Early use of infliximab improves outcomes In patients with Rheumatoid Arthritis associated sight threatening ocular surface inflammation

Hanifudin, Abdul, McAlister, James C, Konstantopoulos, Aristides, Ardjomand, Navid, Anderson, David F. and Hossain, Parwez (2011) Early use of infliximab improves outcomes In patients with Rheumatoid Arthritis associated sight threatening ocular surface inflammation. Investigative Ophthalmology & Visual Science, 52 (14).

Abstract

Purpose: : Monoclonal antibody therapy such as Infliximab is currently advocated as a second line therapy in treating rheumatoid arthritis (RA) when there is failure to control disease with more than one disease modifying anti-α rheumatic drug (DMARD). However, whether it has a similar role in rheumatoid arthritis associated non-infectious ocular surface inflammatory is unclear. Current data on the use of anti-TNF-α therapy in this group of patients is limited. The purpose of this study is to evaluate the efficacy and safety of standard DMARD alone or in combination with Infliximab at inducing and maintaining disease remission in patients with sight threatening ocular surface disease. Methods: : Retrospective case series of 16 patients with RA was undertaken at a single unit. Equal numbers had either a step up in standard DMARD therapy or the addition of Infliximab to induce remission. Stabilization of melt, perforation, surgical intervention, time to remission and treatment related morbidity were the measured outcomes. Results: : Infliximab induced faster remission, within 4 weeks (1-8 weeks) than with standard DMARD alone, 9 months (4-20 weeks) (t-test, p<0.002). Infliximab treated patients were more likely to be steroid independent. Two RA associated deaths occurred in standard DMARD therapy group. Conclusions: : The addition of Infliximab to standard DMARD therapy achieved rapid and full remission of inflammatory disease. Infliximab infusions were safe, well tolerated and maintained disease control in the longer term.This data supports the early and regular use of Infliximab in rheumatoid associated ocular inflammatory disease.

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Contributors

Author: Parwez Hossain

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