METHOTREXATE FOR OCULAR LESIONS OF BEHCET'S DISEASE. COHORT STUDY ON 262 PATIENTS.


Abstract: INTRODUCTION: Ocular lesions of Behcet's Disease (BD) progress usually toward severe loss of vision or blindness, if not aggressively treated. Cytotoxic drugs are the main therapeutic arsenals used for it: Low dose methotrexate (MTX) by its safety and its efficacy is one of the best therapeutic choices. MATERIALS &METHODS: MTX was used as 7.5 mg weekly. Prednisolone was associated as 0.5 mg/kg/ daily. Upon the suppression of the inflammatory reaction, prednisolone was tapered gradually. Inclusion Criteria were:1- Fulfilling the Iran criteria for BD. 2- Existence of active posterior uveitis (PU) and/or retinal vasculitis (RV). 3- Treatment time not less than 6 months. Total Inflammatory Activity Index (TIAI) was calculated for each patient upon the inflammatory state of the anterior chamber, the uvea, and the retina. Visual acuity (VA): was calculated by the Snellen chart. The threshold level for improvement or aggravation was set to 20% change from the base line. RESULTS: The mean follow-up time was 22.7 months for 262 patients. For VA, 37%±4.1 (confidence interval at 95%) of the eyes improved, 44%±4.3 were stabilized, and 20%±3.4 were aggravated. The mean VA improved from 4.9 to 5.4 (t=2.837, p<0.005). For anterior uveitis (AU) 68%±4 of the eyes improved, 11%±2.7 were stabilized, and 21 %±3.5 were aggravated. The mean DAI for AU improved from 2.3 to 0.9 (t=8.087, p<0.0001). For (PU) 59%±4.3 of the eyes improved, 29%±4 were stabilized, and 11 %±2.8 were aggravated. The men DAI for PU improved from 1.9 to 0.8 (t=13.136, p<0.0001). For (RV) 45%±4.5 of the eyes improved, 28%±4.1 were stabilized, and 28%±4.1 were aggravated. The mean DAI for RV improved from l.7 to 1.4 (t=2.134, p<0.04). TIAI improved in 66.8%±5.7, it was stabilized in 15.6%+4.5, and it was aggravated in 17.6%±4.7 of patients. The mean TIAI improved from 12.8 to 7.3 (t=7.740, P<0.0001). Side Effects: were minor and seen only in 9% of patients. CONCLUSION: MTX is more effective on AU and PU than in RV. In a previous study (A & R 1996; 39: S217, abs 1141) we showed that MTX was as effective as other cytotoxic drugs in the treatment of ocular lesions of BD. Due to its safety MTX is the first choice, especially in the absence of RV, or when RV is mild.