Methotrexate in ocular Behcet, preliminary report.


Abstract: Posterior uveitis and retinal vasculitis are the most serious lesions­ of ocular Behcet. Pulse cyclophosphamide and cyclosporine A are the most efficient treatment. Oral cytotoxic drugs (cyclophosphamide, chlorambucil , and azathioprine) are less efficient. We present here our first impression on weekly pulsed methotrexate (MTX). MTX was administereted as 7.5 mg weekly in 3 divided doses, every 12 hours Prednisolone was given as 0.5 mg/kg/day. 23 patients with posterior uveitis (PU) and retinal vasculitis (RV) were chosen for this study. A Disease Activity Index (DAI), based upon the inflammatory state of the eye was calculated for each section of each eye before the MTX therapy and after each successive controls. A comparison between the DAI before MTX, and after the last control, was made by the Student paired t-test: The mean follow up time was 5.2 months. 73% of eyes with PU improved, 25% were stabilized, while 2% were aggravated (only 1 eye). The mean DAI improved from 2.1 to 0.8 with t=7.381 (p<0.000001). 65% of the eyes with RV improved, 23% were stabilized, while 12% were aggravated (4 eyes). The mean DAI improved from 1.5 to 0.7 with t=3.760 (p=0.00073). The Visual Acuity(VA), as an overall index, improved in 84% of eyes. VA was stabilized in 11% and decreased in 5% of eyes (2 eyes). The mean VA improved from 4.2 to 6.4 on 10 with t=5.058 (p=0.000012). MTX when used in low doses is very well tolerated. We had no major side effects in our patients, although our follow time is not enough long for hepatic lesions to appear. A comparison of results between patients who had received MTX and patients who had pulsed cyclophosphamide (in the same range of follow up time) demonstrate an equal efficiency of both regimes. however, patients on PCP had more aggressive lesions than those on MTX. From this preliminary report we may conclude that MTX is better indicated in patients with posterior uveitis who have not a severe retinal vasculitis.