[Clinical observation of 85 patients with Behçet's uveitis treated with immunosuppressive agents combined with...

To investigate the effect and safety of immunosuppressive treatment (IMT) combined with steroids in patients with Behçet's uveitis.

Case-series study. Eighty-five patients (167 eyes) were enrolled in this study from June 2010 to June 2011 at the Beijing Tongren Hospital. The patients were examined before the initiation of IMT and were followed up once every 3 months after the therapy. The corrected visual acuity, inflammation score, ocular complications and side effects of IMT and steroid use were recorded. The rate of positive outcomes was reported in person years (PY) or eye years (EY). The intervals between the episodes of ocular inflammation were analyzed using Kaplan-Meier survival analysis. The difference of the proportion of stable cases before and after treatment was analyzed by Log-rank test.

There were 67 males and 18 females. The mean age of diagnosis with Behçet's disease was (30.4 ± 9.5) years. The total follow-up period was 255.5 EY and 129.67 PY. The percentages of eyes with inflammation that had been stable for at least 3 months (91.6%, 153/167) or more than 1 year (22.3%, 37/167) after treatment were significantly higher than those before treatment [34.7% (58/167) and 1.0% (2/167), respectively] (χ(2) = 137.80, P < 0.01). The incident rate of a decrease in visual acuity was 0.11 per EY, and the incident rate of an increased in visual acuity was 0.22 per EY. The incident rates of cataracts, an intraocular pressure greater than 30 mm Hg (1 mm Hg = 0.133 kPa) or a severe vitreous haze were 0.39 per EY, 0.07 per EY and 0.79 per EY, respectively. The incident rates of obesity, osteoporosis and hypertension caused by steroid use were 0.4 per PY, 0.22 per PY and 0.13 per PY, respectively. The common side effects of IMT were reversible leukopenia (0.26 per PY by chlorambucil and 0.46 per PY by methotrexate), hepatotoxicity (0.21 per PY by cyclophosphamide, 0.13 per PY by azathioprine), hematuria (0.21 per PY by cyclophosphamide) and gum hyperplasia caused by cyclosporine (0.15 per PY).

Although the use of IMT combined with steroids is effective for the control of intraocular inflammation in patients with Behçet's uveitis, the occurrence of complications is still high, and the vision prognosis is poor. We should pay attention to the side effects of the long-term use of steroids, such as hypertension, obesity and osteoporosis. The initiation of IMT is recommended over the long-term administration of large doses of steroids. The side effects of IMT should be monitored.