Treatment of refractory posterior uveitis with infliximab: a 7-year follow-up study

Objective: To describe, in a 7-year follow-up study, the use of infliximab in patients with refractory posterior uveitis and scleritis. Methods: A 7-year follow-up case series study was performed. Patients with posterior uveitis and scleritis refractory to conventional therapies (steroids and at lea...

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Bibliographic Details
Published in:Scandinavian journal of rheumatology 2009, Vol.38 (1), p.58-62
Main Authors: Lopez-Gonzalez, R., Loza, E., Jover, J. A., Benitez Del Castillo, J. M., Mendez, R., Hernandez-Garcia, C., Pato, E.
Format: Article
Language:English
Subjects:
Adult
Aged
Antibodies, Monoclonal - adverse effects
Antibodies, Monoclonal - therapeutic use
Antirheumatic Agents - adverse effects
Antirheumatic Agents - therapeutic use
Biological and medical sciences
Diseases of the osteoarticular system
Dose-Response Relationship, Drug
Female
Follow-Up Studies
Humans
Immunomodulators
Infliximab
Longitudinal Studies
Male
Medical sciences
Middle Aged
Ophthalmology
Pharmacology. Drug treatments
Scleritis - drug therapy
Scleritis - physiopathology
Tumor Necrosis Factor-alpha - antagonists & inhibitors
Uvea diseases
Uveitis, Posterior - drug therapy
Uveitis, Posterior - physiopathology
Visual Acuity - physiology
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Summary:Objective: To describe, in a 7-year follow-up study, the use of infliximab in patients with refractory posterior uveitis and scleritis. Methods: A 7-year follow-up case series study was performed. Patients with posterior uveitis and scleritis refractory to conventional therapies (steroids and at least one immunosuppressive agent) were included. Three infliximab intravenous doses of 5 mg kg were administered at weeks 0, 2, and 6. Further infusions were allowed in patients undergoing a relapse of the uveitis after initial remission. All patients were followed up for at least 8 months. We defined uveitis improvement as an increase in the best-corrected visual acuity or an objective and significant improvement in retinal exudates and or haemorrhages, cystoid macular oedema (CME), and vitreous haze. Infliximab-related adverse events, final prednisone doses, and the number of immunosuppressive agents used were recorded. A descriptive analysis was performed. Results: A total of 11 patients (17 eyes were affected at baseline) were included, 63% were women, the mean age was 43±14 years, and the median follow-up was 80 months (p25-p75: 50-80). After infliximab treatment, six eyes maintained their basal visual acuity, nine eyes showed improvement, and two worsened (in the two patients diagnosed with choroiditis). Vitreous haze, active retinal vasculitis, and CME, but not chorioretinal lesions, improved in all patients. All patients tapered their daily steroid dose and the number of immunosuppressive agents. No infliximab-related adverse events were reported. Conclusions: Infliximab could be an effective and safe treatment in patients with posterior uveitis and scleritis refractory to conventional therapy.
ISSN:0300-9742
1502-7732
DOI:10.1080/03009740802366076