الفهرس 
Chapter (1)Only 14 pages are availabe for public view
 |  | from | 148 |  |  |
| | | from | 148 | | |
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.