Infliximab Effective, Safe in Refractory Uveitis From Behçet Disease

Using infliximab (IFX) to treat refractory uveitis from Behçet disease (BD) seems effective and “relatively safe” according to findings from a large case series, published in The Journal of Rheumatology. The research was initially presented at an American College of Rheumatology conference. 

The multicenter study assessed the long-term efficacy and safety of IFX and IFX optimization when ocular remission was achieved. It looked at 185 affected eyes of 103 IFX-treated patients (all White, 55 men, mean age 40.4 ± 10.1 years) with BD uveitis refractory to conventional immunosuppressant agents. The treatment was the first biologic therapy given in these intervals: 3 to 5 mg/kg intravenous at 0, 2, 6, and every 4 to 8 weeks. Main outcome variables were analyzed at baseline, first week, first month, sixth month, first year, and second year of IFX therapy. The IFX optimization was performed after remission based on the shared decision of patient and clinician.

Investigators found that, in all patients, the main outcome variables showed a “rapid and maintained improvement,” with 78 patients reaching remission following a mean IFX duration of 31.5 months. 

Nine patients had serious adverse events (and IFX treatment was discontinued) including infusion reactions (n=4), tuberculosis (n=1), Mycobacterium avium pneumonia (n=1), severe oral ulcers (n=1), palmoplantar psoriasis (n=1), and colon carcinoma (n=1). 

In the optimization subanalysis, researchers indicate that the comparative study between optimized and nonoptimized groups showed (1) no differences in clinical characteristics at baseline, (2) similar maintained improvement in most ocular outcomes, (3) lower severe adverse events, and (4) lower mean IFX costs in the optimized group.

The study’s limitations include its observational design and relatively low number of optimized patients. More randomized controlled trials are needed to compare conventional immunosuppressive drugs and other anti-TNF agents, researchers say.

Reference

Martín-Varillas JL, Atienza-Mateo B, Calvo-Rio V, et al. Long Term follow-up and optimization of infliximab in refractory uveitis due to Behçet’s disease. National study of 103 caucasian patients. J Rheumatol. Published online October 1, 2020. doi:10.3899/jrheum.200300.