Background Uncontrolled studies, mainly of short duration suggest that infliximab, an anti TNF agent, is beneficial in controlling severe uveitis of BS (1).
Objectives To evaluate the efficacy and safety of prolonged infliximab treatment in severe sight-threatening uveitis of BS.
Methods The charts of 43 BS patients (33 men; age at the initiation of infliximab: 31±8.4 SD years) treated with infliximab (5 mg/kg) were reviewed retrospectively. All patients had severe, sight-threatening posterior uveitis of long-duration (82±50 SD months) refractory to previous treatments with multiple immunosuppressives (azathioprine=43, Cyclosporin A=42, Interferon alfa=38; duration of treatment: 62±43 SD months) and steroids. Efficacy was assessed by the change of visual acuity (LogMAR VA) and the decrease in the number of attacks under infliximab.
Results The duration of infliximab treatment was 31±18 SD months (median 29 months). In 37 (86%) patients infliximab was combined with azathioprine (n= 26), azathioprine and cyclosporine A (n=10) or interferon alfa (n=1). Twenty-nine (67%) patients had no useful vision (LogMAR >1) in at least one eye at the time of initiation of infliximab. Five of them (17%) had gained useful vision of both eyes under infliximab. The mean VA (all patients) was maintained under infliximab (right eye: 0.83± 0.74 vs 0.84 ±0.79; left eye: 1.27±0.83 vs 1.13± 0.88). VA of the worse eye improved in 11 patients, remained stable in 24 and worsened in 8 patients. Eleven patients (26%) with no attacks during previous treatment were prescribed infliximab to protect the already compromised vision. The VA was stable or improved in 10 and 9 remained attack free. Of the 32 patients (74%) with attacks before infliximab, 11 (34%) became attack free under infliximab. The number of uveitis attacks per year (all patients) under previous immunosuppressive treatment dropped from 1.9 ±3 to 0.3 ±0.6 in the right eye (p=0.0001) and from 2.5± 2.9 to 0.3 ±0.6 in the left eye (p=0.0001). There was also a significant decrease in the numbers of patients with hypopyon (11 and 3; x2= 5.46, p=0.019), vascular infiltrations (23 and 12; x2= 5.83, p=0.016), macular edema (8 and 1; x2= 6.08, p=0.014), and retinal hemorrhages (7 and 0; x2= 7.62, p=0.006) under infliximab.
Infliximab treatment was terminated in 16 patients (adverse events =5, inefficacy =1, terminal eye disease = 4, unrelated reasons = 6). Fifteen of these patients received further treatment (biologics = 3, azathioprine =12) for 22±13 SD months and 12 of them remained attack free during this period. The adverse events causing discontinuation were pulmonary tuberculosis in 3 (at 17. 32. and 46. month of infliximab treatment, respectively), depression in 1, pneumonia in1 patient.
Conclusions Infliximab combined with immunosuppressives was useful in preserving visual acuity and in controlling the attacks in BS patients with refractory, sight-threatening uveitis at the long-term. Relapses were infrequent after discontinuation. Tuberculosis appears as a concern in prolonged treatment.
Arida A, et al. Semin Arthritis Rheum 2011; 41: 61.
Disclosure of Interest: None Declared