Elsevier

Ophthalmology

Volume 109, Issue 12, December 2002, Pages 2342-2346
Ophthalmology

Regular article
Anti–tumor necrosis factor-alpha therapy with infliximab as an alternative to corticosteroids in the treatment of human leukocyte antigen b27–associated acute anterior uveitis

https://doi.org/10.1016/S0161-6420(02)01292-7Get rights and content

Abstract

Objective

To evaluate the potentials of infliximab, a mouse–human chimeric immunoglobulin G1 monoclonal antibody that binds both the soluble form and the membrane-bound precursor of tumor necrosis factor-α (TNF-α), thus inhibiting a broad range of biologic activities of TNF-α, in the therapy of patients with acute HLA B27–associated anterior uveitis.

Design

Prospective noncomparative case series.

Participants

Seven consecutive patients with acute onset of HLA B27–associated anterior uveitis, with at least three anterior chamber cells.

Intervention

Infliximab IV (Centocor, Malvern, PA) at a dosage of 10 mg/kg body weight was used as the only anti-inflammatory drug.

Main outcome measures

Anterior chamber cells and flare were evaluated before infliximab treatment and at defined time points after treatment. C-reactive protein (CRP) levels were assessed in all patients before IV delivery of infliximab and were re-evaluated after 1 week.

Results

Patients were observed for a mean period of 17 ± 0.8 months. Seven patients received a single infliximab infusion of 10 mg/kg body weight. One patient received a second infusion 3 weeks after the first because of a uveitis flare-up. The median duration (± standard deviation) of uveitis was 8 ± 12 days. All patients responded to infliximab with immediate improvement of clinical symptoms and a rapid decrease in anterior chamber cells. Total resolution of the uveitis was achieved with infliximab as the sole anti-inflammatory drug in all but one patient, who also showed systemic inflammatory activity, as indicated by a threefold increase in the serum CRP level. A relapse was seen in four patients after a median period of 5 ± 6.4 months.

Conclusion

Infliximab proved to be a powerful therapeutic agent in acute HLA B27–associated uveitis and may therefore be a future alternative or supplement to steroid treatment. Larger controlled studies on the efficacy and dosage of infliximab in different forms of anterior uveitis will nonetheless be needed to evaluate the effectiveness of anti–TNF-α treatment in acute, as well as chronic, uveitis.

Section snippets

Materials and methods

This study observed only acute HLA B27–positive uveitis. The clinical trial protocol and informed consent form followed Austrian national guidelines and were approved by the institutional Ethics and Research Committee; written, informed consent was obtained from all patients. The study conformed to the tenets of the Declaration of Helsinki, as revised in 1989. Disease activity was graded in accordance with the International Uveitis Study Group.17 Anterior chamber cells, as a validated indicator

Results

Seven patients received a single infusion of 10 mg/kg of infliximab. Because of a flare-up, one patient received a second infusion 3 weeks after the first. Table 1 outlines patient data on enrollment. The median age of the patients was 40 ± 13 years. The median follow-up was 17 ± 0.8 months. All but one patient had a history of at least one episode of uveitis. The current flare-up involved only one eye in all patients, and only one of them (patient 5) had received prior treatment with hourly

Discussion

We present the results of IV treatment of seven patients with HLA B27–positive anterior uveitis with infliximab at a dosage of 10 mg/kg. This dosage was used because it was proven to be highly effective in prior studies of patients with rheumatoid arthritis.13 Infliximab was very efficient in suppressing intraocular inflammation; clinical symptoms improved significantly, and anterior chamber cells decreased rapidly. Only one patient with positive CRP levels as a systemic sign of inflammation

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