Lai Yung Jen, Chan Wei-Chun
Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan.
Taiwan J Ophthalmol. 2018 Jul-Sep;8(3):168-172. doi: 10.4103/tjo.tjo_99_17.
We report a young male patient with Behçet's disease who suffered from sight-threatening recurrences under treatment with azathioprine, cyclosporine, and prednisolone. His uveitis responded well to antitumor necrosis factor (TNF)-alpha (adalimumab) for 5 months subsequently. Severe uveitis recurred soon after discontinuation of anti-TNF alpha therapy and could not be controlled well with reinstitution of the anti-TNF alpha therapy. Interferon-2a (IFN-2a) was then given along with low-dose oral prednisone (10 mg/day), and the uveitis responded well to this therapy. We continued a maintenance dose with of IFN-2a three times/week for 2 years. Sight-threatening uveitis did not recur under IFN-2a therapy, and the visual acuity improved from "counting fingers" to 20/100 in the right eye, while remaining stable with 20/20 vision in the left eye. The patient had flu-like symptoms, fever, and severe depression during IFN therapy, but an attempt to discontinue INF led to relapse within 1 month. This case report suggests that IFN-2a could be an option for treatment in Behçet's uveitis. Further study is needed to clarify the efficacy and appropriate strategy for IFN-2a therapy for Behçet's uveitis in Taiwan.
我们报告一名患有白塞病的年轻男性患者,在用硫唑嘌呤、环孢素和泼尼松龙治疗期间,出现了威胁视力的病情复发。随后,他的葡萄膜炎对抗肿瘤坏死因子(TNF)-α(阿达木单抗)治疗反应良好,持续了5个月。停用抗TNF-α治疗后,严重葡萄膜炎很快复发,重新使用抗TNF-α治疗也无法很好地控制病情。随后给予干扰素-2a(IFN-2a)联合小剂量口服泼尼松(10毫克/天),葡萄膜炎对此治疗反应良好。我们持续给予IFN-2a维持剂量,每周三次,共2年。在IFN-2a治疗期间,威胁视力的葡萄膜炎未再复发,右眼视力从“数指”提高到20/100,而左眼视力保持稳定,为20/20。患者在IFN治疗期间出现类似流感的症状、发热和严重抑郁,但尝试停用IFN导致在1个月内病情复发。本病例报告表明,IFN-2a可能是治疗白塞病葡萄膜炎的一种选择。需要进一步研究以阐明IFN-2a治疗台湾地区白塞病葡萄膜炎的疗效和合适策略。