Comparison of infliximab versus cyclophosphamide on treatment of refractory uveitis of Behcets disease: pilot clinical study

BackgroundTo evaluate the effect of infliximab (IFX), in comparison with cyclophosphamide (CP) on refractory uveitis of BD. MethodsSubjects with uveitis and retinal vasculitis (RV) resistant to conventional treatment were included. Ten patients were divided in the IFX and CP groups. Patients in the IFX group received four courses of 3 mg/kg of IFX, intravenously. Patients in the CP group received four courses of pulse CP of 1000 mg, by the monthly interval. All patients received weekly 25 mg of methotrexate, (or 5 mg/kg of cyclosporine daily), and 3 mg/kg and 1 mg/kg of daily azathioprine and prednisolone, respectively. To evaluate the treatment effects, visual acuity (VA), anterior uveitis (AU), posterior uveitis (PU), and RV were assessed, at the baseline and four months after treatment. ResultsIn ten patients included in this study there were no significant differences in the treatment effects of IFX, compared to the CP regarding VA, PU, AU and RV. RV became inactive after four months of treatment in all five patients in the IFX group versus four patients in the CP group. ConclusionIFX and CP have the same efficacy in the short-term treatment of uveitis in BD. In future investigations, multi-center studies with larger sample sizes are required to investigate the cost-effectiveness of IFX in the treatment of uveitis of BD. HighlightsO_LIA new anti-TNF biologic agent, infliximab and cyclophosphamide have the same efficacy in the treatment of uveitis in BD, and since it has less toxicity, it is a superior treatment option. C_LIO_LIIn areas where access to the contemporary treatment is limited and expensive, the use of traditional medication results in an increased quality-adjusted life year (QALY). C_LIO_LIMulti-center studies with larger sample sizes are required to investigate the cost-effectiveness of infliximab in the treatment of uveitis of BD. C_LI