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

Authors Katsuyama A, Kusuhara S, Nishisho R, Matsumiya W, Azumi A, Nakamura M

Received 20 December 2018

Accepted for publication 15 February 2019

Published 20 March 2019 Volume 2019:13 Pages 521—527


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Scott Fraser

Atsuko Katsuyama,1 Sentaro Kusuhara,1 Ryuto Nishisho,1 Wataru Matsumiya,1 Atsushi Azumi,2 Makoto Nakamura1

1Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, Chuo-ku, Kobe 650-0017, Japan; 2Department of Ophthalmology, Kobe Kaisei Hospital, Nada-ku, Kobe 657-0068, Japan

Purpose: This study aimed to evaluate the long-term efficacy and safety of infliximab (IFX) and cyclosporine (CsA) combination therapy for refractory uveoretinitis in Behçet’s disease (BD).
Patients and methods: The study involved a retrospective review of the medical records of 11 patients with Behçet’s uveoretinitis refractory to conventional treatment who had been treated with IFX+CsA combination therapy. The frequency of ocular inflammatory attacks and a Behçet’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 Behçet’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.

Keywords: Behçet’s disease, uveitis, infliximab, cyclosporine, efficacy, safety

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