LONG-TERM FOLLOW-UP OF PATIENTS WITH CHRONIC UVEITIS AFFECTING THE POSTERIOR POLE TREATED WITH COMBINATION CYCLOSPORINE AND KETOCONAZOLE

Purpose: Combined treatment with cyclosporine (CsA) and ketoconazole i n autoimmune diseases has received little attention. This article repo rts the outcome of a pilot study in patients receiving combination the rapy for chronic uveitis affecting the posterior pole. Methods: Six pa tients initially treated with CsA and oral prednisone were observed pr ospectively on a combination of CsA, prednisone, and ketoconazole, Dat a were analyzed for visual acuity, number of flare-ups, and signs of s ystemic toxicity. Results: Patients were treated with CsA for a mean o f 13 months and CsA-ketoconazole for a mean of 33 months, Although pat ients had a number of flare-ups before combination therapy, only two f lare-ups in two patients were noted during combined therapy (P = 0.055 ). Three patients showed signs of renal toxicity on CsA, and two conti nued to show signs of toxicity on CsA-ketoconazone, One patient: stabi lized and maintained normal renal parameters. Using CsA, three of six patients showed elevations of systolic and diastolic pressure, After s witching to CsA-ketoconazole, the patient's systolic pressure remained unchanged, and the diastolic pressure returned to normal in all patie nts (P = 0.03), No toxicity related to ketoconazole alone was observed . Conclusion: A combination of CsA and ketoconazole is effective in th e treatment of chronic uveitis affecting the posterior pole. It appear s to be more effective in preventing recurrences than does CsA alone a nd does not lead to an increased risk of renal toxicity.