Response to: Silvestri E, Emmi G, Prisco D. Vascular Behçet's disease: new insights in the management of thrombosis. Expert Rev. Cardiovasc. Ther. 11(12), 1583–1585 (2013).
We read with interest the article ‘Vascular Behçet's disease: new insights in the management of thrombosis' by Silvestri et al. Citation[1]. The authors discussed the etiology and management of thrombosis in Behçet's disease (BD) and concluded that immunosuppressive therapy represents the treatment of choice for thrombosis in BD patients.
Endothelial dysfunction is considered to play an important role in the pathogenesis of vasculitis and thrombosis in BD Citation[2,3]. Therefore, there is a need to search for markers endothelial dysfunction and hemostasis (e.g., endocan and mean platelet volume) Citation[2,3].
Vascular involvement in BD affects veins and arteries and is more frequent and has a more severe course in young males Citation[4]. Male sex, younger age of onset and HLAB51 positivity are related to more vascular involvement Citation[5]. Silvestri et al. Citation[1]. did not consider the relation between vascular findings and age of onset, family history, positive pathergy test and other systemic manifestations.
Treatment with anti-TNF-α for BD is important due to the disadvantages of systemic therapy for BD Citation[6]. However, these agents have limitations Citation[7] and a large number of studies ended up with disappointing results Citation[8].
Adalimumab (a TNF-α antagonist) induced a rapid response in vascular BD patients with improved clinical and imaging findings and good tolerability and safety as presented in current article Citation[1]. However, many studies showed that infliximab (a TNF-α antagonist) was widely used and was safe Citation[1]. Although anti-TNF-α agents are a new option, treatment for vascular BD is refractory to conventional therapy.
Financial & competing interests disclosure
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.
No writing assistance was utilized in the production of this manuscript.
References
- Silvestri E, Emmi G, Prisco D. Vascular Behçet's disease: new insights in the management of thrombosis. Expert Rev Cardiovasc Ther 2013;11(12):1583-5
- Balta I, Balta S, Koryurek OM, et al. Mean platelet volume is associated with aortic arterial stiffness in patients with Behçet's disease without significant cardiovascular involvement. J Eur Acad Dermatol Venereol 2013. [Epub ahead of print]
- Balta I, Balta S, Koryurek OM, et al. Serum endocan levels as a marker of disease activity in patients with Behçet's disease. J Am Acad Dermatol 2014;70(2):291-6
- Balta I, Akbay G, Kalkan G, Eksioglu M. Demographic and clinical features of 521 Turkish patients with Behçet's disease. Int J Dermatol 2013. [Epub ahead of print]
- Alpsoy E, Zouboulis CC, Ehrlich GE. Mucocutaneous lesions of Behcet's disease. Yonsei Med J 2007;48(4):573-85
- Arida A, Fragiadaki K, Giavri E, Sfikakis PP. Anti-TNF agents for Behçet's disease: analysis of published data on 369 patients. Semin Arthritis Rheum 2011;41(1):61-70
- Smith CH, Anstey A V, Barker JNWN, et al. British Association of Dermatologists guidelines for use of biological interventions in psoriasis 2005. Br J Dermatol 2005;153(3):486-97
- Chung ES, Packer M, Lo KH, et al. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (AT TACH) trial. Circulation 2003;107(25):3133-40