Chlorambucil and cyclosporine A in Brazilian patients with Behçet's disease uveitis: a retrospective study.
OBJECTIVE
To assess the efficacy and side effects of immunosuppressive therapy in patients with Behçet's disease uveitis.


METHODS
A nonrandomized retrospective case-series study analyzed data from 22 patients with Behçet's disease uveitis, from a single Uveitis Service, São Paulo, Brazil (period 1978-2007), under systemic chlorambucil and/or cyclosporine A, for at least 6 months with a minimum one-year follow-up. Drug efficacy was measured by reduction in relapse rate and reduction of prednisone dose.


RESULTS
Patients (10M/12F) mean age was 29 (range 10-43) years-old at the onset of uveitis. The median duration of followup was 11 (range 1-29) years-old. Chlorambucil (2-6 mg/day) was used in 13 patients and cyclosporine A (3-5 mg/kg/day) in 9 patients at initiation. Drugs were switched because of no effectiveness or side-effects. Chlorambucil was effective in 78.5% (11/14) and induced disease remission in 43% (6/14) of patients, whereas cyclosporine A was effective in 57% (8/14) of patients. Chlorambucil and cyclosporine A were discontinued due to side effects in 21% (leucopenia) and in 57% of patients (nephrotoxicity, 36% and gastrointestinal complications, 21%), respectively. No case of late malignancy was observed. 36% (16/44) of eyes had final visual acuity < or =0.1, among which 69% (11/16) had already this visual acuity at the first visit.


CONCLUSIONS
This study reiterates previous data that chlorambucil can induce long-term remission of Behçet's disease uveitis, whereas cyclosporine is effective but side effects limit its use. Chlorambucil therapy may still be a reasonable option in patients with intractable, sight-threatening Behçet's disease uveitis.
Zaghetto
Juliana Marques
JM
Uveitis Service, Department of Ophthalmology, Hospital das Clínicas - Universidade de São Paulo - São Paulo (SP) - Brazil. jmzaghetto@hotmail.com
Yamamoto
Mirian Mina
MM
Souza
Murilo Barreto
MB
Silva
Felipe Theodoro Bezerra Gaspar Carvalho da
FT
Hirata
Carlos Eduardo
CE
Olivalves
Edilberto
E
Yamamoto
Joyce Hisae
JH
D000293:Adolescent; D000328:Adult; D001528:Behcet Syndrome / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002699:Chlorambucil / Q000009:adverse effects / Q000627:therapeutic use*; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D014605:Uveitis / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
D007166:Immunosuppressive Agents; D002699:Chlorambucil; D016572:Cyclosporine