Long-term Efficacy and Safety of Low-dose Interferon Alpha2a Therapy in Severe Uveitis Associated With Behçet Disease - 21/08/11

Doi : 10.1016/j.ajo.2008.08.038

Julie Gueudry ^a, Bertrand Wechsler ^b, Céline Terrada ^a, Gaël Gendron ^a, Nathalie Cassoux ^a, Christine Fardeau ^a, Phuc Lehoang ^a, Jean-Charles Piette ^b, Bahram Bodaghi ^a,^⁎
^a Department of Ophthalmology, University of Paris VI, Pitié-Salpêtrière Hospital, Paris, France
^b Department of Internal Medicine, University of Paris VI, Pitié-Salpêtrière Hospital, Paris, France

Inquiries to Bahram Bodaghi, Department of Ophthalmology, University of Paris VI, Pitié-Salpêtrière Hospital, 47 bd de l'Hôpital, 75013 Paris, France

Résumé

Purpose

To investigate long-term responsiveness of patients with severe uveitis associated with Behçet disease to interferon alpha2a (IFN-⍺2a).

Design

Retrospective study.

Methods

Thirty-two patients with sight-threatening uveitis associated with Behçet disease who relapsed despite corticosteroids and immunosuppressive agents were included. IFN-⍺2a was administered subcutaneously (three million units thrice a week). Ophthalmologic examination and fluorescein angiography associated with laboratory tests were performed at regular intervals. Main outcome measures were visual acuity and recurrence of uveitis attacks before, during, and after initiation of IFN-⍺2a therapy.

Results

Control of inflammation was achieved in 28 of 32 patients (88%). Mean observation period of the 28 responder patients was 70.6 months (range, 30.3 to 129.2 months). Median visual acuity improved from 0.52 to 0.33 (logarithm of the minimum angle of resolution units; P = .005) two years after initiation of IFN-⍺2a therapy. The relapse rate decreased significantly during IFN-⍺2a treatment from 1.68 ± 1.22 relapses/patient/year to 0.11 ± 0.20 relapses/patient/year (P < .0001). IFN-⍺2a was discontinued in 19 of 28 patients (68%) after 32 months of treatment (range, 16 to 50 months). Mean follow-up after IFN-⍺2a discontinuation was 43 months (range, 11 to 84 months). After IFN-⍺2a discontinuation, the relapse rate increased from 0.08 ± 0.21 relapse/person/year to 0.74 ± 1.40 relapse/person/year (P = 0.04).

Conclusions

IFN-⍺2a is efficient and safe for the long-term management of severe uveitis associated with Behçet disease. Meanwhile it seems to be a suspensive therapeutic strategy, even though long-term remission is possible in some patients.

Le texte complet de cet article est disponible en PDF.