Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine Hospital, Fevzi Çakmak Mahallesi, Ust-Kaynarca, Pendik, Istanbul, Turkey.
Curr Rheumatol Rep. 2021 May 20;23(6):47. doi: 10.1007/s11926-021-01011-z.
To assess current management of Behcet's disease (BD). Controversies on therapeutic approaches to different manifestations, whether conventional immunosuppressives (IS) or biologic agents, should be chosen, and options for refractory disease are discussed.
Glucocorticoids are still the main agents for remission-induction and azathioprine the first-line conventional IS in maintenance phase to prevent relapses of major organ involvement. Apremilast is shown to be a safe and effective option approved by the FDA for oral ulcers. Large case series confirmed the efficacy and safety of TNFα inhibitors and Interferon-α. Promising results are observed with IL-1 inhibitors, ustekinumab, secukinumab, and tocilizumab for refractory BD. Although both conventional IS and biologic agents are effectively used to suppress inflammation in BD, there is still an unmet need for clear therapeutic strategies in the management for different manifestations. Further controlled studies with new biologic agents, anticoagulants and the benefit of concomitant IS usage with biologics are needed to optimize the management of BD.
评估白塞病（BD）的当前治疗方法。应该选择针对不同表现的治疗方法，包括传统免疫抑制剂（IS）或生物制剂，并且讨论难治性疾病的选择。
糖皮质激素仍然是诱导缓解的主要药物，而硫唑嘌呤是维持期预防主要器官受累复发的一线传统 IS。阿普米司特已被 FDA 批准用于口腔溃疡，被证明是一种安全有效的选择。大型病例系列证实了 TNFα 抑制剂和干扰素-α的疗效和安全性。对于难治性 BD，IL-1 抑制剂、乌司奴单抗、司库奇尤单抗和托珠单抗观察到有希望的结果。尽管传统 IS 和生物制剂都有效地用于抑制 BD 中的炎症，但在不同表现的治疗策略方面仍存在未满足的需求。需要进一步进行新的生物制剂、抗凝剂的对照研究，以及 IS 与生物制剂联合使用的益处，以优化 BD 的管理。
