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Akbar Shakoor, Elizabeth J. Esterberg, Nisha Acharya; Recurrence of Ocular Inflammatory Disease after Discontinuation of Infliximab. Invest. Ophthalmol. Vis. Sci. 2011;52(14):4260.
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Anti -TNFα agents are now widely used to treat a number of ocular and systemic inflammatory diseases. Little is known about the duration of sustained remission and clinical course of ocular inflammatory disease upon cessation of infliximab. The purpose of this study was to evaluate progression and recurrence of ocular inflammatory disease after discontinuation of infliximab once control of inflammation has been achieved
A retrospective review of clinical charts of 67 patients with ocular inflammatory disease seen at the Proctor Foundation between 1998 and 2010 who were treated with infliximab was performed. Patients who achieved control of their inflammation on infliximab by Standardization of Uveitis Nomenclature criteria and then discontinued the agent were selected. Data collected included demographic information, disease characteristics, co-morbid conditions, prior and concurrent medical interventions and visual outcomes.
Seventeen patients discontinued infliximab after achieving control of inflammation. The median age at the time of drug cessation was 19 years (IQR 13-35), and 70% were female. Patients stopping infliximab had chronic (100%) and largely bilateral (88.2%) ocular inflammatory disease. Median duration of ocular inflammatory disease upon stopping infliximab was 4.7 years (IQR 3.8-10.8). Median time on infliximab was 1.4 years (IQR 0.7-2.5). Of patients who stopped after achieving control, reasons for cessation were presumed remission (n=9), adverse effects (n=3), pregnancy (n=2), poor compliance (n=2), and difficulty with administration (n=1). Ten patients had a relapse of their ocular inflammatory disease. Median time to relapse was 559 days (95% CI: 84 - 1371 days). Four out of 8 patients with anterior uveitis, 6 out of 7 with panuveitis and neither of 2 patients with posterior uveitis relapsed. The median time to relapse for patients that did not have juvenile idiopathic arthritis (JIA)-associated uveitis was 603 days. Patients with JIA (n=4) relapsed within a significantly shorter period (median time to relapse: 76 days, P=0.004). The median age of patients who relapsed off infliximab was 19 years (IQR 15.5-27.3), compared to 29 years (IQR 10-35.5) in patients who did not relapse.
The majority of patients who achieved control of inflammation on infliximab had a recurrence after cessation of therapy. Patients with JIA had significantly shorter disease-free periods off infliximab.
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