新しい免疫抑制剤FK 506の難治性ぶどう膜炎に対する使用経験

Clinical evaluation of a new immunosuppressant FK 506 in refractory uveitis

　わが国で開発された新しい免疫抑制剤FK 506の難治性ぶどう膜炎に対する治療効果を検討した。症例は副腎皮質ステロイド，シクロスポリンやコルヒチンなどが無効であったベーチェット病5例，特発性網膜血管炎3例の8例であった。FK 506は0.15〜0.2mg／kg／dayの用量でこれらのぶどう膜炎に有効であった。腎機能障害を1例に認めたが，その他重篤な副作用はなく，FK 506は内因性の難治性ぶどう膜炎の治療に有効であると考えられた。

We treated 8 patients with refractory uveitis with peroral FK 506, a new immunosuppressive agent. The series comprised 5 patients with Behçet's dis-ease and 3 with idiopathic retinal vasculitis. They failed to respond to previous treatment with sys-temic corticosteroids or imunosuppressants includ-ing cyclosporine. During the observation period of 21.6±7.8 weeks (mean±SD) with 0.05,0.1,0.15 or 0.2 mg/kg/day of FK 506 b. i. d., the visual acu-ity increased in 44% of eyes and decreased in 12%.Improvements in visual acuity and uveitis activity were dose-dependent, as the doses of 0.05 and 0.1 mg/kg/day were ineffective and higher doses were effective in most cases. Uveitis improved in 6 cases and remained unchanged in 2. One patient with Behçet's disease converted from systemic cyclospo-rine developed moderate renal impairment after 4 weeks of FK 506 necessitating discontinuation of the therapy at the 8 th week, although the uveitis activity and visual acuity showed marked improve-ments. No severe side effects were seen in the other 7 cases. The present finding suggests the efficacy of FK 506 for refractory uveitis.