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Infliximab Might Help Children With Chronic Inflammatory Uveitis: Presented at ACR
By Jerry Ingram
ORLANDO, FL -- October 28, 2003 -- Preliminary research suggests that infliximab at higher than standard doses may be an effective treatment for children with chronic inflammatory uveitis, researchers from Duke University Medical Center reported here on October 26th at the American College of Rheumatology 67th Annual Scientific Meeting.
"Though some [physicians] may have given up on infliximab at standard doses, we found that it has been effective at higher doses and more frequent dosing intervals," said Stacy Ardoin, principal researcher, Duke University Medical Center, Durham, North Carolina. However, she pointed out that no data have been published previously concerning the safety or efficacy of infliximab therapy in children with uveitis.
For this investigation, the Duke team conducted a retrospective analysis of five boys and one girl, 7 to 11 years old, with chronic, inflammatory uveitis refractory to oral, periocular, and/or topical corticosteroids and methotrexate who were treated with infliximab.
One patient had juvenile idiopathic arthritis of oligoarticluar onset, while the remaining patients were diagnosed with idiopathic inflammatory uveitis, researchers stated.
At the time of infliximab initiation, all patients were on methotrexate at an average dose of 17.5 mg per week (range 0.3 to 0.7 mg/kg; four subcutaneous and two oral administration), and all were treated with oral, periocular and/or topical steroids. In addition, investigators pointed out that none of the patients were treated with etanercept, cyclosporin or other disease modifying anti-rheumatic drugs.
Patients were given three to 19 doses of infliximab with maximum doses ranging from 5.4 to 10 mg/kg (average dose 7.6 mg/kg). All participants were treated with monthly doses at initiation of therapy; thereafter, the interval between doses ranged from 4 to 8 weeks.
Acetaminophen 10 to 15 mg/kg and diphenhydramine 0.5 mg/kg were administered prior to infliximab treatment.
Researchers found that all of the patients had decreased anterior chamber inflammatory cells and two had complete resolution of active uveitis after treatment with infliximab. None of the patients experienced recurrence of uveitis attributable to infliximab, although one patient flared after cataract surgery. Another patient worsened after the dosing interval was increased to once very 8 weeks, but improved after the dosing was decreased to every 5 weeks.
Researchers concluded that infliximab might be an effective treatment for this condition in children. They suggest that higher than standard doses and more frequent dosing intervals may be necessary to control uveitis but caution that these results need to be confirmed in a prospective, controlled trial.
[Study title: Infliximab to Treat Pediatric Chronic Inflammatory Uveitis. Abstract P127]
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