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Infliximab in refractory uveitis due to Behçet's disease

B. Wechsler¹, R. Sablé-Fourtassou¹, B. Bodaghi², D.L.T. Huong¹, N. Cassoux², I. Badelon⁴, O. Fain³, P. LeHoang², J.-C. Piette₁

¹Department of Internal Medicine and ²Department of Ophthalmology Hôpital Pitié-Salpètrière, Paris; ³Department of Internal Medicine and 4Department of Ophthalmology, Hôpital Jean Verdier, Bondy, France.

ABSTRACT
Objective
To report 4 cases of refractory panuveitis due to Behçet's disease treated with a novel therapy: infliximab.

Methods
Retrospective study of 3 women and 1 man of Causasian origin with Behçet's disease complicated with panuveitis. Their uveitis was relapsing from 48 to 96 months and was resistant to the combination of colchicine (n = 4), high-dose prednisone (n = 4), pentoxyphilline (n = 2) and various immunossuppressors and/or immunomodulators given successively: intravenous cyclophosphamide (n = 4), azathioprine (n = 3), interferon alpha (n = 3), cyclosporine A (n = 2), oral cyclophosphamide (n = 1), mycophenolate mofetil (n = 1), methotrexate (n = 1), high-dose immunoglobulin (n = 1). Combination with respectively 1, 3, 4 and 5 immunossuppressors and/or immunomodulators failed before institution of infliximab. After informed consent was obtained, infliximab was administered as a single infusion of 5 mg/kg (maximum dose: 400 mg) at day 1, at week 2, 6 and then every 8 weeks.

Results
With a follow-up ranging from 7 to 22 months, infliximab was efficient in all cases. The mean prednisone dose decreased from 45 mg to 13 mg daily. Total recovery of visual acuity was observed in half of the cases. Infliximab was well tolerated without fever, severe sepsis or autoimmune manifestation.

Conclusion
Infliximab may be efficient in refractory uveitis due to Behçet's disease. The optimal dose, rhythm and duration of infliximab infusions need to be standardized.

Key words
Behçet's disease, uveitis, anti-TNF, infliximab.

Please address correspondence to: Bertrand Wechsler, MD, Department of Internal Medicine, Hôpital Pitié-Salpètrière, 75013 Paris, France.