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Zeidan MJ, Saadoun D, Garrido M, Klatzmann D, Six A, Cacoub P. Behçet's disease physiopathology: a contemporary review. AUTOIMMUNITY HIGHLIGHTS 2016; 7:4. [PMID: 26868128 PMCID: PMC4751097 DOI: 10.1007/s13317-016-0074-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/09/2015] [Indexed: 12/13/2022]
Abstract
Behçet’s disease, also known as the Silk Road Disease, is a rare systemic vasculitis disorder of unknown etiology. Recurrent attacks of acute inflammation characterize Behçet’s disease. Frequent oral aphthous ulcers, genital ulcers, skin lesions and ocular lesions are the most common manifestations. Inflammation is typically self-limiting in time and relapsing episodes of clinical manifestations represent a hallmark of Behçet’s disease. Other less frequent yet severe manifestations that have a major prognostic impact involve the eyes, the central nervous system, the main large vessels and the gastrointestinal tract. Behçet’s disease has a heterogeneous onset and is associated with significant morbidity and premature mortality. This study presents a current immunological review of the disease and provides a synopsis of clinical aspects and treatment options.
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Affiliation(s)
- Mohamad J Zeidan
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France
- INSERM, UMR_S 959, 75013, Paris, France
- CNRS, FRE3632, 75005, Paris, France
| | - David Saadoun
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France
- INSERM, UMR_S 959, 75013, Paris, France
- CNRS, FRE3632, 75005, Paris, France
- Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Marlene Garrido
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France
- INSERM, UMR_S 959, 75013, Paris, France
- CNRS, FRE3632, 75005, Paris, France
| | - David Klatzmann
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France
- INSERM, UMR_S 959, 75013, Paris, France
- CNRS, FRE3632, 75005, Paris, France
| | - Adrien Six
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France
- INSERM, UMR_S 959, 75013, Paris, France
- CNRS, FRE3632, 75005, Paris, France
| | - Patrice Cacoub
- Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, 75005, Paris, France.
- INSERM, UMR_S 959, 75013, Paris, France.
- CNRS, FRE3632, 75005, Paris, France.
- Department of Internal Medicine and Clinical Immunology, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013, Paris, France.
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Takeuchi M, Kezuka T, Sugita S, Keino H, Namba K, Kaburaki T, Maruyama K, Nakai K, Hijioka K, Shibuya E, Komae K, Hori J, Ohguro N, Sonoda KH, Mizuki N, Okada AA, Ishibashi T, Goto H, Mochizuki M. Evaluation of the Long-Term Efficacy and Safety of Infliximab Treatment for Uveitis in Behçet's Disease. Ophthalmology 2014; 121:1877-84. [DOI: 10.1016/j.ophtha.2014.04.042] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Revised: 02/05/2014] [Accepted: 04/18/2014] [Indexed: 01/01/2023] Open
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Abstract
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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Affiliation(s)
| | - Thurayya Arayssi
- Weill Cornell Medical College-Qatar, Education City, PO Box 24144, Doha, Qatar
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Heo J, Sepah YJ, Yohannan J, Renner M, Akhtar A, Gregory A, Shulman M, Do DV, Nguyen QD. The role of biologic agents in the management of non-infectious uveitis. Expert Opin Biol Ther 2012; 12:995-1008. [PMID: 22780091 DOI: 10.1517/14712598.2012.688021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Uveitis is an intriguing group of disorders characterized by inflammation of the uveal tract. Due to the potential grave consequences of the disease process, it is important to assess the various therapeutic options available for treating uveitis, and their outcomes. AREAS COVERED This review discusses the use of conventional agents in the management of uveitis, including discussion of the molecular and clinical properties of corticosteroids, antimetabolites, calcineurin inhibitors and alkylating agents and their side effects. In addition, it also discusses the molecular and clinical properties of novel biologic agents and their side effects. Moreover, recommendations as to when biologic agents should be employed are also discussed. EXPERT OPINION We recommend that in general (except in selected cases of Adamantiades-Behçet's disease) biologics should not be used as a first-line therapy for uveitis due to inconvenience, high cost, and potential immunosuppressive effects. However, many biologics are potent in inducing drug-free remission of uveitis and may be employed to manage recurrent diseases or diseases not responsive to conventional agents.
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Affiliation(s)
- Jangwon Heo
- Johns Hopkins University School of Medicine, Wilmer Eye Institute, Johns Hopkins Hospital, Retinal Imaging Research and Reading Center, 600 North Wolfe Street, Maumenee 745, Baltimore, MD 21287, USA
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Yoshida A, Kaburaki T, Okinaga K, Takamoto M, Kawashima H, Fujino Y. Clinical background comparison of patients with and without ocular inflammatory attacks after initiation of infliximab therapy. Jpn J Ophthalmol 2012; 56:536-43. [PMID: 23053631 DOI: 10.1007/s10384-012-0182-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Accepted: 07/19/2012] [Indexed: 12/11/2022]
Abstract
PURPOSE To examine the factors affecting the efficacy of infliximab (IFX) as a treatment for uveitis in Behçet's disease. METHODS Clinical records of 29 patients with refractory uveoretinitis were examined retrospectively for the period between 6 months before the initiation of IFX therapy to 12 months thereafter. The patients were divided into two groups based on the absence (Group 1) or occurrence (Group 2) of ocular inflammatory attacks during the observation period after IFX therapy, and the clinical records of the groups were compared RESULTS The mean age at onset of ocular inflammation in Group 1 patients (n = 17) was lower than that in Group 2 patients (n = 12) (p = 0.023). Compared to Group 2 patients, the period from onset to IFX therapy in Group 1 was longer (p = 0.037), and the frequency of ocular inflammatory attacks before IFX therapy was lower (p = 0.013). The rates of ocular fundus attacks before IFX therapy were 0.82 ± 0.28 in Group 1 and 0.96 ± 0.10 in Group 2 (p = 0.040). Three of 33 (9.1 %) eyes in Group 1 and nine of 24 eyes (37.5 %) in Group 2 had an improved best-corrected visual acuity of >0.2 logarithm of the minimal angle resolution (p < 0.01). CONCLUSIONS Patients in Group 1 tended to have fewer intraocular attacks (fewer fundus attacks in particular) prior to IFX therapy and have a longer period from onset of intraocular inflammation to IFX therapy. The improvement of the BCVA in Group 2 tended to be better.
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Affiliation(s)
- Atsushi Yoshida
- Department of Ophthalmology, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi 329-0498, Japan.
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Abstract
Autoimmune uveitis (AIU) is among the leading causes of preventable blindness. It can be isolated, precede, or appear in the course of a systemic autoimmune inflammatory disease. When suspected, AIU should be promptly referred to an ophthalmologist for proper anatomic classification and local treatment. In recurrent and chronic forms, systemic treatment should be started, usually with corticosteroids and immunesuppressors. In cases of lack of efficacy or intolerance, biologic agents such as monoclonal antibodies anti-TNF (infliximab and adalimumab) and others (abatacept and tocilizumab) are being used. The clinical diseases associated to AIU and the experimental models have helped in the understanding of the pathogenic mechanism. The treatment schemes have improved, and recent advances in basic knowledge are leading to even more effective targeted therapies.
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Cantini F, Niccoli L, Nannini C, Kaloudi O, Cassarà E, Susini M, Lenzetti I. Efficacy of infliximab in refractory Behçet's disease-associated and idiopathic posterior segment uveitis: a prospective, follow-up study of 50 patients. Biologics 2011; 6:5-12. [PMID: 22291462 PMCID: PMC3266861 DOI: 10.2147/btt.s27343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the long-term efficacy of infliximab in patients with refractory Behçet's disease (BD)-associated and idiopathic posterior uveitis (PU). METHODS Single center, prospective, 6-year duration, follow-up study on 50 consecutive patients (20 [40%] males and 30 [60%] females with a mean age of 37.5 ± 12.3 years) with refractory BD-associated PU (36 patients) and idiopathic PU (14 patients) who had failed at least one immunosuppressive drug. At baseline, patients received prednisone 1 mg/kg/day with rapid tapering and infliximab infusions (5 mg/kg) at weeks 0, 2, 6, and every 8 weeks thereafter. Nonresponders after the third infusion withdrew from the study. Primary outcome measures were visual acuity (VA) value improvement compared to baseline. Secondary outcome measures were proportion of patients with VA improvement from baseline; proportion of patients achieving disease remission; number of PU flare-ups; and incidence of adverse events. RESULTS At the final follow-up, mean right and left eye VA respectively increased from 0.57 ± 0.31 at baseline to 0.68 ± 0.33 (P = 0.048) and from 0.67 ± 0.28 to 0.76 ± 0.27 (P = 0.047). None of the patients had VA worsening and new onset ocular complications. A complete response of PU was recorded in 34/50 (68%) patients and partial response in 11/50 (22%). Five patients were nonresponders and withdrew from the study after the third infusion. A significant reduction of ocular attacks and of the proportion of patients with cystoid macular edema was observed. No differences in infliximab efficacy was recorded between patients with BD-associated and idiopathic PU. No serious adverse events occurred. The mean follow-up duration was 36.8 months. CONCLUSION Long-term infliximab therapy was equally effective and safe with a significant VA gain in refractory BD-associated and idiopathic PU.
