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We appreciate Dr Suhler et al¹ for studying infliximab prospectively for the treatment of refractory uveitis and for the scientific manner in which they evaluated the treatment. We did want to make several points regarding their treatment protocol that may have influenced their associated adverse events. These events are unexpected given that multiple large randomized studies of the anti–tumor necrosis factor (anti-TNF) agents have been conducted with excellent safety profiles and given the successful and extensive use in systemic inflammatory diseases.

In the study by Suhler and colleagues, it appeared that 3 of 23 patients were receiving monotherapy including only infliximab and that the remainder (20) of the 23 patients were receiving some form of concurrent immunosuppression. There is evidence to suggest that concurrent treatment with antimetabolites (ie, methotrexate or azothioprine) may decrease autoantibody levels and suppresses systemic symptoms from the autoantibodies in those with systemic inflammatory diseases.^2-4 The use . . . [Full Text of this Article]

AUTHOR INFORMATION
Nathan Rudometkin, MD; Naresh Mandava, MD; Kevin Deane, MD; Jeffrey L. Olson, MD

RELATED ARTICLE

A Prospective Trial of Infliximab Therapy for Refractory Uveitis: Preliminary Safety and Efficacy Outcomes
Eric B. Suhler, Justine R. Smith, Michael S. Wertheim, Andreas K. Lauer, Daryl E. Kurz, Terri D. Pickard, and James T. Rosenbaum
Arch Ophthalmol. 2005;123(7):903-912.
ABSTRACT | FULL TEXT