Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 5;18(1):261.
doi: 10.1186/s12886-018-0929-5.

Conventional immunosuppressive therapy in severe Behcet's Uveitis: the switch rate to the biological agents

Hande Celiker  1 , Haluk Kazokoglu  2 , Haner Direskeneli  3
Affiliations

Conventional immunosuppressive therapy in severe Behcet's Uveitis: the switch rate to the biological agents

Hande Celiker et al. BMC Ophthalmol. .

Abstract

Background: To report the switch rate of conventional immunosuppressive (CIS) therapies to the biological agents (BA) in patients with refractory Behcet's uveitis (BU).

Methods: In this retrospective study, clinical records were reviewed of 76 patients' 116 eyes presenting with BU who had been treated with immunosuppressive drug therapy. Mann Whitney U test was used for the intergroup comparisons of parameters without normal distribution as well as calculation of descriptive statistical methods (mean, standard deviation, median, frequency and rate). Wilcoxon Signed Ranks test was used for the intragroup comparisons of parameters without normal distribution. Pearson's Chi-Square test and Fisher-Freeman-Halton test were used for the comparisons of qualitative data.

Results: Except for one, all patients were first treated with CIS regimens for BU. Thirty-one patients (41.3%) who were unresponsive to CIS regimens were switched to IFNα2a therapy. After that, eight of these cases were switched to the anti-TNF-α treatments. The presence of initial ocular complications were found to be statistically higher in BA treated patients than the CIS treated cases (p < 0.001). Both in CIS treated and in BA treated cases, an increase in visual acuity (VA) was observed during the last examination compared to the initial examination and was significant (p < 0.001 and p = 0.018, respectively).

Conclusions: CIS treatment was found to be effective and safe, as suggested in the management guidelines for severe BU. Biological therapy was also found effective for the improvement of the VA. We observed that 58.7% of cases could be treated with strong immunosuppressive therapies, however, nearly half of the patients could have lost their VA if BAs were not existent. During the treatment course of severe cases with BU, classical therapy stage must still be protected as the first-line therapy due to the their reasonable activity and safety.

Keywords: Anti-TNF-α therapy; Behçet’s uveitis; Immunosuppressive therapy; Interferon therapy; Uveitis.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

This study was conducted in accordance with the amendments of the Declaration of Helsinki. The retrospective study protocol was approved by the Marmara University Human Research Ethics Committee, and informed consent was obtained from all participants before the study began.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Our stepwise therapeutic approach for the patients with Behcet’s uveitis and distribution of the cases. *First Line Therapy: AZA: azathioprine, CS: corticosteroid, CsA: cyclosporine A, IFNα2a: interferon alpha2a, MTX: methotrexate. † except one case. **Second Line Therapy: Interferon alpha2a. ***Third Line Therapy: ADA: adalimumab, Anti-TNF-α: Anti tumor necrosis factor alpha, INX: infliximab. ****Fourth Line Therapy: this line is used if necessary
Fig. 2
Fig. 2
Distribution of LogMAR visual acuity of conventional agent treated patients and Interferon alpha 2a  treated cases
See this image and copyright information in PMC

References

    1. Behçet H. Über rezidivierende aphthöse durch ein virus verursachte Geschwüre am Mund, am Auge, und an den Genitalien. Dermatol Wochenschr. 1937;105:1152–1157.
    1. Michelson JB, Chisari FV. Behçet’s disease. Surv Ophthalmol. 1982;26:190–203. doi: 10.1016/0039-6257(82)90079-0. - DOI - PubMed
    1. Kaçmaz RO, Kempen JH, Newcomb J, Gangaputra S, Daniel E, Levy-Clarke GA, et al. Ocular inflammation in Behçet disease: incidence of ocular complications and of loss of visual acuity. Am J Ophthalmol. 2008;146:828–836. doi: 10.1016/j.ajo.2008.06.019. - DOI - PMC - PubMed
    1. Deuter CM, Kotter I, Wallace GR, Murray PI, Stübiger N, Zierhut M. Behcet’s disease: ocular effects and treatment. Prog Retin Eye Res. 2008;27:111–136. doi: 10.1016/j.preteyeres.2007.09.002. - DOI - PubMed
    1. Gueudry J, Wechsler B, Terrada C, Gendron G, Cassoux N, Fardeau C, et al. Long-term efficacy and safety of low-dose interferon alpha2a therapy in severe uveitis associated with Behcet disease. Am J Ophthalmol. 2008;146:837–844. doi: 10.1016/j.ajo.2008.08.038. - DOI - PubMed