Retrospective Case Review of Pediatric Patients with Uveitis Treated with Infliximab
Poster presented at: American Academy of Ophthalmology Annual Meeting, October, 2004; New Orleans, Louisiana.
Received 9 February 2005; accepted 8 September 2005. published online 09 January 2006.
Purpose
To assess the response and adverse events associated with infliximab treatment for refractory, noninfectious pediatric uveitis.
Design
Retrospective noncomparative case series of pediatric patients with refractory uveitis treated with infliximab.
Participants
Six patients were identified. Diagnoses of the participants included idiopathic uveitis (n = 1), juvenile rheumatoid arthritis with uveitis (n = 3), idiopathic retinal vasculitis with uveitis (n = 1), and bilateral pars planitis, with vitreitis and papillitis of the left eye (n = 1). Uveitis developed in the patients (5 female, 1 male) at a mean age of 9.0 years (±5.0 years; range, 0.9–14.8 years). All patients had bilateral eye involvement. These patients were refractory to or dependent on topical steroids (n = 4), oral prednisone (n = 3), or both, and were also refractory to the following therapies: methotrexate (n = 6), cyclosporine (n = 3), mycophenolate mofetil (n = 3), etanercept (n = 3), and daclizumab (n = 1).
Intervention
All patients initially received infliximab at doses between 5 and 10 mg/kg at 2- to 4-week intervals, and then were maintained at 4- to 8-week intervals at doses of 5 to 18 mg/kg. Mean follow-up time on treatment has been 48.1 weeks (±14.9 weeks; range, 32–74 weeks).
Main Outcome Measures
Primary outcome measures included the quantitative measurement of the amount of ocular inflammation in different locations within the eye. Patients were monitored for infusion reactions as well as other potential side effects. The children’s clinical status, complete blood counts, and liver function panels were monitored by pediatric rheumatologists every 6 weeks.
Results
All 6 patients showed reduction in their intraocular inflammation after infliximab therapy was initiated. Furthermore, control of ocular inflammation was achieved while receiving infliximab therapy. Topical and systemic corticosteroids were able to be discontinued in all patients except for 1 patient, who is currently weaning off prednisone. The only adverse reactions seen were the development of vitreous hemorrhage in 1 patient and a case of transient upper respiratory infusion reaction. No patient has had to discontinue treatment.
Conclusions
Infliximab seems to be an effective agent for the treatment of refractory pediatric uveitis without apparent serious toxicity in this series of patients.
1Joseph M. Sanzari’s Children Hospital, Hackensack University Medical Center, Hackensack, New Jersey
2University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey
3Institute of Ophthalmology & Visual Sciences, University of Medicine and Dentistry of New Jersey–New Jersey Medical School, Newark, New Jersey
Correspondence to David S. Chu, MD, Institute of Ophthalmology & Visual Sciences, UMDNJ–New Jersey Medical School, Doctors Office Center, Suite 6100, 90 Bergen Street, Newark, NJ 07101.
Manuscript no. 2005-126.
Supported in part by an unrestricted grant from Research to Prevent Blindness, Inc., New York, New York.
ABSTRACT