Bodaghi Bahram, Gendron Gael, Wechsler Bertrand, Terrada Céline, Cassoux Nathalie, Huong Du Le Thi, Lemaitre Claire, Fradeau Christine, LeHoang Phuc, Piette Jean-Charles
Department of Ophthalmology, AP-HP, University of Paris VI, Paris, France.
Br J Ophthalmol. 2007 Mar;91(3):335-9. doi: 10.1136/bjo.2006.101550. Epub 2006 Oct 18.
Severe uveitis is potentially associated with visual impairment or blindness in young patients. Therapeutic strategies remain controversial. The efficacy of interferon alpha-2a (IFN-alpha2a) in severe uveitis, refractory to steroids and conventional immunosuppressive agents, was evaluated.
Patients were included after a major relapse of uveitis following corticosteroids and immunosuppressants. IFN-alpha2a (3 million units three times a week) was administered subcutaneously. Efficacy was assessed by improvement in visual acuity, decrease in vitreous haze, resolution of retinal vasculitis and macular oedema, assessed by fundus examination and fluorescein angiography, and decrease in oral prednisone threshold.
45 patients were included. Median age was 32.3 years (range 8-58) and sex ratio (F/M) was 0.66. Uveitis was associated with Behçet's disease in 23 cases (51.1%) and with other entities in 22 cases (48.9%). Median duration of uveitis before interferon therapy was 34.9 months (range 3.4-168.7) and an average of 3.26 relapses following corticosteroids and immunosuppressants was noted. Uveitis was controlled in 82.6% of patients with Behçet's disease and 59% of patients with other types of uveitis (p = 0.07). During a mean follow-up of 29.6 months (range 14-55), median oral prednisone threshold decreased significantly from 23.6 mg/day (range 16-45) to 10 mg/d (range 4-14) (p<0.001). Interferon was discontinued in 10 patients (22.2%) with Behçet's disease and in four patients without Behçet's disease. Relapses occurred in four and one cases, respectively.
Interferon therapy appears to be an efficient strategy in severe and relapsing forms of Behçet's disease but also in other uveitic entities. However, it seems to act more to suspend rather than cure the disease. Therefore, IFN-alpha2a may be proposed as a secondline strategy after failure of conventional immunosuppressants.
严重葡萄膜炎可能导致年轻患者视力受损或失明。治疗策略仍存在争议。我们评估了干扰素α-2a（IFN-α2a）对类固醇和传统免疫抑制剂治疗无效的严重葡萄膜炎的疗效。
患者在使用皮质类固醇和免疫抑制剂后葡萄膜炎出现严重复发时被纳入研究。皮下注射IFN-α2a（每周三次，每次300万单位）。通过视力改善、玻璃体混浊减轻、视网膜血管炎和黄斑水肿消退（通过眼底检查和荧光素血管造影评估）以及口服泼尼松阈值降低来评估疗效。
纳入45例患者。中位年龄为32.3岁（范围8 - 58岁），性别比（女/男）为0.66。23例（51.1%）葡萄膜炎与白塞病相关，22例（48.9%）与其他疾病相关。干扰素治疗前葡萄膜炎的中位病程为34.9个月（范围3.4 - 168.7个月），使用皮质类固醇和免疫抑制剂后平均复发3.26次。82.6%的白塞病患者和59%的其他类型葡萄膜炎患者的葡萄膜炎得到控制（p = 0.07）。在平均29.6个月（范围14 - 55个月）的随访期间，口服泼尼松的中位阈值从23.6毫克/天（范围16 - 45毫克/天）显著降至10毫克/天（范围4 - 14毫克/天）（p<0.001）。10例（22.2%）白塞病患者和4例非白塞病患者停用了干扰素。分别有4例和1例复发。
干扰素治疗似乎是治疗严重复发性白塞病以及其他葡萄膜炎疾病的有效策略。然而，它似乎更多地是起到延缓疾病的作用而非治愈疾病。因此，在传统免疫抑制剂治疗失败后，IFN-α2a可作为二线治疗策略。
