Original ArticleFavorable Response to High-Dose Infliximab for Refractory Childhood Uveitis
Section snippets
Patients and Methods
A retrospective review of 17 pediatric patients with chronic, medically refractory uveitis who were treated with high-dose IV infliximab (10–20 mg/kg/dose) as standard of care was conducted. Failure of prior medical therapy was defined as persistent or worsening uveitis despite other immunosuppressive therapy as shown in Table 1 (available at http://aaojournal.org). The case of patient 12 is an exception, because the indication for initiation of infliximab was a flare of her arthritis while
Results
Patient demographics are detailed in Table 1 (available at http://aaojournal.org). Three patients were male, 14 were female; the median age at initiation of infliximab was 11 years (range, 8–21 years). The cause of the uveitis was JIA (10 patients), Vogt–Koyanagi–Harada syndrome (2 patients), sarcoidosis (2 patients), and idiopathic (3 patients). The median duration of uveitis before initiation of infliximab was 36 months (range, 9–220 months). With the exception of patient 12, all patients
Discussion
In this series, we have demonstrated a positive clinical response to infliximab for 17 children with refractory uveitis of multiple origins. The treatment was well tolerated without significant side effects noted.
Tumor necrosis factor α is a ubiquitous cytokine involved in the upregulation of an array of proinflammatory mediators. Research has implicated TNF-α in the initiation and prolongation of experimental uveitis.18, 19 In humans, elevated aqueous levels of TNF-α have been demonstrated in
Acknowledgments
The authors thank Dr Christine Hom, Dr C. Stephen Foster, Dr Michael Sampson, Dr Paul Latkany, Dr Phyllis Weingarten, Dr Steven Kane, and Dr Sherry Solomon for contributing patients to this study.
References (34)
- et al.
A clinical trial of FK506 in refractory uveitis
Am J Ophthalmol
(1993) - et al.
Long-term follow-up of patients treated with short-term high-dose chlorambucil for sight-threatening ocular inflammation
Ophthalmology
(2002) - et al.
Mycophenolate mofetil as an immunomodulatory agent in the treatment of chronic ocular inflammatory disorders
Ophthalmology
(2003) - et al.
Infliximab (chimeric anti-tumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexatea randomised phase III trial
Lancet
(1999) - et al.
ACCENT I Study Group. Maintenance infliximab for Crohn’s diseasethe ACCENT I randomised trial
Lancet
(2002) - et al.
Effect of infliximab on sight-threatening panuveitis in Behcet’s disease
Lancet
(2001) - et al.
Infliximab in the treatment of refractory posterior uveitis
Ophthalmology
(2003) - et al.
Anti-tumor necrosis factor-alpha therapy with infliximab as an alternative to corticosteroids in the treatment of human leukocyte antigen B27-associated acute anterior uveitis
Ophthalmology
(2002) - et al.
Tumor necrosis factor alpha blockade with infliximab for refractory uveitis and scleritis
Ophthalmology
(2004) - et al.
Cachectina novel polypeptide induces uveitis in the rabbit eye
Exp Eye Res
(1988)
Neutralizing TNF-alpha activity modulates T-cell phenotype and function in experimental autoimmune uveoretinitis
J Autoimmun
Methotrexate therapy for chronic noninfectious uveitisanalysis of a case series of 160 patients
Ophthalmology
Uveitis associated with juvenile idiopathic arthritisenvisioning the future
J Rheumatol
Treatment of severe refractory uveitis with intravenous cyclophosphamide
J Rheumatol
Cyclosporin A therapy in refractory non-infectious childhood uveitis
Br J Ophthalmol
Cytokines and uveitis, a review
Curr Eye Res
Cytokines in human intraocular inflammation
Curr Eye Res
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Manuscript no. 2005-515.
The authors have no conflicts of interest to disclose.