Long term loss of efficacy of Remicade in JIA uveitis

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Mike Bartolatz
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Long term loss of efficacy of Remicade in JIA uveitis

Post by Mike Bartolatz » Thu Dec 06, 2007 10:58 am

Presentation Number:226
Poster Board Number:226
Presentation Time:11/8/2007 8:00:00 AM

Title:Loss of Efficacy During Long-Term Infliximab Therapy for
Sight-Threatening Childhood Uveitis

Category:11. Pediatric rheumatology clinical and therapeutic disease
Author(s):Gabriele Simonini1, Fernanda Falcini1, Roberto Caputo2, Cinzia De
Libero2, Teresa Giani1, Maurizio de Martino1, Rolando Cimaz1. 1Rheumatology
Unit-Department of Pediatrics, Firenze, Italy; 2Ophtalmologic
Unit-Department of Pediatrics, Firenze, Italy

Purpose. To describe the efficacy and safety of Infliximab in the treatment
of childhood chronic uveitis during a long term follow-up.

Methods. Eight patients (median age at uveitis diagnosis: 48 months, range
24-150) with inflammatory chronic U, long-lasting and refractory to previous
treatments, were enrolled: 4 JIA, 1 early-onset sarcoidosis, 1 Behçet
disease, and 2 idiopathic uveitis.

Before Infliximab treatment, all children presented active uveitis: 10/16
involved eyes, despite treatment with methotrexate (5/8) and cyclosporine A
(1). All were receiving oral and/or topical steroids. All patients initially
received Infliximab (5 mg/kg) at t 0, 2, 6 and then every 6-8 weeks for at
least 1 year (range 12-16 months). Later on, the administration rate was
progressively increased up to 10 weeks if uveitis did not flare.

Absence or recurrence rate of uveitis throughout the study period was
recorded. Spearman's correlation test was used, and Cox regression model and
Kaplan Meyer curves were constructed, in order to identify predictors of
outcome.

Results. Median follow-up time of treatment was 29 months (range, 12-40),
median n° of infusions 18 (range, 10-23). During the first year of
treatment, 7/8 children achieved a complete remission, but all relapsed
thereafter.

At the first relapse of uveitis, median follow-up on treatment was 12 months
(range 9-18), median n° of infusions 11 (range 8-19). The figure shows
survival curve of our patients up to the first uveitis flare.

The number of flares showed a statistically significant association with the
length of follow-up (rs=0.84; p<0.03) and with the total number of infusions
(rs= 0.81; p<0.04). Cox regression analysis showed that the probability of a
first episode of flare was correlated to the number of infusions and to a
length of treatment > 1 year.

No patient developed any serious complications attributable to Infliximab,
and none had to discontinue treatment due to adverse events.

Conclusions. Even if limited to a small group, Infliximab appears to be an
effective treatment for uveitis on the short-term, but its efficacy seems to
wane over time.

Disclosures: G. Simonini, None; F. Falcini, None; R. Caputo, None; C. De
Libero, None; T. Giani, None; M. de Martino, None; R. Cimaz, None.
Mike Bartolatz
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