Combined cyclosporine and corticosteroid therapy for sight-threatening uveitis in Behçet's disease

Behçet's disease is a multisystem disorder that may cause profound ocular inflammation and blindness. We reviewed 19 patients with severe ocular Behçet's disease treated with combined cyclosporine and corticosteroid therapy. Previous treatment with corticosteroids alone failed to control the uveitis in all patients. Ten patients were given cyclosporine therapy alone (mean dosage, 8.6 mg/kg of body weight per day), and nine patients were given lower dosages of cyclosporine (mean dosage, 6.2 mg/kg of body weight per day) in combination with prednisone (mean dosage, 29.4 mg per day). The mean follow-up on therapy was 51 months. After three months of therapy, a trend toward greater improvement in visual acuity was noted in patients treated with combined cyclosporine and prednisone compared to those receiving cyclosporine alone (17.8 letters vs 10.2 letters, P = .2379), but after one year little difference was observed in the improvement between the two groups (5.8 letters vs 3.3 letters, P = .7984). However, a trend toward greater renal toxicity was seen in patients treated with cyclosporine alone after both three months and one year of therapy. Because of either a suboptimal therapeutic response or adverse effects, all patients treated with cyclosporine alone at baseline had prednisone added to their regimen after a mean time of 23.5 months. Overall, visual acuity remained stable or improved in 28 of 37 eyes (75.7%) over the course of therapy. These data suggest that combined cyclosporine and prednisone therapy is an effective treatment for Behçet's uveitis and may be less toxic than therapy with cyclosporine alone. A prospective, randomized trial with a larger sample size is needed to provide definitive data.