Tocilizumab an effective substitute to anti-TNF agents in refractory Behçet disease

Tocilizumab (TCZ) may be used as an alternative treatment to antitumour necrosis factor (anti-TNF) agents for patients with Behçet disease (BD)-related uveitis and neurological manifestations, a recent study has shown.

To gauge the efficacy of TCZ in patients with refractory BD, a team of investigators conducted this multicentre study in 30 participants who met the international criteria for BD and were treated with TCZ at different European referral centres. Subsequently, they evaluated the clinical response of these individuals at 6 months from treatment initiation.

Of the patients with BD, 90 percent were refractory or intolerant to anti-TNF medications. Treatment with TCZ proved effective in 25 patients (83 percent), of whom 18 (60 percent) were complete responders and seven (23 percent) were partial responders.

Specifically, the complete response was achieved by 67 percent of patients with uveitis (18/30), 60 percent of those with neurological manifestations (5/30), and 42 percent of those with mucocutaneous or articular manifestations (7/30).

TCZ also provided a significant steroid-sparing effect that allowed patients to reduce their median daily prednisone dose from 20 to 9 mg at 6 months (p<0.001). In addition, the proportion of patients with BD requiring concomitant disease-modifying antirheumatic drugs decreased from 23 percent to 13 percent at 6 months.

Notably, six patients (20 percent) reported mild to moderate side effects, and three (10 percent) experienced serious adverse events (ie, pneumonia, intestinal perforation, and septicaemia), leading to treatment discontinuation in two patients.