1
|
Ucar D, Esatoglu SN, Cerme E, Batu-Oto B, Hamuryudan V, Seyahi E, Melikoglu M, Fresko I, Ozyazgan Y, Hatemi G. Mycophenolate mofetil may be an alternative for maintenance therapy of Behçet syndrome uveitis: a single-center retrospective analysis. Rheumatol Int 2023; 43:2099-2106. [PMID: 37592141 DOI: 10.1007/s00296-023-05420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
Experience with mycophenolate in uveitis due to Behçet syndrome (BS) is limited. Twelve patients with panuveitis or posterior uveitis who were started mycophenolate were included. Data on demographic characteristics, therapies, ocular attacks, and adverse events were extracted from patient charts. Seven patients with BS uveitis were prescribed mycophenolate for remission induction, of which 6 were refractory/intolerant to conventional immunosuppressives. Mycophenolate was combined with anti-TNFs in 3 patients, resulting in no further ocular attacks. Mycophenolate had to be stopped in the fourth patient due to adverse events. The remaining 3 patients continued to have ocular attacks and were switched to other agents without any drop in visual acuity. Among the 5 patients who were prescribed mycophenolate for maintenance, 2 were relapse free, but 3 experienced ocular attacks. One patient had an exacerbation of mucocutaneous lesions, and 2 experienced adverse events. Mycophenolate monotherapy may not be adequate for remission induction of refractory BS uveitis, but it can be a safe and effective alternative when combined with a biologic agent. It may also be an option for maintenance therapy.
Collapse
Affiliation(s)
- Didar Ucar
- Department of Ophthalmology, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey.
| | - Emir Cerme
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Bilge Batu-Oto
- Department of Ophthalmology, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Vedat Hamuryudan
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Emire Seyahi
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Melike Melikoglu
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Izzet Fresko
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Yılmaz Ozyazgan
- Department of Ophthalmology, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Gulen Hatemi
- Behçet's Disease Research Center, Istanbul University-Cerrahpaşa, Istanbul, Turkey
- Division of Rheumatology, Department of Internal Medicine, Cerrahpaşa Medical Faculty Istanbul University-Cerrahpaşa, Istanbul, Turkey
| |
Collapse
|
2
|
Ozguler Y, Esatoglu SN, Hatemi G. Current pharmacological solutions for Behçet's syndrome. Expert Opin Pharmacother 2023; 24:221-231. [PMID: 36458741 DOI: 10.1080/14656566.2022.2155047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Behçet's syndrome (BS) has a heterogeneous clinical phenotype, and its clinical manifestations may respond differently to drugs commonly used to treat BS. The type, dose, and duration of immunomodulatory, immunosuppressive, and biologic agents should be tailored individually. AREAS COVERED We reviewed the literature for articles on BS management that were published until June 2022 and summarized the management options in BS for each type of organ involvement. We aimed to cover all currently available pharmacological agents used in BS, as well as surgical and interventional options, focusing on recent evidence. EXPERT OPINION The management aims in BS are to preserve function and quality of life and to avoid damage. The choice of treatment modalities depends on the organs that are actively involved, the severity of that involvement, and prognostic factors. A treat-to-attack strategy would help improve long-term outcomes in BS.
Collapse
Affiliation(s)
- Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Behçet's Disease Research Center, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Behçet's Disease Research Center, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Behçet's Disease Research Center, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| |
Collapse
|
3
|
Tukek NB, Esatoglu SN, Hatemi G, Calıskan EB, Ozyazgan Y, Ucar D, Ozguler Y, Seyahi E, Melikoglu M, Uygunoglu U, Siva A, Kutlubay Z, Hatemi İ, Celik AF, Ugurlu S, Fresko I, Yurdakul S, Yazici H, Hamuryudan V. Emergence of New Manifestations During Infliximab Treatment in Behçet Syndrome. Rheumatology (Oxford) 2021; 61:3746-3753. [PMID: 34958357 DOI: 10.1093/rheumatology/keab944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/10/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Infliximab (IFX) is being increasingly used for the treatment of severe manifestations of Behçet syndrome (BS). However, emergence of new manifestations has also been occasionally reported during IFX treatment. We aimed to assess the frequency of new manifestations in our BS patients treated with IFX. METHODS A chart review was conducted to identify all BS patients treated with IFX in our clinic between 2004 and 2020. Demographic data, indications for IFX initiation, concomitant treatments, and outcomes were recorded. A new manifestation was defined as the emergence of a new organ involvement or mucocutaneous manifestation developing for the first time during IFX treatment or within 12 weeks after the last infusion of IFX. RESULTS Among our 282 patients who used IFX, 19 (7%) patients had developed a total of 23 new manifestations during a mean follow up of 20.0 ± 15.3 months. Patients with vascular involvement were more likely to develop a new manifestation (12/19, 63%). Initial manifestations that required IFX were in remission at the time of new manifestation in 14/19 patients. IFX treatment was intensified (n = 6) and/or glucocorticoids, immunosuppressives, or colchicine were added to IFX (n = 21). IFX was switched to another agent for the remaining manifestations (n = 8). These treatment modifications led to remission in 17/19 patients. CONCLUSION New manifestations developed during IFX treatment in 7% of our patients with BS. They could be managed by intensifying IFX treatment or adding other agents in majority of these manifestations.
