Background There is a group of patients with non-infectious posterior uveitis (PU) who are refractory to corticosteroid or immunosuppressive (IS) regimens. The important role played by TNF-a in experimental uveitis models, and the efficacy shown by the various anti-TNF-a agents in autoimmune diseases have been reported.
Objectives To demonstrate the usefulness of infliximab in the treatment of non-infectious PU.
Methods Open, non-controlled trial, including 7 patients with corticosteroid-refractory PU who were receiving one or more of the following IS agents for a minimum of 2 years: CsA, AZA, MTX. Treatment was administered on a compassionate use basis, after EC approval at our institution and patient informed consent. All IS agents except MTX were discontinued one month prior to the start of treatment. Prednisone dose was adjusted to 0.5 mg/kg/day and decreased by 5 mg/day every week in the absence of posterior pole inflammation. Three doses of 5 mg/kg infliximab were administered IV at weeks 0, 2, and 6. Visits including a full ophthalmological assessment took place at weeks 1, 3, 4, 5, 7, 8, and 12; fluorescein angiographies (FAG) and retinograms were performed at baseline and week 16.
Results No adverse effects, and no ocular or systemic exacerbations were observed. Final prednisone dose was = or < 7.5 mg for six patients, and 15 mg for patient 2. Vitreous haze improved in all patients except patient 7. Measurable improvement of visual acuity was documented in patients 2, 3, 4, 5, and 6. FAGs and retinograms confirmed vitreous clearance in all patients, showing improvement of active retinal bleeding in patient 4 and disappearance of a macular oedema (which had been present for years) in patient 5. Only patient 7, with chronic multifocal choroiditis, had no improvement.
Conclusion In this preliminary open trial, infliximab treatment appears to be a useful option in the short term for the management of refractory PU patients with retinal vasculitis.
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