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Longterm Visual Prognosis of Patients with Ocular Adamantiades-Behçet's Disease Treated with Interferon-α-2a

LOTHAR KRAUSE, ANDREAS ALTENBURG, UWE PLEYER, ANNE-KATRIN KÖHLER, CHRISTOS C. ZOUBOULIS, and MICHAEL H. FOERSTER

ABSTRACT.

Objective. Relapsing ocular involvement is one of the major manifestations in Adamantiades-Behçet's disease (ABD). Combining systemic corticosteroids with cyclosporin A is currently the treatment of choice. Interferon-a (IFN-a) has proven to be effective in mucocutaneous ABD and has been reported to improve ocular lesions. We examined the longterm effects of IFN-a-2a in a case series of 45 patients with ocular involvement.

Methods. Since 1988, 45 patients (79 eyes of 90 eyes) with ocular involvement in ABD have been treated with IFN-a (3 ´ 6–9 Mio IU per wk). In the initial acute phase of the disease, patients additionally received short-term corticosteroids (oral prednisolone 100 mg/day), tapered to a maintenance dose of 10 mg/day within 2 weeks. IFN-a-2a was administered as longterm therapy with a mean duration of 30 months (range 1.1–101 mo).

Results. IFN-a-2a/prednisolone treatment was effective against vasculitis, optic nerve neuropathy, and iritis. Sixty-four eyes had no recurrence under therapy. To date, recurrences have been seen in 26 eyes under IFN-a treatment. Flu-like symptoms were recorded in nearly all patients (n = 43). Further side effects were dose-dependent reversible thrombocytopenia (n = 1), psychosis (n = 3), depression (n = 13), thyroiditis (n = 1), and reversible diffuse alopecia (n = 7). In our series, 92% of all eyes showed stable or improved visual acuity in longterm followup.

Conclusion. Longterm remission of ocular inflammation can be achieved with the combination of IFN-a and low-dose corticosteroids. (First Release April 15 2008; J Rheumatol 2008;35:896-903)

Key Indexing Terms:

ADAMATIADES-BEHÇET'S DISEASE
INTERFERON-a
UVEITIS

From the Department of Ophthalmology, Campus Benjamin Franklin, and Department of Ophthalmology, Campus Virchow-Klinikum, Charité Universitaetsmedizin Berlin, Berlin; and Department of Dermatology and Department of Immunology, Dessau Medical Center, Dessau, Germany.

L. Krause, MD, Senior Registrar, Department of Ophthalmology, Charité–Campus Benjamin Franklin; A. Altenburg, MD, Registrar, Departments of Dermatology and Immunology, Dessau Medical Center; A-K. Köhler, MD, Registrar, Department of Ophthalmology, Charité–Campus Benjamin Franklin; U. Pleyer, MD, Consultant, Department of Ophthalmology, Charité–Campus Virchow-Klinikum; C.C. Zouboulis, MD, Head of Department, Departments of Dermatology and Immunology, Dessau Medical Center; M.H. Foerster, MD, Head of Department, Department of Ophthalmology, Charité–Campus Benjamin Franklin.

Address reprint requests to Dr. L. Krause, Department of Ophthalmology, Charité–Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, Germany. E-mail: lothar.krause@charite.de

Accepted for publication December 6, 2007.