Monthly Intravitreal Infliximab in Behçet's Disease Active Posterior Uveitis

Refaat, Mohammad; Abdullatif, Abdussalam M; Hamza, M; Macky, Tamer A.; El-Agha, Mohamed-Sameh H; Ragab, Gaafar; Soliman, Mahmoud M.

doi:10.1097/iae.0000000000003095

Cited by 17 publications

(13 citation statements)

References 18 publications

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“…The reported improvement in clinical parameters places intravitreal IFX as a promising strategy in the treatment of ocular inflammation. However, previous results differ from recent findings of severe immunological reactions and a high percentage of therapeutic failure after intravitreal administration of IFX in patients with posterior uveitis associated with Behçet’s disease [ 118 ]. Furthermore, evidence of an inflammatory reaction and a strong suggestion of retinotoxicity to intravitreal IFX were shown in a pilot safety study of patients with diabetic macular oedema or choroidal neovascularization secondary to age-related macular degeneration who failed conventional therapies [ 119 ].…”

Section: Implications Of Ocular Drug Pkcontrasting

confidence: 94%

Perspectives of Therapeutic Drug Monitoring of Biological Agents in Non-Infectious Uveitis Treatment: A Review

et al. 2023

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Biological drugs, especially those targeting anti-tumour necrosis factor α (TNFα) molecule, have revolutionized the treatment of patients with non-infectious uveitis (NIU), a sight-threatening condition characterized by ocular inflammation that can lead to severe vision threatening and blindness. Adalimumab (ADA) and infliximab (IFX), the most widely used anti-TNFα drugs, have led to greater clinical benefits, but a significant fraction of patients with NIU do not respond to these drugs. The therapeutic outcome is closely related to systemic drug levels, which are influenced by several factors such as immunogenicity, concomitant treatment with immunomodulators, and genetic factors. Therapeutic drug monitoring (TDM) of drug and anti-drug antibody (ADAbs) levels is emerging as a resource to optimise biologic therapy by personalising treatment to bring and maintain drug concentration within the therapeutic range, especially in those patients where a clinical response is less than expected. Furthermore, some studies have described different genetic polymorphisms that may act as predictors of response to treatment with anti-TNFα agents in immune-mediated diseases and could be useful in personalising biologic treatment selection. This review is a compilation of the published evidence in NIU and in other immune-mediated diseases that support the usefulness of TDM and pharmacogenetics as a tool to guide clinicians’ treatment decisions leading to better clinical outcomes. In addition, findings from preclinical and clinical studies, assessing the safety and efficacy of intravitreal administration of anti-TNFα agents in NIU are discussed.

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Section: Implications Of Ocular Drug Pkcontrasting

confidence: 94%

Perspectives of Therapeutic Drug Monitoring of Biological Agents in Non-Infectious Uveitis Treatment: A Review

et al. 2023

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“…Data related to the intravitreal use of anti-vascular endothelial growth factors such as bevacizumab and ranibizumab seem to be encouraging, even if still limited [ 147 , 150 , 151 ]. On the contrary, in a prospective open-label pilot study, monthly intravitreal infliximab injections (1 mg/0.05 mL) in patients with BD with active posterior uveitis were ineffective and associated with a high complication rate [ 152 ].…”

Section: Treatmentmentioning

confidence: 99%

Treatment Options in Pediatric Behçet’s Disease

2023

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Behçet’s disease is a rare and poorly understood vasculitis affecting blood vessels of all types and sizes. Uveitis and oral and genital ulcers represent the typical clinical triad. Populations along the ancient trading route connecting the Mediterranean basin with the Middle and Far East are most affected. Up to a quarter of the cases has a pediatric onset, typically around puberty. The aim of the treatment is early intervention to control inflammation, with symptom relief and prevention of relapses, damage, and complications. The heterogeneous clinical presentation often requires a multidisciplinary and tailored approach. Ocular, neurological, gastrointestinal, and vascular involvement is associated with a worse prognosis and needs more aggressive treatments. In young patients with expected prolonged disease, treatment should also focus on preventive measures and lifestyle advice. In recent years, the pharmacological armamentarium has grown progressively, although only a limited number of drugs are currently authorized for pediatric use. Most evidence for these drugs still derives from adult studies and experience; these are prescribed as off-label medications and are only available as adult formulations. Corticosteroids frequently represent the mainstay for the management of the initial acute phases, but their potential serious adverse effects limit their use to short periods. Different conventional disease-modifying anti-rheumatic drugs have long been used. Many other biologic drugs targeting different cytokines such as interleukin-1, interleukin-6, and interleukin-17 and treatments with small molecules including the phosphodiesterase 4 and Janus kinase inhibitors are emerging as novel promising therapeutic agents. In recent years, a growing interest has developed around anti-tumor necrosis factor agents that have often proven to be effective in severe cases, especially in those with a gastrointestinal and ocular involvement.

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“…The main indication for infliximab therapy was uveitis in 137 patients (48.5%) and only 4 of them developed new manifestations of BD [54]. In an open-label study of monthly intravitreal infliximab injections, the authors reported a high ocular complication rate and failure to control BD uveitis; therefore, such an approach was not recommended [55].…”

Section: Andandmentioning

confidence: 99%

Uveitis in Behçet disease - an update

Tuğal-Tutkun

2022

Current Opinion in Rheumatology

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Purpose of reviewUveitis is a major manifestation of Behc ¸et disease (BD) and potentially has a high morbidity. This article reviews recently published data on BD uveitis. Recent findingsA set of classification criteria and a diagnostic algorithm have been developed for BD uveitis. Recent reports have confirmed male predominance and posterior segment inflammation in the majority of BD uveitis patients. A high uveitis attack severity score, fluorescein angiographic leakage at the posterior pole, and disruption of outer retinal layers on optical coherence tomography (OCT) predict poor visual outcome. OCT-angiography studies have suggested subclinical changes of retinal capillaries in patients with or without ocular involvement. In a randomized controlled trial, interferon-a was superior to cyclosporine. Favorable outcomes were reported with earlier initiation, optimization, and withdrawal of infliximab after remission. Adalimumab as first-line was superior to conventional therapy. SummaryClassification criteria will be used to select a homogeneous group of patients for research and the diagnostic algorithm may help ophthalmologists predict the probability of BD uveitis based on ocular findings. Fluorescein angiography and OCT are the routine imaging modalities. Clinical relevance of OCT-angiography is unclear. Interferon-a, infliximab, and adalimumab have proven superior efficacy compared to conventional therapy.

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Monthly Intravitreal Infliximab in Behçet's Disease Active Posterior Uveitis

Cited by 17 publications

References 18 publications

Perspectives of Therapeutic Drug Monitoring of Biological Agents in Non-Infectious Uveitis Treatment: A Review

Perspectives of Therapeutic Drug Monitoring of Biological Agents in Non-Infectious Uveitis Treatment: A Review

Treatment Options in Pediatric Behçet’s Disease

Uveitis in Behçet disease - an update

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