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Y. Yamada, S. Sugita, K. Kamoi, Y. Iwanaga, M. Yokota, H. Tanaka, H. Takase, M. Mochizuki; Efficacy of Infliximab Treatment in Behcet’s Disease With Refractory Uveoretinitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4723.
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Behcet’s disease (BD) can cause sight-threatening uveoretinitis. Refractory uveitis in the disease is not well managed even with cyclosporine A (CsA) in many patients. In this study, we evaluated the efficacy and safety of a new therapy, infliximab (anti-TNFα antibody) on refractory uveitis in BD.
Subjects were patients with BD at uveitis clinic of TMD Hospital between 1998 and 2007 treated with 3-5 mg/kg of CsA (n=41) or 5mg/kg of infliximab (n=11). Extra-ocular systemic symptoms as well as adverse events during the whole periods on each agent were compared between the two groups. Number of episodes of acute uveitis attacks and vision were compared between the two groups, but in limited periods of treatments, i.e. 6 months before each treatment and initial 6 months after the treatment (number of patients: 20 in CsA group and 9 in inflixmab group).
Uveitis attacks in 6 months before the treatment were 3.1±2.3 in infliximab group, while 3.3±2.4 in CsA group (n.s.), and in the 6 months after the initiation of the treatment were 0.1±0.3 in infliximab group, while 1.2±1.2 in CsA group (P<0.05). Infliximab improved or unchanged the vision in 89% of eyes, while 93% in CsA (n.s.). Complete disappearance of extra-ocular symptoms was achieved in 64% of infliximab-treated patients, while only in 2% of CsA-treated patients (P<0.001). Infliximab induced a few adverse events, e.g. skin eruption in 3 patients, leucopenia in 2 and infusion reaction in one patient, but no serious adverse events such as tuberculosis. CsA caused many adverse events: central nervous system symptoms in 10 patients, renal toxicity in 7 patients, and 6 of them discontinued CsA due to the side effects.
The new therapy with infliximab is effective in refractory uveitis in patients with BD. Comparing to CsA, infliximab is much more effective and much less side effects.
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