Azathioprine in severe uveitis of Behçet's disease

Saadoun, David; Wechsler, B.; Terrada, C.; Hajage, David; Huong, D. Lê Thi; Resche-Rigon, Matthieu; Cassoux, Nathalie; Hoang, P. Le; Amoura, Zahir; Bodaghi, Bahram; Cacoub, Patrice

doi:10.1002/acr.20308

Cited by 85 publications

(45 citation statements)

References 17 publications

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“…Azathioprine Eye involvement RCT [Yazici et al 1990] Retrospective study [Saadoun et al 2010] Vascular disease RCT [Yazici et al 1990] GI involvement Retrospective study Neuro-Behçet Case series [Kurtuncu et al 2008] Mycophenolate mofetil Neuro-Behçet Case series [Shugaiv et al 2011] Cyclosporine A Eye involvement RCTs [Ozyazgan et al 1992;Masuda et al 1989;BenEzra et al 1988] Open-label studies [Ermakova, 2003;Ozdal et al 2002;Fujino et al 1999;Sullu et al 1998;Whitcup et al 1994;Sajjadi et al 1994;Pacor et al 1994;Hayasaka et al 1994;Atmaca and Batioglu, 1994;Chavis et al 1992; [Mochizuki et al 1991[Mochizuki et al , 1992Ishioka et al 1994] Cyclophosphamide Vascular disease Retrospective studies [Hamuryudan et al 1994[Hamuryudan et al , 2004 Neuro-Behçet Retrospective study...…”

Section: ]mentioning

confidence: 99%

“…A 7-year follow up of these patients [Hamuryudan et al 1997] demonstrated that patients originally allocated to the azathioprine group had less blindness (NNT = 4; 95% CI 1.9-43.9) and less development of new eye disease (NNT = 3; 95% CI 1.3-3.3). More recently, a retrospective study [Saadoun et al 2010] evaluated the efficacy of azathioprine combined with prednisolone in 157 consecutive patients with BD with active posterior uveitis or panuveitis. After a mean follow up of 71.5 months, 93% of the patients had either partial or complete response.…”

Section: Azathioprine Ocular Diseasementioning

confidence: 99%

See 1 more Smart Citation

Update on the therapy of Behçet disease

Saleh

Arayssi

2014

Therapeutic Advances in Chronic Disease

111

101

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Behçet disease is a chronic inflammatory systemic disorder, characterized by a relapsing and remitting course. It manifests with oral and genital ulcerations, skin lesions, uveitis, and vascular, central nervous system and gastrointestinal involvement. The main histopathological finding is a widespread vasculitis of the arteries and veins of any size. The cause of this disease is presumed to be multifactorial involving infectious triggers, genetic predisposition, and dysregulation of the immune system. As the clinical expression of Behçet disease is heterogeneous, pharmacological therapy is variable and depends largely on the severity of the disease and organ involvement. Treatment of Behçet disease continues to be based largely on anecdotal case reports, case series, and a few randomized clinical trials.

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Section: ]mentioning

confidence: 99%

Section: Azathioprine Ocular Diseasementioning

confidence: 99%

Update on the therapy of Behçet disease

Saleh

Arayssi

2014

Therapeutic Advances in Chronic Disease

111

101

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“…Pregnancy is often associated with a flare in 20% of the cases. In the postpartum remission, rates are up to 61% with an exacerbation of about 17% [1]. Also, severe neurologic or vascular disease flares have been reported, which raises the question about the influence of Behçet disease on the outcome of pregnancy (2) .…”

Section: Discussionmentioning

confidence: 99%

“…It is more common in the Middle East and the Mediterranean area. NeuroBehcet develops over a time interval after the onset of Behçet disease, the neurological involvement can be severe, and its evolution can be fatal (1) .…”

