Jun Woong Moon; Su Jeong Song; Bo Kyung Koo; Young Min Cho; Hyeong Gon Yu

doi:10.3341/jkos.2007.48.12.1654

Journal List > J Korean Ophthalmol Soc > v.48(12) > 1007986

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Moon, Song, Koo, Cho, and Yu: Short-term Effects and Side Effects of Tacrolimus for Behçet's Uveitis

Original Article

J Korean Ophthalmol Soc 2007;48(12):1654-1662.

Published online: 30 August 2007

DOI: https://doi.org/10.3341/jkos.2007.48.12.1654

Short-term Effects and Side Effects of Tacrolimus for Behçet's Uveitis

Jun Woong Moon, M.D.¹, Su Jeong Song, M.D.¹, Bo Kyung Koo, M.D.², Young Min Cho, M.D.², Hyeong Gon Yu, M.D., Ph.D.¹

¹Department of Ophthalmology, College of Medicine and Medical Research Center, Seoul National University, Seoul, Korea

²Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

Address reprint requests to Hyeong Ggon Yu, M.D. Ph.D., Department of Ophthalmology, College of Medicine and Medical Research Center, Seoul National University, #28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea Tel: 82-2-2072-2438, Fax: 82-2-741-3187, E-mail: hgonyu@snu.ac.kr

Received 27 February 2007 Accepted 31 July 2007

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical effects and side effects of Tacrolimus for ocular Behçet's disease.

Methods

Eight patients (male: 5, age: 35±7.5 (25-48) years) with Behçet's uveitis, refractory posterior uveitis unresponsive to combination treatment with cyclosporine, azathioprine, and oral steroid or significant cyclosporine-related adverse effects were recruited prospectively, and cyclosporine was switched to Tacrolimus. Visual acuity, degree of anterior chamber, and vitreous haze were compared before the conversion and three months after. Oral glucose tolerance, plasma insulin, cholesterol, creatinine, and aspartate (AST)/alanine aminotransferase (ALT) were measured to monitor systemic effects.

Results

Visual acuity did not change significantly after conversion to Tacrolimus. Anterior chamber (seven patients) and vitreous (four patients) inflammation were found before conversion and decreased or disappeared after conversion. Overall plasma levels of glucose, insulin, creatinine, and AST/ALT were similar before and after conversion. However, cholesterol was significantly decreased after conversion (p=0.028). One patient developed diabetes mellitus.

Conclusions

Tacrolimus may be effective for Behçet's uveitis unresponsive to or intolerable of traditional treatments. In addition, periodic monitoring for side effects, such as hyperglycemia and diabetes mellitus, may be necessary.

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Keywords: Behcet's uveitis, Cyclosporine, Tacrolimus

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Figure 1.

Comparison of plasma glucose concentrations (oral glucose tolerance test) before and 3 months after conversion from cyclosporine to Tacrolimus. No significant differences are found at all points.

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Figure 2.

Comparison of plasma insulin concentrations during oral glucose tolerance test before and 3 months after conversion from cyclosporine to Tacrolimus. No significant differences are found at all points.

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Table 1.

Patient data

	Sex	Age	Baseline VA (R/L)	Reasons for vonversion from cyclosporine to tacrolimus	previous systemic medication
1	F	38	0.04/FC	osteopenia, nausea, vomiting	PD 10 mg gd
					AZA 100 mg bid
					CSA 100 mg bid
2	M	27	0.4/0.4	hypertension	PD 10 mg gd
					AZA 100 mg bid
					CSA 100 mg bid
3	F	30	1.2/0.3	refractory uveitis	PD 10 mg gd
					AZA 100 mg bid
					CSA 100 mg bid
4	M	25	0.06/0.02	refractory uveitis	PD 10 mg gd
					AZA 100 mg bid
					CSA 100 mg bid
5	M	39	HM/0.2	burning sensation	PD 10 mg gd
					AZA 100 mg bid
					CSA 50 mg bid
6	F	37	0.3/HM	refractory retinal vasculitis	AZA 100 mg bid
					CSA 100 mg bid
7	M	48	HM/0.1	refractory uveitis	PD 15 mg gd
					AZA 100 mg bid
					CSA 100 mg bid
8	M	38	0.3/0.5	facial swelling	PD 30 mg gd
					AZA 100 mg bid
					CSA 100 mg bid

FC: finger count, HM: hand motion, PD: prednisone, AZA: azathioprine, CSA: cyclosporine.

Table 2.

Results of treatment

		VA		Inflammatory activity				TDM		Tacrolimus adverse effects
		pre	post	anterior chamber		Viterous		1 Mo	3 Mo
		pre	post	pre	post	pre	post	1 Mo	3 Mo
1	R	0.04	0.04	+3	0	0	0	3.2	4.5	Diabetes mellitus
	L	FC	FC	0	0	0	0
2	R	0.4	0.4	0	0	0	0	5.6	6.8
	L	0.4	0.4	0	0	0	0
3	R	1.2	1.2	+1/2	0	+1/2	0	4.5	4.9	Gastric soreness
	L	0.3	0.4	+1	0	+2	+ 1/2
4	R	0.06	0.04	+2	0	+2	+ 1/2	1.2	1.7	Polyuria
	L	0.02	0.04	+1/2	0	0	0
5	R	HM	HM	0	0	0	0	6.1	1.5
	L	0.2	0.08	+0.5	0	0	0
6	R	0.3	0.3	0	0	+1	0	7.3	5.5
	L	HM	HM	+1/2	0	+2	1
7	R	HM	FC	+1	+1	+1/2	+ 1/2	6.2	6.7	Facial flush
	L	0.1	0.15	0	+ 1/2	+2	+ 1/2
8	R	0.3	0.4	+2	+1	0	0	8.1	6.2
	L	0.5	0.5	+1	+ 1/2	0	0

VA=visual acuity; TDM=therapeutic drug monitoring; R=right eye; L=left eye; FC=finger counting; HM=hand motion.

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