Rheumatology Advance Access originally published online on May 3, 2007
Rheumatology 2007 46(7):1161-1164; doi:10.1093/rheumatology/kem101
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Long-term efficacy of infliximab in refractory posterior uveitis of Behçet's disease: a 24-month follow-up study
2nd Division of Internal Medicine, Rheumatology Unit, 1Division of Ophthalmology, Hospital of Prato, 2Rheumatology Unit of Nuovo Ospedale S. Giovanni di Dio, Firenze, 3Division of Rheumatology, Hospital of Reggio Emilia, Italy and 4Division of Ophthalmology, Hospital of Reggio Emilia, Italy.
Correspondence to: Dr Fabrizio Cantini, 2^ Divisione di Medicina, Unità Reumatologica, Ospedale Misericordia e Dolce di Prato, Piazza Ospedale, 1, 59100 Prato, Italy. E-mail: fcantini{at}usl4.toscana.it
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Abstract |
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Objectives. To evaluate the long-term efficacy and safety of infliximab in patients with Behçet's disease (BD) and refractory bilateral posterior uveitis, and to assess the proportion of relapse-free subjects through months 12 and 24.
Methods. Open-label, multicentre, 24-month, prospective, follow up study on 12 consecutive patients with BD and refractory posterior uveitis who had failed at least one immunosuppressive drug. At baseline patients received prednisolone 1 mg/Kg/day with rapid tapering and nine infliximab infusions (5 mg/kg) over a 12-month period. Non-responders after the third infusion withdrew from the study. Patients were evaluated for ocular inflammation degree, visual acuity (VA), number of ocular attacks and incidence of adverse events (AEs).
Results. At 12-month visit, 9/12 (75%) patients achieved a complete remission with no relapse during the treatment period. All had a dramatic improvement of ocular inflammation after the first infusion, six were in complete remission after three infusions, and three after four. All these patients suspended corticosteroids at week 22. At 24-month visit, seven out of nine (78%) were still in remission. Mean VA improved from 0.2 ± 0.6 to 0.5 ± 0.2 (P < 0.001), and ocular attacks dropped from 40 in the year before therapy to 5 after infliximab cessation (P < 0.001). One patient had a partial remission with two relapses during treatment, and 2/12 (17%) patients showed no improvement. Infliximab was well tolerated with no serious AEs.
Conclusions. Infliximab is rapidly effective and safe in a high proportion BD patients with refractory posterior uveitis, and may be helpful to prevent recurrences.
KEY WORDS: Infliximab, Anti-TNF-
drugs, Behçet's disease, Uveitis, Retinal vasculitis
Submitted 18 January 2007;
revised version accepted 23 March 2007.
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