AB0710 Interferon Α2a for the treatment of refractory behÇet’s disease uveitis
Authors: W. Zheng, J. Shi, C. Zhao, J. Liu, J. Zhou, F. Gao, M. Zhang
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Behçet's Disease uveitis(BDU) mostly involved bilateral panuveitis and retinal vasculitis, which are very challenging to treat. Interferon alfa-2a (IFNα 2a) has been shown to have comparable effectiveness and tolerance profiles for BDU as tumour necrosis factor (TNF) inhibitors in a number of studies with a much lower cost. IFNα−2a treatment combined with corticosteroids without immunosuppressants was common in previous studies. We herein report a cohort of highly refractory BDU patients who experienced recurrence despite aggressive treatment with multiple immunosuppressants at their therapeutic doses. <h3>Objectives</h3> To investigate the efficacy and safety of IFNα2a treatment in combination with corticosteroids and immunosuppressants in patients with refractory BDU. <h3>Methods</h3> Clinical records of refractory BDU patients who underwent IFNα2a treatment in our centre between 2015 and 2017 were retrospectively reviewed. IFNα2a was initially given 3.0 million IU (MIU) subcutaneously daily for 4 weeks, on the basis of conventional corticosteroid and immunosuppressive therapy. The dosage was gradually tapered down to 3.0 MIU three times or even once per week for maintenance. Primary outcome measure was success rate and changes in ocular relapse rates before and after initiation of IFN-α2a treatment. Disease activity, corticosteroid- and immunosuppressive agent-sparing effects and potential side effects were considered to be secondary outcomes. <h3>Results</h3> A total of 26 patients (23 males and 3 females) were included, with a median disease course of 41 months (range 5–168) before IFNα 2a treatment. No major organ involvement except for ocular inflammation was noted. Concomitant medical conditions include chronic hepatitis B virus infection in 2 patients, pulmonary tuberculosis in 1 patient who was treated with antitubercular agents in the meanwhile. Prior to IFNα2a therapy, the median minimum dosage of corticosteroids was 20 (range 15–45) mg/day prednisone or equivalent, and 17 patients (65.4%) were treated with at least two immunosuppressive agents. Four received short terms of TNFα inhibitor therapy but stopped due to economic burden. Severe side effects related to previous therapies including femoral head necrosis and secondary hypertension were observed in some patients. Treatment success of IFNα2a was achieved in the majority of the patients (24/26, 92.3%). During a mean follow-up of IFNα2a therapy for 13.6±6.0 months, the median rate of uveitis relapse decreased notably from 8 per patient-year (range 2–12) to 0 per patient-year (range 0–6) (p=0.000008). Oral corticosteroids were successfully decreased in 20 cases (76.9%) and completely discontinued in 2 patients (7.7%), with the median minimum dosage reduced from 20 mg/day (range 15–45) to 15 mg/day (range 0–50) (p=0.006221). Moreover, immunosuppressive agents were cut down on types and dosage in 15 (57.7%) and 23 patients (88.5%), respectively, and were totally quitted in 5 cases (19.2%). Slight elevated liver and renal function parameters were detected in one and two patients, respectively. No other severe adverse events occurred. The serum autoantibodies were all negative during treatment with IFNα2a. <h3>Conclusions</h3> IFNα2a, in combination with corticosteroids and immunosuppressants, was effective and relatively safe in refractory BDU, with a potential steroid- and immunosuppressive agent-sparing effect. <h3>Disclosure of Interest</h3> None declared