Session 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.
« Back to 2013 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/infliximab-for-sight-threatening-and-refractory-uveitis-of-behcets-syndrome/