Infliximab for the Treatment of Refractory Noninfectious Uveitis A Study of 88 Patients with Long-term Follow-up

Objective: To establish the safety and efficacy of infliximab for the treatment of refractory noninfectious uveitis. Design: Retrospective, interventional, noncomparative cohort study. Participants: Eighty-eight patients from a single-center private practice. Methods: Patients with chronic, recalcitrant uveitis treated with infliximab (Remicade; Janssen Biotech, Inc., Titusville, NJ) were identified through an electronic medical record database. All charts were reviewed for sex, diagnosis, location of inflammation, presence of vasculitis, prior immunomodulatory treatments, duration of infliximab treatment, dose received, secondary side effects, and other medications continued while receiving treatment with infliximab. Main Outcome Measures: The primary outcome measures were the rate of remission, time to remission, relapse rate, failure rate, and patient tolerance. Additional analysis aimed to identity risk factors that would predict a higher success rate of infliximab to treat various types of noninfectious uveitis. Results: Of the 72 patients (81.8%) who achieved clinical remission while being treated with infliximab, 42 (58.3%) required additional immunomodulatory medications. At 7, 18.1, and 44.7 weeks, 25%, 50%, and 75% of patients, respectively, achieved clinical remission off all corticosteroids. Thirty-two patients (36.4%) experienced at least 1 side effect while on infliximab therapy, and 17 patients (19.3%) discontinued treatment secondary to 1 or more intolerable side effects. The most common adverse effects were skin rash (9.1%) and fatigue (8%). Factors associated with a higher chance to achieve clinical remission were nonidiopathic uveitis (P< 0.001), intermediate or panuveitis (P< 0.001), absence of vasculitis (P< 0.001), and a starting dose >= 5 mg/kg (P< 0.011). Conclusions: Infliximab induces a high rate of complete clinical remission in recalcitrant uveitis and is well tolerated by most patients. (C) 2014 by the American Academy of Ophthalmology.