Abstract
Background. Infliximab (INF) has been shown to be beneficial in treating refractory uveitis, however, no data exist on optimal dosing and the efficacy of higher dosing. Objectives. To compare the efficacy of low-dose (LD) (<10 mg/kg), moderate-dose (MD) (≥10–15 mg/kg), and high-dose (HD) INF (≥15–20 mg/kg) in the treatment of uveitis. Methods. Retrospective chart review children with uveitis diagnosed at Childrens Hospital Los Angeles and Millers Children's Hospital, CA, USA. Results. Of the 34 INF-treated children, 6 patients received LD, 19 received MD, and 9 received HD. Average disease duration prior to therapy was 10.6, 24.6, and 37.1 months each group, respectively. Topical steroids were discontinued after an average of 3 months, 9.5 months, and 10.2 months in the LD, MD, and HD groups, respectively. We found that 66% of patients receiving LD, 42% of MD, and 66% receiving HD INF failed therapy and required either dose escalation or alternate medication for disease control. Conclusions. INF is beneficial in the treatment of uveitis, and dose escalation up to 4 times above the approved dose is often necessary to achieve disease control in patients with uveitis. Doses < 10 mg/kg every 4 weeks may not be sufficient to control disease.
Highlights
The term uveitis defines several ocular disease states characterized by inflammation of the entire or individual parts of the uveal tract including iris, ciliary body, or choroid
Uveitis can be classified by location in the eye as anterior uveitis or iridocyclitis, intermediate uveitis or pars planitis, and posterior uveitis or by primary and secondary uveitis, whereby primary uveitis refers to intraocular inflammation of unknown etiology, and secondary uveitis refers to inflammatory ocular conditions that are either associated with systemic, intrinsic, or infectious diseases
Of the 34 patients, 16 (47%) had idiopathic uveitis, 6 (18%) had uveitis associated with oligoarticular juvenile idiopathic arthritis (JIA), 3 (9%) had uveitis secondary to polyarticular JIA, 3 (9%) had uveitis associated with enthesitis-related arthritis, 2 (6%) had Vogt-Koyanagi-Harada disease (VKH), and one patient each had uveitis associated with chronic noninfectious osteomyelitis (CNO), sarcoidosis, Blau’s syndrome, and psoriatic arthritis
Summary
The term uveitis defines several ocular disease states characterized by inflammation of the entire or individual parts of the uveal tract including iris, ciliary body, or choroid. Infliximab (INF) has been shown to be beneficial in treating refractory uveitis, no data exist on optimal dosing and the efficacy of higher dosing. To compare the efficacy of low-dose (LD) (
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