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Lucia Kuffova, Kurt Spiteri Cornish, Seen Chia, John V Forrester; Efficacy and safety of treatment with Interferon-α for non-infectious sight-threatening intraocular inflammation.. Invest. Ophthalmol. Vis. Sci. 2014;55(13):100.
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Non-infectious sight threatening intraocular inflammation (STII) is one of the leading causes of visual loss in working population. In some patients a combination of systemic steroids and immunosuppression can be effective in preserving sight. However, other patients are intolerant to current immunosuppression or are non-responsive to treatment. Interferon-α therapy has become available for refractory cases of STII offering the possibility of reduction in side effects of systemic immunosuppression.
A retrospective study of patients with STII (data collected from 2003-13 including disease characteristics and level of activity recorded using SUN criteria) seen in a tertiary referral uveitis centre at Aberdeen Royal Infirmary. A total of 43 patients (39.5% male) with mean age 36.8years (range 12-68) were treated with Interferon-α-2a (Intron A). The side effects, efficacy and safety of the treatment together with success to reduce dose of systemic steroids were recorded.
Indications for Intron A therapy were (1) refractory STII (79.5%) or (2) very severe STII - retinal vasculitis or chronic uveitic CMO (21.5%). Retinal vasculitis was present in a majority of cases: 24% of patients had Behçet’s disease-related STII and 34% patients treated had idiopathic retinal vasculitis. The mean follow-up was 38.7 months (±27.4). Disease remission was achieved in 88.4% of patients while concomitant oral steroids were completely stopped in 67.4% of patients. In patients who required continued use of oral steroid while taking Intron A, the mean daily dose of was 5.8mg of Prednisolone. Efficacy of treatment was assessed by comparing pre- and on Intron A treatment for presence of activity in AC (cells) (p=0.0001), BIO score (p=0.0003), presence of CMO (46.5% pre- to 7% on the treatment). Intron A was eventually stopped in 21 patients (48.8%); 3 patients (6%) due to treatment failure, 5 patients (11%) for intolerance to side effects. However, 13 patients (30%) achieved complete remission as determined by treatment-free status and normal vision.
Interferon-α-2a is safe and very effective systemic treatment for refractory STII and is tolerated well by majority of the patients. In addition to its use in refractory cases, the possibility of its use as a first line treatment in cases of severe, acute STII should be considered.
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