Long-term safety and efficacy of infliximab therapy in refractory uveitis due to Behçet's disease.
OBJECTIVE
To evaluate the long-term safety and efficacy of infliximab therapy for refractory uveitis associated with Behçet's disease (BD).


METHODS
We prospectively enrolled six patients who failed to respond to conventional immunosuppressive treatment. Infliximab infusions (5 mg/kg) were administered at weeks 0, 2, 6, and then every 8 weeks. The outcome variables were visual acuity, control of inflammation, reduction of macular edema, tapering of immunosuppressive therapy, and adverse effects.


RESULTS
The follow-up period ranged from 16 to 36 months (mean +/- SD, 23 +/- 7.4 months). The number of infliximab infusions ranged from 10 to 23 (14 +/- 4.6). By the 2-month follow-up, all patients had achieved remission, the cystoid macular edema had resolved, and visual acuity had improved dramatically. Throughout the follow-up period, three patients remained attack-free. One patient had one relapse, and another patient had two relapses before the scheduled infusions; all three relapses resolved rapidly after the subsequent infusion. One patient developed five relapses, and infusions at 6-week intervals were necessary to achieve sustained remission. At the end of the follow-up period, visual acuity improved in five patients. Concomitant immunosuppressive therapy was substantially reduced. Antinuclear antibodies developed in two patients who received 17 and 23 infusions. No major adverse effects requiring withdrawal of infliximab were observed.


CONCLUSIONS
Infliximab is efficient and safe for long-term treatment of refractory uveitis associated with BD. Repeated infusions are required to maintain long-term remission.
Abu El-Asrar
Ahmed M
AM
Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia. abuasrar@KSU.edu.sa
Abboud
Emad B
EB
Aldibhi
Hassan
H
Al-Arfaj
Abdulrahman
A
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D001528:Behcet Syndrome / Q000150:complications*; D002648:Child; D004351:Drug Resistance; D005260:Female; D005451:Fluorescein Angiography; D005500:Follow-Up Studies; D005654:Fundus Oculi; D006801:Humans; D000069285:Infliximab; D007262:Infusions, Intravenous; D008297:Male; D011446:Prospective Studies; D012074:Remission Induction; D013997:Time Factors; D041623:Tomography, Optical Coherence; D014409:Tumor Necrosis Factor-alpha; D014606:Uveitis, Anterior / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab