Long-term outcome of pulse cyclophosphamide (PCP) in Behcet's disease (BD) ocular lesions.


Abstract: Since our first report in 1987 to the 11th EULAR congress of rheumatology several reports had shown the efficacy of PCP in posterior uveitis (PU) and retinal vasculitis (RV) of BD. The aim of this report is to show the safety and the efficacy of PCP even in patients who have been followed for more than 2 years (49 cases) . PCP was given as 1g/m2/body surface, once per month, with 0.5 mg prednisolone/kg/day. A Disease Activity Index (DAI) was calculated for each section of the eye. The DAI before PCP and last one were compared by the Student t test. Our patients received a total number 685 PCPs. ­the mean PCP per patient was 14.0 and the mean follow up time was 33.8 months. In PU, 79% of the eyes improved. The mean DAI decreased from 2.3 to 0.9 with t=6.327 (p<0.000001). In RV, 69% of eyes improved. The mean DAI decreased from 1.7 to 0.8 with t=3.863 (p=0003). The visual acuity (VA) as an overall index improved in 50% of the eyes. The wean VA improved from 3.7 to 4.6 on 10 (snellen chart) with t=2.523 (p=0.013). None of the major side effects of oral cyclophosphamide was ob­served with PCP. From these results we may conclude that: 1- PCP is a useful method for severe ophthal­mological manifestations of BD. 2- In responder patients PCP maintains it's efficiency over long period of time. 3- Unlike Cyclosporine A, PCP is safe even if administered for long period of time.