Safety of systemic treatments for Behçet’s syndrome

ABSTRACT

Introduction

Treatment of Behçet’s syndrome (BS) is aimed at controlling all symptoms of such a complex disorder, ensuring a good quality of life and preventing life-threatening complications. A better understanding of the pathogenic role of different chemokines has improved our knowledge of BS and elicited a more specific use of therapies currently available, minimizing the burden of potential side-effects related to treatment.

Areas covered

This work aims to provide a detailed overview of the safety profile for current therapies available in the treatment of BS, focusing on the main side-effects, toxicity and contraindications.

Expert opinion

The greatest experience in the management of BS has been achieved with the employment of monoclonal anti-tumor necrosis factor antibodies which have been advocated for BS refractory manifestations. Moreover, interleukin-1 inhibitors have proven to be effective as well as safe, despite escalation of their dosage, especially to manage the most severe and difficult-to-treat ocular manifestations. However, general treatment of BS patients remains awkward as protean clinical features may respond differently to the same treatment or even worsen. Therefore, patients’ safety for therapies used in BS promotes the implementation of precision medicine, which could help targeting accurately the pathogenetic mechanisms concealed behind specific clinical phenotypes.

KEYWORDS:

• Autoinflammatory diseases
• anti-TNF agents
• il-1 inhibitors
• precision medicine
• behçet’s disease

Article highlights

• Behçet’s syndrome is a systemic inflammatory disorder currently classified at a crossroad between autoimmune and autoinflammatory disorders

• The management of Behçet’s syndrome is aimed at controlling symptoms, ensuring a good quality of life and preventing life-threatening complications

• The therapeutic approach of Behçet’s syndrome should be tailored on the disease severity and nature of organs involved, taking into account all potential toxic effects related to treatments

• A large experience has been achieved with monoclonal anti-TNF antibodies, but among the latest opportunities IL-1 inhibitors have been proven to be effective as well as safe especially to manage the most severe and difficult-to-treat phenotypes

• The safety of treatment for Behçet’s syndrome encourages the implementation of precision medicine, which could help targeting correctly the pathogenetic mechanism underlying each disease manifestation

This box summarizes key points contained in the article.

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert

testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This paper was not funded.