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J. Gueudry, G. Gendron, B. Wechsler, C. Terrada, N. Cassoux, C. Fardeau, P. Le Hoang, J. C. Piette, B. Bodaghi; Longterm Efficacy and Safety of Low-Dose Interferon-Alpha Therapy in Severe Uveitis Associated With Behcet's Disease. Invest. Ophthalmol. Vis. Sci. 2007;48(13):3908.
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To investigate longterm responsiveness of patients with severe uveitis associated with Behcet's disease to interferon-alpha (IFN).
Patients with panuveitis and/or retinal vasculitis, who relapsed despite steroids and immunosuppressive agents, were included in this retrospective study. IFN-alpha2 (3 million units three times a week) was administered subcutaneously. Ophthalmological examination and fluorescein angiography associated with laboratory tests were performed at regular intervals. Main outcome measures were recurrence of posterior or panuveitis attacks and decrease of oral prednisone threshold.
Thirty-five patients were included. Median age was 30.6 years (range 11-58 years). Control of inflammation was achieved in 86% of cases (three non-responders, two incomplete responses). One patient developed major depression leading to permanent interferon discontinuation. Mean follow-up was 68 months (29-130). The relapse rate decreased significantly during IFN treatment: 1.6 +/-1 relapses/patient/year before IFN therapy and 0.03 +/- 0.02 relapses/patient/year during IFN therapy (p<0.0001). Median oral prednisone threshold decreased significantly from 19.7 mg/d (range 7-40) to 6.8 mg/d (range 2-10) (p<0.0001). Interferon was discontinued in 18 patients (67%) after 31 months of treatment (range 16-50). Mean follow up after IFN discontinuation was 41 months (range 4-84). Ocular inflammation relapses occurred in 6 cases (33%) 8 months after interferon discontinuation (range 2 -20) and 3 relapses occurred during interferon tapering. The relapse rate after IFN therapy discontinuation or tapering was 0.22 +/-0.08 relapses/patient/year.
IFN is efficient and safe for the therapeutic management of refractory posterior uveitis associated with Behçet's disease. However, it seems to be a suspensive strategy. Further controlled trials are mandatory in order to define the optimal dosage and duration of the drug.
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