Long-term Efficacy and Safety of Low-Dose and Dose-Escalating Interferon Alfa-2a Therapy in Refractory Behçet Uveitis

Abstract

To investigate the long-term efficacy and safety of low-dose and dose-escalating therapy of interferon alfa-2a in the treatment of Behçet uveitis. Methods: This study included 37 patients with refractory Behçet panuveitis unresponsive to conventional immunosuppressive therapy. Induction interferon alfa-2a therapy was given as a daily dose of 3.0 million IU (MIU) subcutaneously for 14 days. Maintenance dose was achieved with 3.0 MIU 3 times per week given subcutaneously. The dosage was increased sequentially to 4.5, 6.0, and 9.0 MIU 3 times per week if uveitis relapses occurred. Total therapy duration was 24 months. Primary outcome measure was control of uveitis with quiescence during maintenance therapy. Ocular relapses per patient-year before and after initiation of interferon alfa-2a therapy and a corticosteroid-sparing effect were secondary outcomes. We also estimated the rate of remission after discontinuing interferon alfa-2a therapy. Results: During maintenance therapy, interferon alfa-2a controlled uveitis in 35 patients (95%). In 15 patients (41%), a maintenance dosage of 3.0 MIU 3 times per week controlled uveitis without any relapse. The rate of uveitis relapses decreased from 3.52 per patient-year before to 0.75 per patient-year after initiating interferon alfa-2a therapy. Seventeen patients were receiving systemic corticosteroids at the time of initiation of interferon therapy. During the maintenance stage, 9 patients were able to discontinue and 8 to taper systemic corticosteroid therapy. Survival analysis estimated that the rate of remission after discontinuation of interferon alfa-2a therapy was 76% by 3 months. The rate of remission remained stable thereafter. Conclusion: A treatment protocol using a low-dose and dose-escalating therapy with interferon alfa-2a was able to control and achieve remission of uveitis in most patients with refractory ocular Behçet disease.

Factors Affecting Relapse and Remission in Behçet's Uveitis Treated with Interferon Alpha2a

“…Several studies have reported the beneficial effect of interferon therapy in such cases. 5,16,[19][20][21][22][23][24][25][26] Our results were compatible with different studies about the effectiveness of IFNa2a therapy in patients with BU. In the present study, 32 patients with severe BU treated with IFNa2a were reviewed.…”

Factors Affecting Relapse and Remission in Behçet's Uveitis Treated with Interferon Alpha2a

“…Several studies have reported the beneficial effect of interferon therapy in such cases. 5,16,[19][20][21][22][23][24][25][26] Our results were compatible with different studies about the effectiveness of IFNa2a therapy in patients with BU. In the present study, 32 patients with severe BU treated with IFNa2a were reviewed.…”

Uveitis in paediatric Behçet disease: a large multicentric Italian cohort

“…In adult cohorts, there is instead quite large evidence that IFN represents an appealing and valuable option for severe uveitis associated with BD. [33][34][35] During the follow-up, we observed an improvement in ocular outcomes, with a significant reduction in patients with complications (80% vs 30%), additionally, all the eligible children achieved a visual acuity in the normal range at the last available follow-up. Considering paediatric BD patients belonging to different cohorts, we observed a better visual acuity compared to the Turkish cohort, 26 similar to Koné-Paut et al 36 However, as recently reported in an adulthood cohort, complications and visual acuity showed a significant improvement over time over the treatment.…”

New Evidence-Based Treatment Approach in Behçet's Disease

“…Tugal-Tutkun et al [57] evaluated the IFN- α treatment in 44 patients with uveitis unresponsive to conventional immunosuppressive therapy. Although the overall response rate was 91%, complete response rate (36.4%) was lower than that of the study of Kötter et al In a newer study, Onal et al [58] investigated the long-term efficacy and safety of low dose (3.0 MIU daily for 14 days, maintenance dose, 3 MIU 3 times per week for 24 months) therapy of IFN- α 2a in 37 patients with refractory Behçet panuveitis unresponsive to conventional immunosuppressive therapy. During maintenance therapy, IFN- α 2a controlled uveitis in 35 patients (95%).…”

Factors Affecting Relapse and Remission in Behçet's Uveitis Treated with Interferon Alpha2a

“…Several studies have reported the beneficial effect of interferon therapy in such cases. 5,16,[19][20][21][22][23][24][25][26] Our results were compatible with different studies about the effectiveness of IFNa2a therapy in patients with BU. In the present study, 32 patients with severe BU treated with IFNa2a were reviewed.…”

Uveitis in paediatric Behçet disease: a large multicentric Italian cohort

“…In adult cohorts, there is instead quite large evidence that IFN represents an appealing and valuable option for severe uveitis associated with BD. [33][34][35] During the follow-up, we observed an improvement in ocular outcomes, with a significant reduction in patients with complications (80% vs 30%), additionally, all the eligible children achieved a visual acuity in the normal range at the last available follow-up. Considering paediatric BD patients belonging to different cohorts, we observed a better visual acuity compared to the Turkish cohort, 26 similar to Koné-Paut et al 36 However, as recently reported in an adulthood cohort, complications and visual acuity showed a significant improvement over time over the treatment.…”

New Evidence-Based Treatment Approach in Behçet's Disease

“…Tugal-Tutkun et al [57] evaluated the IFN- α treatment in 44 patients with uveitis unresponsive to conventional immunosuppressive therapy. Although the overall response rate was 91%, complete response rate (36.4%) was lower than that of the study of Kötter et al In a newer study, Onal et al [58] investigated the long-term efficacy and safety of low dose (3.0 MIU daily for 14 days, maintenance dose, 3 MIU 3 times per week for 24 months) therapy of IFN- α 2a in 37 patients with refractory Behçet panuveitis unresponsive to conventional immunosuppressive therapy. During maintenance therapy, IFN- α 2a controlled uveitis in 35 patients (95%).…”

Factors Affecting Relapse and Remission in Behçet's Uveitis Treated with Interferon Alpha2a

“…Several studies have reported the beneficial effect of interferon therapy in such cases. 5,16,[19][20][21][22][23][24][25][26] Our results were compatible with different studies about the effectiveness of IFNa2a therapy in patients with BU. In the present study, 32 patients with severe BU treated with IFNa2a were reviewed.…”

Uveitis in paediatric Behçet disease: a large multicentric Italian cohort

“…In adult cohorts, there is instead quite large evidence that IFN represents an appealing and valuable option for severe uveitis associated with BD. [33][34][35] During the follow-up, we observed an improvement in ocular outcomes, with a significant reduction in patients with complications (80% vs 30%), additionally, all the eligible children achieved a visual acuity in the normal range at the last available follow-up. Considering paediatric BD patients belonging to different cohorts, we observed a better visual acuity compared to the Turkish cohort, 26 similar to Koné-Paut et al 36 However, as recently reported in an adulthood cohort, complications and visual acuity showed a significant improvement over time over the treatment.…”

New Evidence-Based Treatment Approach in Behçet's Disease

“…Tugal-Tutkun et al [57] evaluated the IFN- α treatment in 44 patients with uveitis unresponsive to conventional immunosuppressive therapy. Although the overall response rate was 91%, complete response rate (36.4%) was lower than that of the study of Kötter et al In a newer study, Onal et al [58] investigated the long-term efficacy and safety of low dose (3.0 MIU daily for 14 days, maintenance dose, 3 MIU 3 times per week for 24 months) therapy of IFN- α 2a in 37 patients with refractory Behçet panuveitis unresponsive to conventional immunosuppressive therapy. During maintenance therapy, IFN- α 2a controlled uveitis in 35 patients (95%).…”