Favorable response to high-dose infliximab for refractory childhood uveitis.
OBJECTIVE
Uveitis in children most commonly is associated with juvenile idiopathic arthritis. In addition to topical glucocorticoids, treatment may include systemic immunosuppressive agents. Tumor necrosis factor alpha (TNF-alpha) has been implicated in the pathogenesis of uveitis; therefore, TNF-alpha blockade seems to be a reasonable therapeutic option to investigate. We report successful treatment of children with uveitis using infliximab.


METHODS
A retrospective study of our complete experience using infliximab for the treatment of childhood uveitis was conducted.


METHODS
Seventeen children (14 females, 3 males) with chronic uveitis were administered high-dose infliximab (10-20 mg/kg/dose).


METHODS
Our main outcome measure was the ability to eliminate all signs of intraocular inflammation.


RESULTS
All 17 patients demonstrated a dramatic, rapid response, with no observed inflammation in 13 patients after the second infusion, and 4 patients requiring 3 to 7 infusions to achieve disease quiescence. Additional immunosuppressives and topical glucocorticoids were tapered when patients achieved no intraocular inflammation.


CONCLUSIONS
In this series, high-dose infliximab was a rapidly effective, well-tolerated therapeutic agent for the treatment of chronic, medically refractory, noninfectious uveitis.
Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York 10032, USA.
Philip
P
Kahn
Michael
M
Weiss
Lisa F
LF
Imundo
Deborah M
DM
Levy
D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D001171:Arthritis, Juvenile / Q000150:complications; D002648:Child; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology; D014605:Uveitis / Q000188:drug therapy* / Q000209:etiology; D014607:Uveomeningoencephalitic Syndrome / Q000150:complications
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab