Infliximab for the Treatment of Active Scleritis
Year of Publication
Sen, HN; Sangave, A; Hammel, K; Levy-Clarke, G; Nussenblatt, RB
Can J Ophthalmol
Adult; Anti-Inflammatory Agents; Antibodies-Monoclonal; Dose-Response Relationship-Drug; Drug Administration Schedule; Female; Follow-Up Studies; Infliximab; Injections; Male; Middle Aged; Prospective Studies; Scleritis; Tumor Necrosis Factor-alpha
OBJECTIVE: This study aimed to evaluate the possible safety and effectiveness of infliximab in patients with active scleritis. STUDY DESIGN: Prospective, nonrandomized, open-label pilot study (Protocol No. 04-EI-0065). PARTICIPANTS: Five patients with active anterior scleritis. METHODS: This single-centre, pilot study of infliximab for the treatment of active anterior scleritis was conducted at the National Eye Institute, National Institutes of Health, between 2003 and 2007. Scleritis patients with active disease who had used at least 1 conventional immunosuppressive agent in the past were included. Primary outcome was a 2-step decrease in scleral inflammation within 14 weeks. Patients received infliximab (5 mg/kg) at baseline, at weeks 2 and 6, and every 4 weeks through week 30, after which the infusion interval was increased (week 36, 48). RESULTS: All patients met the primary outcome by achieving quiescence of their active scleritis by week 14 with no additional immunosuppressives. However, after 14 weeks 1 patient developed new-onset intraocular inflammation that did not respond to reinduction and was terminated from the study. Side effects attributable to infliximab included ear infection with transient decreased hearing, urinary tract infection, lower respiratory tract infection, and facial rash in 1 patient and urinary tract infection, diarrhea, upper respiratory tract infection, nasal congestion and headache, mouth sores, head tremor, and occasional numbness and tingling in extremities in another patient, all of which resolved spontaneously or with appropriate treatment. CONCLUSIONS: Infliximab may be considered as a viable option in treating patients with active scleritis; however, patients should be monitored closely for potentially serious side effects.