A SINGLE, SUCCESSFUL INFLIXIMAB INFUSION FOR BEHCET’S DISEASE ASSOCIATED SIGHT-THREATENING UVEITIS ATTACK, FOLLOWED BY 2 ADDITIONAL INFUSIONS, PRODUCE LONG TERM OCULAR REMISSION

Background: Recommendations on the use of anti-TNF agents in Behcet’s disease BD include the administration of a single infusion of infliximab, 5 mg/kg for bilateral posterior eye segment inflammation as a first-line agent to achieve a fast-onset response (Sfikakis PP et al, Rheumatology 2007). On the other hand, long-term remission is feasible after discontinuation of successful anti-TNF treatment given for severe BD, including posterior ocular inflammation (Sfikakis PP et al. Arthritis Rheumatol 2017). Objectives: To report the long-term outcome of successful short-term infliximab treatment for sight-threatening uveitis in Behcet’s disease. Methods: In this retrospective single-center analysis, we identified all patients with BD followed up in our center at least once yearly since 2001, who received one successful IV infusion of infliximab (5mg/kg) for bilateral sight threatening posterior uveitis attack, followed by 2 additional infusions 2 months apart. Other severe BD manifestations at the time of attack included severe mucocutaneous disease (n=3), arthritis (n=2), vascular (n=1), and gastrointestinal involvement (n=1).The first infliximab infusion was considered successful if complete suppression of acute ocular inflammation was achieved. Study’s endpoint was the proportion of patients remaining in complete ocular remission for at least 5 years after cessation of infliximab. Results: We identified 10 patients (aged 52±14.3 years, 60% men, disease duration 12±5.2 years) who received 3 IV infliximab infusions (5 mg/kg each) for sight-threatening posterior ocular inflammation (20 eyes), either at the first attack (n=5) or for relapsing attacks (n=5). Infliximab was given as add-on to azathioprine (n=7) or to azathioprine in combination with cyclosporine (n=2). Nine of ten patients (90%) achieved the study’s endpoint, i.e. After cessation of short-term infliximab treatment remain in complete ocular remission for a mean of 9.5±4.2 years (range 5-15.3 years). The last patient relapsed 6 months after infliximab discontinuation, but subsequently responded to antiTNF re-treatment, which is continued to date. Notably, four of the nine patients who achieved the study’s endpoint were also able to discontinue azathioprine and are currently any drug free. Conclusion: The majority of patients with sight-threatening uveitis who responded completely to a first infliximab infusion and received 2 additional infusions, remain in remission for many years thereafter. Additional studies to confirm that short term infliximab treatment with observation for objective improvement should be promptly administered in every BD patient with sight-threatening uveitis attack are warranted. REFERENCES: [1] Sfikakis PP, Markomichelakis N, alpsoy E, assaad-Khalil S, Bodaghi B, Gul a, Ohno S, Pipitone N, Schirmer M, Stanford M, Wechsler B, Zouboulis C, Kaklamanis P, Yazici H. Anti-TNF therapy in the management of Behcet’s disease-review and basis for recommendations. Rheumatology (Oxford). 2007May;46(5):736-41. [2] Sfikakis PP, arida a, Panopoulos S, Fragiadaki K, Pentazos G, Laskari K, Tektonidou M, Markomichelakis N. Brief Report: Drug-Free Long-Term Remission in Severe Behçet’s Disease Following withdrawal of Successful anti-Tumor Necrosis Factor Treatment. Arthritis Rheumatol.2017Dec;69(12):2380-2385. Disclosure of interests: None declared DOI: 10.1136/annrheumdis-2019-eular.5494Citation: Ann Rheum Dis, volume 78, supplement 2, year 2019, page A1768Session: Vasculitis (Scientific Abstracts)