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Effect of infliximab on threatening panuveitis in Behçet's disease

2001; Elsevier BV; Volume: 358; Issue: 9293 Linguagem: Inglês

10.1016/s0140-6736(01)06677-6

1474-547X

Santiago Muñoz‐Fernández, Ventura Hidalgo, Julia Fernández-Melón, Armelle Schlincker, E. Martín‐Mola,

Ocular Infections and Treatments

P Sfikakis and colleagues (July 28, p 295)1Sfikakis PP Theodossiadis PG Katsiari CG Kaklamanis P Markomichelakis NN Effect of infliximab on sight-threatening panuveitis in Behçet's disease.Lancet. 2001; 358: 295-296Summary Full Text Full Text PDF PubMed Scopus (453) Google Scholar report on five patients with panuveitis and Behçet's disease who were treated with the anti-tumour necrosis factor (TNF) agent, infliximab. The patients made excellent progress after one 5 mg/kg dose. We report our experience with a similar patient who we successfully treated with infliximab. Our patient was a woman aged 34 years who had been diagnosed in 1995 in another hospital as having Behçet's disease with unilateral chronic panuveitis and retinal vasculitis of the right eye. She was referred to our uveitis outpatient clinic for the first time in 1998 after she changed address. She was taking prednisone 5·0 mg daily and ciclosporin A 5·0 mg/kg daily. Her left eye was normal and she had refractory panuveitis lesions in her right eye, with a visual acuity of 0·1, lesions that we judged to be non-active and that we thought might improve. We lowered the dose of ciclosporin A to 0·5 mg/kg daily every month. In October, 1998, the patient started to develop panuveitis in her healthy left eye, and we increased the ciclosporin A dose to 5·0 mg/kg daily and prednisone to 1·0 mg/kg daily. The patient has since had new flares of left uveitis, sometimes with chorioretinitis, vitreous inflammation, or retinal vasculitis, for each of which we have increased predisone up to a total of 20 mg daily. Since 1998, the dose of ciclosporin A has remained at 5 mg/kg daily. In December, 2000, the patient developed a new flare of panuveitis in her left eye with anterior-chamber inflammatory cells, vitreous haze, and retinal vasculitis; visual acuity was 0·2. We decided to stop ciclosporin, started methotrexate, and raised the prednisone dose to 1 mg/kg daily. There was poor improvement of the ocular inflammation on the visual acuity to 0·3 after 3 months. We offered the patient treatment infliximab at 5 mg/kg in three doses at weeks 0, 2, and 6. After we obtained written informed consent, we started the treatment, which led to a striking reduction of the inflammatory cells in the anterior chamber, vitreous haze, and vasculitis, with an improvement of the visual acuity from 0·3 to 0·6 at the 2nd week and to 0·8 at the 6th week. The right eye also improved, mainly in vitreous haze. 5 months after the last infusion, the improvement was sustained and we were able to lower the dose of prednisone to 5 mg daily and maintain the same methotrexate dose. The treatment was well tolerated and caused no adverse effect.