Efficacy of infliximab in refractory Behçet’s disease-associated and idiopathic posterior segment uveitis: a prospective, follow-up study of 50 patients

Figures & data

Table 1 Baseline demographic and concurrent clinical manifestations in 50 patients with idiopathic and Behçet’s disease-associated posterior uveitis

	Overall	Idiopathic PU	BD-associated PU
Patient number	50	14	36
Male/female (no/%)	20 (40%)/30 (60%)	5 (36%)/9 (64%)	15 (42%)/21 (58%)
Age at first visit (years/mean ± SD)	37.5 ± 12.3	40.9 ± 15.3	36.1 ± 10.9
Disease duration (months/mean ± SD)	60.3 ± 64.6	51.1 ± 48.4	63.8 ± 70.2
HLA-B51+ (no/%)	26 (52%)	3 (21%)	23 (64%)
ESR (mm/h/mean ± SD)	29.5 ± 14.2	28.6 ± 13.8	29.8 ± 14.5
CRP (mg/dL/mean ± SD)	1.25 ± 1.1	0.84 ± 0.7	1.41 ± 1.2
Bilateral PU (no/%)	33 (66%)	12 (86%)	23 (64%)
Unilateral PU (no/%)	8 (16%)	1 (7%)	6 (17%)
Panuveitis (no/%)	9 (18%)	1 (7%)	7 (19%)
Retinal vasculitis (no/%)	31 (62%)	9 (64%)	22 (61%)
Ocular attacks before IFX (total no/mean ± SD)	285 (5.7 ± 5.7)	61 (4.35 ± 3.29)	224 (6.2 ± 6.3)
Previous treatment (no/%)
CS+AZA	14 (28%)	6 (43%)	8 (22%)
CS+MTX	6 (12%)	2 (14%)	4 (11%)
CS+CSA	15 (30%)	5 (36%)	10 (28%)
CS+MTX+CSA	11 (22%)	1 (7%)	10 (28%)
CS+AZA+CSA	3 (6%)	0 (0%)	3 (8%)
CS+MTX+CSA+AZA	1 (2%)	0 (0%)	1 (3%)
Ocular complications (no/%)
Cataract	9 (18%)	2 (14%)	7 (19%)
Cystoid macular edema	19 (38%)	5 (36%)	14 (39%)
Retinal detachments	4 (8%)	1 (7%)	3 (8%)
Papillitis	8 (16%)	2 (14%)	6 (17%)
Intra/subretinal hemorrhage	5 (10%)	1 (7%)	4 (11%)
Intravitreal hemorrhage	3 (6%)	1 (7%)	2 (5.5%)
Optic atrophy	5 (10%)	1 (7%)	4 (11%)
Visual acuity (mean ± SD)
Right eye	0.57 ± 0.31	0.6 ± 0.31	0.56 ± 0.32
Left eye	0.67 ± 0.28	0.65 ± 0.30	0.68 ± 0.27

Abbreviations: AZA, azathioprine; BD, Behçet’s disease; CS, corticosteroids; CSA, cyclosporine A; IFX, infliximab; MTX, methotrexate; PU, posterior uveitis; SD, standard deviation.

Table 2 Baseline and end of follow up results of IFX therapy in 50 patients overall with refractory PU

Clinical feature	Baseline	Week 8 (After the 3rd IFX infusion)	End of follow-up	P value
PU response to IFX (n/%)
– Complete		29 (58%)	34 (68%)	ns
– Partial		16 (32%)	11 (22%)	ns
– Absent		5 (10%)	5 (10%)	ns
Proportion of patients with VA improvement (n/%)		36 (72%)	41 (82%)	ns
Relapse-free subjects (n/%)		38/50 (76%)	31 (62%)	ns
Visual acuity (mean ± SD)
Right eye	0.57 ± 0.31	0.63 ± 0.32	0.68 ± 0.33	0.048
Left eye	0.67 ± 028	0.74 ± 0.26	0.76 ± 0.27	0.047
Uveitis flares up (no/mean ± SD)	285/5.70 ± 5.6	NA	38/0.76 ± 1.11	0.0001
Cystoid macular edema (no/%)	19 (38%)	14 (28%)	7 (14%)	0.008
FFA retinal vasculitis (no/%)	31 (62%)	12 (24%)	7 (14%)	0.0001

Abbreviations: FFA, fundus fluorescein angiography; IFX, infliximab; NA, not applicable; ns, not significant; PU, posterior uveitis; SD, standard deviation; VA, visual acuity.

