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Abstract Objective: This study was designed to assess the efficacy and safety of Infliximab (IFX) in the treatment of ocular manifestations in patients with Behcet’s disease, namely BD-associated refractory posterior uveitis (PU) as expressed by VA improvement from baseline and to investigate the efficacy of IFX to reduce disease flare-up, to assess the proportion of relapse free subjects at the end of follow-up, and the percentage of patients achieving a complete or partial remission, and to evaluate the tolerability and safety of the treatment. Methods: Twenty patients with refractory Behcet uveitis PU (17 males and 3 females) were included in this study. patients were subjected to full history taking, physical examination, purified protein derivative (PPD) test, laboratory tests including erythrocyte sedimentation rate (ESR), Creactive protein (CRP), blood cell count with differential count, renal and liver function, antinuclear antibody titer .Ophthalmologic evaluation consisted of a complete ocular examination including best-corrected VA , slit-lamp biomicroscopy, tonometry and ophthalmoscopy, optical coherence tomography (OCT), & fundus fluorescein angiography (FFA). Results: By the end of week 8 ( induction), we observed a highly significant improvement inVA (right eyes: 0.1±0.09 vs 0.6±0.2, P=0.001) (Left eyes: 0.19±0.17 vs 0.6±0.3, P=0.001), and by the end of week 32 there was further improvement in VA, (right eye: 0.6±0.2 vs 0.8±0.2, P=0.001), (left eyes: 0.6±0.3 vs 0.8±0.2, P=0.001), but this improvement was nearly the same by the end of week 58, (right eyes: 0.8±0.2 vs 0.8±0.2) (left eyes: 0.8±0.2 vs 0.8±0.2). It was noted that improvement in VA was more evident in group A than in group B (P<0.05). At the end of a follow-up of 12 months, 16/20 (80%) patients showed a complete remission, 4/20(20%) showed partial response, none of the patients were non-responders. All of the patients (20) who were taking corticosteroids were able to stop it by week 22 during infliximab treatment, and all showed a reduction in extraocular manifestations of Behçet’s disease. None of the patients had worsening VA or new onset ocular complications. Conclusions: Infliximab seems to be a useful alternative therapy for patients with sight-threatening uveitis unresponsive to the standard immunosuppressive therapy. Although infliximab can be used as first-line medications in bilateral OBD, unilateral case with visual acuity below (6/60) may also need initial infliximab infusion as the first-line drug. Azathioprine can be used as a long-term therapy to control recurrent attacks upon first suppression of ocular inflammation by biologicals. Infliximab is also effective treatment in ocular Behcet disease regarding long term therapy. Key Words: Anti-tumor necrosis factor, Behcet’s disease uveitis. |