Purpose:
We aimed to evaluate the efficacy of infliximab therapy in Behçet patients with severe ocular involvement resistant to conventional treatment.
Material-Method:
We retrospectively studied seven patients who were followed at the Department of Ophthalmology, Istanbul Faculty of Medicine and received infliximab therapy. Before starting treatment, a complete ophthalmologic and physical examination, including complete blood cell count, liver and kidney function tests, chest X-ray, purified protein derivative test were performed. Infliximab infusions (5 mg/kg) were administered at weeks 0., 2., 6., and then every 4-8 weeks. Efficacy and adverse effects of treatment were evaluated.
Results:
Six (85.7%) patients were male and 1 (14.2%) was female. Their ages varied from 12-34 years (average: 22.2) at presentation. Follow-up period was 4-64 months (average: 25.2) prior to the administration of infliximab and 11-64 months (average: 33.4) after the infliximab treatment was started. The number of infliximab infusions ranged from 9 to 34 (average: 15). Concomitant treatment with azathioprine, cyclosporine and prophylactic isoniazid was administered to 6, 1 and 3 cases, respectively. Interval between infusions was reduced in 5 cases because of occurrence of uveitis attacks before 8 weeks. Resistance developed in one patient after long-term treatment. In others, remission was maintained and corticosteroids were tapered or discontinued during infliximab infusions given every 4-6 weeks. Treatment was stopped in one patient who developed pulmonary tuberculosis. Potential visual acuity was preserved in 5 patients.
Conclusion:
Infliximab is effective in resistant cases of Behçet uveitis. Remission and potential visual acuity can be maintained with frequently administered infusions. However, optimum duration of treatment is not known. Furthermore, serious potential adverse effects and the risk of tuberculosis should be taken into consideration.
Keywords: Behçet's disease, uveitis, infliximab, anti tumor necrosis factor-alpha