Background Application of topical corticosteroids is the first-line treatment of anterior uveitis. Its most common form is HLA B27 associated. Of these patients approximately 55% suffer from additional systemic diseases, such as ankylosing spondylitis or chronic inflammatory bowel disease. In a recent report Brandt, et al.1 reported a dramatic response to Infliximab in patients with ankylosing spondylitis. In about 50% of uveitis patients additional periocular or oral corticosteroids or both are needed because no adequate response to intensive (hourly) topical corticosteroid therapy can be achieved. This together with the fact that recurrent treatment of these young patients with corticosteroids dramatically increases the risk of steroid-induced side effects such as glaucoma, cataract or, in the case of oral or intravenous application, hypertension, diabetes mellitus or osteoporosis new approaches to the therapy of acute uveitis are highly needed.
Objectives To evaluate the potentials of Infliximab, a neutralising Anti-TNFa antibody in the therapy of patients with an acute HLA B27 associated anterior uveitis.
Methods Seven consecutive patients with an acute onset of an HLA B 27 associated anterior uveitis, with at least 3+ anterior chamber cells were included in this prospective non-comparative case series. Infliximab (Centocor, Malvern, Pa.) at a dose of 10 mg/kg body weight given intravenously was used as the sole anti-inflammatory drug.
Anterior chamber cells and flare were evaluated prior to Infliximab treatment and at defined time points after treatment. CRP levels were assessed in all patients prior to intravenous delivery of Infliximab and re-evaluated after one week.
Results Patients were followed for a mean period of 194 ± 32 days. No patient treated showed clinical signs of a spondylarthropathy. Seven patients received a single Infiximab infusion of 10 mg/kg body weight. A second infusion was administered in one patient 21 days after first dosage due to a reactivation of the uveitis. The median duration (± SD) of uveitis of 8 ± 12 days. All patients responded to Infliximab with an rapid improvement of clinical symptoms a decrease of anterior chamber cells. Only in one patient a total resolution of the uveitis was not achieved using Infliximab.
Conclusion In our study Infliximab proofed to be a powerful therapeutic agent in acute HLA B27 associated uveitis. It therefore seems to be an excellent alternative or an additive to steroid treatment. Only in patients with a systemic sign of an inflammatory disease additional local, systemic low dose corticosteroids or immunosuppressive agents might be needed.
Brandt J, Haibel H, Cornely D, Golder W, Gonzalez J, Reddig J, Thriene W, Sieper J, Braun J. Successful treatment of active ankylosing spondylitis with the anti-tumor necrosis factor alpha monoclonal antibody infliximab. Arthritis Rheum. 2000;43(6):1346–52
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