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Infliximab Could Prevent Sight Loss From Behcet's Disease (p 295)

July 25, 2001

A drug used to treat rheumatoid arthritis and Crohn's disease could play an important role in preventing sight loss associated with the inflammatory disorder Behcet's disease, suggest authors of a fast-track research letter published in this week's issue of THE LANCET.

Beh'§et's disease is a rare condition (although with increased incidence in mediterranean countries) affecting the small blood vessels which can cause deep-vein thrombosis, arthritis, oral and genital ulceration, skin lesions, central nervous system dysfunction, and retinal damage. Despite intensive immunosuppressive therapy, relapsing ocular inflammation, which occurs in about 70 % of cases, can lead to permanent blindness. The cause of Beh'§et's disease is unknown; however, concentrations of tumour necrosis factor (TNF) and soluble TNF receptors are increased in the blood of patients with active disease. Therapeutic blockade of the activity of TNF has been successfully used for treatment of rheumatoid arthritis and Crohn's disease, in which TNF has a key role in mediating inflammation. Petros Sfikakis and colleagues from Athens University Medical School, Greece, aimed to find out whether treatment with the anti-TNF monoclonal antibody infliximab had any beneficial therapeutic effect in five patients with long-standing Beh'§et's disease and a history of multiple relapses of uveitis.

The investigators studied four men and one woman, aged 21-56 years, within 48 hours of relapse of disease syymptoms after initial diagnosis. Acute deterioration of visual acuity and the involvement of both anterior and posterior chambers confirmed the relapse of the eye condition panuveitis in all patients. A single intravenous infusion of 5 mg/kg infliximab was given over three hours in an outpatient setting. Systemic examination and detailed ophthalmological assessment (including visual acuity and measurement of intraocular pressure) were done before (day 0) and 1, 2, 4, 7, 10, 14, 21, and 28 days after treatment. Remission of ocular inflammation was evident within the first 24 hours, and complete suppression of symptoms was seen 7 days after treatment in all patients; no side-effects were noted.

Petros Sfikakis comments: "These findings indicate that infliximab administration leads to rapid and effective suppression of acute ocular inflammation and extraocular manifestations in patients with Beh'§et's disease. A rapid therapeutic effect is essential in these patients in order to prevent the development of fixed retinal lesions that cause permanent visual impairment. Taken together with two case-reports describing successful treatment with infliximab of orogenital and skin ulcers and the gastrointestinal complications of Beh'§et's disease, our findings indicate that TNF has a central pathogenetic role in this disease. We suggest that TNF blockade is an effective new therapy for sight-threatening uveitis and perhaps other severe vasculitic manifestations of Beh'§et's disease."



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