Human recombinant interferon alfa-2a for the treatment of Behcet's disease with sight threatening posterior or panuveitis

Kötter, Ina; Zierhut, Manfred; Eckstein, Anja; Vonthein, Reinhard; Neß, Thomas; Günaydın, İlhan; Grimbacher, Bodo; Blaschke, Sabine; Meyer-Riemann, W; Peter, HH; Stübiger, Nicole

doi:10.1136/bjo.87.4.423

Cited by 245 publications

(128 citation statements)

References 46 publications

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“…Usually, a significant improvement in visual acuity was noted after 2 infusions of infliximab, which is consistent with resolution of intraocular inflammation, although there were individual differences depending on the part of the eye in which the attack occurred. Because of the spontaneously remitting nature of Behçet's uveitis, these observations need to be repeated in larger patient groups, with control groups of subjects who would be assigned to receive therapy with conventional antiinflammatory agents (i.e., corticosteroids) and possibly other biologic agents (i.e., interferon-␣ [IFN␣] and different anti-TNF agents) that seem to have a rapid antiinflammatory effect as well when used as monotherapy (23).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of infliximab in the treatment of uveitis that is resistant to treatment with the combination of azathioprine, cyclosporine, and corticosteroids in behçet's disease: An open‐label trial

Tuğal-Tutkun¹,

Mudun²,

Urgancioğlu³

et al. 2005

Arthritis & Rheumatism

283

151

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Objective. To investigate the effect of infliximab on the frequency of uveitis attacks and the visual prognosis in male patients with Behçet's disease in whom uveitis was resistant to combination therapy with corticosteroids, azathioprine, and cyclosporine.Methods. The study group comprised patients who were receiving combination therapy but experienced at least 2 attacks of posterior uveitis/panuveitis or retinal vasculitis during the 6-month period prior to enrollment. Infliximab infusions (5 mg/kg) were administered at weeks 0, 2, 6, and 14. Weeks 0-22 were defined as the infusion period, and weeks 23-54 were defined as the observation period. Patients continued to receive azathioprine and corticosteroids, but cyclosporine was discontinued after the screening visit. The primary outcome measures were the absence of uveitis attacks during the infusion period (remission), and the absence of uveitis attacks throughout the study period (sustained remission).Results. Thirteen patients were enrolled in the study. Thirty-two uveitis attacks involving the posterior segment occurred during the previous-treatment period. During the infusion period, 4 patients (30.8%) remained attack-free, and 9 patients had a total of 13 uveitis attacks. Ten of these attacks (76.9%) occurred at either week 14 or week 22. One of 13 patients fulfilled the definition of sustained remission, and the remaining 12 patients had a total of 36 uveitis attacks during the observation period. The mean number of uveitis attacks and daily corticosteroid doses were significantly lower during the infusion period than during the previoustreatment period or the observation period. Although potential visual acuity was regained following infliximab infusion, this beneficial effect was not preserved until week 54. None of the patients experienced a serious adverse event.Conclusion. The results of this trial suggest that infliximab is effective in suppressing the occurrence of uveitis attacks, has a corticosteroid-sparing effect, and has favorable implications for the visual prognosis of patients with resistant Behçet's uveitis.Behçet's disease (BD) is a multisystem inflammatory disorder with a chronic, relapsing course. Patients with ocular involvement typically have bilateral nongranulomatous panuveitis and retinal vasculitis that involves all elements of the retinal vasculature (1). The course of the disease is characterized by recurrent, explosive attacks of uveitis followed by spontaneous remissions. The severity and frequency of these inflammatory episodes determine the extent of permanent damage to the intraocular structures and resultant visual loss. Permanent sequelae of posterior segment involvement include optic atrophy, maculopathy, sheathing and occlusion of retinal vessels, and diffuse atrophy and gliosis of the retina. Although the course of the disease shows individual variability, male patients have a younger age at disease onset, more severe disease, and

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Section: Discussionmentioning

confidence: 99%

Efficacy of infliximab in the treatment of uveitis that is resistant to treatment with the combination of azathioprine, cyclosporine, and corticosteroids in behçet's disease: An open‐label trial

Tuğal-Tutkun¹,

Mudun²,

Urgancioğlu³

et al. 2005

Arthritis & Rheumatism

283

151

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“…Open-label studies [Boyvat et al 2000;O'Duffy et al 1998;Georgiou et al 1998;Azizlerli et al 1996;Alpsoy et al 1994] Eye involvement Uncontrolled prospective study [Kotter et al 2003] Retrospective studies [Onal et al 2011;Sobaci et al 2010;Deuter et al 2010;Bodaghi et al 2007;Tugal-Tutkun et al 2006;Deuter et al 2004;Krause et al 2003;Calguneri et al 2003;Hamuryudan et al 2002;Wechsler et al 2000;Yalcindag and Uzun, 2012] Systematic review [Kotter et al 2004a] Mucocutaneous disease and arthritis Uncontrolled prospective study [Kotter et al 2004b] Systematic review [Kotter et al 2004a] Neuro-Behçet Case reports [Nichols et al 2001;Kuemmerle-Deschner et al 2008;…”

Section: ]mentioning

confidence: 99%

Update on the therapy of Behçet disease

Saleh

Arayssi

2014

Therapeutic Advances in Chronic Disease

115

101

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Behçet disease is a chronic inflammatory systemic disorder, characterized by a relapsing and remitting course. It manifests with oral and genital ulcerations, skin lesions, uveitis, and vascular, central nervous system and gastrointestinal involvement. The main histopathological finding is a widespread vasculitis of the arteries and veins of any size. The cause of this disease is presumed to be multifactorial involving infectious triggers, genetic predisposition, and dysregulation of the immune system. As the clinical expression of Behçet disease is heterogeneous, pharmacological therapy is variable and depends largely on the severity of the disease and organ involvement. Treatment of Behçet disease continues to be based largely on anecdotal case reports, case series, and a few randomized clinical trials.