Table 3 Results of IFX therapy divided by the diagnosis in 14 patients with idiopathic refractory PU and BD-associated PU and comparison between the two groups

Clinical feature	Idiopathic PU (14 patients)			BD-associated PU (36 patients)			P Id. PU vs BD
	Baseline	End of follow-up	P	Baseline	End of follow-up	P
PU response (N/%)							ns
– Complete		9 (64%)			25 (69%)
– Partial		3 (21%)			8 (22%)
– Absent		2 (14%)			3 (8%)
Proportion of patients with VA gain (N/%)		11 (79%)			30 (83%)		ns
Visual acuity (mean ± SD)							ns
RE	0.6 ± 0.31	0.70 ± 0.31	0.011	0.56 ± 0.32	0.65 ± 0.33	0.0005
LE	0.65 ± 0.30	0.75 ± 0.29	0.016	0.68 ± 0.27	0.76 ± 0.27	0.0004
Uveitis flares up (no/mean ± SD)	61 (4.35 ± 3.29)	7 (0.5 ± 0.94)	0.003	224 (6.22 ± 6.39)	31/0.86 ± 1.17	0.0001	ns
Cystoid macular edema (no/%)	5 (36%)	0 (0%)	0.0003	14 (39%)	5 (14%)	0.03	ns
FFA retinal vasculitis (no/%)	9 (64%)	1 (7%)	0.0002	22 (61%)	2 (5.5%)	0.0001	ns

Abbreviations: FFA, fundus fluorescein angiography; IFX, infliximab; NA, not applicable; ns, not significant; PU, posterior uveitis; SD, standard deviation; VA, visual acuity; BD, Behçet’s disease.

Table 4 Reported clinical series of IFX therapy in patients with BD-associated or idiopathic refractory PU

Reference	PU type	Patient N°	IFX dose	Primary outcome measure	Responders (N/%)	Follow-up (months)
Sfikakis et al^Citation34	BD	5	5 mg/kg	Inflammation suppression	5 (100%)	1
Joseph et al^Citation35	BD, idiopathic	5	5 mg/kg	Inflammation suppression	4 (80%)	6
Sfikakis et al^Citation36	BD	15	5 mg/kg	Inflammation suppression	19 (76%)	8
Ohno et al^Citation37	BD	13	5 mg/kg/10 mg/kg	Flare-up frequency	10 (77%)	3
Wechsler et al^Citation38	BD	4	5 mg/kg	Inflammation suppression	4 (100%)	22
Benitez-del Castillo et al^Citation39	BD, idiopathic	7	5 mg/kg	Inflammation suppression	4 (57%)	36
Tugal-Tutkun et al^Citation40	BD	13	5 mg/kg	Inflammation suppression	4/13 (31%)	12
Lindstedt et al^Citation41	BD, idiopathic	13	3 mg/kg	Inflammation suppression	13/13 (100%)	24
Lanthier et al^Citation42	BD	4	5 mg/kg	Inflammation suppression	2 (50%)	11
Suhler et al^Citation43	BD, idiopathic	23	5 mg/kg	See note*	18 (78%)	2
Mushtaq B et al^Citation44	BD	3	5 mg/kg	Flare-up frequency	3 (100%)	16
Abu El-Asrar AM^Citation45	BD	6	5 mg/kg	Inflammation suppression	6 (100%)	36
Niccoli et al^Citation19	BD	12	5 mg/kg	Inflammation suppression	7 (58%)	24
Accorinti et al^Citation46	BD	12	5 mg/kg	Flare-up frequency	11 (92%)	16
Tognon et al^Citation47	BD	7	3 mg/kg 5 mg/kg	Flare-up frequency	6 (86%)	23
Al-Rayes et al^Citation48	BD	10	5 mg/kg	Flare-up frequency	7 (70%)	36
Tabbara and Al-Hemidan^Citation49	BD	10	5 mg/kg	Flare-up frequency	NA	30
Yamada et al^Citation50	BD	17	5 mg/kg	Flare-up frequency		6
Giardina et al^Citation51	BD	21	5 mg/kg	Inflammation suppression	18 (86%)	12
Adán et al^Citation52	BD	4	5 mg/kg	Inflammation suppression	2 (50%)	12
Yamada et al^Citation53	BD	23	5 mg/kg	Flare-up frequency	10 (43%)	20
Sugita et al^Citation54	BD	20	5 mg/kg	Flare-up frequency	15 (75%)	28

* Notes: Patients were considered responders if improved in at least one of four variables (visual acuity, control of intraocular inflammation, ability to taper concomitant medication therapy, improvement in inflammatory signs on FFA and/or OCT) and if they worsened in none.

Abbreviations: BD, Behçet’s disease; IFX, infliximab; NA, not applicable; PU, posterior uveitis; SD, standard deviation.

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