Efficacy of infliximab in treatment of refractory panuveitis associated with Behçet disease

Abstract

Introduction. Behcet disease (BD) is a chronic multi-system disorder with manifestations in the ocular, urological, articular, and vascular systems. Tumor necrosis factor alpha is believed to play a pivotal role in BD. Therapeutic blockade of its activity by infliximab is a novel therapeutic approach and has successfully led to remission of the disease. The aim is to report two cases of refractory BD-associated panuveitis (PU) treated with infliximab. The patients were followed for 12 months. The main therapy assessment parameters were the best corrected visual acuity (BCVA) in the better eye, slit lamp and fluorescein angiography (FAG) from baseline findings and from the final examination. Case outline. A male patient (45 years old, 25 years of BD history) and a female patient (45 years old, 15 years of BD history), both with posterior synechia, 3+ flare and complicated cataract, while the female also had hypopyon, were treated with infliximab administered at the dose of 5 mg/kg at weeks 0, 2, 6, and 14. The results for the male patient were as follows (baseline vs. the final examination): BCVA ? 0.5 vs. 0.8; cellular reaction ? 3+ vs. 1+; FAG ? 1/2 vs. 0. The results for the female patient were as follows: BCVA ? 0.1 vs. 0.3; FAG ? 2/3 vs. 0. After 12 months, relapses or side-effects were not observed. Conclusion. Infliximab is an effective and promising drug in treating refractory BD-associated PU. It promptly reduces acute symptoms of PU, but it still remains to be seen if a long-term remission in a great number of patients will be achieved.