Long-term safety and efficacy of infliximab therapy in refractory uveitis due to Behçet's disease

Abstract

Purpose: To evaluate the long-term safety and efficacy of infliximab therapy for refractory uveitis associated with Behçet's disease (BD).

Methods: We prospectively enrolled six patients who failed to respond to conventional immunosuppressive treatment. Infliximab infusions (5 mg/kg) were administered at weeks 0, 2, 6, and then every 8 weeks. The outcome variables were visual acuity, control of inflammation, reduction of macular edema, tapering of immunosuppressive therapy, and adverse effects.

Results: The follow-up period ranged from 16 to 36 months (mean +/- SD, 23 +/- 7.4 months). The number of infliximab infusions ranged from 10 to 23 (14 +/- 4.6). By the 2-month follow-up, all patients had achieved remission, the cystoid macular edema had resolved, and visual acuity had improved dramatically. Throughout the follow-up period, three patients remained attack-free. One patient had one relapse, and another patient had two relapses before the scheduled infusions; all three relapses resolved rapidly after the subsequent infusion. One patient developed five relapses, and infusions at 6-week intervals were necessary to achieve sustained remission. At the end of the follow-up period, visual acuity improved in five patients. Concomitant immunosuppressive therapy was substantially reduced. Antinuclear antibodies developed in two patients who received 17 and 23 infusions. No major adverse effects requiring withdrawal of infliximab were observed.

Conclusion: Infliximab is efficient and safe for long-term treatment of refractory uveitis associated with BD. Repeated infusions are required to maintain long-term remission.