Infliximab for Refractory Noninfectious Uveitis

Kruh et al. set out to establish whether infliximab is safe and effective for the treatment of refractory noninfectious uveitis. They found that the drug—a monoclonal antibody used in treating several chronic inflammatory diseases—induced a high rate of complete clinical remission in recalcitrant uveitis and was well tolerated by most patients. In this retrospective, interventional, noncomparative cohort study, the researchers evaluated 88 patients from a single-center private practice. All of the patients had noninfectious uveitis that was resistant to other therapy, including corticosteroids and conventional immunomodulatory drugs. In addition, all of the patients had active inflammation at the time they were first infused with infliximab. The drug was administered at an initial dose of 4 to 6 mg/kg, with loading doses given at zero, two, and six weeks and maintenance doses given every four weeks until clinical remission was achieved. At that point, the interval between infusions was slowly lengthened in two-week increments. Primary outcome measures included the rate of remission, time to remission, relapse rate, failure rate, and tolerance. Of the 88 patients, 72 (81.8 percent) achieved complete clinical remission while being treated with infliximab, and 33 patients (37.5 percent) were able to discontinue all other medications within 180 days of beginning infliximab therapy. The rate of continuing remission without relapse was 84.7 percent at six months, 75.6 percent at one year, 56.4 percent at 18 months, and 53.4 percent at two years. Patients who relapsed typically did so when the infusion interval was lengthened; when this occurred, they were returned to a shorter interval. Thirty-two patients (36.4 percent) experienced at least one side effect, and 17 (19.3 percent) discontinued therapy as a result. One factor that affected remission and relapse was a patient’s medication history. For instance, those who had previously taken mycophenolate or azathioprine had among the highest incidence rates of remission. Incidence of relapse was highest among patients with prior use of methotrexate and daclizumab. The researchers noted that while their results require confirmation by a large multicenter study, continued follow-up of their patient cohort is also necessary to fully determine the longterm effects of infliximab.