a promising agent for refractory eye disease in combination with other immunosuppressants. It is important to be cautious for reactivation of tuberculosis [89][90][91][92][93][94].…”

Section: Intravitreal Antitumor Necrosis Factormentioning

confidence: 99%

Ocular Manifestations of Behçet’s Disease

Şahlı¹,

Gurbuz-Koz²

2017

Behcet's Disease

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Behçet's disease (BD) is a multisystemic autoimmune inflammatory disorder characterized by oral aphthous lesions, genital ulcerations, iridocyclitis with hypopyon, and skin lesions. While ocular manifestations occur in nearly 50% of the patients with Behçet's disease, ocular involvement is the initial manifestation in only less than 20% of the patients. Ocular Behçet's disease clinically presents iridocyclitis with or without hypopyon, vitritis, retinitis, occlusive retinal vasculitis, and cystoid macular edema. However, anterior uveitis is usually the only initial ocular manifestation; the most common form is panuveitis. The usual course of the disease is characterized by recurrent inflammatory periods. Recurrent inflammatory attacks may result in irreversible damage and significant visual loss. Early and effective treatment is required to prevent ocular morbidity. Recent developments in the treatment of ocular Behçet's disease like biological agents are promising with a rapid effect and high remission rates.

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“…Infliximab is a chimeric monoclonal antibody directed against TNF and has been shown to be effective and fast acting in the treatment of Behçet-associated panuveitis [56–62]. …”

Section: Introductionmentioning

confidence: 99%

“…Hamza et al further demonstrated the safety and efficacy of a single injection of 1 mg/0.05 ml intravitreal infliximab in a series of 20 patients with refractory uveitis due to BD. By 18 weeks follow-up, they reported a statistically significant improvement in mean visual acuity, reduction in mean central macular thickness, and reduction in mean vitreous haze scores [62]. …”

Section: Introductionmentioning

confidence: 99%

An update on the use of biologic therapies in the management of uveitis in Behçet’s disease: a comprehensive review

McNally

Damato

Murray

et al. 2017

Orphanet J Rare Dis

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ᅟBehçet’s disease (BD) is a systemic vasculitis characterised by a relapsing remitting course, affecting multiple organ systems. In the eye, it is a cause of potentially blinding inflammation in the form of uveitis. Management of uveitis in BD often requires the use of systemic immunosuppression, in order to reduce disease activity and prevent accumulation of irreversible damage. Whilst corticosteroids remain the mainstay of treatment, long-term use is limited by the development of adrenocorticotrophic side effects. There has therefore been significant interest in the use of corticosteroid-sparing immunosuppressive agents, and more recently, biologic therapies. Recent publications have demonstrated biologic therapy to have beneficial effects both on overall disease control, and quality of life for patients with BD. Widespread use of such agents is however limited, partly by the lack of high quality research evidence, and partly by the prohibitive cost of biologic treatments. In this review, we discuss the most recent research investigating the use of biologic therapy in uveitis due to BD, with consideration of health economics and quality of life outcomes.

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Intravitreal Infliximab in Refractory Uveitis in Behcet's Disease

Abstract: Intravitreal infliximab appeared to be safe and effective in treating uveitis in Behcet's disease and should be considered as an alternative to systemic therapies.

Cited by 32 publications

References 35 publications

Efficacy and safety of intravitreal anti‐tumour necrosis factor drugs in adults with non‐infectious uveitis – a systematic review

Efficacy and safety of intravitreal anti‐tumour necrosis factor drugs in adults with non‐infectious uveitis – a systematic review

Ocular Manifestations of Behçet’s Disease

An update on the use of biologic therapies in the management of uveitis in Behçet’s disease: a comprehensive review

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