Long-term treatment of refractory posterior uveitis with anti-TNFα (infliximab)

Abstract

Purpose To evaluate the long-term efficacy and safety of infliximab as treatment for noninfectious posterior uveitis. Methods An open-label clinical trial including seven patients (12 eyes) with posterior uveitis refractory to conventional treatment regimens with corticosteroids and at least one immunosuppressive agent. Three intravenous doses of 5 mg/kg of infliximab were administered at weeks 0, 2, and 6. Infliximab infusion was repeated in patients undergoing a relapse of uveitis after initial remission. Improvement was defined as amelioration of visual acuity or disappearance of retinal exudates and/or haemorrhages, decreased macular oedema and/or vitreous opacities. All patients were followed up for at least 36 months.

Update on the therapy of Behçet disease

“…In uveoretinitis, a large number of case reports/ series [Munoz-Fernandez et al 2001;Sfikakis et al 2001;Capella and Foster, 2012;Alokaily et al 2010;Olivieri et al 2008;Takamoto et al 2007;Merino et al 2006;Lindstedt et al 2005;Lanthier et al 2005;Wechsler et al 2004;Sayarlioglu et al 2004a;Rosenbaum, 2004;Giansanti et al 2004;Falappone et al 2004;Morris et al 2003;Gulli et al 2003;Triolo et al 2002;Takayama et al 2013], open-label clinical trials Handa et al 2011;Giardina et al 2011;Tanaka et al 2010;Adan et al 2010;Al-Rayes et al 2008;Tognon et al 2007;Niccoli et al 2007;Accorinti et al 2007;Tugal-Tutkun et al 2005;Benitez-del-Castillo et al 2005;Arayssi et al 2005;Sfikakis et al 2004;Ohno et al 2004;Cantini et al 2012;Keino et al 2011], and nonrandomized comparative studies Yamada et al 2010;Markomichelakis et al 2011] showed that intravenous infliximab, as single therapy, is effective in inducing prompt suppression of ocular inflammation, decreasing the frequency of uveitis attacks and allowing gradual tapering of corticosteroids (CS). As would be expected, vision of eyes with permanent lesions due to irreversible retinal damage does not improve.…”

Efficacy of Infliximab in Patients with Refractory Uveitis Associated with Behcet Disease

“…These results propose that IFX is a better choice of treatment to control resistant ocular inflammatory attacks than traditional treatment modalities. In accordance with present study, Benitez del Castillo et al showed that infliximab is safer than conventional immunosuppressives for refractory uveitis especially in patients with predominant retinal vasculitis and vitritis, stabilizing the course of the illness and maintaining visual acuities [15]. Also, Keino et al reviewed medical records of 14 patients with BD and showed that IFX was effective in reducing ocular inflammatory attacks, background retinal and disc vascular leakage [16].…”

Infliximabe no tratamento de uveíte posterior refratária em paciente com doença de Behçet

“…Até o início de 2002, quando se cogitou usar infliximabe no paciente estudado neste caso, haviam sido descritos na literatura apenas 12 casos semelhantes tratados com infliximabe, ainda sem um consenso com relação à dose, ao número e ao intervalo das infusões. Desde 2002 diversos trabalhos têm sido realizados, alguns com número maior de pacientes, mostrando uma tendência à boa resposta com o uso do infliximabe (9)(10)(11)(12)(15)(16)(17)(18)(19)(20) , havendo apenas descrição de três casos com resposta inadequada (13,14) . O maior estudo, realizado na Grécia e publicado em março de 2004, envolveu 25 pacientes com doença de Behçet e uveíte posterior, que receberam infusão única de infliximab 5 mg/ kg, com controle da inflamação ocular já no primeiro dia pós-tratamento em 24 dos 25 pacientes.…”