Long-term efficacy and safety of infliximab and cyclosporine combination therapy for refractory uveoretinitis in Behcet's disease

Purpose: This study aimed to evaluate the long-term efficacy and safety of infliximab (IFX) and cyclosporine (CsA) combination therapy for refractory uveoretinitis in Behcet's disease (BD). Patients and methods: The study involved a retrospective review of the medical records of 11 patients with Behcet's uveoretinitis refractory to conventional treatment who had been treated with IFX+CsA combination therapy. The frequency of ocular inflammatory attacks and a Behcet's disease ocular attack score 24 (BOS24) were used as indices for the evaluation of efficacy during each 6-month period prior to and following initiation of therapy. For the assessment of safety, adverse events (AEs) were recorded throughout the treatment period. Results: The patients had received IFX+CsA combination therapy for 5.6 +/- 2.3 years. The frequency of ocular attacks per 6-month period decreased markedly from 2.9 +/- 1.6 during the baseline period to 0.6 +/- 0.9 during months 1-6, 0.5 +/- 0.9 during months 7-12, 0.3 +/- 0.5 during months 13-18, 0.3 +/- 0.7 during months 19-24, and 0.0 +/- 0.0 thereafter (P=0.003). The BOS24 score per ocular attack significantly decreased from 5.2 +/- 2.4 during the baseline period to 1.5 +/- 2.1 during months 1-6, 1.7 +/- 3.1 during months 7-12, 1.6 +/- 2.9 during months 13-18, and 0.4 +/- 1.0 during months 19-24 (P=0.002). No serious AEs were observed, with the exception of urinary tract infection and cataract progression. Two patients exhibited transient elevation of the serum creatinine level, which was normalized following a reduction in the dose of CsA. Conclusion: For refractory Behcet's uveoretinitis, IFX+CsA combination therapy offers a promising treatment option as it appears to have an acceptable safety profile and can reduce the frequency and severity of ocular inflammatory attacks over a long period of time.