Therapeutic use of infliximab in sight–threatening uveitis : efficacy, safety and limiting factors

Abstract

Abstract: : Purpose: To evaluate the anti–inflammatory and immunomodulatory effects of infliximab in patients with refractory uveitis. Methods: Infliximab was administered as a single infusion of 5 mg/kg (maximum dose: 400 mg) at day 1, at week 2, 6 and then every 8 weeks. Treatment efficacy was evaluated by ophthalmologic examination, laser flare photometry and fluorescein angiography. All patients were thoroughly screened for infectious conditions, especially tuberculosis before treatment and followed up closely during therapy. Prednisone was tapered progressively after infliximab administration. Results: Twelve patients were included in this retrospective study. The mean age was 35 years (range 16–52) and the F/M ratio was 1. Five patients presented with Behçet's diasease, 3 patients had ankylosing spondylitis, 2 patients had psoriatic uveitis and 2 patients had idiopathic panuveitis. During acute uveitis, ocular inflammation decreased dramatically few days after the first infusion of infliximab. Control of inflammation was initially achieved in all cases. The mean follow–up period was 16.6 months (range 7–25 mo). Mean daily prednisone dose decreased from 48 mg to 12 mg but prednisone has never been discontinued. Infliximab was well tolerated without fever, severe sepsis or auto–immune manifestations. Relapses occurred in 5 cases (41.6%) after a mean period of 10 months (range 4–82) including 3 cases of Behçet's disease, 1 case of ankylosing spondylitis and 1 case of idiopathic panuveitis. Methotrexate had to be secondarily associated in 5 cases. Conclusions:Infliximab remains effective in the treatment of refractory uveitis. However, relapses seem to occur, especially when infusions are performed less frequently. The optimal dose, the rhythm and the duration of infliximab infusions need to be standardized. The long–term use of anti–TNF–alpha agents should be evaluated.

Keywords: inflammation • autoimmune disease • corticosteroids