Long-term efficacy of infliximab in refractory posterior uveitis of Behcet's disease: a 24-month follow-up study

Niccoli, Laura; Nannini, Carlotta; Benucci, Maurizio; Chindamo, Daniela; Cassarà, Emanuele; Salvarani, Carlo; Cimino, Luca; Gini, Guido; Lenzetti, Ivo; Cantini, Fabrizio

doi:10.1093/rheumatology/kem101

Cited by 151 publications

(77 citation statements)

References 21 publications

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“…IFX and ADA, however, remain the drug of choice for patients with uveitis. We have opted to use regularly scheduled IFX infusion as the main first-line biological therapy option in the majority of our patients because of its proven dramatic sustained efficacy in previous studies, especially for uveitis associated with BD (31)(32)(33)(34). In comparison to the 2008 EULAR recommendations that suggested IFX be used as a combination or add-on therapy with azathioprine in refractory eye involvement, our patients who presented with uveitis were treated early with IFX as monotherapy and had favorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

The real-world use of different anti-tumor necrosis factor agents in a Northern European population of patients with Behçet’s disease

Adeeb¹,

Ng²,

Khan³

et al. 2017

Eur J Rheumatol

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Objective: The aim of this study was to evaluate prescription practices, treatment responses, and serious adverse events of anti-tumor necrosis factor (anti-TNF) therapies in Behçet's disease (BD). Material and Methods: Patients with BD satisfying the International Study Group for Behçet's Disease or the International Criteria for Behçet's Disease criteria were recruited from a regional rheumatology program. The choice of anti-TNF, treatment response, and adverse events were specified. Response to treatment was evaluated by the detection of new, worsening, or improving clinical features, and management was benchmarked against current The European League against Rheumatism recommendations published in 2008. Results: Out of the total of 22 patients, 18 (81.9%) received anti-TNF therapies, resulting in 14 (77.8%) complete and 4 (22.2%) partial remissions. Eleven (61.1%) patients switched to a second anti-TNF, seven patients (38.9%) required three different anti-TNFs, and one required a fourth anti-TNF to achieve remission. Two patients required retrials before their disease was controlled. Anti-TNF therapy included infliximab (IFX): n=15, 83.3%; adalimumab (ADA): n=9, 50%; golimumab: n=6, 33.3%; etanercept: n=5, 27.8%; and certolizumab pegol: n=2, 11.1%. Secondary failure was observed with IFX (4/15; 26.7%) and ADA (2/9; 22.2%), and these (100%) were manifested after at least 2 years of treatment. Five patients with potentially life-threatening laryngeal involvement received anti-TNFs successfully halting disease progression. Five allergic reactions were encountered, and five serious infections were documented involving three patients aged ≥ 50 years, all with the use of IFX. Conclusion: Anti-TNF therapy induced a clinical response in 100% patients and achieved complete remission in 78% patients. It provides an effective alternative option for first-line therapy in severe BD where many conventional immunosuppressive therapies fail. Patients with BD who do not respond to one or more anti-TNFs because of intolerance, ineffectiveness, or secondary failure might benefit from switching to another drug from this group or even a retrial of a previously administered anti-TNF because unsatisfactory results with one biologic is not predictive of response to another anti-TNF. For those with potentially life-threatening destructive laryngeal manifestation, anti-TNF as a first choice may be considered.

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Section: Discussionmentioning

confidence: 99%

The real-world use of different anti-tumor necrosis factor agents in a Northern European population of patients with Behçet’s disease

Adeeb¹,

Ng²,

Khan³

et al. 2017

Eur J Rheumatol

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“…Furthermore, this study confirms what has already been reported for Behc¸et's disease patients with shorter term follow-up on infliximab. [19][20][21] Recently, we have shown that infliximab therapy significantly reduced retinal vascular leakage scores at 12 months compared with the baseline. 14 In the present study, we confirmed the sustained effect of infliximab on suppressing background vascular leakage over 4 years, although it took B2 years for vascular leakage scores to reach their lowest level.…”

Section: Discussionmentioning

confidence: 99%

Long-term efficacy of infliximab on background vascular leakage in patients with Behçet’s disease

Keino

Okada

Watanabe

et al. 2014

Eye

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Purpose To evaluate the effect of infliximab over the initial 4 years of treatment on inflammatory ocular attacks and background retinal/disc vascular leakage in patients with refractory uveoretinitis associated with Behc¸et's disease. Methods Clinical records of nine patients were retrospectively reviewed. The main outcomes analyzed were frequency of ocular inflammatory attacks, background retinal and disc vascular leakage as assessed by fluorescein angiography during periods of clinical quiescence, best-corrected visual acuity, and adverse effects. Results The median follow-up on infliximab was 50 months (range 48-58 months). Mean frequency of attacks decreased significantly in years 1, 2, 3, and 4 compared with the baseline 1-year period before infliximab use. Mean background retinal and disc vascular leakage scores also decreased significantly at the end of each 1-year period compared with baseline. Visual acuity improved or was unchanged at the end of 4 years in 17 of 18 eyes. No serious adverse effects were observed. Conclusion Infliximab reduced the mean frequency of ocular attacks and mean background retinal/disc vascular leakage in a long-term sustained manner over 4 years of treatment in Behc¸et's disease patients.

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“…No safety problems were noted. Niccoli et al (2007) assessed the efficacy of infliximab 5mg/kg (9 infusions) plus prednisolone 1mg/kg over a long-term follow-up (24 months) in 12 consecutive patients with refractory posterior uveitis. A rapid response was noted after first infusion.…”

Section: Eye Diseasementioning

confidence: 99%

The Role of Biological Therapies in the Management of Systemic Vasculitis

Vela¹,

Andrés²

2011

Advances in the Diagnosis and Treatment of Vasculitis

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Long-term efficacy of infliximab in refractory posterior uveitis of Behcet's disease: a 24-month follow-up study

Abstract: Infliximab is rapidly effective and safe in a high proportion BD patients with refractory posterior uveitis, and may be helpful to prevent recurrences.

Cited by 151 publications

References 21 publications

The real-world use of different anti-tumor necrosis factor agents in a Northern European population of patients with Behçet’s disease

The real-world use of different anti-tumor necrosis factor agents in a Northern European population of patients with Behçet’s disease

Long-term efficacy of infliximab on background vascular leakage in patients with Behçet’s disease

The Role of Biological Therapies in the Management of Systemic Vasculitis

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