Infliximab Effects Compared to Conventional Therapy in the Management of Retinal Vasculitis in Behcet Disease

PURPOSE: To assess the outcome of retinal vasculitis in patients with Behcet disease treated with infliximab compared to treatment with conventional therapy. DESIGN: Nonrandomized, retrospective comparative clinical study. METHODS: Patients with Behcet disease with all four major criteria were included in this study. Patients had recurrent episodes of uveitis and retinal vasculitis. Thirty-three patients (Group 1) were treated with oral prednisone, cyclosporine, and azathioprine or methotrexate for a minimum period of three months. Ten patients (Group 2) who failed to respond to conventional therapy were given infliximab at a dose of 5 mg/kg in a single intravenous infusion on day I and every two weeks for a total of six doses. Patients were given the same treatment during each subsequent relapse. The main outcome measures were the number of relapses, visual outcome, and ocular complications. RESULTS: The mean follow-up period was 36 months in Group 1 and 30 months in Group 2. The mean number of relapses was significantly reduced and the duration of remission was longer in the infliximab therapy group compared to conventional therapy group (P < .0001). The visual acuity at 24 months follow-up was significantly better in patients treated with infliximab (Group 2) when compared to conventional therapy (Group 1) (P = .0059). CONCLUSIONS: Patients with Behcet disease had significant decrease in inflammation, improvement of visual acuity, and reduced ocular complications following infliximab when compared to conventional therapy. The number of relapses was less in the infliximab treatment group than the conventional therapy group. (Am J Ophthalmol 2008;146:845-850. (C) 2008 by Elsevier Inc. All rights reserved.)