AMSTERDAM — Treatment with infliximab successfully controlled refractory ocular inflammation in two patients with sarcoidosis, Dr. Boris A. Cruz reported at the annual European Congress of Rheumatology.
Ocular involvement in this granulomatous multisystem disorder is a serious complication that is associated with significant visual loss. Tumor necrosis factor-α plays an important pathophysiologic role in granuloma formation; anti-TNF-α therapy is being considered in cases that are unresponsive to corticosteroids and immunosuppressants, Dr. Cruz said.
The first patient was an 18-year-old white male who had an 18-month history of pulmonary, cutaneous, and central nervous system necrotizing sarcoid granulomatosis, a variant form of sarcoidosis. He did not respond to first-line treatment with steroids, so methotrexate was added. This ameliorated the multiorgan involvement, but severe retinal vasculitis with typical candle-wax exudate developed in his right eye. Three 300-mg infusions of infliximab were given on days 0, 14, and 42, and the retinal lesions cleared. At 18 months, the patient remained in full remission and continued to get methotrexate plus quarterly infliximab infusions, Dr. Cruz wrote in a poster.
The second patient was a 64-year-old white woman with an 8-year history of pulmonary, cutaneous, and ocular sarcoidosis. Ophthalmologic evaluation confirmed the presence of bilateral retinal vasculitis with capillaritis, papillitis, peripheral multifocal choroiditis, and pathologic neovascularization. Her extraocular symptoms responded to steroids, but visual impairment progressed despite combined treatment with methotrexate plus intraocular steroid injections. She was given three 200-mg infusions of infliximab in the same schedule as the first patient, with clearance of all retinal inflammation and improvement of visual acuity. She too remains in clinical remission on a regimen of methotrexate and quarterly infusions of infliximab, according to Dr. Cruz of the department of rheumatology, Biocor Instituto, Nova Lima, Brazil.