Anti-TNF- therapy for sight threatening uveitis. E W Lindstedt, G S Baarsma, R W A M Kuijpers, and P M van Hagen. Netherlands. 2005. This paper describes the use of infliximab in 13 patients (one with Birdshot) with sight threatening uveitis. Ocular inflammation was suppressed, with eleven patients having improved or stable visual acuity. The table giving the results includes visual acuity gains and some of these are startling. The authors comment that some of these eyes already had irreversible damage and that stable vision in such cases is an indicator of successful treatment. The one Birdshot patient developed a rash and had to stop treatment after the first infusion. The paper gives the varying lengths of time taken for the effects of infliximab to be seen – from six days to two months.
Infliximab for refractory uveitis. Preliminary safety and efficacy outcomes. Eric B Suhler Justine R Smith Michael S Wertheim Andreas K Lauer Daryl E Kurz Terri D Pickard James T Rosenbaum. US. Twenty three patients, including three with Birdshot, received infliximab initially for ten weeks – three infusions. At this point, 18 patients were deemed treatment successes and 7 of these enrolled to continue treatment, every eight weeks for 50 weeks. The paper gives very detailed results of its success and failure criteria and also makes clear the side effects seen in these patients. It makes reference to other studies.
Infliximab Improves Uveitis: Initial RESCU Results. Europe. 2005.
These findings come from the Remicade European Study for Chronic Uveitis (RESCU), a multicenter trial that included patients from 10 European centers. Forty nine patients, including ten with Birdshot, in a European multi centre trial had improved visual acuity by week 10 and were able to reduce their use of corticosteroid. 4 patients had to discontinue treatment due to adverse effects.
Tumour necrosis factor antagonists: preliminary evidence for an emerging approach in the treatment of ocular inflammation. Theodossiadis, Panagiotis G. MD *; Markomichelakis, Nikolaos N. MD +; Sfikakis, , Petros P. MD . Greece. 2007. This is a positive review on the work done to date on the effectiveness of infliximab in sight threatening posterior uveitis. The abstract is free, but access to the full document requires subscription.
Ocular vasculitis a multidisciplinary approach Carl P. Herbort. Switzerland. 2005. ( It deals with the classification of ocular vasculitis, one of the sections approximately half way through deals with Birdshot Uveitis.
Infliximab for the treatment of recalcitrant uveitis. H.Nida Sen MD MHS1,2, Grace Levy- This paper describes the effects of treatment with infliximab for nine uveitis patients (no birdshot patients). If uveitis was quiet, patients were begun on doses of 3mg/kg, if active 5mg/kg. Infusions were 4 weeks apart, then decreased to six after 4 months of therapy in some patients. Patients were followed for 53 months. All patients had been treated with combinations of two immunosuppressants in the past and had developed intolerance or adverse side effects to them. The average duration of their uveitis was 9 years. In the patients with active disease, it took three weeks for inflammation to be quietened, eight patients were able to reduce their other immunosuppressives and seven patients had no uveitis flare ups while on this treatment and off their previous treatments. Eight patients either made gains in visual acuity or remained stable. There were side effects and treatment with infliximab had to be stopped in three patients.
High Dose Infliximab in Refractory Chronic Pediatric Non-Infectious Uveitis. Jasmine Francis, Paul Latkany,M.D., Michael Samson, M.D., Kenan Narayana, M.D. US. 2006. Five children with chronic uveitis, who had failed methotrexate and/or cellcept treatment, were given high dose infliximab (15-20 mg/kg) and in all cases, within two months of treatment, there was a dramatic resolution of inflammation. The authors conclude that this high dose treatment requires further investigation. In the UK, infliximab for uveitis is usually given at 3 – 5mg/kg and side effects are an issue at the higher doses cited in this paper. One of the children treated had a diffuse herpetic eruption during treatment.
TNF inhibitors and uveitis – is there a causal relationship?
Lyndell L. Lim, Frederick W. Fraunfelder, Frederick T. Fraunfelder, James T. Rosenbaum. US. 2006. TNF inhibitors are infliximab (remicade), etanercept (enbrel) and adalimumab (humira). This study makes reference to the World Health Organization adverse drug events and the National Registry of Drug-Induced Ocular Side Effects prior to January 1st, 2006. The authors state that there were 43 reported cases of uveitis associated with etanercept, 14 with infliximab and 3 with adalimumab. In contrast, optic neuritis was reported in 22 cases treated with etanercept, 40 cases with infliximab and 4 with adalimumab. Adalimumab associated uveitis was deemed too uncommon for further study.