Management of severe complications in Behçet’s disease with TNF inhibitors

ABSTRACT

Introduction: The efficacy of anti-TNFα agents has been recently evaluated in many studies in Behçet’s disease (BD), particularly in ocular and life-threatening manifestations such as neurological and vascular disease.

Areas covered: The following article aims to summarize the currently available efficacy and safety data of anti-TNFα agents in BD.

Expert opinion: Most studies have shown dramatic and rapid efficacy with anti-TNFα agents on the main BD-associated issues including posterior uveitis, gastro-intestinal and neurological complications as well as major vessel disease. Experts in the field do recommend the use of anti-TNF agents (either infliximab or adalimumab) as a first-line therapy in severe posterior uveitis in BD and now use anti-TNFα treatment in BD-associated life threatening manifestations. However, data is mainly based on retrospective cohorts or open-label prospective studies. Controlled studies (versus conventional immunosuppressants such as azathioprine and cyclophosphamide) are warranted to properly evaluate their efficacy as first line therapeutic in life-threatening manifestations of BD.

KEYWORDS:

• Anti-TNFα agents
• infliximab (IFX)
• adalimumab (ADA)
• Behcet’s disease (BD)
• treatment

Article Highlights

• There are many studies providing data on the efficacy of anti-TNF α treatment in BD uveitis and life-threatening manifestations.

• International experts recommend the use of anti-TNF agents (either infliximab or adalimumab) as a first-line therapy in severe posterior uveitis of BD.

• Many experts in the field now use anti-TNFα treatment in these life threatening manifestations such as major vessel disease, central nervous system involvement or gastrointestinal disease.

• In BD, safety seems to be similar to that observed in other diseases.

• Controlled studies (versus conventional immunosuppressants) are warranted to evaluate their efficacy as a first line therapy in life-threatening manifestations of BD.

This box summarizes key points contained in the article.

Declaration of interest

AC Desbois has received speaker’s fees from Gilead Sciences Inc. D Saadoun has acted as a consultant, received honoraria, acted on advisory boards and/or received speaker’s fees from AstraZeneca, Medimmune and Gilead Sciences Inc, AbbVie, Roche and Bristol-Myers Squibb. P Cacoub has received consultancies, honoraria, advisory board and speakers’ fees from AbbVie, AstraZeneca, Bayer, Boehringer Ingelheim, Gilead Sciences Inc, GlaxoSmithKline, Janssen Pharmaceuticals, Merck Sharp Dohme, Pfizer Inc, Roche, Servier, and Vifor Pharma. P Cacoub is an inventor of a patent application owned by his academic institution and licensed to ILTOO pharma, a biotechnology company developing low dose IL-2 in autoimmune diseases, in which he holds shares. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This manuscript has not been funded.