Long-term efficacy and safety of infliximab and cyclosporine combination therapy for refractory uveoretinitis in Behçet's disease

Abstract

Purpose: This study aimed to evaluate the long-term efficacy and safety of infliximab (IFX) and cyclosporine (CsA) combination therapy for refractory uveoretinitis in Behçet's disease (BD).

Patients and methods: The study involved a retrospective review of the medical records of 11 patients with Behçet's uveoretinitis refractory to conventional treatment who had been treated with IFX+CsA combination therapy. The frequency of ocular inflammatory attacks and a Behçet's disease ocular attack score 24 (BOS24) were used as indices for the evaluation of efficacy during each 6-month period prior to and following initiation of therapy. For the assessment of safety, adverse events (AEs) were recorded throughout the treatment period.

Results: The patients had received IFX+CsA combination therapy for 5.6±2.3 years. The frequency of ocular attacks per 6-month period decreased markedly from 2.9±1.6 during the baseline period to 0.6±0.9 during months 1-6, 0.5±0.9 during months 7-12, 0.3±0.5 during months 13-18, 0.3±0.7 during months 19-24, and 0.0±0.0 thereafter (P=0.003). The BOS24 score per ocular attack significantly decreased from 5.2±2.4 during the baseline period to 1.5±2.1 during months 1-6, 1.7±3.1 during months 7-12, 1.6±2.9 during months 13-18, and 0.4±1.0 during months 19-24 (P=0.002). No serious AEs were observed, with the exception of urinary tract infection and cataract progression. Two patients exhibited transient elevation of the serum creatinine level, which was normalized following a reduction in the dose of CsA.

Conclusion: For refractory Behçet's uveoretinitis, IFX+CsA combination therapy offers a promising treatment option as it appears to have an acceptable safety profile and can reduce the frequency and severity of ocular inflammatory attacks over a long period of time.

Keywords: Behçet’s disease; cyclosporine; efficacy; infliximab; safety; uveitis.

Figure 1

Effect of IFX+CsA combination therapy on the frequency of ocular inflammatory attacks. The frequency of ocular inflammatory attacks, assessed by the mean number of ocular attacks per 6-month period, decreases significantly following the initiation of IFX+CsA combination therapy (P=0.003, linear mixed models analysis). Data are presented as the mean±standard deviation. Abbreviations: IFX, infliximab; CsA, cyclosporine; M, months.

Figure 2

Effect of IFX+CsA combination therapy on the severity of ocular inflammatory attacks. IFX+CsA combination therapy significantly decreased the severity of ocular inflammatory attack as evaluated by the mean BOS24 value in each ocular attack (P=0.002, linear mixed models analysis). Data are presented as the mean±standard deviation. Abbreviations: IFX, infliximab; CsA, cyclosporine; BOS24, Behçet’s disease ocular attack score 24; M, months.