TREATMNT OF OPHTHALMOLOGIC MANIFESTATIONS OF BEHCET'S DISEASE. ANALYSIS OF 6 DIFFERENT TREATMENT MODALTLES


Abstract: INTROUCTION: Ophthalmologic manifestations are the major cause of morbidity in Behcet's Disease. If not treated, they usually progress toward sever loss of vision or blindness. Cytotoxic drugs are the main therapeutic agents. MATERIALS & METHOD: In an open, non randomized, control study, Pulse Cyclophosphamide (PCP), low dose pulse cyclophos­phamide (LDP), weakly methotrexate (MTX), chlorambucil (CHL), oral cyclophosphamide (OCP), and cyclosporine A (CYA) were used in a standard protocol for 778 patients. Criteria for inclusion were; 1-Fulfilling the Iran criteria. 2- ­Having posterior uveitis (PU) and/or retinal vasculitis (RV). 3-To have an inflammatory lesion of the eye. For each section of each eye (anterior chamber, uvea, retina) a Disease Activity Index (DAI) was calculated. The visual acuity (VA) was calculated for each eye. A Total Adjusted DAI (TADAI) was calculated for each patient upon the inflammatory indexes of both eyes and their visual acuity. PCP group: Patient : 308, mean follow ­up (MFU):21.4months, TADAI 40.5. LDP group: Patients: 115, MFU : 14.3, TADAI: 14.3. CHL group : Patients: 73, MFU : 22.9, TADAI: 36.4. CYA group : Patients : 19, MFU: 24.5, TADAI : 35.2. OCP group : Patients : 39, MFU : 16.5, TADAI :34.3, MTX group : Patients:224, MFU : 18.6, TADAI: 30.7. RESULTS : The percentage of cured, improved, or stabilized eyes with their confidence interval calculated at 95% were as follow: PU: PCP:82±3.2, LDP: 83±5.1, CHL: 87±5.9, CYA: 93±8.7, OCP: 80±9.8, MTX: 86±3.3, RV: PCP: 72±4, LOP: 72±6.5, CHL :71 ±6.3, CYA: 68±16. OCP: 79±10.6, MTX: 65±4.7. VA : PCP:68±3.7, LDP:66+ 6.1. CHL:72±7.3, CYA:68± 15.4, OCP:71 ± 10.1, MTX:70±4.3. The percentage patients in whom the TADAI improved or stabilized was as follow: PCP: 73.4±4.9, LDP: 76.5±7.9, CHL:82.2±9, CYA:84.2± 17.6, OCP:69.2 ± 15, MTX:74.1 ±5.7. Side Effects: PCP: 19%, LDP: 27%, CHL: 30%, CYA:90%, OCP:22%. MTX:9%. COMPARISON OF RESULTS: The comparison of results in PU RV. VA. and TADAI did not show any statistically significant difference between are six months. However it is important to note that the patients treated by MTX had a milder disease (low TADAI) than those treated with PCP and LDP MTX had the lowest and CYA CONCLUSION: As all the methods had the same efficacy and as MTX had the lowest side effects we propose to use MTX as the first choice specially in patients without RV or with mild RV(MTX had the least improvement in RV than other methods). In moderate to severe RV the first choice would be Cyclophosphamide. In non responders a change in the treatment modality is indicated because all non responders are not always refractory to other methods. Cyclosporin A is the last choice bucause of its high rate of side effects and its high cost.