Long-term outcome of cyclophosphamide I.V. bolus in Behcet's disease ocular lesions.


Abstract: Since our first report in 1987 to the XIth EULAR Congress of Rheumatology several reports had proved the efficacy of pulsed cyclophosphamide (PCP) in severe posterior uveitis (PU) and retinal vasculitis (RV) of Behcet's Disease (BD). The aim of this report is to show the outcome of 45 patients who have been followed for more than 2 years. PCP was administered as lg/m2/body surface, once per month, with 0.5 mg prednisolone>/kg/day. A Disease Activity Index (DAI), based upon the inflammatory state of the eye, was calculated for section of each eye before the first PCP and then after each one. When a remission was Obtained the gap between PCP was increased to 2, and then to 3 months, and prednisolone was tapered. If the result remained stable, PCP was given only in case of a new attack. A comparison between the DAI before PCP, and after the last one, was made by the Student t-test, Our patients received a total number of 597 PCPs. The mean PCP per patient was 13.3 and the mean follow up time was 32.1 months. In PU, 82% of the eyes improved while 18% were aggravated. The mean DAI improved from 2.2 to 0. 9 with 5=5.825 (p<0.000001). In RV, 67% of the eyes improved, 12% were stabilized, while 21% were aggravated. The mean DAI improved from 1.8 to 0.8 with t=3.844 and p=0.0003. The Visual Acuity (VA) is an overall index of the eye status, demonstrating both the inflammatory state and sequelae. The VA improved in 52% of the eyes. The VA was stabilized in 11% and decreased in 37% of the eyes. The mean VA improved from 3.8 to 4.9 on 10 (Snellen chart) with t=2.781 and p=0.007. Non of the major side effects of oral cyclophosphamide was observed with PCP. From these results we conclude that: 1- PCP is a very useful method for severe ophthalmotogical manifestations of BD. 2-In responder patients PCP maintains it's efficiency over the time.