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Affiliation(s)
- Fabrizio Cantini
- Second Division of Internal Medicine, Rheumatology Unit, Prato, Italy
| | - Laura Niccoli
- Second Division of Internal Medicine, Rheumatology Unit, Prato, Italy
| | - Carlotta Nannini
- Second Division of Internal Medicine, Rheumatology Unit, Prato, Italy
| | - Olga Kaloudi
- Second Division of Internal Medicine, Rheumatology Unit, Prato, Italy
| | - Emanuele Cassarà
- Second Division of Internal Medicine, Rheumatology Unit, Prato, Italy
| | | | - Ivo Lenzetti
- Division of Ophthalmology, Prato Hospital, Prato, Italy
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Kraus CL, Culican SM. Use of biologic agents in ocular manifestations of rheumatic disease. Int J Rheumatol 2011; 2012:203819. [PMID: 22229035 PMCID: PMC3246731 DOI: 10.1155/2012/203819] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 10/31/2011] [Indexed: 01/14/2023] Open
Abstract
Biologic agents have dramatically shifted the treatment paradigm for rheumatic disease. Use of these agents can decrease disease burden, allow the patient to be weaned from corticosteroids, and reduce the likelihood of relapse. Eye disease associated with rheumatic conditions may present with a wide range of signs and symptoms. This coexisting pathology should not be overlooked and should be considered a reason for initiation or continuation of biologic therapy. Additionally, many of the ocular manifestations of rheumatic disease respond preferentially to specific targeting molecules. This paper summarizes the available studies on the use, efficacy, and safety of biologic agents in the treatment of ocular manifestations of rheumatic disease.
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Affiliation(s)
- Courtney L. Kraus
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Susan M. Culican
- Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA
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Anti-tumor necrosis factor monoclonal antibody therapy for intestinal Behçet disease in an adolescent. J Pediatr Gastroenterol Nutr 2011; 53:686-8. [PMID: 22134497 DOI: 10.1097/mpg.0b013e318223652f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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Benitah NR, Sobrin L, Papaliodis GN. The Use of Biologic Agents in the Treatment of Ocular Manifestations of Behcet’s Disease. Semin Ophthalmol 2011; 26:295-303. [DOI: 10.3109/08820538.2011.588665] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Patel R, Cafardi JM, Patel N, Sami N, Cafardi JA. Tumor necrosis factor biologics beyond psoriasis in dermatology. Expert Opin Biol Ther 2011; 11:1341-59. [PMID: 21651458 DOI: 10.1517/14712598.2011.590798] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION TNF-α is a cytokine essential for immune response and its receptors has been shown to be dysregulated in a variety of diseases including psoriasis vulgaris. There are a number of TNF-α inhibitors approved for psoriasis, however there is a growing body of literature supporting their use in a wide variety of dermatological conditions. AREAS COVERED The use of biologic TNF-α antagonists in conditions for which they have not yet been approved by the FDA ('off-label' uses) and the literature that supports the most appropriate agents and conditions for use. A PubMed/MEDLINE search was performed with the keywords 'TNFα antagonist', 'biologic therapy', 'off-label' and 'unapproved'. The list of references and citing articles of the articles retrieved were also used as sources. This complete list was evaluated for inclusion, based on relevance to the proposed goal of this review. EXPERT OPINION There are a large number of conditions for which biologic antagonists of TNFα are effective, beyond those already approved by the FDA. The various agents vary in their efficacy in treatment, with infliximab consistently the most effective, particularly in granulomatous diseases. Although effectiveness varies among these conditions, biologic antagonists of TNF-α are promising for the treatment of these diseases.
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Affiliation(s)
- Raj Patel
- University of Alabama at Birmingham, Dermatology, 1530 Third Avenue South, EFH suite 414 Birmingham, AL 35294, USA
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Ocular inflammation in Behçet disease: incidence of ocular complications and of loss of visual acuity. Am J Ophthalmol 2008; 146:828-36. [PMID: 18708181 DOI: 10.1016/j.ajo.2008.06.019] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 06/16/2008] [Accepted: 06/17/2008] [Indexed: 12/29/2022]
Abstract
PURPOSE To estimate the risk of structural ocular complications and loss of visual acuity (VA) in cases of Behçet disease (BD) and to evaluate potential risk and protective factors for these events. DESIGN Retrospective cohort study. METHODS A total of 168 consecutive patients with BD-associated ocular inflammation treated at five academic center ocular inflammation subspecialty practices were included. Clinical data for these patients were ascertained by standardized chart review. Main outcome measures included VA, structural ocular complications of inflammation, and intraocular pressure (IOP). RESULTS Over a median follow-up of 1.05 years, the incidence of specific structural complications and IOP disturbances were common: the incidence rate of any ocular complication was 0.45 per eye-year (EY). Rates of loss of VA to 20/50 or worse and to 20/200 or worse were 0.12 per EY and 0.09 per EY, respectively. Risk factors for loss of VA during follow-up were persistent inflammatory activity, presence of posterior synechiae, presence of hypotony, and presence of elevated IOP. In a time-dependent analysis, current activity of ocular inflammation was associated with an increased risk of loss of VA to 20/50 or worse (relative risk [RR], 2.45; 95% confidence interval [CI], 1.1 to 5.5; P = .03) and to 20/200 or worse (RR, 2.67; 95% CI, 1.2 to 5.8; P = .01). CONCLUSIONS Loss of VA and occurrence of ocular complications were common in patients with ocular inflammation associated with BD, even with aggressive therapy. Ongoing inflammation during follow-up, presence or occurrence of posterior synechiae, hypotony, and elevated IOP were associated with an increased risk of loss of VA.
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