Long-term Follow-up and Optimization of Infliximab in Refractory Uveitis Due to Behçet Disease: National Study of 103 White Patients
J. L. Martín-Varillas, Belén Atienza‐Mateo, V. Calvo-Río, E. Beltrán, Juan Sánchez‐Bursón, Alfredo Adán, Marisa Hernández‐Garfella, Elia Valls Pascual, A. Sellas, N. Ortego, O. Maíz, I. Torre, Cruz Fernández-Espartero, Vega Jovaní, Diana Peiteado, David Díaz‐Valle, Elena Aurrecoechea, Miguel A. Caracuel, Alfredo J. García-González, Enrique Raya Álvarez, N. Vegas-Revenga, Rosalía Demetrio‐Pablo, Santos Castañeda, Miguel Á. González‐Gay, José L. Hernández, Ricardo Blanco, Ricardo Blanco on behalf of the Spanish Collaborative Group of Refractory Behçet’s Disease
Abstract
OBJECTIVE: In a large series of White patients with refractory uveitis due to Behçet disease (BD) being treated with infliximab (IFX), we assessed (1) long-term efficacy and safety of IFX, and (2) IFX optimization when ocular remission was achieved. METHODS: Our multicenter study of IFX-treated patients with BD uveitis refractory to conventional immunosuppressant agents treated 103 patients/185 affected eyes with IFX as first biologic therapy in the following intervals: 3-5 mg/kg intravenous at 0, 2, 6, and then every 4-8 weeks. The main outcome variables were analyzed at baseline, first week, first month, sixth month, first year, and second year of IFX therapy. After remission, based on a shared decision between patient and clinician, IFX optimization was performed. Efficacy, safety, and cost of IFX therapy were evaluated. RESULTS: pneumonia (n = 1), severe oral ulcers (n = 1), palmoplantar psoriasis (n = 1), and colon carcinoma (n = 1). In the optimization subanalysis, the comparative study between optimized and nonoptimized groups showed (1) no differences in clinical characteristics at baseline, (2) similar maintained improvement in most ocular outcomes, (3) lower severe adverse events, and (4) lower mean IFX costs in the optimized group (€4826.52 vs €9854.13 per patient/yr). CONCLUSION: IFX seems to be effective and relatively safe in White patients with refractory BD uveitis. IFX optimization is effective, safe, and cost-effective.