Elsevier

Ophthalmology

Volume 113, Issue 5, May 2006, Pages 860-864.e2
Ophthalmology

Original Article
Favorable Response to High-Dose Infliximab for Refractory Childhood Uveitis

https://doi.org/10.1016/j.ophtha.2006.01.005Get rights and content

Objective

Uveitis in children most commonly is associated with juvenile idiopathic arthritis. In addition to topical glucocorticoids, treatment may include systemic immunosuppressive agents. Tumor necrosis factor α (TNF-α) has been implicated in the pathogenesis of uveitis; therefore, TNF-α blockade seems to be a reasonable therapeutic option to investigate. We report successful treatment of children with uveitis using infliximab.

Study Design

A retrospective study of our complete experience using infliximab for the treatment of childhood uveitis was conducted.

Participants

Seventeen children (14 females, 3 males) with chronic uveitis were administered high-dose infliximab (10–20 mg/kg/dose).

Main Outcome Measures

Our main outcome measure was the ability to eliminate all signs of intraocular inflammation.

Results

All 17 patients demonstrated a dramatic, rapid response, with no observed inflammation in 13 patients after the second infusion, and 4 patients requiring 3 to 7 infusions to achieve disease quiescence. Additional immunosuppressives and topical glucocorticoids were tapered when patients achieved no intraocular inflammation.

Conclusions

In this series, high-dose infliximab was a rapidly effective, well-tolerated therapeutic agent for the treatment of chronic, medically refractory, noninfectious 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.

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  • Cited by (0)

    Manuscript no. 2005-515.

    The authors have no conflicts of interest to disclose.

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