Abstract
Purpose
To investigate the clinical course of Behçet’s uveitis patients following discontinuation of infliximab therapy.
Methods
This retrospective chart review study examined Behçet’s disease patients who received infliximab treatment between 2000 and 2012. Medical records of patients whose infliximab treatment was discontinued were reviewed, with special focus on the frequency of uveitis attacks in the period before initiation, during treatment and after cessation of the infliximab therapy. Mean visual acuities were evaluated for each treatment period.
Results
Out of the 43 patients treated with infliximab at our uveitis clinic, ten were discontinued due to adverse events or inefficiency. Data for seven patients followed for more than 12 months before initiation and after cessation of infliximab were analyzed. Frequency of acute uveitis attacks was 7.43 per 12 months before initiation of infliximab, 2.86 during treatment and 0.57 after cessation. A statistically higher frequency of uveitis attacks was observed before initiation of infliximab compared to during (p < 0.05) and after cessation of treatment (p < 0.05). There was no statistical significance observed between the period during treatment and after cessation (p = 0.29). The mean logMAR was 0.79 at baseline, 0.68 during treatment, and 0.88 at 12 months after cessation. These differences were not statistically significant.
Conclusions
A satisfactory clinical course with well-controlled ocular inflammation was found after discontinuation of infliximab therapy in Behçet’s uveitis patients. These results suggest that a safe, pre-planned discontinuation of infliximab therapy can be performed in patients with Behçet’s uveitis.
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References
Sakane T, Takeno M, Suzuki N, Inaba G. Behçet’s disease. N Engl J Med. 1999;341:1284–91.
Nussenblatt RB. Uveitis in Behçet’s disease. Int Rev Immunol. 1997;14:67–79.
George RK, Chan CC, Whitcup SM, Nussenblatt RB. Ocular immunopathology of Behçet’s disease. Surv Ophthalmol. 1997;42:157–62.
Takeuchi M, Hokama H, Tsukahara R, Kezuka T, Goto H, Sakai J, et al. Risk and prognostic factors of poor visual outcome in Behçet’s disease. Graefe’s Arch Clin Exp Ophthalmol. 2005;243:1147–52.
Mochizuki M. Immunotherapy for Behçet’s disease. Int Rev Immunol. 1997;14:49–66.
Tugal-Tutkun I, Onal S, Altan-Yaycioglu R, Huseyin Altunbas H, Urgancioglu M. Uveitis in Behçet’s disease: an analysis of 880 patients. Am J Ophthalmol. 2004;138:373–80.
Ohno S, Nakamura S, Hori S, Shimakawa M, Kawashima H, Mochizuki M, et al. Efficacy, safety, and pharmacokinetics of multiple administration of infliximab in Behçet’s disease with refractory uveoretinitis. J Rheumatol. 2004;31:1362–8.
Tugal-Tutkun I, Mudun A, Urgancioglu M, Kamali S, Kasapoglu E, Inanc M, et al. Efficacy of infliximab in the treatment of uveitis that is resistant to treatment with the combination of azathioprine, cyclosporine, and corticosteroids in Behçet’s disease: an open-label trial. Arthritis Rheum. 2005;52:2478–84.
Abu El-Asrar AM, Abboud EB, Aldibhi H, Al-Arfaj A. Long-term safety and efficacy of infliximab therapy in refractory uveitis due to Behçet’s disease. Int Ophthalmol. 2005;26:83–92.
Accorinti M, Pirraglia MP, Paroli MP, Priori R, Conti F, Pivetti-Pezzi P. Infliximab treatment for ocular and extraocular manifestations of Behçet’s disease. Jpn J Ophthalmol. 2007;51:53–7.
Yamada Y, Sugita S, Tanaka H, Kamoi K, Kawaguchi T, Mochizuki M. Comparison of infliximab versus cyclosporine during the initial 6-month treatment period in Behçet’s disease. Br J Ophthalmol. 2010;94:284–8.
Kawaguchi T, Sugita S, Yamada Y, Miyanaga M, Mochizuki M. Regression of optic disc neovascularization in patients with Behçet’s uveoretinitis after infliximab therapy. J Ocul Pharmacol Ther. 2010;26:627–30.
Keino H, Okada AA, Watanabe T, Taki W. Decreased ocular inflammatory attacks and background retinal and disc vascular leakage in patients with Behçet’s disease on infliximab therapy. Br J Ophthalmol. 2011;95:1245–50.
Okada AA, Goto H, Mochizuki M. Ocular Behçet’s Disease Research Group of Japan. Multicenter study of infliximab for refractory uveoretinitis in Behçet disease. Arch Ophthalmol. 2012;130:592–8.
Yoshida A, Kaburaki T, Okinaga K, Takamoto M, Kawashima H, Fujino Y. Clinical background comparison of patients with and without ocular inflammatory attacks after initiation of infliximab therapy. Jpn J Ophthalmol. 2012;56:536–43.
Plank SR, Huang XN, Robertson JE, Rosenbaum JT. Cytokine mRNA in rat tissues after systemic endotoxin treatment. Invest Ophthalmol Vis Sci. 1994;35:924–30.
De Vos AF, Van Haren MA, Verhagen C, Hoekzema R, Kijlstra A. Tumour necrosis factor-induced uveitis in the Lewis rat is associated with intraocular interleukin 6 production. Exp Eye Res. 1995;60:199–207.
Sartani G, Silver PB, Rizzo LV, Chan CC, Wiggert B, Mastorakos G, et al. Anti-tumor necrosis factor alpha therapy suppresses the induction of experimental autoimmune uveoretinitis in mice by inhibiting antigen priming. Invest Ophthalmol Vis Sci. 1996;37:2211–8.
