Comparative Study of Infliximab Versus Adalimumab in Refractory Uveitis due to Behçet's Disease: National Multicenter Study of 177 Cases.

OBJECTIVE: To compare the efficacy of infliximab (IFX) versus adalimumab (ADA) as a first-line biologic drug over 1 year of treatment in a large series of patients with refractory uveitis due to Behçet's disease (BD). METHODS: We conducted an open-label multicenter study of IFX versus ADA for BD-related uveitis refractory to conventional nonbiologic treatment. IFX or ADA was chosen as the first-line biologic agent based on physician and patient agreement. Patients received 3-5 mg/kg intravenous IFX at 0, 2, and 6 weeks and every 4-8 weeks thereafter, or 40 mg subcutaneous ADA every other week without a loading dose. Ocular parameters were compared between the 2 groups. RESULTS: The study included 177 patients (316 affected eyes), of whom 103 received IFX and 74 received ADA. There were no significant baseline differences between treatment groups in main demographic features, previous therapy, or ocular sign severity. After 1 year of therapy, we observed an improvement in all ocular parameters in both groups. However, patients receiving ADA had significantly better outcomes in some parameters, including improvement in anterior chamber inflammation (92.31% versus 78.18% for IFX; P = 0.06), improvement in vitritis (93.33% versus 78.95% for IFX; P = 0.04), and best-corrected visual acuity (mean ± SD 0.81 ± 0.26 versus 0.67 ± 0.34 for IFX; P = 0.001). A nonsignificant difference was seen for macular thickness (mean ± SD 250.62 ± 36.85 for ADA versus 264.89 ± 59.74 for IFX; P = 0.15), and improvement in retinal vasculitis was similar between the 2 groups (95% for ADA versus 97% for IFX; P = 0.28). The drug retention rate was higher in the ADA group (95.24% versus 84.95% for IFX; P = 0.042). CONCLUSION: Although both IFX and ADA are efficacious in refractory BD-related uveitis, ADA appears to be associated with better outcomes than IFX after 1 year of follow-up.

Topical tacrolimus ointment for treatment of intractable atopic keratoconjunctivitis: a case report and review of the literature.

PURPOSE: To report the utility of tacrolimus 0.03% dermatologic ointment (Protopic) in a case of refractory atopic keratoconjunctivitis with giant papillae. A review of the medical literature is presented. METHODS: A 32-year-old man with a long-standing history of severe atopic disease was referred to our department because of bilateral intense eye pain, itching, photophobia, and epiphora. Biomicroscopy examination showed conjunctival hyperemia, superficial punctata keratitis, and tarsal giant papillae. This patient had undergone previous treatment with systemic and topical steroids, antihistamines, topical antihistamine/mast cell stabilizer drops, cyclosporine A, and even surgical resection-cryopexy of giant papillae-without success. RESULTS: The patient was started on tacrolimus 0.03% ointment treatment of the conjunctival fornix twice daily. After 2 months, the patient experienced resolution of his clinical symptoms with a significant decrease in papillae size. No side effects were reported. Treatment was continued for 1 month and gradually reduced with increasingly wide intervals between applications. Eight months after treatment, there were no signs of reactivation, and the patient remains asymptomatic. CONCLUSIONS: Application of tacrolimus 0.03% dermatologic ointment into the lower fornix seems to constitute an interesting alternative treatment for atopic keratoconjunctivitis that is refractory to traditional treatment.