[Comparative study of the treatment of autoimmune uveitis with prednisone and with cyclophosphamide and azathioprine]

BACKGROUND

Uveitis is considered an autoimmune disease that compromises any internal structure of eye; its main characteristic is the inflammatory process inside eye.

OBJECTIVE

To determine which is the most effective therapy for autoimmune uveitis: cyclophosphamide, azathioprine and prednisone.

MATERIAL AND METHODS

Patients between 16 and 65 years old, both sexes, with diagnosis of autoimmune uveitis (anterior, intermediate and posterior). Patients were submitted to clinical history, physical exploration and clinical studies. Their written informed consent was requested and patients were divided into three treatment groups: group 1 (azathioprine) 14 (42.4%) patients; group 2 (prednisone) 15 (45.5%) patients, and group 3 (cyclophosphamide) 4 (12.1%) patients. Blind double observations and assessments at day 0 and at week 1, 2, 4 and 6 of treatment were performed.

RESULTS

Out of 33 patients studied, 13 (39.4%) were male and 20 (60.6%) female, the most frequent diagnosis was uveitis due to Toxoplasmosis. With azathioprine 100 mg/day it was observed a better and faster control of inflammation after 6.2 weeks at anterior chamber with p < 0.0001, with prednisone, p = .000, and with cyclophosphamide, p = 135. In the posterior chamber there were no significant inflammatory changes for three groups with p = .353. The most frequent adverse effects occurred in the prednisone group with p < 0.05 in 24.2%, characterized by neutropenia and urinary tract infection.

CONCLUSIONS

Azathioprine, 100 mg/day oral during six weeks, is considered the most effective drug, since it demonstrated significant diminishment of inflammatory process in less time, with less side effects and with conservation of visual acuity.

Histamine as a therapeutic alternative in migraine prophylaxis: a randomized, placebo-controlled, double-blind study

This study was undertaken to test the efficacy of the subcutaneous administration (twice a week) of consecutively increasing doses of histamine (0.1 to 1 ng) in the prophylaxis of migraine, compared to placebo, under a controlled, double-blind, clinical trial for 12 weeks. Sixty patients were selected, under criteria established by the International Headache Society (both sexes, 18 to 65 years of age, a migraine history of more than 1 year, one to six headache attacks per month), having no additional neurological or cardiovascular pathologies, and after a complete clinical and laboratory examination including computer-assisted tomography. Comparison between the groups treated with placebo (n = 30) and histamine (n = 30), on data collected for the 4th, 8th, and 12th weeks of treatment, revealed that histamine exerted a significantly (P < .0001) greater reduction (compared to placebo) in the frequency, intensity, and duration of migraine attacks, as well as on the use of rescue medication. No significant (P > .05) adverse experiences or side effects in either group developed to impede the blinding of the study or the planned order of events. We conclude that the subcutaneous administration of histamine (at very low doses) constitutes a novel and effective therapeutic approach in migraine prophylaxis, aimed at limiting excessive inflammatory responses involved in the pathophysiology of migraine through the activation of H3 receptors.