New approaches in the treatment of Adamantiades-Behçet's disease.

Abstract

PURPOSE OF REVIEW:

To update clinicians on the recent advances in the treatment of Adamantiades-Behçet's disease.

RECENT FINDINGS:

Interferon-alpha-2a and infliximab have proved able to induce prompt remission in the vast majority of Adamantiades-Behçet's patients with DMARD-resistant uveoretinitis. Efficacy of interferon-alpha-2a has also been reported for mucocutaneous lesions, arthritis, and (more anecdotally) for neuro-Behçet, while results from small case series suggest that infliximab is beneficial for mucocutaneous lesions and (more anecdotally) for arthritis and gastro-intestinal manifestations. Two cases of neuro-Behçet treated with infliximab showed a complete resolution. Finally, in a randomized controlled trial of patients with mucocutaneous, arthritic manifestations, or both, etanercept effectively suppressed mucocutaneous lesions.A different approach is tolerization by oral administration of the 336-351 peptide of the human heat shock protein 60 (thought to have a pathogenic role in Adamantiades-Behçet's disease-associated uveitis), linked to recombinant cholera B-toxin B-subunit. Preliminary results have shown that tolerization is safe and effective in preventing relapses of uveitis.

SUMMARY:

Biologic agents have proved effective in patients resistant to conventional treatment. However, disease subsets characterized by severe morbidity and mortality such as vasculo-Behçet and neuro-Behçet still pose major therapeutic challenges. Further studies are needed to devise better treatment strategies for severe Adamantiades-Behçet's disease.

• Authors: Nicolò Pipitone, Ignazio Olivieri, Fabrizio Cantini, Giovanni Triolo, Carlo Salvarani
• Journal: Current opinion in rheumatology (Curr Opin Rheumatol) Vol. 18 Issue 1 Pg. 3-9 (Jan 2006) ISSN: 1040-8711 [Print] United States
• PMID: 16344613 (Publication Type: Journal Article, Review)

Chemical References

• Antibodies, Monoclonal
• Chaperonin 60
• Immunoglobulin G
• Immunologic Factors
• Interferon alpha-2
• Interferon-alpha
• Receptors, Tumor Necrosis Factor
• Recombinant Proteins
• Infliximab
• Etanercept

Topics

• Antibodies, Monoclonal (therapeutic use)
• Behcet Syndrome (drug therapy)
• Chaperonin 60 (therapeutic use)
• Etanercept
• Humans
• Immunoglobulin G (therapeutic use)
• Immunologic Factors (therapeutic use)
• Infliximab
• Interferon alpha-2
• Interferon-alpha (therapeutic use)
• Receptors, Tumor Necrosis Factor (therapeutic use)
• Recombinant Proteins