Immunosuppressive Therapy of Ocular Inflammatory Diseases

Ten-year experience of pulsed intravenous cyclophosphamide and methylprednisolone protocol (PICM protocol) in severe ocular inflammatory disease

“…Despite the advantages of a more rapid response to therapy and less associated systemic adverse events compared with the potential lag period for the oral preparation, intravenous cyclophosphamide has only been used cautiously in the management of ocular inflammatory disease with correspondingly less published data. A variety of protocols have been described with success and these include weekly intravenous cyclophosphamide in six patients with a range of inflammatory eye diseases,23 monthly dosing in patients with either Behçet's disease-associated ocular inflammation or a spectrum of uveitis types,20 24 and delivery of 3–4 weekly infusions to a heterogeneous group of patients including uveitis, Behçet's disease, rheumatoid arthritis and mucous membrane pemphigoid requiring 2–10 doses over a 14-month period 8. This series noted a positive response to treatment in 68% patients during the study period with 55% achieving complete quiescence versus our overall figures of 55% achieving a positive response (ie, complete success or partial success) and 34% achieving complete quiescence (12 months results).…”

Behçet’s disease and the alimentary tract

“…In contrast, Dolby (1972) Corticosteroids relieve some symptoms but do not affect the overall condition (O'Duffy et al, 1971). Some reports of immunosuppressive therapy have been favourable (Mamo and Azzam, 1970;Rosselet, Saundan and Zenklusen, 1968) while other workers have been less impressed (Wong, 1969). Haim and Sherf (1966) reported a transient favourable response to transfusion of fresh blood or plasma, and O' Duffy et al (1971) were also impressed by this effect: we did not note any such response to blood transfusion in our patients,'but blood was given only as indicated and no trial of this therapy was undertaken.…”

Behcet’s disease

“…B cells return rapidly to normal compared with T cells [414]. Cyclophosphamide has been used successfully for control of corticosteroid-resistant BD [415]. It can be given orally or intravenously.…”