Available online 20 September 2022

SummaryPurpose

To evaluate the efficacy of infliximab (IFX) therapy in patients with Behçet's uveitis (BU) refractory to conventional immunomodulatory treatment (IMT).

Materials and methods

This study, trial registration number TCTR20200806007, included cases of BU with a minimum of 18 months follow-up on IFX treatment. Demographic characteristics, ophthalmological examination findings, control of ocular inflammation with IFX, response to treatment and the rate of clinical remission were analyzed in this study.

Results

Sixty-two eyes of 35 patients on IFX therapy were included in the study. The mean follow-up was 49.5 ± 25.9 months. The mean frequency of recurrences during the IMT was 1.47 ± 0.78 (attacks/year), decreasing to 0.31 ± 0.40 (attacks/year) with IFX (P < 0.001). Visual acuity improved significantly in the 1st month of IFX treatment (P = 0.026). Partial response to treatment was achieved in 91.4% of cases.

Conclusion

IFX is a safe and effective treatment in cases of BU refractory to conventional IMT.

RésuméObjectif

Évaluer l’efficacité du traitement par infliximab (IFX) chez les patients atteints d’uvéite de Behçet (UB) réfractaires au traitement immunomodulateur conventionnel (TIC).

Matériel-méthode

Cette étude portant le numéro d’enregistrement d’essai TCTR20200806007 a inclus des cas d’UB ayant eu un suivi minimum de 18 mois sous traitement IFX. Les caractéristiques démographiques, les résultats de l’examen ophtalmologique, le contrôle de l’inflammation oculaire avec IFX, la réponse au traitement et le taux de rémission clinique ont été étudiés dans cette étude.

Résultats

Soixante-deux yeux de 35 patients sous traitement IFX ont été inclus dans l’étude. Le suivi moyen était de 49,5 ± 25,9 mois. La fréquence moyenne des uvéites pendant l’TIC était de 1,47 ± 0,78 (attaque/an) et a diminué à 0,31 ± 0,40 (attaque/an) avec l’IFX (p < 0,001). L’acuité visuelle s’est considérablement améliorée au cours du 1er mois d’IFX (p = 0,026). Une réponse partielle au traitement a été obtenue dans 91,4 % des cas.

Conclusion

IFX est un traitement sûr et efficace dans les cas d’UB réfractaires à l’IMT conventionnel.

Introduction

Behçet's disease (BD) has a worldwide distribution which is prevalent along the historic “Silk Road” [1]. It is a chronic, relapsing multisystemic vasculitis which may present with ocular involvement in approximately 50–70% of patients [2]. The visual potential depends mainly on the cumulative intraocular damage of the inflammation and vascular leakage [3].

The goal of treatment in Behçet uveitis (BU) is to suppress the acute inflammation and reduce the frequency and severity of recurrences. Prevention of anticipated complications and maintaining a long lasting remission is crucial for determining the therapeutical efficacy [4]. Evidence from the literature shows that early and aggressive treatment with conventional immunomodulatory agents can improve the prognosis of BU significantly [5]. However, a number of patients with BU are still refractory to conventional therapies. Besides, patients presenting with profound vision loss, severe macular and/or bilateral involvement need more effective and faster treatment modalities.

With the introduction of biologic agents, favorable results have been achieved in cases with BD. Fewer ocular and systemic complications, and good control of inflammation have been put forward in this subset of patients with infliximab (IFX) [6], [7]. Yet, long-term follow-up results of this approach has not been well established.

In this manuscript, we aim to share the results of BU cases which had been refractory to conventional immunomodulatory treatment (IMT) and then switched to IFX.

Section snippetsMaterials and methods

Medical records of patients between the age of 19 to 56 and treated with the diagnosis of BU were reviewed for this study. This university based retrospective and cross-sectional study comprises the clinical experience from June 2008 to June 2019. Cases that were switched from conventional IMT to IFX therapy and had a minimum of 18 months of follow-up under IFX treatment were included to the study group. Cases attending irregular follow-ups and those with other retinal diseases were excluded

Results

Medical records of 86 patients who had the diagnosis of BU and were using biological agents were reviewed for this study. Further investigation was focused on 46 cases that were using IFX. Eleven patients from this IFX population were excluded. Eight patients of the original IFX population experienced infusion reactions at some point and the treatment was discontinued in these patients (16.7%). IFX was stopped in 2 cases (4.3%) of the IFX population due to later on diagnosed malignancies namely

Discussion

BU still remains an important public health problem in certain parts of the world. Preferred treatment modalities for this multisystemic vasculitis differs among physicians. In the past, conventional IMT has been used commonly in Turkey for the management of BU due to economic concerns and the relatively good results achieved in selected cases. Although an expert panel recommends anti-TNF agents as the first-line of treatment in ocular involvement of BD, a tendency to restrict this relatively

Disclosure of interest

The authors declare that they have no competing interest.

References (25)N. Yalcindag et al.Comparison of the treatment results for Behçet uveitis in patients treated with infliximab and interferon

Ocul Immunol Inflamm

(2020)

G. Levy-Clarke et al.Expert panel recommendations for the use of anti-tumor necrosis factor biologic agents in patients with ocular inflammatory disorders

Ophthalmology

(2014)

View full text

© 2022 Elsevier Masson SAS. All rights reserved.