Background/Purpose:

Interferon (IFN) is an effective immune-modulatory agent in the medical management of eye disease of Behçet’s syndrome (BS). The agent is frequently associated with psychiatric adverse events, such as depressive disorders and suicide attempts are the most feared complication (1). We evaluated psychiatric status of a group of BS patients in whom IFN was used for the first time. As a control group we studied BS patients who started to use drugs other than IFN. 

Methods:

We studied BS patients who were seen between January 2012 and January 2014 at the Behçet’s syndrome outpatient clinic at Cerrahpaşa Medical Faculty. Patients who have a history of psychiatric illness, who use illicit drugs/alcohol, or who have parenchymal neurological involvement due to BS were not included in the study. Patients who started to use IFN for the first time (Group 1) and those who started to use drugs other than IFN (Group 2) were studied. Beck Depression Inventory (BDI) and Hospital Anxiety and Depression Scale (HADS) were used to measure status of depression at baseline and at week 12. 

Results: Group 1 included 17 (14 M, 3F) while Group 2 included 21 (13 M, 8 F) patients. During 12 weeks of follow-up, in Group 1, 6 patients used corticosteroids while 3 used colchicine in addition to IFN. Drugs that were started in Group 2, were azathioprine and cyclosporine combination (n=5), infliximab (n=2), methotrexate (n=1), azathoprine alone (n=6) and colchicine (n=7). Patients who used IFN were more likely to be male, to have longer disease duration and to have eye disease. Besides that, demographic, socio-economical and clinical characteristics were similar between the Groups. Among patients who used IFN, both BDI and HADS scores increased significantly after 3 months of follow-up. These scores did not change among patients who used other drugs (Table 2). (Table 1). Additionally, those who answered (I have thoughts of killing myself but I would not carry them out) to question no: 9 was more common in the IFN group at week 12 (35 % vs 10 %, p =0.053). These were 24 % vs 10 %, respectively, (p = 0.24) at baseline. 

Conclusion:

We found that the depression scales increased among IFN users after 12 weeks of follow-up compared to those who used other drugs. Additionally, after 12 weeks of follow-up, the frequency of those with suicidal ideation also increased among the IFN users. A recent survey indicated that BS patients with major organ involvement have already increased risk for depression and suicidal behavior (2). Physicians should be cautious while using IFN in BS, since this drug may further increase this risk. 

Table 1. Depression scales at baseline and at week 12

	Interferon, n = 17			Other drugs, n=21
	Baseline	Week 12	p	Baseline	Week 12	p
BDI, mean ± SD	11.4± 8.7	14.7±9.0	0.05	10.9±9.6	10.0±8.0	0.39
HADS, mean ± SD	5.0±4.5	7.1±4.2	0.04	5.5±4.2	5.3±3.2	0.71

BDI:  Beck Depression Inventory; HADS: Hospital Anxiety and Depression Scale

References:

1)      Schaefer M, et al.  Ann Intern Med. 2012;157:94-103.

2)      Uzunaslan D, et al.  Ann Rheum Dis 2013;72(Suppl3):927

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