Biological therapies for the treatment of Behçet’s disease-related uveitis beyond TNF-alpha blockade: a narrative review

Sota, Jurgen; Rigante, Donato; Lopalco, Giuseppe; Frediani, Bruno; Franceschini, Rossella; Gargiulo, Mauro; Iannone, Florenzo; Tosi, Gian Marco; Fabiani, Claudia; Cantarini, Luca

doi:10.1007/s00296-017-3775-5

Cited by 16 publications

(14 citation statements)

References 84 publications

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“…Secukinumab, binding IL-17A, was not successful in the treatment of 118 BD uveitis patients [43,46].…”

Section: Secukinumabmentioning

confidence: 95%

“…It has conflicting effects on OBD, none better than the placebo [48]. In other studies, malignancies were detected as well as adverse dermatologic events [43].…”

Section: Daclizumabmentioning

confidence: 97%

“…In a prospective controlled study of 83 patients (40 gevokizumab, 43 placebo), gevokizumab did not significantly affect the risk of occurrence of ocular exacerbations [42]. Blocking IL-1 might be safer than TNF-α inhibition, especially in areas with endemic tuberculosis [43].…”

Section: Interleukin-1 Inhibitorsmentioning

confidence: 98%

“…In 11 patients (20 eyes) with OBD refractory to conventional and biologic immunosuppressive drugs, TCZ 8 mg/ kg yielded rapid and maintained improvement with complete remission in eight patients, but TCZ was withdrawn in two cases because of severe infusion reaction and one due to arthritis impairment; only in 3 patients was TCZ effective for the extraocular manifestations of BD [45]. TCZ is ineffective on mucocutaneous BD and may cause worsening [43].…”

Section: Interleukin-6 Blockade Toceluzimab )Tcz(mentioning

confidence: 99%

“…Relapse was common and seemed to be related to a lower dosage. Severe side effects are common, including thyroid disease, infections, pneumonia, colitis due to clostridium difficile, autoimmune hemolytic anemia, and esophageal carcinoma [43,50].…”

Section: Alemtuzumabmentioning

confidence: 99%

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Refractory Ocular Behçet’s Disease; Outcome of Low Dose Infliximab

Ferdous¹,

Islam

Rahman³

et al. 2019

Rheum Res

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A 40-year-old woman had been suffering from many symptoms of Behçet's disease (BD) since her childhood without being diagnosed. She had recurrent mouth ulcers and, from the age of 21, vulva ulcers followed by loss of vision due to central retinitis and later also ankle arthritis. At the age of 31, uveitis due to BD was diagnosed. The fact that BD is often not recognized in Bangladesh explains the marked delay in her diagnosis. The initial central retinitis responded well to oral glucocorticoids, azathioprine, and cyclosporine, but in the course of time she became refractory to these agents. Considering her financial constraints, low dose Infliximab (3mg/kg) was used and resulted in a remarkable but temporal improvement. She went into remission by using a regimen of 5 mg/kg with increased interval time. In this article, the treatment options for ocular involvement in BD patients are summarized. Conclusions: In countries like Bangladesh, the diagnosis of Behçet's disease can be delayed. The early cooperation of dermatologists and eye surgeons with rheumatologists is necessary. Most cases of resistant ocular BD today can be successfully treated with anti-TNF agents. Promising results are published with other biologics for refractory and multi-resistant cases.

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“…Secukinumab, binding IL-17A, was not successful in the treatment of 118 BD uveitis patients [43,46].…”

Section: Secukinumabmentioning

confidence: 95%

“…It has conflicting effects on OBD, none better than the placebo [48]. In other studies, malignancies were detected as well as adverse dermatologic events [43].…”

Section: Daclizumabmentioning

confidence: 97%

Section: Interleukin-1 Inhibitorsmentioning

confidence: 98%

Section: Interleukin-6 Blockade Toceluzimab )Tcz(mentioning

confidence: 99%

Section: Alemtuzumabmentioning

confidence: 99%

See 3 more Smart Citations

Refractory Ocular Behçet’s Disease; Outcome of Low Dose Infliximab

Ferdous¹,

Islam

Rahman³

et al. 2019

Rheum Res

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Shaping the Future of Behçet’s Uveitis Management: A Comprehensive Review of Efficacy, Challenges, and Prospects of Biologic Therapies

Huang

et al. 2023

Ophthalmol Ther

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Behçet’s uveitis (BU), a vision-threatening manifestation of Behçet’s disease, poses substantial management challenges due to its chronic, relapsing nature and potential for vision loss. This review explores the role of biologic therapies in the treatment of BU, providing a comprehensive overview of their effectiveness, drawbacks, and future possibilities. Traditionally, management has relied heavily on corticosteroids and conventional immunosuppressants. However, their long-term use is frequently associated with systemic side effects and insufficient control of ocular inflammation. Biologic therapies, particularly TNF-alpha inhibitors like infliximab and adalimumab, have emerged as effective alternatives, offering better disease control and a more favorable safety profile. We critically evaluated these agents, noting their clinical efficacy in reducing inflammatory flares and preserving visual acuity. Despite their benefits, several issues remain. Accessibility, cost, and lack of long-term safety data limit their widespread use. Additionally, individual variability in treatment response necessitates personalized therapeutic strategies. Recent research has shown promise in addressing these challenges, with the emergence of novel biologic agents and personalized medicine approaches. In summary, biologic therapies represent a paradigm shift in BU management, contributing to better patient outcomes. Yet, there are significant challenges to be overcome. As we move forward, continued research, development of novel biologic agents, and a precision medicine approach will shape the future landscape of BU treatment.

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