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Abstract Number: 2626

Infliximab For Sight-Threatening and Refractory Uveitis Of Behcet’s Syndrome

Vedat Hamuryudan1, Gulen Hatemi2, Yilmaz Ozyazgan2, Didar Ucar2, Sebahattin Yurdakul2, Emire Seyahi2, Koray Tascilar2, Serdal Ugurlu2 and Hasan Yazici3, 1Division of Rheumatology, Istanbul University, Cerrahpasa Medical Faculty, Rheumatology, Istanbul, Turkey, 2Cerrahpasa Medical Faculty University of Istanbul, Behcet's Syndrome Research Center, Cerrahpasa Medical Faculty University of Istanbul, Istanbul, Turkey, 3Cerrahpasa Medical Faculty University of Istanbul, Istanbul University, Cerrahpasa Medical Faculty, Rheumatology, Istanbul, Turkey

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Adverse events, anti-TNF therapy and eye disease

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Session Information

Title: Vasculitis III

Session Type: Abstract Submissions (ACR)

Background/Purpose: Uncontrolled studies suggest a beneficial effect of infliximab in the treatment of severe uveitis of BS. The majority of these studies had short observation periods.

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 previous 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 (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 under infliximab. Eleven patients (26%) had no attacks during previous treatment and were prescribed infliximab to protect the already compromised vision. The VA remained stable or improved in 10 patients and 9 patients remained attack free under infliximab. Thirty-two patients (74%) had attacks before infliximab. Eleven (34%) of them 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. 

Conclusion: Infliximab combined with immunosuppressives was useful in preserving visual acuity and in controlling the attacks of BS patients with refractory, sight-threatening uveitis at the long-term. Relapses were infrequent after discontinuation. Tuberculosis appears as a concern in prolonged treatment.


Disclosure:

V. Hamuryudan,
None;

G. Hatemi,
None;

Y. Ozyazgan,
None;

D. Ucar,
None;

S. Yurdakul,
None;

E. Seyahi,
None;

K. Tascilar,
None;

S. Ugurlu,
None;

H. Yazici,
None.

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