Rheumatology Advance Access published online on August 1, 2008
Rheumatology, doi:10.1093/rheumatology/ken298
Loss of efficacy during long-term infliximab therapy for sight-threatening childhood uveitis
1Department of Paediatrics, Rheumatology Unit, Anna Meyer Children's Hospital and University of Florence, Florence 2Ophtalmology Unit, Children's Hospital of Padua, Padua 3Ophtalmology Unit, Anna Meyer Children's Hospital and University of Florence, Florence and 4Department of Paediatrics, Rheumatology Unit, Children's Hospital of Padua, Padua, Italy.
Correspondence to:
G. Simonini, Department of Pediatrics, Rheumatology Unit, University of Florence, Anna Meyer Children's Hospital, viale Pieraccini 24, 50139 Florence, Italy. E-mail: gabriele.simonini{at}unifi.it
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Abstract |
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Objective. To describe efficacy and safety of infliximab in the treatment of childhood chronic uveitis during a long-term follow-up.
Methods. Fifteen patients (median age 12 yrs, range 5–21 yrs) with chronic uveitis were enrolled. Before infliximab treatment, children had presented active uveitis despite treatment with MTX and/or CSA. All were also receiving oral prednisone (1–2 mg/kg/day) for at least 1 month. Infliximab (5 mg/kg) was administered at weeks 0, 2, 6 and then every 6–8 weeks. Later on, in patients enrolled in Florence the administration interval was progressively increased up to 10 weeks if uveitis did not flare, whilst in children from Padua the scheduled infusion rate was maintained every 6 weeks. Absence or recurrence rate of uveitis up to the last visit was recorded.
Results. Median follow-up on treatment was 30 months (range 16–38 months), median number of infusions 22 (range 11–30). During the first year, 13/15 children achieved a complete remission over a median period of 10 weeks, but all relapsed thereafter. The probability of a first relapse was correlated to length of treatment, once remission was achieved (P < 0.03). The total number of relapses correlated with the duration of treatment (rs = 0.81; P < 0.002) and with the total number of infusions (rs = 0.83; P < 0.001). The total number of relapses on treatment at last follow-up was not significantly different between the two centres.
Conclusions. Even if limited to a small group, infliximab appears to be an effective treatment for uveitis in children, but its efficacy seems to wane over time.
KEY WORDS: Children, Chronic uveitis, Infliximab
*F. Zulian and R. Cimaz contributed equally to this work.
Submitted 22 January 2008;
revised version accepted 30 June 2008.
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