The use of interferon-alpha in Behçet's disease--review of the literature and possible mechanisms of action

Old and New Challenges in Uveitis Associated with Behçet's Disease

Behçet’s disease (BD) is a systemic vasculitis disease of unknown origin occurring in young people, which can be venous, arterial or both, classically occlusive. Ocular involvement is particularly frequent and severe; vascular occlusion secondary to retinal vasculitis may lead to rapid and severe loss of vision. Biologics have transformed the management of intraocular inflammation. However, the diagnosis of BD is still a major challenge. In the absence of a reliable biological marker, diagnosis is based on clinical diagnostic criteria and may be delayed after the appearance of the onset sign. However, therapeutic management of BD needs to be introduced early in order to control inflammation, to preserve visual function and to limit irreversible structural damage. The aim of this review is to provide current data on how innovations in clinical evaluation, investigations and treatments were able to improve the prognosis of uveitis associated with BD.

Long-term efficacy and safety of low-dose interferon alpha2a therapy in severe uveitis associated with Behçet disease

PURPOSE

To investigate long-term responsiveness of patients with severe uveitis associated with Behçet disease to interferon alpha2a (IFN-alpha2a).

DESIGN

Retrospective study.

METHODS

Thirty-two patients with sight-threatening uveitis associated with Behçet disease who relapsed despite corticosteroids and immunosuppressive agents were included. IFN-alpha2a was administered subcutaneously (three million units thrice a week). Ophthalmologic examination and fluorescein angiography associated with laboratory tests were performed at regular intervals. Main outcome measures were visual acuity and recurrence of uveitis attacks before, during, and after initiation of IFN-alpha2a therapy.

RESULTS

Control of inflammation was achieved in 28 of 32 patients (88%). Mean observation period of the 28 responder patients was 70.6 months (range, 30.3 to 129.2 months). Median visual acuity improved from 0.52 to 0.33 (logarithm of the minimum angle of resolution units; P = .005) two years after initiation of IFN-alpha2a therapy. The relapse rate decreased significantly during IFN-alpha2a treatment from 1.68 +/- 1.22 relapses/patient/year to 0.11 +/- 0.20 relapses/patient/year (P < .0001). IFN-alpha2a was discontinued in 19 of 28 patients (68%) after 32 months of treatment (range, 16 to 50 months). Mean follow-up after IFN-alpha2a discontinuation was 43 months (range, 11 to 84 months). After IFN-alpha2a discontinuation, the relapse rate increased from 0.08 +/- 0.21 relapse/person/year to 0.74 +/- 1.40 relapse/person/year (P = 0.04).

CONCLUSIONS

IFN-alpha2a is efficient and safe for the long-term management of severe uveitis associated with Behçet disease. Meanwhile it seems to be a suspensive therapeutic strategy, even though long-term remission is possible in some patients.

Interferon-alpha2a and Vogt-Koyanagi-Harada disease: a double-edged sword?

Successful therapy based on the use of interferon-alpha has been reported in different types of severe chronic uveitis. The immunomodulatory effects of this drug, combined with its antiviral properties seem to contribute to its efficacy in the treatment of different forms of severe and refractory uveitis such as Vogt-Koyanagi-Harada disease, Behçet-associated uveitis, or even human herpes virus 8 (HHV-8) associated uveitis. At the same time, severe ocular complications have been reported in patients treated with interferon-alpha for chronic viral hepatitis C. Among these complications, six cases of Vogt-Koyanagi-Harada-like disease have been described.We report a small case series of two patients with refractory Vogt-Koyanagi-Harada disease, treated with interferon-alpha and discuss the potential benefits or detrimental role of interferon therapy in these patients.