Efficacy of Infliximab in Patients with Refractory Uveitis Associated with Behcet Disease

Abstract

Background: Ocular involvement in Behcet disease is responsible for severe morbidity by causing nongranulomatous panuveitis and retinal vasculitis. In some cases, recurrent attacks cannot be controlled by conventional immunosuppressives and corticosteroid or interferon. The aim of this study is to investigate the efficacy of infliximab treatment in patients with refractory uveitis associated with Behcet disease.Methods: Nine patients with Behcet disease related uveitis were included in the study. Uveitis had been refractory to treatment with either a combination of cyclosporine-A, azathioprine, and corticosteroid or interferon α-2a monotherapy in all patients. Patients received infliximab infusions (5 mg/kg) at weeks 0, 2, 6, and every 8 weeks thereafter. In patients receiving interferon α-2a at the time of initiation of infliximab therapy, interferon was ceased before starting infliximab. We evaluated visual acuity, ocular inflammatory attacks, and adverse effects.Results: The Patients consist of seven men and two women; their ages ranging from 28 to 49 years. The mean follow-up after initiating infliximab therapy was 14.4 months. Four of the patients had no ocular inflammatory attacks during follow-up. Two of the remaining five patients developed a mild anterior uveitis only once after the start of infliximab infusions. Three of the patients had a mild panuveitis attack 2-4 months after the initiation of infliximab therapy. Best corrected visual acuity (BCVA) improved at least 2 lines in 6 (33.3%) eyes, from no light perception to hand motion in one eye, and from light perception to hand motion in another eye. BCVA remained stable in 9 (50%) eyes. In one patient, infliximab treatment was terminated owing to HPV+genital warts at 8th month of therapy. No other adverse effects were noticed apart from temporary infusion reaction and urticaria-like rash.Conclusions: With a follow-up period ranging from seven to thirty three (7-33) months, infliximab was effective and well tolerated in refractory Behcet uveitis.