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“…Tedaviye yan›t oranlar› çeflitli yay›nlarda %82-92 aras›nda bildirilmektedir. [3][4][5][6] Öte yandan bu ajan›n Behçet hastal›¤› d›fl›nda nonenfeksiyöz idiopatik üveit, birdshot korioretinopati gibi farkl› endikasyonlarda da baflar›l› oldu¤unu bildiren yay›nlar da mevcuttur. 7 IFN-α kullan›m›na ba¤l› olarak, nezle-benzeri k›rg›n-l›k hali, karaci¤er enzimlerinde yükselme, lökopeni, trombositopeni, depresyon, psoriaziste kötüleflme ve enjeksiyon sahas› ülserleri yan etki olarak tan›mlanmak-la birlikte, ciddi depresyon d›fl›nda genel olarak ilaç b›-rakt›rmay› gerektirecek ciddiyette sorunlar olarak görül-memektedirler.…”

Section: Interferon-alfaunclassified

New Treatment Alternatives in the Management of Non-İnfectious İntraocular İnflammations: Biologic Agents

Emre¹,

Tutkun²

2011

tjo

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ÖzetEnfeksiyöz olmayan üveitlerin tedavisinde son y›llara kadar genel olarak immün sistemi bask›layan ilaçlar kullan›lmak-tayd›. Ancak gen mühendisli¤indeki geliflmeler, inflamatuar süreçte yer alan özgün molekülleri hedefleyen proteinlerin sentezini ve bu proteinlerin terapötik olarak kullan›lmalar›n› mümkün k›lm›flt›r. Genel olarak protein yap›s›ndaki bu ajanlar biyolojik ajanlar olarak adland›r›lm›fllard›r. Oftalmologlar›n biyolojik ajanlar ile tecrübeleri s›n›rl› olsa da, bu ajanlar romatoloji ve dermatoloji baflta olmak üzere di¤er disiplinler taraf›ndan yo¤un biçimde kullan›lmaktad›rlar. ‹nterferon, infliksimab ve adalimumab baflta olmak üzere birçok biyolojik ajan›n üveit hastalar›nda kullan›m› ile ilgili literatür verisi olmas›na ra¤men henüz bu endikasyonda ruhsatl› kullan›mlar› yoktur. Ayr›ca bu ajanlar›n kullan›m› s›ras›nda dikkat edilmesi gereken güvenlik önlemleri ve önemli risk faktörleri mevcuttur. Bu derlemenin amac›, dirençli üveit hastalar›nda kullan›labilen biyolojik ajanlar konusunda güncel ve kapsaml› bilgi sunmakt›r. ( SummaryConventional immunosuppressive agents have been traditionally used for the treatment of noninfectious uveitis. Recent developments in genetic engineering have made it possible to synthesize proteins that target specific molecules playing role in the inflammatory response. These agents are generally in protein structure and are named biologic agents. While there is limited experience with biologics in the field of ophthalmology, they are commonly used in other disciplines such as rheumatology and dermatology. Although considerable data have accumulated in the uveitis literature regarding the use of biologic agents, including mainly interferon, infliximab, and adalimumab, their use for this indication is still off-label. Moreover, there are certain precautions that have to be taken into account, as well as important safety issues associated with their use. The purpose of this paper is to present an updated comprehensive review of biologic agents that may be used for the treatment of refractory uveitis. (Turk J Ophthalmol 2011; 41: 243-55 GiriflEnfeksiyöz olmayan üveitlerin tedavisinde kullan›lmakta olan immunsupresan ajanlar, ba¤›fl›kl›k sistemini genel olarak bask›lamakta veya sapt›rmaktad›rlar. Bu tedavi yöntem-lerinin sebep olduklar› ciddi yan etkiler ile tedaviye dirençli olgular, hekimleri yeni tedavi aray›fllar›na itmektedir. Son y›llarda araflt›r›lan biyolojik ajanlar, inflamatuar süreçteki öz-gün molekülleri (proteinleri) etkileyerek ba¤›fl›kl›k sisteminde daha s›n›rl› ancak etkin bir tedavi sa¤lamaktad›rlar. Biyolojik ajanlar, moleküler rekombinant DNA teknolojisi kullan›larak elde edilen proteinlerdir. Bu ajanlar›n büyük ço¤un-lu¤u monoklonal antikorlard›r. fiu an için enfeksiyöz olmayan üveitlerin tedavisinde bafll›ca kullan›lan biyolojik ajanlar 3 grupta s›n›fland›r›labilir; i. Interferon-α, ii. TNF-α antagonistleri ve iii. Çeflitli sitokin veya yüzey membran proteini gibi farkl› hedeflere yönelik antikorlar veya füzyon proteinleri.

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Human recombinant interferon alfa-2a for the treatment of Behcet's disease with sight threatening posterior or panuveitis

Cited by 245 publications

References 46 publications

Efficacy of infliximab in the treatment of uveitis that is resistant to treatment with the combination of azathioprine, cyclosporine, and corticosteroids in behçet's disease: An open‐label trial

Efficacy of infliximab in the treatment of uveitis that is resistant to treatment with the combination of azathioprine, cyclosporine, and corticosteroids in behçet's disease: An open‐label trial

Update on the therapy of Behçet disease

New Treatment Alternatives in the Management of Non-İnfectious İntraocular İnflammations: Biologic Agents

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