Comparing 3 methods of cytotoxic therapy in ophthalmologic lesions of Behcet's disease.

Abstract: It is accepted today that cytotoxic drugs are the only re­mittent agents in posterior uveitis (PU) and retinal vasculitis (RV) of Behcet's disease (BD). The important question is which cytotoxic is the most effective and the least harmful. We compare here the results of 3 efficient methods of cyto­toxic therapy with the same mean follow-up time of 12 months: I.V. Pulse Cyclophosphamide (PCP) in 121 patients, weekly low dose Methotrexate (MTX) in 95 patients and Cy­closporine A (CYA) in 16 patients. All the patients received prednisolone 0.5 mg/kg/d. Improvement or stabilization of he lesions for each section of the eyes or visual acuity (VA) were accepted as a good result. In anterior uveitis the good result was 77% (CI = 6.8) with PCP, 74% (CI = 8.2) with MTX and 88% (CI = 15.4) with CYA. For PU the good result was 82% (CI = 5.6) with PCP, 87% (CI = 5.4) with MTX and 100% with CYA. In RV the good results was 73% (CI = 7.5) with PCP, 74% (CI = 8.7) with MTX and 67% (CI = 18.8) with CYA. For VA it was 66% (CI = 6.5) with PCP, 76.5% (CI = 6.8) with MTX and 73% (CI = 18.5) with CYA. Con­cerning a total adjusted Disease Activity Index in each pa­tient the good result was 72% (CI = 8) with PCP, 79% (CI = 8.2) with MTX and 81% (CI = 19.2) with CYA. This study shows that these 3 methods are approximately equal in efficacy, but it is important to emphasize that CYA is more effective in PU and PCP is still the drug of choice in RV. As side effects with CYA were higher than the other two methods, we suggest MTX as the first drug in PU and/or mild RV ind BD, while PCP for severe RV and for the non respon­ders to MTX. The more toxic drug CYA can be reserved for non responders to both groups.