Multicenter Study of Infliximab for Refractory Uveoretinitis in Behçet Disease

Abstract

Objective: To describe the effects of infliximab on refractory uveoretinitis in patients with Behçet disease during the first year of treatment. Methods: Data were collected prospectively at 8 tertiary uveitis centers. Safety was analyzed in 63 patients. Efficacy was analyzed in 50 patients, after exclusion of those who had received infliximab for various reasons before the study. Results: Eighty-nine percent (56 of 63) of the patients were male, with 70% (44 of 63) of the patients aged 25 to 44 years. The safety analysis demonstrated that 34 episodes of adverse effects occurred in 46% (29 of 63) of patients during 1 year, including 3 episodes of infusion reactions. No adverse effects were deemed serious. The efficacy analysis at 1 year showed that uveoretinitis had improved in 69% (33 of 48), had improved somewhat in 23% (11 of 48), was unchanged in 8% (4 of 48), and had worsened in no patients. The mean number of ocular attacks per 6-month period decreased from 2.66 at baseline to 0.44 during months 1 through 6 of infliximab therapy and to 0.79 during months 7 through 12. Forty-four percent (21 of 48) of patients had no ocular attacks during the 1-year period. Efficacy was best for patients with uveoretinitis duration of less than 5 years. The mean best-corrected visual acuity improved logarithm of the minimum angle of resolution from 0.736 at the first infliximab infusion to 0.616 at the end of 1 year (P=.01). Conclusions: Infliximab treatment for Behçet disease uveoretinitis was well tolerated, with nonserious adverse effects occurring in about half of the patients. At the end of 1 year, uveoretinitis had improved or improved somewhat in 92% (44 of 48) of patients, accompanied by improvement in the mean visual acuity.

<p>Long-term efficacy and safety of infliximab and cyclosporine combination therapy for refractory uveoretinitis in Beh&ccedil;et&rsquo;s disease</p>

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<p>Long-term efficacy and safety of infliximab and cyclosporine combination therapy for refractory uveoretinitis in Beh&ccedil;et&rsquo;s disease</p>

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Systemic therapies for inflammatory eye disease: Past, Present and Future

“…Importantly TNFr-Ig therapy appeared to be effective across uveitic subtypes, including Behçet’s disease, idiopathic intermediate uveitis, multifocal choroiditis and sympathetic ophthalmia. These findings are supported by a large body of work from other groups [30-35], and subsequent reviews and editorials have highlighted the impact of anti-TNF-α therapies in ophthalmic practice [7,36-39]. …”

2018 update of the EULAR recommendations for the management of Behçet's syndrome

“…Some experts have preferred interferon-alpha and others preferred monoclonal anti-TNF antibodies for such patients. A review of the literature for open-label, observational studies or retrospective case series with these agents hinted at certain differences such as a rapid response and improvement in visual acuity with infliximab, a sustained response with interferon-alpha as well as high remission rates with both of these agents 27–63. The choice of treatment would depend on patient factors such as risk of infections including tuberculosis with monoclonal anti-TNF antibodies and tolerability of interferon-alpha, physician’s experience with these agents and reimbursement policies of each country.…”

<p>Long-term efficacy and safety of infliximab and cyclosporine combination therapy for refractory uveoretinitis in Beh&ccedil;et&rsquo;s disease</p>

“……”

“……”

Systemic therapies for inflammatory eye disease: Past, Present and Future

“…Importantly TNFr-Ig therapy appeared to be effective across uveitic subtypes, including Behçet’s disease, idiopathic intermediate uveitis, multifocal choroiditis and sympathetic ophthalmia. These findings are supported by a large body of work from other groups [30-35], and subsequent reviews and editorials have highlighted the impact of anti-TNF-α therapies in ophthalmic practice [7,36-39]. …”

2018 update of the EULAR recommendations for the management of Behçet's syndrome

“…Some experts have preferred interferon-alpha and others preferred monoclonal anti-TNF antibodies for such patients. A review of the literature for open-label, observational studies or retrospective case series with these agents hinted at certain differences such as a rapid response and improvement in visual acuity with infliximab, a sustained response with interferon-alpha as well as high remission rates with both of these agents 27–63. The choice of treatment would depend on patient factors such as risk of infections including tuberculosis with monoclonal anti-TNF antibodies and tolerability of interferon-alpha, physician’s experience with these agents and reimbursement policies of each country.…”

<p>Long-term efficacy and safety of infliximab and cyclosporine combination therapy for refractory uveoretinitis in Beh&ccedil;et&rsquo;s disease</p>

“……”

“……”

Systemic therapies for inflammatory eye disease: Past, Present and Future

“…Importantly TNFr-Ig therapy appeared to be effective across uveitic subtypes, including Behçet’s disease, idiopathic intermediate uveitis, multifocal choroiditis and sympathetic ophthalmia. These findings are supported by a large body of work from other groups [30-35], and subsequent reviews and editorials have highlighted the impact of anti-TNF-α therapies in ophthalmic practice [7,36-39]. …”

2018 update of the EULAR recommendations for the management of Behçet's syndrome

“…Some experts have preferred interferon-alpha and others preferred monoclonal anti-TNF antibodies for such patients. A review of the literature for open-label, observational studies or retrospective case series with these agents hinted at certain differences such as a rapid response and improvement in visual acuity with infliximab, a sustained response with interferon-alpha as well as high remission rates with both of these agents 27–63. The choice of treatment would depend on patient factors such as risk of infections including tuberculosis with monoclonal anti-TNF antibodies and tolerability of interferon-alpha, physician’s experience with these agents and reimbursement policies of each country.…”