Systemic monoclonal antibody therapy (daclizumab) in the treatment of cicatrizing conjunctivitis in stevens-johnson syndrome, refractory to conventional therapy.

ABSTRACT

PURPOSE: At least one-year follow-up of a case series of young Stevens-Johnson syndrome (SJS) patients with cicatrizing ocular surface disease and recurrent inflammation (SJS-RI) treated with systemic humanized monoclonal antibody (daclizumab). METHODS: Five patients (median age 16 yr; range 8-34 yr) with SJS, with recurrent inflammation refractory to conventional immunotherapy, were enrolled in a prospective non-randomized case series study. Inclusion criteria were patients with SJS and ocular cicatrizing inflammatory disease with severe visual impairment, using topical or systemic anti-inflammatory and/or immunomodulatory drugs without clinical improvement resulting in persistent inflammation (SJS-RI). Treatment with Daclizumab 1 mg/Kg (intravenous) was scheduled in three cycles. First cycle with concomitant immunotherapy a total of 5 doses, with 14 days interval between them (total of this cycle 10 weeks). Second cycle interval was increased to 3 weeks; the patients received 2 doses (the second cycle had a total of 6 weeks). Third cycle maintenance phase with 4 weeks interval between each application, until at least 12 months of the total follow up. After the first cycle (5th dose), the patients were kept with preservative-free lubricants and systemic doxycycline. RESULTS: Control of ocular inflammation was observed at a median of 8 weeks (range 6-10 weeks) in all patients, with relapses in two patients at 20-36 weeks. Relapses were controlled with topical steroids at a median of 10 days, and within 2 weeks the steroids were tapered for both patients. CONCLUSION: In this small case series, daclizumab demonstrated to play a beneficial role in the control of the inflammatory process of the recurrent inflammation in SJS, refractory to conventional immunomodulatory therapy.