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Infliximab for the treatment of refractory scleritis
  1. Priyanka Doctor1,
  2. Amyna Sultan2,
  3. Sana Syed2,
  4. William Christen3,
  5. Pooja Bhat2,
  6. Karina Quinones2,
  7. Stephen Foster2,*
  1. 1 Massachusetts Eye Research and Surgery Institution, Cambridge, MA; Bay View Clinic, Mumbai, United States;
  2. 2 Massachusetts Eye Research and Surgery Institution, United States;
  3. 3 Department of Medicine, Division of Preventive Medicine, Brigham & Women's Hospital,Harvard Medical, United States
  1. Correspondence to: Stephen Foster, Massachusetts Eye Research and Surgery Institution, 5, Cambridge Center,, 8th Floor, Cambridge, 02142, United States; fosters{at}uveitis.org

Abstract

Background: Scleritis is a potentially blinding inflammatory disorder. Standard care consists of systemic corticosteroids and immunosuppresants. We describe a series of ten patients suffering from refractory scleritis treated with the TNF inhibitor infliximab because this scleritis was refractory to standard therapy.

Methods: We reviewed the medical records of patients with scleritis at the Massachusetts Eye Research and Surgery Institution, treated with infliximab. All cases had non-infectious scleritis refractory to traditional immunomodulatory therapy and received 5mg/kg of infliximab at 4 or 8 weekly intervals. The main outcome measures evaluated were clinical response, reduction in concomitant immunomodulatory therapy and adverse effects. Inflammation control and visual acuity were assessed using life-table methods.

Results: A favorable clinical response to infliximab was seen in 100% of the patients, with 6(60%) of them achieving remission and cessation of concomitant immunosuppression. A clinical response to infliximab therapy occurred within 13.24 weeks on average. Based on clinical response, we found that repeat monthly infusions were required to maintain remission. One (10%) patient developed a lupus-like reaction necessitating discontinuation of infliximab.

Conclusion: Infliximab may be considered in the treatment of non-infectious scleritis refractory to other treatment.

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