Long-term follow-up of patients with chronic uveitis affecting the posterior pole treated with combination cyclosporine and ketoconazole.
OBJECTIVE
Combined treatment with cyclosporine (CsA) and ketoconazole in autoimmune diseases has received little attention. This article reports the outcome of a pilot study in patients receiving combination therapy for chronic uveitis affecting the posterior pole.


METHODS
Six patients initially treated with CsA and oral prednisone were observed prospectively on a combination of CsA, prednisone, and ketoconazole. Data were analyzed for visual acuity, number of flare-ups, and signs of systemic toxicity.


RESULTS
Patients were treated with CsA for a mean of 13 months and CsA-ketoconazole for a mean of 33 months. Although patients had a number of flare-ups before combination therapy, only two flare-ups in two patients were noted during combined therapy (P = 0.055). Three patients showed signs of renal toxicity on CsA, and two continued to show signs of toxicity on CsA-ketoconazone. One patient stabilized and maintained normal renal parameters. Using CsA, three of six patients showed elevations of systolic and diastolic pressure. After switching to CsA-ketoconazole, the patient's systolic pressure remained unchanged, and the diastolic pressure returned to normal in all patients (P = 0.03). No toxicity related to ketoconazole alone was observed.


CONCLUSIONS
A combination of CsA and ketoconazole is effective in the treatment of chronic uveitis affecting the posterior pole. It appears to be more effective in preventing recurrences than does CsA alone and does not lead to an increased risk of renal toxicity.
Ramadan
A M
AM
Clinical Immunology Section, National Eye Institute, Bethesda, MD 20892-1858, USA.
Nussenblatt
R B
RB
de Smet
M D
MD
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002908:Chronic Disease; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007654:Ketoconazole / Q000009:adverse effects / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008875:Middle Aged; D010865:Pilot Projects; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D014605:Uveitis / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D007654:Ketoconazole; D011241:Prednisone