From the Guidelines
Treatment for Behcet's syndrome should be individualized according to age, gender, type and severity of organ involvement, and patients' preferences, with the goal of promptly suppressing inflammatory exacerbations and recurrences to prevent irreversible organ damage 1. The treatment approach should be multidisciplinary, involving close collaboration with specialists such as ophthalmologists, dermatologists, and vascular surgeons, as needed.
- For mucocutaneous manifestations, colchicine (0.5-1.2 mg daily) is commonly prescribed as first-line therapy, with topical steroids and anesthetics providing relief for oral and genital ulcers 1.
- For more severe disease, immunosuppressants such as azathioprine (2-3 mg/kg/day), cyclosporine (3-5 mg/kg/day), or mycophenolate mofetil (2-3 g/day) are necessary, with TNF inhibitors like infliximab (5 mg/kg IV at 0,2, and 6 weeks, then every 8 weeks) or adalimumab (40 mg subcutaneously every 2 weeks) effective for refractory cases, particularly for ocular, neurological, or vascular involvement 1.
- Apremilast has shown promise for oral ulcers at 30 mg twice daily, and other biologic agents such as interleukin-1 blockade with anakinra and canakinumab may provide partial benefit in patients with mucocutaneous involvement 1. The treatment should be continued long-term with periodic reassessment, as Behcet's is a chronic condition with unpredictable flares, and the goal is to suppress inflammation, prevent organ damage, and improve quality of life by targeting the dysregulated immune response that characterizes this autoinflammatory condition 1.
From the Research
Treatment Options for Behcet's Syndrome
The treatment for Behcet's syndrome can vary depending on the severity and manifestations of the disease. Some of the treatment options include:
- Colchicine: Studies have shown that colchicine can be effective in treating some of the manifestations of Behcet's syndrome, especially among women 2, 3, 4.
- Interferon alpha-2a: This treatment has been shown to be effective in patients with Behcet uveitis refractory to conventional immunosuppressive agents 5.
- Azathioprine: A controlled trial has demonstrated that azathioprine can be effective in controlling the progression of Behcet's syndrome, especially its most serious manifestation, eye disease 6.
- Corticosteroids: These are often used to treat acute attacks of ocular Behcet's disease, but may not be effective in preventing recurrent inflammation 5.
Specific Treatment Outcomes
Some specific treatment outcomes that have been reported in studies include:
- Reduced occurrence of genital ulcers, erythema nodosum, and arthritis in patients treated with colchicine 2.
- Improved visual acuity and reduced inflammation in patients with Behcet uveitis treated with interferon alpha-2a 5.
- Prevention of new eye disease and reduction in episodes of hypopyon uveitis in patients treated with azathioprine 6.
- Improvement in cutaneous manifestations such as oral aphthosis, erythema nodosum-like lesions, and genital erosions in patients treated with colchicine 4.