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Y. El-Shabrawi, H. Mangge, J. Hermann; Treatment of Chronic Inflammatory Treatment Refractory Anterior Segment Inflammation With Selective Anti-TNFa Therapy . Invest. Ophthalmol. Vis. Sci. 2003;44(13):2400.
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Purpose: To test the efficacy of selective anti-TNFa therapy in chronic inflammatory diseases of the anterior segment of the eye, non-responsive to standard antiinflammatory treatment consisting of combined immunomodulatory and corticosteroid therapy.Patients : Eight patients suffering from anterior segment inflammation non-responsive to standard (DMARDs incl. MTX, CyA, Endoxan,) anti-inflammatory treatment were included in this study. Seven patients developed anterior segment inflammation associated with a rheumatic disease. Of these, four were diagnosed with an HLAB27 associated uveitis, two patients with a chronic JIA associated iridocyclitis and one patient with Wegener’s granulomatosis suffering from a severe necrotizing scleritis. One additional patient with a uveitis associated with tubulointerstitial nephritis was also included. All but one patient received at least 3 infliximab infusions of 3mg/kg/BW at 0, 2 and 6 weeks. Results :The follow-up was 11±7 months. All four HLAB27 positive patients responded with a rapid improvement of their disease after the first infusion and remained in remission for at least six months. The same was seen in the patient with Wegener’s granulomatosis. However the response towards infliximab therapy in both patients suffering from a chronic uveitis associated with JIA showed a moderate and transient response only. In both patients the uveitis flared-up despite prolonged (18 weeks) infliximab therapy and despite adjustment of the dose (up to 10 mg/kg). The patient suffering from TINU syndrome did not respond towards anti-TNFa therapy.Conclussion : In our patients the response of the ocular disease towards infliximab treatment in large resembled the response of the systemic disease. Systemic manifestations of the disease in HLA B27 associated inflammatory conditions as well as in Wegener’s granulomatosis have already been described to respond to Infliximab treatment and we found it to be highly efficient in inhibiting the ocular inflammation too. However in both patients suffering from a chronic uveitis in association with JIA, the antiinflammatory effect of infliximab was not sustained and was lost despite adjustment to higher dose.
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