Efficacy and Tolerance of Interferon Alpha in the Treatment of Refractory and Sight–Threatening Uveitis: A Retrospective Monocentric Study of 45 Patients

Abstract

Abstract: : Purpose: To evaluate the efficacy and safety of interferon alpha–2a (IFN–α2a) in severe uveitis, refractory to steroids and conventional immunosuppressive agents. Methods: Patients were included after a major relapse of their uveitis, occurring under immunosupressive therapy. IFN–α2a (3 millions units three times a week) was administered subcutaneously. Ophthalmological and general examinations, including slit–lamp biomicroscopy, fundus examination and fluorescein angiography were performed at regular intervals. Evolution of visual acuity and steroid requirement were retrospectively analyzed. Results: Forty–five patients were included. Mean age was 30.6 years (range 8–58 years) and sex ratio (F/M) was 0.66. Uveitis was associated with Behçet’s disease in 23 patients (51.1%) and with other entities in 22 patients (48.9%). Mean duration of uveitis before interferon therapy was 50.5 months (range 3.4–168.7 months) and an average of 3 relapses under corticosteroids and immunosupressive therapy has been noted. Ocular inflammation was controlled in 82.6% of patients with BD and 59% of the patients with other types of uveitis (p=0.07). During a mean follow–up of 23.5 months (range 8–50 months), mean oral prednisone threshold decreased significantly from 21.5 mg/d (range 16–45 mg/d) to 10.9 mg/d (range 4–14 mg/d) (p<0.001). Interferon has been discontinued in 10 patients (22.2%) with BD and 4 patients without BD. Relapses occurred in 4 and 1 cases, respectively. Conclusions: Interferon therapy is an efficient and safe strategy in severe and relapsing forms of BD but also in other uveitic entities. However, it seems more suspensive than curative. IFN–α2a may be proposed as a second line strategy after the failure of conventional immunosuppressants.

Keywords: immunomodulation/immunoregulation • uveitis-clinical/animal model • inflammation