Cyclosporin‐A therapy in severe uveitis of Behçet's disease

Abstract

ABSTRACT.Purpose: Cyclosporine-A (CSA) combined with corticosteroid therapy was administered to 12 patients with severe Behçet's uveitis who were resistant to colchicine or cytotoxic therapy. Methods: Previous colchicine or cytotoxic therapies were tapered off one month before CSA therapy. All patients were started on an initial oral dose of 5 mg/ kg/day of CSA. After the first three months, the CSA dose was reduced to a maintenance dose according to the intraocular inflammatory response. Results: The average follow-up period was 20 (12-36) months. Visual acuity remained the same in 12 (%54.5) and improved in 8 (%36.4) eyes. There was a decrease in the frequency (p∞0.01) and severity (p∞0.01) of ocular attacks and in the maintenance steroid dose (p∞0.01) when compared with conventional therapy. The frequent side effects were paraesthesia-hyperesthesia, fatigue, nausea, hirsutism and dose-related nephrotoxicity in one patient. Conclusion:The results of the study suggest that low dose CSA combined with low dose corticosteroid may be an effective therapeutic alternative in the treatment of severe refractory Behçet's uveitis.

Update on the therapy of Behçet disease

“…Azathioprine Eye involvement RCT [Yazici et al 1990] Retrospective study [Saadoun et al 2010] Vascular disease RCT [Yazici et al 1990] GI involvement Retrospective study Neuro-Behçet Case series [Kurtuncu et al 2008] Mycophenolate mofetil Neuro-Behçet Case series [Shugaiv et al 2011] Cyclosporine A Eye involvement RCTs [Ozyazgan et al 1992;Masuda et al 1989;BenEzra et al 1988] Open-label studies [Ermakova, 2003;Ozdal et al 2002;Fujino et al 1999;Sullu et al 1998;Whitcup et al 1994;Sajjadi et al 1994;Pacor et al 1994;Hayasaka et al 1994;Atmaca and Batioglu, 1994;Chavis et al 1992; [Mochizuki et al 1991[Mochizuki et al , 1992Ishioka et al 1994] Cyclophosphamide Vascular disease Retrospective studies [Hamuryudan et al 1994[Hamuryudan et al , 2004 Neuro-Behçet Retrospective study...…”

Traitements actuels et perspectives thérapeutiques dans la maladie de Behçet

“…L'uvé ite anté rieure peut ê tre efficacement traité e par des corticoïdes locaux en collyre associé s à des mydriatiques ou des cycloplé giques locaux afin de pré venir la survenue de syné chies iridocristaliniennes. Pour les manifestations les plus sé vè res, en particulier les uvé ites posté rieures et les vascularites ré tiniennes, le traitement standard consiste en une association de glucocorticoïdes à fortes doses par voie systé mique (per os ou en bolus intraveineux lors des poussé es aiguë s) à l'un des agents immunosuppresseurs suivants : cyclophosphamide 0,5 à 1 g en bolus IV mensuels, azathioprine 2,5 mg/kg/j, chlorambucil 5 mg/j et enfin ciclosporine A. Ce dernier agent semble ê tre le plus efficace pour le traitement conventionnel de ces formes d'uvé ites et s'est ré vé lé bé né fique chez 70 à 80 % des cas ré sistants aux autres agents [12,[17][18][19][20][21] mais il existe un risque de rebond à l'arrê t du traitement. Il faut cependant souligner que parmi tous ces traitements, seul l'azathioprine a é té é valué e dans une é tude contrô lé e [12].…”

Intravitreal implantation of the biodegradable cyclosporin A drug delivery system for experimental chronic uveitis

“…Approximately 4-10% of blindness in China can be attributed to uveitis [11]. Cyclosporin A (CsA) has been widely and effectively used for the treatment of various forms of chronic uveitis [4,9,10]. However, poor penetration of topical CsA into the eye and serious systemic toxicity produced by oral administration require a new approach to overcome the hurdles of blood-ocular block and low bioavailability of CsA.…”