Elsevier

Ophthalmology

Volume 111, Issue 2, February 2004, Pages 352-356
Ophthalmology

Case report
Tumor necrosis factor α blockade with infliximab for refractory uveitis and scleritis

Presented in part at the 5th International Conference on New Trends in Clinical and Experimental Immunosuppression, Geneva, Switzerland, February 2002.
https://doi.org/10.1016/S0161-6420(03)00721-8Get rights and content

Abstract

Objective

To assess the efficacy and safety of the anti–tumor necrosis factor α agent infliximab in treatment-resistant uveitis and scleritis.

Design

Retrospective, noncomparative interventional case series.

Participants

Seven patients with noninfectious ocular inflammatory disease that was refractory to alternative immunosuppression. These included one patient with idiopathic retinal vasculitis and panuveitis, one patient with intermediate uveitis, one patient with chronic juvenile anterior uveitis, three patients with scleritis, and one patient with scleritis and peripheral ulcerative keratitis. Four patients had an underlying systemic disease that was in remission in three cases.

Intervention

Infusions of infliximab, 200 mg, were given at 4-week to 8-week intervals, depending on the clinical response.

Main outcome measures

Clinical response, including symptoms, visual acuity, degree of scleral vascular engorgement, corneal thinning, anterior chamber activity, and posterior segment inflammation, reduction in concomitant immunosuppression, and adverse effects.

Results

The mean patient age was 47 years (range, 24–78), and four patients were female. The mean number of infliximab infusions was seven (range, 2–19), and the mean follow-up period was 12 months (range, 4–22 months). Six patients experienced a clinical improvement, with five achieving remission and significant reduction in immunosuppression. One patient showed an initial response but developed a delayed hypersensitivity response that precluded further treatment. No other adverse effects occurred.

Conclusions

Infliximab seems to be an effective and safe treatment for noninfectious uveitis and scleritis and may be indicated as rescue therapy for relapses of ocular inflammation or as maintenance therapy when conventional immunosuppression has failed. Further investigation of infliximab for treatment-resistant scleritis and uveitis is warranted.

Section snippets

Methods

A retrospective analysis was carried out of the case records of seven patients with scleritis or uveitis who received infliximab (Remicade, Schering-Plough, Welwyn Garden City, UK) from July 2000 to May 2002. Treatment was given on a compassionate basis for either sight-threatening disease or intractable pain after failure of alternative immunosuppression. Institutional review board/ethics committee approval was not required for this study. All patients attended the ocular inflammatory disease

Results

Presenting diagnoses were scleritis (three patients), scleritis with peripheral ulcerative keratitis (one patient), intermediate uveitis (one patient), idiopathic retinal vasculitis with panuveitis (one patient), and chronic juvenile anterior uveitis (one patient). Four patients had an underlying systemic inflammatory disorder, including a perinuclear antineutrophil cytoplasmic antibody positive systemic vasculitis with renal involvement, juvenile idiopathic arthritis, rheumatoid arthritis, and

Discussion

Infliximab, a chimeric monoclonal antibody to TNF-α, is a novel immunomodulatory agent that has shown great promise in a number of autoimmune diseases, in particular rheumatoid arthritis and Crohn's disease and, more recently, psoriasis and systemic vasculitis.6, 7, 8, 11, 12 In view of this, we treated seven patients with noninfectious ocular inflammatory disease that was refractory to conventional immunosuppression. A favorable response to infliximab was seen in six of the patients, with five

References (22)

  • J.V Forrester

    Duke-Elder Lecturenew concepts on the role of autoimmunity in the pathogenesis of uveitis

    Eye

    (1992)
  • Cited by (0)

    Manuscript no. 220367.

    The authors have no proprietary interest in any of the products mentioned in this study.

    View full text