AZATHIOPRINE AND LOW DOSE PULSE CYCLOPHOSPHAMIDE IN SEVERE OCULAR LESIONS OF BEHCET’S DISEASE, A PRELIMINARY REPORT.


Abstract: Introduction: Combination of cytotoxic drugs was suggested to decrease the rate of non-responders in severe ocular lesions of Behcet’s disease (BD). We present here our preliminary data with low dose pulse Cyclophosphamide (LDP) and Azathioprine (AZA) in the treatment of posterior uveitis (PU) and/or retinal vasculitis (RV) of BD. Patients & methods: Twelve BD patients with PU and RV were selected. They all received LDP as 0.5 g/m2 body surface/month by intravenous infusion, AZA 2-3 mg/kg/day and Prednisolone 0.5 mg/kg/day orally. Visual acuity (VA), a Disease Activity Index (DAI), based on the inflammatory state of each section of each eye, and a Total Adjusted DAI for each patient was calculated. Improvement and stabilization of the lesions were classified as good result. The threshold level was set to 20% change from the baseline. The comparisons were made by the student t test. Results: The mean follow up time was 9.3 months. We had good result for the anterior uveitis (AU) in 88%13.2 (confidence interval at 95%), for PU in 85%15.6, for RV in 79%21.5, and for VA in 79%16.3 of the eyes. The total adjusted DAI improved in 92%15.3 of the patients. Side effect was nausea seen only in one case. We compared these results with patients who received LDP or AZA alone, after the same mean follow up time. The difference was not statistically significant. Conclusion: Combination therapy with LDP and AZA was effective in ocular lesions of BD in short term. The rate of side effects did not increase with their combination. Longer follow up time with more patients are needed to confirm the efficacy of this regimen.