Behcet's Disease, Panuveitis, Posterior Uveitis, Retinal Vasculitis
Conditions
Keywords
Ocular Behcet's disease, Panuveitis, Posterior Uveitis, Retinal vasculitis, Treatment, Interferon-alpha, Cyclosporin A
Brief summary
The purpose of this study is to investigate if interferon-alpha2a is superior to the standard treatment with cyclosporin A for the treatment of severe ocular manifestations of Behcet's disease.
Detailed description
Behcet's disease is a multisystem vasculitis often involving ocular (retinal) blood vessels (in 70% of all cases). This form of uveitis or retinal vasculitis still leads to blindness in 25 to 50% of the patients irrespective of immunosuppressive treatment. The aim of the study is to evaluate if Interferon-alpha2a is superior to the present standard treatment (cyclosporin A (CSA)) for severe ocular (panuveitis, posterior uveitis, retinal vasculitis) Behçet's Disease (BD) and significantly improves visual prognosis and quality of health and life of the patients with ocular BD and is acting more rapidly than standard treatment. Furthermore, we want to evaluate if IFN-α induces long term remissions of ocular BD which can be maintained without further medical treatment. The patients are randomised into two treatment groups (IFN/CSA) and treated for one year according to an algorithm which adapts dosages to clinical course. A crossover from one treatment arm to the other is planned in case of inefficacy.
Interventions
DRUGCyclosporin A
3 mg/kg bw, augmented to 5 mg if necessary and combined with prednisolone. Adapted to serum levels
3-6 million iU per day sc., augmented to up to 9 if necessary, later reduced (according to clinical response) to 3 x 3 million iU /week.
Sponsors
University Hospital Tuebingen
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Behçet's disease fulfilling the International Study Group Criteria with active pan- or posterior uveitis (according to the posterior uveitis scoring system) or retinal vasculitis and active disease according to the Behcet's Disease activity scoring system.
Exclusion criteria
* Previous treatment with interferon-α or cyclosporin A * Pregnancy, breast feeding women, malignancy * Renal impairment (creatinine \> 1.5 mg/dl) * Uncontrolled hypertension or diabetes * Depression or other psychic disorders(also history of depression) * History of acute or chronic inflammatory joint or autoimmune disease * Organ or bone marrow transplant recipient, cardiac failure \> NYHAIII * Acute liver disease with SGPT 2x above normal * White blood cell count \< 3500/mm3 * Platelet count \< 100000/mm3 * Hgb \< 8.5g/dl * Body weight \<45 kg * Alcohol abuse or drug abuse * Mental impairment * Uncooperative attitude
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Improvement of disease activity and preservation of visual acuity (monthly, at one and 2 years) | 2 years |
| Time to improvement and remission | 2 years |
Secondary
| Measure | Time frame |
|---|---|
| Number of ocular and non-ocular relapses (1 year, 2 years) | 2 years |
| Number of switches from one treatment to the other | 2 years |
| Laboratory values for inflammatory activity (monthly) | 2 years |
| Duration of the treatment-free period (second year) | 2 years |
| Quality of life for patients with low vision (monthly) | 2 years |
Countries
Germany
Outcome results
None listed