Efficacy of infliximab in refractory posterior uveitis in Behcet's disease patients

Aim of the work: Ocular manifestations are the main cause of morbidity in Behcet's disease (BD). Infliximab (IFX), a chimeric monoclonal antibody directed against tumor necrosis factor-alpha, may be efficient in refractory uveitis due to BD. The aim of this study was to assess the efficacy and safety of IFX in the treatment of patients with BD-associated refractory posterior uveitis (PU). Patient and Methods: Twenty patients with refractory Behcet's PU received IFX therapy as intravenous infusions at the dose of 5 mg/kg at weeks 0,2, 6 (induction) and every 8 weeks for a maximum of 6 infusions. Results: The mean age of the patients was 31.8 ± 9.1 years, disease duration was 8 ± 6 years and 17 (85%) were males. After the third IFX infusion (week 8) a complete remission of PU was recorded in 8/20 (40%) patients and partial remission in 12/20 (60%) patients. At the end of week 32 a complete remission of PU was recorded in a total of 14 (70%) patients. The visual acuity of the 36 affected eyes (16 bilateral and 4 unilateral) showed a significant improvement at the week 8, and at week 32, while there was no additional improvement at week 56. Relapse occurred in 6 patients (30%) between week 9 and week 18 with a mean of 13.5 weeks. Conclusion: IFX infusion should be considered for the control of acute PU, whereas repeated long-term IFX infusions were effective in reducing the number of episodes in refractory PU with fast regression and complete remission of complications. Keywords: Behçet’s disease, Posterior uveitis, Retinal vasculitis, Inflixima