Treatment considerations for Behçet disease in the era of COVID ‐19: A narrative review

Abstract

COVID‐19 is a multisystem disease caused by severe acute respiratory syndrome coronavirus 2. It has been declared a pandemic by the World Health Organization in March 2020 and the outbreak still keeps its impacts worldwide. Behçet disease (BD) is a multi‐systemic vasculitis involving the skin, mucosa, eyes, joints, nervous system, cardiovascular system, and gastrointestinal system. The precise etiopathogenesis of the disorder is unknown but autoimmunity is believed to play a key role. A considerable part of patients with BD are susceptible to immunosuppression and are more predisposed to infections than healthy individuals. Hence, the protection and control measures for patients with BD against the COVID‐19 are of the utmost significance. Given the requirement to balance proper treatment of BD with the smallest risk of COVID‐19 associated mortality and morbidity, we aimed to review the management of BD in the era of the pandemic with a special focus on treatment considerations. According to current expert recommendations, there is no reason to discontinue topical treatments, colchicine, and nonsteroidal antiinflammatory drugs. Systemic steroids can be used at the lowest possible dose if needed. Ongoing treatments can be continued unchanged in patients with no suspected or confirmed COVID‐19. In cases with COVID‐19 symptoms, immunosuppressive and biological agents can be temporarily stopped but the decision should be made on a case by case basis. Considering their potential beneficial effects on the course of COVID‐19, colchicine, pentoxifylline, and dapsone can be considered as safe treatment options in BD.

Behçet uveitis: Current practice and future perspectives

“…Considering their potential beneficial effects on the course of COVID-19; colchicine, pentoxifylline, and dapsone can be considered as safe treatment options where indicated in BD. However, their role needs further evaluation ( 140 ). A retrospective analysis conducted by Bolletta et al showed that despite immunosuppression (or some patients having stopped treatment) along with Covid-19 infection in Behçet patients, few of their cohort required hospitalization, none was admitted to the ICU and eventually about one third had exacerbation in at least one of their BD-related symptoms ( 141 ).…”

Clinical course of Covid-19 in a cohort of patients with Behçet disease

“… 1 The pathogenesis is unclear but it has been established that immunological aberrations might play a main role in the BD development. 2 To date, there is limited evidence regarding the susceptibility and severity of Covid-19 infection is patients displaying BD 3 , 4 and only case series studies have explored the characteristics and outcomes of BD patients with Covid-2019. 5 , 6 …”

Adamantiades‐Behçet 's disease therapy: current treatment options and recommendations with regard to the COVID ‐19 pandemic

“…Among one of the most common known side effects are viral upper respiratory infections.With the COVID-19 outbreak, questions about disease-related immunosuppression and treatments in autoinflammatory diseases such as ABD have been posed. Elmas et al16 reviewed the recommendations from task force of the American College of Rheumatology, the European League Against Rheumatism and the International Society for Behçet disease stating that there is no reason to discontinue topical treatments, colchicine, and nonsteroidal anti-inflammatory drugs. Systemic steroids should be used at the lowest possible dose if needed and ongoing treatments can be continued unchanged in patients with no suspected or confirmed COVID-19 infection 16.…”

“…Elmas et al16 reviewed the recommendations from task force of the American College of Rheumatology, the European League Against Rheumatism and the International Society for Behçet disease stating that there is no reason to discontinue topical treatments, colchicine, and nonsteroidal anti-inflammatory drugs. Systemic steroids should be used at the lowest possible dose if needed and ongoing treatments can be continued unchanged in patients with no suspected or confirmed COVID-19 infection 16. In patients with COVID-19 symptoms, immunosuppressive and targeted drugs can be temporarily suspended, but the decision should be made on a case-by-case basis considering the potential beneficial effects on the course of COVID-19.…”

“…efficacy tial protective effects against cytokine storm observed in COVID-19 16. Suggestions on this issue include postponing the initiation of targeted therapy and continuing in case of non-suspected or nonconfirmed COVID-19 and evaluating on a case-by-case basis for patients with suspected or confirmed COVID-19 16.…”