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High‐dose intravenous steroid pulse therapy in ocular involvement of Behcet's disease: a pilot double‐blind controlled study
Author(s) -
Mohammadi Mastaneh,
Shahram Farhad,
Shams Hormoz,
Akhlaghi Massoomeh,
Ashofteh Farimah,
Davatchi Fereydoun
Publication year - 2017
Publication title -
international journal of rheumatic diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.795
H-Index - 41
eISSN - 1756-185X
pISSN - 1756-1841
DOI - 10.1111/1756-185x.13095
Subject(s) - medicine , behcet's disease , methylprednisolone , placebo , retinal vasculitis , prednisolone , azathioprine , corticosteroid , uveitis , cyclophosphamide , gastroenterology , vasculitis , chemotherapy , ophthalmology , disease , pathology , alternative medicine
Aim To evaluate the efficacy of intravenous high‐dose pulses of methylprednisolone ( IVPM ) for treatment of ocular involvement in Behcet's disease ( BD ). Method In a double‐blind control study, we randomized BD patients with posterior uveitis ( PU ) and/or retinal vasculitis ( RV ) into two groups. They received either IVPM (1000 mg methylprednisolone) or placebo for 3 consecutive days. Both groups received combination therapy with IV cyclophosphamide, azathioprine and prednisolone for 6 months. Visual acuity ( VA ), Disease Activity Index ( DAI ) based on the inflammatory state of each section of each eye, total inflammatory ( TIAI ) and adjusted DAI ( TADAI ) for each patient were calculated. The comparisons were done by paired t‐ and Mann–Whitney U‐ test. Results Seventeen patients in each group completed the treatment. The mean VA improved from 0.5 to 0.8 ( P < 0.1) for the study and from 0.6 to 0.7 ( P < 0.02) for the placebo group. The difference was significant ( P = 0.01). The comparison showed no significant difference regarding DAI improvement in other items ( P > 0.2): PU , 1.9 to 0.5 ( P < 0.0006) versus 2.3 to 0.8 ( P < 0.0002); RV : 4.0 to 1.1 ( P < 0.0004) versus 3.1 to 1.1 ( P < 0.0005); TIAI : 23 to 5.7 ( P < 0.0002) versus 24.8 to 8.4 ( P < 0.003); TADAI : 24.1 to 7.3 ( P < 0.0002) versus 25.9 to 7.9 ( P < 0.004). We had one flare in the study versus seven in the placebo group ( P < 0.005). Conclusion Adding high‐dose intravenous steroid pulse therapy to conventional combination therapy for severe ocular lesions of BD may cause better improvement on VA and fewer flares during the first 6 months of treatment.