Duration 5min, Q&A 3min
Reasons of the Application of Infliximab Therapy to the Patients with Ocular Behçet's Disease
To clarify the reasons of starting infliximab therapy in ocular Behçet's disease (BD), the clinical data of 6 months before the initiation of infliximab was retrospectively examined.
We investigated 173 ocular BD patients(139 men, 34 women¸ mean age 38.6±11.8 years old) who were referred to the uveitis clinics of 10 the referral-based University Hospitals in Japan, and initially received infliximab therapy between January 2001 and December 2011¸ observed during the 6 months before the application of infliximab.
From the clinical records, we retrospectively examined the backgrounds of the patients just before the application of infliximab (best corrected-visual acuities (BCVA), medications, duration of ocular disease), numbers of ocular inflammatory attacks during 6 months period before the application of infliximab. The severities of ocular inflammatory attacks were determined using Behçet's disease ocular attack score 24 (BOS24), which consists of a total 24 points divided into 6 parameters of ocular inflammatory symptoms.
Results and Conclusion
Just before application of infliximab, 72 patients (42%) received colchicine, 51 patients (42%) received cyclosporine, and 51 patients (42%) received oral corticosteroid. The numbers of ocular attacks were 2.8±2.1 times in the 6 months just before application of infliximab, whereas 31 cases (18%) suffered only one attack and 18 cases (10%) had no attacks during the periods. Severe anterior uveitis (cell 4+) occurred in 29 cases (17%) . Ocular fundus attacks were observed in 123 cases (71%), such as involvements of posterior retina in 81cases (47%), involvements of macula in 54 cases (31%) and new inflammatory findings of optic disc in 14 cases (8%). The accumulation scores of BOS24 during the 6 months before application of infliximab were 17.5±17.2 (the median is 14). The average BOS24 for individual ocular attacks was 5.8±3.7 during the period. On the other hand, infliximab was introduced in 28 cases (16%) without retinal inflammatory attacks during the 6 months before initiation of infliximab because their BCVAs were worse (0.2 or less) and infliximab therapy might be necessary to retain the visual functions. The reasons of introducing infliximab therapy were widely different in each patient, yet, ocular fundus attacks might be the most major cause in the majority of the patients. The 14 points of BOS24-6M, the median value in the current cases, could possibly be an indication for application of infliximab therapy.
[ Keyword ]
infliximab / Behçet's disease / ocular inflammatory attacks / Behçet's disease ocular attack score 24
[ Conflict of Interest ]