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.