Abstract
Abstract: :
Purpose: To evaluate the clinical usefulness of infliximab (Remicade®), an anti–TNF–alpha inhibitor, in patients with inflammatory eye disease that was found to be resistant to conventional immunosuppressive medications. Methods: Fifteen patients (10 males and 5 females aged 16–66 years) who received infliximab primarily for either inflammatory eye disease or joint disease were studied retrospectively to determine the effects of infliximab on their ocular inflammation. Main outcome measures included degree of inflammation and symptoms and visual acuity before and after treatment and side effects of remicade treatment. Results: Nine patients with uveitis (including anterior and panuveitis), 5 patients with scleritis, and 1 patient with ocular cicatricial pemphigoid (OCP) were treated with infliximab. Systemic diagnoses included adult and juvenile rheumatoid arthritis (n=4), ankylosing spondylitis (n=2), Behcet's disease (n=4), and OCP (n=1). Four patients had ocular inflammation without associated systemic disease. Indications for infliximab treatment were systemic and/or joint inflammation unresponsive to other anti–rheumatic drugs in 4 patients (infusion every 5–8 weeks) and ocular inflammation resistant to conventional immunomodulatory agents including methotrexate, cyclosporin A, mycophenolate mofetil, and prednisone in 11 patients (infusions every 2–4 weeks). The mean number of months of follow–up per patient was 10.4 months. Eight of 14 patients with ocular inflammation experienced improvement in ocular inflammation. Two of 14 had stable or no change in inflammation. Two of 14 had worsened inflammation over the course of treatment. Three of 14 patients received only one recent dose of infliximab therefore evaluation of inflammation was not available. Visual acuity was stable in 11 patients, slightly worse in 2 patients, and significantly improved in 2 patients. There were no adverse side effects due to infliximab. Two patients discontinued use of inflixiamb due to insurance noncoverage issues. Conclusions: Infliximab is a well–tolerated and possibly effective alternative for managing certain types of recalcitrant ocular inflammatory diseases including uveitis and scleritis, as well as their associated inflammatory arthrtides.
Keywords: uveitis–clinical/animal model • autoimmune disease • clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials