Interferon α2a Versus Cyclosporine for Refractory Behçet's Disease Uveitis

Detailed description: Both CsA and IFNα2a have been shown to be effective for long-term control of BDU, however, randomized prospective comparative studies are scarce, particularly in East Asian populations. Our preliminary data gave us the impression that IFNα2a might be more effectiveness than CsA in long-term control of refractory BDU, and this study aimed to compare their effectiveness and safety profiles in a well-designed prospective study. Refractory BDU is defined as relapse of posterior or pan- uveitis with at least 10mg daily prednisone (or equivalent) and one traditional immunomodulatory treatment (IMT) agents. The acute attack is controlled with large dose oral corticosteroid (60mg daily prednisone) for 4 weeks, and then the patients are randomly assigned to the IFN arm and the CsA arm, in which patients are treated with IFNα2a (3×10\^6 IU qd for 4 weeks and qod thereafter) and CsA (100mg bid), respectively, along with a fixed tapering regimen of corticosteroid. Patients were followed up until relapse, or for 12 months.

• Interferon Alfa-2A (Drug): 3×10\^6 IU， subcutaneous or intramuscular injection, qd for × 4 weeks, and qod thereafter
• Cyclosporine Pill (Drug): 100mg， oral, bid

Primary outcomes

• Response rate [Within the 12-month follow-up period]: Percentage of participants who achieve complete remission or partial remission
• Complete remission rate [Within the 12-month follow-up period]: Percentage of participants who achieve complete remission without relapse of posterior or pan-uveitis
• Tolerance rate [Within the 12-month follow-up period]: Percentage of participants who adhere to the treatment without severe side effects

Secondary outcomes

• Time to reach complete remission [Within the 12-month follow-up period]: The time from the therapy initiation to a complete absence of ocular inflammation for complete responders
• Duration of relapse-free [within the 12-month follow-up period]: The duration between the therapy initiation to the relapse for partial responders and nonresponders
• BCVA [Within the 12-month follow-up period]: Changes of best-corrected visual acuity
• BOS24 score [Within the 12-month follow-up period]: Score of ocular inflammation using the Behcet disease ocular attack score 24 (BOS24)
• Glucocorticoid-sparing effect [Within the 12-month follow-up period]: Changes of corticosteroid dosage
• Incidence of adverse effects [Within the 12-month follow-up period]: Incidence of adverse effects
• Incidence of significant abnormal changes in vital signs or laboratory test results [Within the 12-month follow-up period]: Incidence of significant abnormal changes in vital signs or laboratory test results
• Adverse effects profile [Within the 12-month follow-up period]: Types of drug adverse effects

Sex: All, ages: 18 Years to 65 Years

Inclusion Criteria:

* Refractory BDU patients fulfilling the International Criteria for Behçet's disease (ICBD) published in 2013 with recent recurrence of pan- or posterior uveitis;
* The patient should be on ≥10mg/d oral prednisone or equivalent with at least one of the following IMT agents: cyclophosphamide≥50mg/d, CsA≥100mg/d, azathioprine≥50mg/d, methotrexate≥15mg/w, mycophenolate≥1000mg/d, tacrolimus≥2mg/d.

Exclusion Criteria:

* Previous treatment with interferon-α;
* Pregnancy, breast feeding women;
* Malignancy;
* Renal impairment (creatinine > 1.5 mg/dl);
* Uncontrolled hypertension or diabetes;
* Depression or other psychic disorders;
* History of acute or chronic inflammatory joint or autoimmune disease;
* Patients with severe extra-ocular involvement other than oral/genital ulcer and skin involvement;
* Organ or bone marrow transplant recipient, cardiac failure > NYHA III;
* Acute liver disease with ALT or SGPT 2x above normal;
* White blood cell count < 3500/mm\^3;
* Platelet count < 100000/mm\^3;
* Hgb < 8.5g/dl;
* T-SPOT TB: ≥200 SFCs per 10\^6 PBMC;
* Active peptic ulcer, systemic or local infection, moderate to severe osteoporosis or other contraindications of large dose corticosteroids;
* Previous intolerance to CsA;
* Other severe ocular diseases or intraocular surgery within 3 months;
* Media opacity precluding a clear view of the fundus;
* Positive screen test for HBV, HCV, HIV infection or syphilis;
* Body weight <45 kg;
* Alcohol abuse or drug abuse;
* Mental impairment;
* Uncooperative attitude.