Human recombinant interferon alfa-2a for the treatment of Behçet's disease with sight threatening posterior or panuveitis
- I Kötter1,
- M Zierhut2,
- A K Eckstein3,
- R Vonthein4,
- T Ness5,
- I Günaydin1,
- B Grimbacher6,
- S Blaschke7,
- W Meyer-Riemann8,
- H H Peter9,
- N Stübiger2
- 1University Hospital, Departments of Internal Medicine II (Hematology, Oncology, Immunology and Rheumatology) and Ophthalmology, Tübingen, Germany
- 2University Hospital, Department of Ophthalmology I, Tübingen, Germany
- 3University Hospital, Department of Ophthalmology, Essen, Germany
- 4Department of Medical Biometry, University of Tübingen, Germany
- 5University Hospital, Department of Ophthalmology, Freiburg, Germany
- 6University Hospital, Division of Rheumatology and Clinical Immunology, Freiburg, Germany
- 7University Hospital, Department of Nephrology and Rheumatology, Göttingen, Germany
- 8University Hospital, Department of Ophthalmology, Göttingen, Germany
- 9University Hospital, Division of Rheumatology and Clinical Immunology, Freiburg, Germany
- Correspondence to: Ina Kötter, MD, Department of Internal Medicine II, (Hematology/Oncology/Immunology/Rheumatology) University Hospital, Otfried-Müller Strasse 10, D-72076 Tübingen, Germany;
- Accepted 14 October 2002
Background: Behçet's disease is a multisystem vasculitis of unknown origin. Standard treatment mainly comprises systemic immunosuppressive agents. Ocular involvement, mostly posterior uveitis with retinal vasculitis, leads to blindness in 20–50% of the involved eyes within 5 years. The efficacy of interferon alfa-2a was studied in patients with sight threatening posterior uveitis or retinal vasculitis.
Methods: 50 patients were included in this open, non-randomised, uncontrolled prospective study. Recombinant human interferon alfa-2a (rhIFNα-2a) was applied at a dose of 6 million units subcutaneously daily. Dose reduction was performed according to a decision tree until discontinuation. Disease activity was evaluated every 2 weeks by the Behçet's disease activity scoring system and the uveitis scoring system.
Results: Response rate of the ocular manifestations was 92% (three non-responder, one incomplete response). Mean visual acuity rose significantly from 0.56 to 0.84 at week 24 (p<0.0001). Posterior uveitis score of the affected eyes fell by 46% every week (p<0.001). Remission of retinal inflammation was achieved by week 24. Mean Behçet's disease activity score fell from 5.8 to 3.3 at week 24 and further to 2.8 at week 52. After a mean observation period of 36.4 months (range 12–72), 20 patients (40%) are off treatment and disease free for 7–58 months (mean 29.5). In the other patients maintenance IFN dosage is three million units three times weekly.
Conclusions: rhIFNα-2a is effective in ocular Behçet's disease, leading to significant improvement of vision and complete remission of ocular vasculitis in the majority of the patients.