Collapse
Affiliation(s)
- Nur Beyza Tukek
- Department of Internal Medicine, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Sinem Nihal Esatoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Gulen Hatemi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Elif Buse Calıskan
- Department of Internal Medicine, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Yılmaz Ozyazgan
- Department of Ophthalmology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Didar Ucar
- Department of Ophthalmology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Yesim Ozguler
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Melike Melikoglu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Ugur Uygunoglu
- Department of Neurology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Aksel Siva
- Department of Neurology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Zekayi Kutlubay
- Department of Dermatology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - İbrahim Hatemi
- Department of Gastroenterology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Aykut Ferhat Celik
- Department of Gastroenterology, Cerrahpasa Medical Faculty Istanbul University-Cerrahpasa Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Izzet Fresko
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Sebahattin Yurdakul
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Hasan Yazici
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| | - Vedat Hamuryudan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty
| |
Collapse
|
4
|
Marcuzzi A, Melloni E, Zauli G, Romani A, Secchiero P, Maximova N, Rimondi E. Autoinflammatory Diseases and Cytokine Storms-Imbalances of Innate and Adaptative Immunity. Int J Mol Sci 2021; 22:11241. [PMID: 34681901 PMCID: PMC8541037 DOI: 10.3390/ijms222011241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/06/2021] [Accepted: 10/12/2021] [Indexed: 02/07/2023] Open
Abstract
Innate and adaptive immune responses have a well-known link and represent the distinctive origins of several diseases, many of which may be the consequence of the loss of balance between these two responses. Indeed, autoinflammation and autoimmunity represent the two extremes of a continuous spectrum of pathologic conditions with numerous overlaps in different pathologies. A common characteristic of these dysregulations is represented by hyperinflammation, which is an exaggerated response of the immune system, especially involving white blood cells, macrophages, and inflammasome activation with the hyperproduction of cytokines in response to various triggering stimuli. Moreover, hyperinflammation is of great interest, as it is one of the main manifestations of COVID-19 infection, and the cytokine storm and its most important components are the targets of the pharmacological treatments used to combat COVID-19 damage. In this context, the purpose of our review is to provide a focus on the pathogenesis of autoinflammation and, in particular, of hyperinflammation in order to generate insights for the identification of new therapeutic targets and strategies.
Collapse
Affiliation(s)
- Annalisa Marcuzzi
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (A.M.); (G.Z.); (A.R.)
| | - Elisabetta Melloni
- LTTA Centre, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (E.R.)
| | - Giorgio Zauli
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (A.M.); (G.Z.); (A.R.)
| | - Arianna Romani
- Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (A.M.); (G.Z.); (A.R.)
| | - Paola Secchiero
- LTTA Centre, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (E.R.)
| | - Natalia Maximova
- Bone Marrow Transplant Unit, Institute for Maternal and Child Health-IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Erika Rimondi
- LTTA Centre, Department of Translational Medicine, University of Ferrara, 44121 Ferrara, Italy; (E.M.); (E.R.)
| |
Collapse
|
5
|
Ozguler Y, Ozdede A, Hatemi G. Recent Insights into the Management of Behçet Syndrome. J Inflamm Res 2021; 14:3429-3441. [PMID: 34321904 PMCID: PMC8313432 DOI: 10.2147/jir.s285400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 06/12/2021] [Indexed: 01/01/2023] Open
Abstract
Behçet syndrome (BS) is a multisystem vasculitis with variable vessel involvement that shows significant heterogeneity among patients in terms of clinical manifestations and disease course. Treatment choice and response are both influenced by this heterogeneity. BS treatments’ main goals are to quickly suppress inflammatory exacerbations and prevent relapses in order to protect organ functions and provide good quality of life. Besides the long-term experience with steroids and traditional immunosuppressives, biologic drugs, especially TNF inhibitors, have gained increasing importance in the treatment of BS over the years. In this review, we aimed to give an overview of the studies with conventional and biological drugs with proven efficacy in the treatment of BS, as well as promising drugs and current management strategies according to clinical phenotypes.
Collapse
Affiliation(s)
- Yesim Ozguler
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology and Behçet Disease Research Center, Istanbul, Turkey
| | - Ayse Ozdede
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology and Behçet Disease Research Center, Istanbul, Turkey
| | - Gulen Hatemi
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Rheumatology and Behçet Disease Research Center, Istanbul, Turkey
| |
Collapse
|