Behcet's disease (BD) is a chronic, relapsing, multisystem disease. In some patients, ocular involvement can lead to severe vision impairment despite immunosuppressive therapy. Since high levels of circulating
TNF-alpha have been found both in peripheral blood and aqueous humor of patients with active BD, we evaluated the efficacy of anti-
TNF-alpha therapy in seven patients with severe ocular involvement resistant to previous treatment. Seven patients with sight-threatening relapsing
uveitis refractory to immunosuppressive regimens received intravenously
infliximab, at a dose of 3-5 mg/kg, on week 0-2-4 and then every 6-8 weeks, in combination with low-dose
prednisone and
methotrexate or
azathioprine. Efficacy was assessed in terms of number and severity of relapses of
posterior uveitis, visual acuity, and reduction of
corticosteroids and immunosuppressive drugs. After a mean follow-up period of 23 months, the total number of relapses dropped to 6, compared to the 21 observed in an equivalent period of time before treatment. The visual acuity improved in 4 eyes, while it remained stable in 9.
Therapy with
infliximab considerably reduced the required daily dose of both
corticosteroids and immunosuppressive drugs. In our experience
infliximab proved to be safe and effective in controlling both the number and intensity of cases of
posterior uveitis and the extraocular manifestations of BD. It also allowed a reduction of
corticosteroids and immunosuppressive drugs required to control the disease. However, ocular and systemic manifestations tended to recur after
drug withdrawal or when the interval between
infliximab courses was longer than 8 weeks. Moreover,
infliximab administration is costly and requires hospital admission.