Interferon alfa for Behçet’s disease?

Currently interferon alfa therapy in ophthalmology is receiving bad press. A recent editorial in Archives of Ophthalmology (1997;115:915–6) reviewed the evidence for the lack of effectivity of interferon alfa in the treatment of subretinal neovascular membranes which occur in some forms of macular degeneration. The authors went further and suggested that previous uncontrolled pilot studies of interferon alfa in age related macular degeneration were ill advised in view of the side effects of the drug which in the USA at least had some serious undesirable consequences. In the current climate in which evidence based medicine is setting the standard, strong views such as these on the place of pilot studies have some justification. However, does this approach mean that only the large multicentre study can be allowed? Is there not a risk that valuable uses of some drugs may be unintentionally sidelined?

Interferon alfa is a case in point. In 1994, Feron et al (Lancet 1994;344:333) reported that interferon alfa was effective in controlling the sight threatening uveoretinal inflammation that occurs as a complication of Behçet’s disease. At the Fourth International Symposium on Uveitis (Yokohama 10–14 October 1997) further support for the use …