Gül A. Behçet’s disease: an update on the pathogenesis. Clin Exp Rheumatol. 2001;19(5 Suppl 24):S6–12.
Ahn JK, Yu HG, Chung H, Park YG. Intraocular cytokine environment in active Behçet uveitis. Am J Ophthalmol. 2006;142:429–34.
Keane J, Gershon S, Wise RP, Mirabile-Levens E, Kasznica J, Schwieterman WD, et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Engl J Med. 2001;345:1098–104.
Rovere Querini P, Vecellio M, Sabbadini MG, Ciboddo G. Miliary tuberculosis after biological therapy for rheumatoid arthritis. Rheumatology (Oxford). 2002;41:231.
Listing J, Strangfeld A, Kary S, Rau R, von Hinueber U, Stoyanova-Scholz M, et al. Infections in patients with rheumatoid arthritis treated with biologic agents. Arthritis Rheum. 2005;52:3403–12.
Warris A, Bjorneklett A, Gaustad P. Invasive pulmonary aspergillosis associated with infliximab therapy. N Engl J Med. 2001;344:1099–100.
Glück T, Linde HJ, Schölmerich J, Müller-Ladner U, Fiehn C, Bohland P. Anti-tumor necrosis factor therapy and Listeria monocytogenes infection: report of two cases. Arthritis Rheum. 2002;46:2255–7.
De Bandt M, Sibilia J, Le Loët X, Prouzeau S, Fautrel B, Marcelli C, et al. Club rhumatismes et inflammation. Systemic lupus erythematosus induced by anti-tumour necrosis factor alpha therapy: a French national survey. Arthritis Res Ther. 2005;7:R545–51.
Sfikakis PP, Iliopoulos A, Elezoglou A, Kittas C, Stratigos A. Psoriasis induced by anti-tumor necrosis factor therapy: a paradoxical adverse reaction. Arthritis Rheum. 2005;52:2513–8.
Kawazoe Y, Sugita S, Yamada Y, Akino A, Miura K, Mochizuki M. Psoriasis triggered by infliximab in a patient with Behçet’s disease. Jpn J Ophthalmol. 2013;57:95–7.
Cheifetz A, Smedley M, Martin S, Reiter M, Leone G, Mayer L, et al. The incidence and management of infusion reactions to infliximab: a large center experience. Am J Gastroenterol. 2003;98:1315–24.
Suhler EB, Smith JR, Wertheim MS, Lauer AK, Kurz DE, Pickard TD, et al. A prospective trial of infliximab therapy for refractory uveitis: preliminary safety and efficacy outcomes. Arch Ophthalmol. 2005;123:903–12.
Niccoli L, Nannini C, Benucci M, Chindamo D, Cassarà E, Salvarani C, et al. Long-term efficacy of infliximab in refractory posterior uveitis of Behçet’s disease: a 24-month follow-up study. Rheumatology (Oxford). 2007;46:1161–4.
Adán A, Hernandez V, Ortiz S, Molina JJ, Pelegrin L, Espinosa G, et al. Effects of infliximab in the treatment of refractory posterior uveitis of Behçet’s disease after withdrawal of infusions. Int Ophthalmol. 2010;30:577–81.
Behçet’s disease research committee of Japan. Behçet’s disease: guide to diagnosis of Behçet’s disease. Jpn J Ophthalmol. 1974;18:291–4.
Caviglia R, Ribolsi M, Rizzi M, Emerenziani S, Annunziata M, Cicala M. Maintenance of remission with infliximab in inflammatory bowel disease: efficacy and safety long-term follow-up. World J Gastroenterol. 2007;13:5238–44.
Quinn MA, Conaghan PG, O’Connor PJ, Karim Z, Greenstein A, Brown A, et al. Very early treatment with infliximab in addition to methotrexate in early, poor-prognosis rheumatoid arthritis reduces magnetic resonance imaging evidence of synovitis and damage, with sustained benefit after infliximab withdrawal: results from a twelve-month randomized, double-blind, placebo-controlled trial. Arthritis Rheum. 2005;52:27–35.
Saleem B, Nizam S, Emery P. Can remission be maintained with or without further drug therapy in rheumatoid arthritis? Clin Exp Rheumatol. 2006; 24(6 Suppl 43): S-33-6.
Baraliakos X, Listing J, Brandt J, Zink A, Alten R, Burmester G, et al. Clinical response to discontinuation of anti-TNF therapy in patients with ankylosing spondylitis after 3 years of continuous treatment with infliximab. Arthritis Res Ther. 2005;7:R439–44.
Baraliakos X, Listing J, Rudwaleit M, Brandt J, Alten R, Burmester G, et al. Safety and efficacy of readministration of infliximab after long-term continuous therapy and withdrawal in patients with ankylosing spondylitis. J Rheumatol. 2007;34:510–5.
Sugita S, Yamada Y, Kaneko S, Horie S, Mochizuki M. Induction of regulatory T cells by infliximab in Behçet’s disease. Invest Ophthalmol Vis Sci. 2011;52:476–84.
Nadkarni S, Mauri C, Ehrenstein MR. Anti-TNF-α therapy induces a distinct regulatory T-cell population in patients with rheumatoid arthritis via TGF-beta. J Exp Med. 2007;204:33–9.
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Kawaguchi, T., Kawazoe, Y., Kamoi, K. et al. Clinical course of patients with Behçet’s uveitis following discontinuation of infliximab therapy. Jpn J Ophthalmol 58, 75–80 (2014). https://doi.org/10.1007/s10384-013-0283-3
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DOI: https://doi.org/10.1007/s10384-013-0283-3