Long-term Efficacy and Safety of Low-Dose and Dose-Escalating Interferon Alfa-2a Therapy in Refractory Behcet Uveitis
Long-term Efficacy and Safety of Low-Dose and Dose-Escalating Interferon Alfa-2a Therapy in Refractory Behcet Uveitis
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DOI：
10.1001/archophthalmol.2011.3
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发表时间：
2011-03-01
影响因子：
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通讯作者：
Yavuz, Sule
中科院分区：
文献类型：
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作者：
Onal, Sumru;Kazokoglu, Haluk;Yavuz, Sule
目的：探讨干扰素α-2a低剂量和剂量递增治疗白塞葡萄膜炎的长期疗效和安全性。方法：本研究纳入了37例对常规免疫抑制治疗无反应的难治性白塞葡萄膜炎患者。诱导干扰素α-2a治疗每天皮下注射300万国际单位（MIU），持续14天。维持剂量为 3.0 MIU，每周皮下注射 3 次。如果葡萄膜炎复发，剂量依次增加至4.5、6.0和9.0 MIU，每周3次。总治疗时间为24个月。主要结果指标是在维持治疗期间以静止状态控制葡萄膜炎。干扰素α-2a治疗开始前后每名患者每年的眼部复发率和皮质类固醇节约效应是次要结果。我们还估计了停止干扰素 α-2a 治疗后的缓解率。结果：在维持治疗期间，干扰素 α-2a 控制了 35 名患者 (95%) 的葡萄膜炎。在 15 名患者 (41%) 中，每周 3 次 3.0 MIU 的维持剂量控制了葡萄膜炎，没有任何复发。葡萄膜炎复发率从之前的每患者年 3.52 例下降到开始干扰素 α-2a 治疗后的每患者年 0.75 例。 17 名患者在开始干扰素治疗时正在接受全身皮质类固醇治疗。在维持阶段，9 名患者能够停止全身皮质类固醇治疗，8 名患者能够逐渐减少全身皮质类固醇治疗。生存分析估计，停止干扰素α-2a治疗后3个月的缓解率为76%。此后缓解率保持稳定。结论：使用干扰素α-2a低剂量和剂量递增治疗的治疗方案能够控制并缓解大多数难治性眼部白塞病患者的葡萄膜炎。
Objective: To investigate the long-term efficacy and safety of low-dose and dose-escalating therapy of interferon alfa-2a in the treatment of Behcet uveitis.Methods: This study included 37 patients with refractory Behcet panuveitis unresponsive to conventional immunosuppressive therapy. Induction interferon alfa-2a therapy was given as a daily dose of 3.0 million IU (MIU) subcutaneously for 14 days. Maintenance dose was achieved with 3.0 MIU 3 times per week given subcutaneously. The dosage was increased sequentially to 4.5, 6.0, and 9.0 MIU 3 times per week if uveitis relapses occurred. Total therapy duration was 24 months. Primary outcome measure was control of uveitis with quiescence during maintenance therapy. Ocular relapses per patient-year before and after initiation of interferon alfa-2a therapy and a corticosteroid-sparing effect were secondary outcomes. We also estimated the rate of remission after discontinuing interferon alfa-2a therapy.Results: During maintenance therapy, interferon alfa-2a controlled uveitis in 35 patients (95%). In 15 patients (41%), a maintenance dosage of 3.0 MIU 3 times per week controlled uveitis without any relapse. The rate of uveitis relapses decreased from 3.52 per patient-year before to 0.75 per patient-year after initiating interferon alfa-2a therapy. Seventeen patients were receiving systemic corticosteroids at the time of initiation of interferon therapy. During the maintenance stage, 9 patients were able to discontinue and 8 to taper systemic corticosteroid therapy. Survival analysis estimated that the rate of remission after discontinuation of interferon alfa-2a therapy was 76% by 3 months. The rate of remission remained stable thereafter.Conclusion: A treatment protocol using a low-dose and dose-escalating therapy with interferon alfa-2a was able to control and achieve remission of uveitis in most patients with refractory ocular Behcet disease.