Evaluation of the Long-Term Efficacy and Safety of Infliximab Treatment for Uveitis in Behcet's Disease

Purpose: To evaluate the long-term efficacy and safety of infliximab for the treatment of uveitis in Behcet's disease (BD). Design: Retrospective multicenter study using a questionnaire. Participants: A total of 164 consecutive patients with BD treated with infliximab for more than 1 year were studied. The mean age at initiation of infliximab treatment was 42.6 +/- 11.7 years, and the mean treatment duration was 32.9 +/- 14.4 months. Methods: Data before and at the last visit during infliximab treatment were analyzed in 4 groups divided by duration of treatment: group A (n = 43, 12-<24 months), group B (n = 62, 24-<36 months), group C (n = 42, 36-<48 months), and group D (n = 17, >= 48 months). Main Outcome Measures: Best-corrected visual acuity (BCVA), relapse of ocular inflammation, numbers of ocular inflammatory attacks per year, and adverse effects of infliximab therapy. Results: The frequency of ocular attacks decreased in all groups (from 5.3 +/- 3.0 to 1.0 +/- 0.3 in group A, 4.8 +/- 4.6 to 1.4 +/- 0.3 in group B, 4.1 +/- 2.9 to 0.9 +/- 0.3 in group C, and 9.5 +/- 5.8 to 1.6 +/- 0.5 in group D; all P < 0.05). The BCVA was improved in approximately 55% of the eyes after treatment. Mean BCVA converted to logarithm of the minimum angle of resolution was improved after treatment with infliximab in groups A to C (from 0.79 +/- 1.04 to 0.59 +/- 0.94 in group A, 0.59 +/- 1.07 to 0.41 +/- 1.04 in group B, and 1.15 +/- 1.77 to 0.92 +/- 1.73 in group C; all P < 0.05) but not in group D. Uveitis relapsed in 59.1% of all patients after infliximab treatment, and no difference in duration until relapse was observed between individual groups. Approximately 80% of relapses occurred within 1 year after the initiation of infliximab treatment in all groups, 90% of which were controlled by increasing doses of topical corticosteroids and shortening the interval of infliximab infusion. Adverse effects were observed in 65 cases or 35% of all subjects. Infliximab treatment was continued in 85% of the patients, but 15% of the patients discontinued infliximab treatment because of adverse effects or insufficient efficacy. Conclusions: Infliximab reduced the frequency of ocular attacks and improved visual acuity in patients with BD-related uveitis and was generally well tolerated with few serious adverse events. (C) 2014 by the American Academy of Ophthalmology.