We have previously reported that infliximab, a chimeric antibody that binds tumor necrosis factor-alpha (TNF), was useful therapy for patients with refractory sarcoidosis. Etanercept, a TNF receptor antagonist, was not effective for ocular sarcoidosis or chronic uveitis. Infliximab and etanercept are equally effective for rheumatoid arthritis, but only infliximab works for Crohn’s disease.
We performed a retrospective review of our experience using infliximab for chronic ocular inflammation. We have treated with infliximab fourteen patients with active ocular disease for at least three months.
The patients (pts) included: 7 with sarcoidosis, 4 with idiopathic uveitis, 2 with Crohn’s disease, one each of Volt-Koyanagi-Harada, birdshot chorioditis, and Behcet’s. All patients had previously received more than six months with various immunosuppressive agents: methotrexate (12 pts), prednisone (9 pts), azathioprine (6 pts), cyclophosphamide (1 pt), cyclosporine (1 pt), and etanercept (3 pts). All patients were maintained on local ocular therapy. Thirteen of 14 pts were felt by their treating ophthalmologist to experience significant ophthalmic improvement while on infliximab. Infliximab treatments were stopped in 5 pts: 2 because of adverse reactions (1 each of allergic reaction and alopecia), 3 for financial reasons. Four patients developed an ophthalmic flare after stopping drug. One patient developed unilateral blindness within two months of drug discontinuation. However, with drug reinstitution, she has regained vision. The 3 patients who failed etanercept all responded to infliximab.CONCLUSIONS: Infliximab was an effective agent for patients with refractory ocular sarcoidosis and similar inflammatory eye diseases.
Patients not responding to etanercept may still respond to infliximab.
R.P. Baughman, Centocor, Grant monies, Discussion of product research or unlabeled uses of product.