Management of Behcet's syndrome

Purpose of reviewCurrent trends in the management of Behcet's syndrome will be reviewed in this article.Recent findingsBiologic agents have gained increasing importance over the years in the management of Behcet's syndrome. Long-term results of observational studies have shown that anti-tumor necrosis factor agents may be effective in Behcet's syndrome patients with refractory eye involvement. Case series reporting about use of anti-tumor necrosis factor agents in vascular and gastrointestinal involvement have also shown good results. Caution is required for infectious complications with these agents. Apremilast is an immunomodulatory agent that works through phosphodiesterase 4 inhibition. A randomized controlled trial has shown that it is effective for the management of oral and genital ulcers and is generally well tolerated.SummaryThe outcome of Behcet's syndrome with major organ involvement has improved with more effective management strategies, especially with the use of biologic agents in severe cases. Controlled trials are needed to guide physicians in making treatment decisions

Recent Insights into the Management of Behcet Syndrome

Behcet 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

Assessing the possible association of anti-TNF use with new malignancies: A neglected methodological consideration

PurposeWhether anti-TNF agents increase, malignancy risk remains debated. The potential problems with comparing the number of observed malignancies in anti-TNF treated cohorts to number of expected malignancies in national cancer registries could have been an important issue. National registries give expected number of malignancies per organ involved regardless of if this is a secondary or a higher malignancy while anti-TNF agents are not or are sparingly used in patients with an existing or history of a malignancy. This results in a biased standardized incidence ratio (SIR). We aimed to formally look at the presence and the magnitude of this bias in published work