Anti-tumor necrosis factor-alpha therapy with infliximab as an alternative to corticosteroids in the treatment of human leukocyte antigen B27-associated acute anterior uveitis.
OBJECTIVE
To evaluate the potentials of infliximab, a mouse-human chimeric immunoglobulin G1 monoclonal antibody that binds both the soluble form and the membrane-bound precursor of tumor necrosis factor-alpha (TNF-alpha), thus inhibiting a broad range of biologic activities of TNF-alpha, in the therapy of patients with acute HLA B27-associated anterior uveitis.


METHODS
Prospective noncomparative case series.


METHODS
Seven consecutive patients with acute onset of HLA B27-associated anterior uveitis, with at least three anterior chamber cells.


METHODS
Infliximab IV (Centocor, Malvern, PA) at a dosage of 10 mg/kg body weight was used as the only anti-inflammatory drug.


METHODS
Anterior chamber cells and flare were evaluated before infliximab treatment and at defined time points after treatment. C-reactive protein (CRP) levels were assessed in all patients before IV delivery of infliximab and were re-evaluated after 1 week.


RESULTS
Patients were observed for a mean period of 17 +/- 0.8 months. Seven patients received a single infliximab infusion of 10 mg/kg body weight. One patient received a second infusion 3 weeks after the first because of a uveitis flare-up. The median duration (+/- standard deviation) of uveitis was 8 +/- 12 days. All patients responded to infliximab with immediate improvement of clinical symptoms and a rapid decrease in anterior chamber cells. Total resolution of the uveitis was achieved with infliximab as the sole anti-inflammatory drug in all but one patient, who also showed systemic inflammatory activity, as indicated by a threefold increase in the serum CRP level. A relapse was seen in four patients after a median period of 5 +/- 6.4 months.


CONCLUSIONS
Infliximab proved to be a powerful therapeutic agent in acute HLA B27-associated uveitis and may therefore be a future alternative or supplement to steroid treatment. Larger controlled studies on the efficacy and dosage of infliximab in different forms of anterior uveitis will nonetheless be needed to evaluate the effectiveness of anti-TNF-alpha treatment in acute, as well as chronic, uveitis.
El-Shabrawi
Yosuf
Y
Department of Ophthalmology, Karl Franzens University, Graz, Austria. yosuf.elshabrawi@kfunigraz.ac.at
Hermann
Josef
J
D000208:Acute Disease; D000328:Adult; D000867:Anterior Chamber / Q000473:pathology; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D004341:Drug Evaluation; D005260:Female; D015796:HLA-B27 Antigen / Q000276:immunology*; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*; D014606:Uveitis, Anterior / Q000188:drug therapy* / Q000276:immunology*
D000911:Antibodies, Monoclonal; D015796:HLA-B27 Antigen; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab