Efficacy of Infliximab in the Treatment of Chronic Severe and Refractory Uveitis : A Review of Six Cases

Abstract

Abstract: : Purpose: The traditional approach to the treatment of severe and sight-threatening uveitis has been the use of corticosteroids mostly in combination with classical immunosuppressive agents. Recently, infliximab, a chimeric monoclonal antibody to tumor necrosis factor (TNF)-alpha has been proposed in severe forms of anterior or posterior uveitis associated with ankylosing spondylitis or Behçet’s disease. Methods: A retrospective review of cases undergoing infliximab infusions in a two-year period (2001-2002) was performed to evaluate the efficacy and the tolerance of this alternative strategy. Infusions of infliximab at the dosage of 5 mg/kg, administered at weeks 0, 2, 6 and maintained every 8 weeks, have been performed in patients suffering from chronic non-infectious uveitis, resistant to high dose corticosteroids and immunosuppressive regimens. The efficacy of the treatment was evaluated by ophthalmologic examination, laser flare photometry and fluorescein angiography. Results: Treatment was performed in 6 patients. The mean age was 37 years-old (21-45). Duration of their condition before infliximab administration was 7.6 years (4-20 years). Three patients presented with Behçet’s disease. In two cases, uveitis was associated with refractory ankylosing spondylitis or psoriatic arthritis. The last patient presented with a bilateral panuveitis, vasculitis and retinal necrosis of non infectious origin. Treatment was considered efficient in all cases within a few days. Therefore, immunosuppressive drugs were discontinued and corticosteroids were tapered. No recurrence occurred after a mean follow-up of 9 months (1-15 months). No serious adverse event related to the treatment was observed. Conclusions: TNF-α plays a major role in different forms of intraocular inflammation. These preliminary results confirm the remarkable and rapid efficacy of infliximab in severe forms of non infectious refractory uveitis. However, larger control studies and long term follow-up are needed before drawing further conclusions.

Keywords: inflammation • uvea • autoimmune disease