Section: Introductionmentioning

confidence: 99%

Neuro Behçet and Pregnancy: a Case Review

Belkouchi¹,

Abounouh²,

Elhassouni³

et al. 2017

IAM

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Behçet's syndrome is a multiple system chronic inflammatory disorder, characterized by the recurrence of genital and oral ulceration, and in most cases, iridocyclitis. The causes of this disease are largely unknown, but are related to autoimmune factors, and can usually lead to thrombotic complications and different sorts of vasculitis. Behçet's syndrome flares sometimes occur during pregnancy, and thus to complications for to the mother and the fetus. Neuro Behçet is a rare and fatal complication that occurs many years after the installation of the main symptoms. Our case is about a 33 years old patient diagnosed with Behçet disease five years ago, under colchicine, who was affected with lateral cerebral thrombosis. Pregnancy associated with Neurobehçet needs to be carefully planned and followed up with strict checkups of the mother and the fetus. The treatments have to be adjusted to avoid any malformations to the fetus and complications to the mother.

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“…The current treatment practice for BD focuses on symptomatic treatment, including the prevention of irreversible organ damage and death, suppression of mucocutaneous or joint manifestations, and improvement of the patients' quality of life. The main treatment for systemic manifestations in BD is tailored based upon the pattern and severity of symptoms and includes corticosteroids together with steroid-sparing immune-modulators, such as azathioprine or cyclosporine, and more recently biological therapies (3)(4)(5)(6). Patient selection for biological therapy has, in general, been based upon individual consultant opinion and several open-label studies.…”

Section: Introductionmentioning

confidence: 99%

The real-world use of different anti-tumor necrosis factor agents in a Northern European population of patients with Behçet’s disease

Adeeb¹,

Ng²,

Khan³

et al. 2017

Eur J Rheumatol

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Objective: The aim of this study was to evaluate prescription practices, treatment responses, and serious adverse events of anti-tumor necrosis factor (anti-TNF) therapies in Behçet's disease (BD). Material and Methods: Patients with BD satisfying the International Study Group for Behçet's Disease or the International Criteria for Behçet's Disease criteria were recruited from a regional rheumatology program. The choice of anti-TNF, treatment response, and adverse events were specified. Response to treatment was evaluated by the detection of new, worsening, or improving clinical features, and management was benchmarked against current The European League against Rheumatism recommendations published in 2008. Results: Out of the total of 22 patients, 18 (81.9%) received anti-TNF therapies, resulting in 14 (77.8%) complete and 4 (22.2%) partial remissions. Eleven (61.1%) patients switched to a second anti-TNF, seven patients (38.9%) required three different anti-TNFs, and one required a fourth anti-TNF to achieve remission. Two patients required retrials before their disease was controlled. Anti-TNF therapy included infliximab (IFX): n=15, 83.3%; adalimumab (ADA): n=9, 50%; golimumab: n=6, 33.3%; etanercept: n=5, 27.8%; and certolizumab pegol: n=2, 11.1%. Secondary failure was observed with IFX (4/15; 26.7%) and ADA (2/9; 22.2%), and these (100%) were manifested after at least 2 years of treatment. Five patients with potentially life-threatening laryngeal involvement received anti-TNFs successfully halting disease progression. Five allergic reactions were encountered, and five serious infections were documented involving three patients aged ≥ 50 years, all with the use of IFX. Conclusion: Anti-TNF therapy induced a clinical response in 100% patients and achieved complete remission in 78% patients. It provides an effective alternative option for first-line therapy in severe BD where many conventional immunosuppressive therapies fail. Patients with BD who do not respond to one or more anti-TNFs because of intolerance, ineffectiveness, or secondary failure might benefit from switching to another drug from this group or even a retrial of a previously administered anti-TNF because unsatisfactory results with one biologic is not predictive of response to another anti-TNF. For those with potentially life-threatening destructive laryngeal manifestation, anti-TNF as a first choice may be considered.

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Azathioprine in severe uveitis of Behçet's disease

Cited by 85 publications

References 17 publications

Update on the therapy of Behçet disease

Update on the therapy of Behçet disease

Neuro Behçet and Pregnancy: a Case Review

The real-world use of different anti-tumor necrosis factor agents in a Northern European population of patients with Behçet’s disease

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