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C. M. Deuter, I. Koetter, A. Moehle, R. Vonthein, N. Stuebiger, M. Zierhut; Long-Term Observations of Vision and Relapse-Free Intervals in Patients With Severe Uveitis Due to Behçet's Disease Treated With Interferon Alfa. Invest. Ophthalmol. Vis. Sci. 2009;50(13):2694.
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Retrospective study to assess the development of visual acuity (VA) and the frequency and duration of relapse-free periods in patients who were treated with interferon (IFN) alfa for severe uveitis due to Behçet's disease (BD) and who completed a follow-up period of at least 2 years.
IFN alfa-2a was administered at an initial dose of 6 mio IU per day for at least 2 weeks, then tapered to a maintenance dose of 3 mio IU 2x/week and finally discontinued if possible. Previous immunosuppressives were stopped one day before start of IFN, steroids reduced to 10 mg prednisolone per day gradually. In case of a relapse IFN was reinstituted in the same way. To evaluate the long-term visual development, VA at the end of follow-up (assessed by the mean of VA during the last 3 visits) was compared to the VA in remission of ocular disease (baseline) calculated as the mean of VA at the visits during the time period from 0.25 to 0.75 years after initiation of IFN treatment. To assess the frequency and duration of remissions after IFN therapy, the time from discontinuation of IFN alfa until occurrence of an uveitis relapse (defined as necessity to re-institute treatment) has been measured. These times were summarized by the Kaplan-Meier method.
A total of 53 consecutive patients (96 affected eyes) have been analyzed. Fiftytwo patients (98.1 %) responded to IFN alfa therapy. In 46 patients (86.8 %) IFN alfa could be discontinued in remission of ocular disease (median duration of first IFN course 22.4 months). Out of these, 20 patients needed a second treatment course (median duration 17.0 months) afterwards. Only 4 patients received a third treatment course. Median follow-up was 6.0 years (2.0 to 12.6 years). During follow-up VA improved or remained unchanged in 88 eyes (91.7 %). As shown by the Kaplan-Meier method, 18.7 months after cessation of the first IFN alfa course 75 % of patients were in remission, after 52.9 months 50% of patients and after 107.2 months still 25 % of patients were free of relapses. Moreover, 8.4 months after cessation of a second IFN alfa course 75 % of patients, after 27.7 months still 50 % were free of relapses.
Our data show that IFN alfa is able to induce long-lasting relapse-free periods in patients with severe ocular BD resulting in a remarkable improvement of long-term visual prognosis.
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