Skip to main content
SpringerLink
Log in

Therapie des Morbus Behçet gestern und heute

Treatment of Behçet’s disease yesterday and today

  • Leitthema
  • Published:
Der Ophthalmologe Aims and scope Submit manuscript

Zusammenfassung

Die Uveitis bei Morbus Behçet zählt zu den intraokularen Entzündungen mit schlechter Visusprognose. Auch eine frühe Therapie mit Kortikosteroiden und Immunsuppressiva konnte eine Erblindung der Patienten häufig nicht verhindern. Mit den sog. Biologika stehen uns heute glücklicherweise hoch wirksame Substanzen zur Verfügung, mit denen rasch Reizfreiheit erzielt sowie weitere Rezidive effektiv vermieden werden können. Kürzlich formulierte eine interdisziplinäre Expertengruppe im Auftrag der EULAR 9 Empfehlungen zur Therapie des Morbus Behçet, von denen 2 die Augenbeteiligung betreffen. Interferon-α besitzt gegenüber den TNF-α-Antagonisten den Vorteil, dass auch nach Beendigung der Therapie ein hoher Prozentsatz der Patienten langfristig in Remission verbleibt. In unserem Beitrag möchten wir einen aktuellen Überblick über die medikamentöse Therapie des okulären Morbus Behçet geben.

Abstract

Uveitis due to Behçet’s disease belongs to those types of intraocular inflammation with a poor visual prognosis. Despite early treatment with corticosteroids and immunosuppressants, patients often become blind. With the so-called biologicals, highly effective drugs are now available which very rapidly lead to quiescence of intraocular inflammation and which successfully avoid further uveitis relapse. Recently, an interdisciplinary group of experts on behalf of the EULAR developed nine recommendations for the treatment of Behçet’s disease. Two of these address ocular involvement. Compared with TNF alpha antagonists, interferon alpha offers the advantage that even after cessation of treatment a high percentage of patients remain in remission. This article provides an overview on current medical treatment of ocular Behçet’s disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Arida A, Fragiadaki K, Giavri E, Sfikakis PP (2011) Anti-TNF agents for Behçet’s disease: analysis of published data on 369 patients. Semin Arthritis Rheum 41:61–70

    Article  PubMed  CAS  Google Scholar 

  2. BenEzra D, Cohen E, Chajek T et al (1988) Evaluation of conventional therapy versus cyclosporine A in Behçet’s syndrome. Transplant Proc 20:136–143

    PubMed  CAS  Google Scholar 

  3. Buggage RR, Levy-Clarke G, Sen HN et al (2007) A double-masked, randomized study to investigate the safety and efficacy of daclizumab to treat the ocular complications related to Behçet’s disease. Ocul Immunol Inflamm 15:63–70

    Article  PubMed  CAS  Google Scholar 

  4. Deuter CME, Kötter I, Wallace GR et al (2008) Behçet’s disease: ocular effects and treatment. Prog Retin Eye Res 27:111–136

    Article  PubMed  CAS  Google Scholar 

  5. Deuter CME, Zierhut M, Möhle A et al (2010) Long-term remissions after cessation of interferon alpha treatment in patients with severe uveitis due to Behçet’s disease. Arthritis Rheum 62:2796–2805

    Article  PubMed  CAS  Google Scholar 

  6. Gueudry J, Wechsler B, Terrada C et al (2008) Long-term efficacy and safety of low-dose interferon alpha2a therapy in severe uveitis associated with Behçet disease. Am J Ophthalmol 146:837–844

    Article  PubMed  CAS  Google Scholar 

  7. Gül A, Tugal-Tutkun I, Dinarello CA et al (2012) Interleukin-1β-regulating antibody XOMA 052 (gevokizumab) in the treatment of acute exacerbations of resistant uveitis of Behçet’s disease: an open-label pilot study. Ann Rheum Dis 71:563–566

    Article  PubMed  Google Scholar 

  8. Hamuryudan V, Kötter I (2010) Medical management of Behçet’s syndrome. In: Yazici Y, Yazici H (Hrsg) Behçet’s syndrome. Springer, Berlin Heidelberg New York Tokyo, S 317–338

  9. Hatemi G, Silman A, Bang D et al (2008) EULAR recommendations for the management of Behçet disease. Ann Rheum Dis 67:1656–1662

    Article  PubMed  CAS  Google Scholar 

  10. Kötter I, Günaydin I, Batra M et al (2006) CNS involvement occurs more frequently in patients with Behçet’s disease under cyclosporin A (CSA) than under other medications – results of a retrospective analysis of 117 cases. Clin Rheumatol 25:482–486

    Article  PubMed  Google Scholar 

  11. Kötter I, Günaydin I, Zierhut M, Stübiger N (2004) The use of interferon α in Behçet disease: review of the literature. Semin Arthritis Rheum 33:320–335

    Article  PubMed  Google Scholar 

  12. Kötter I, Zierhut M, Eckstein AK et al (2003) Human recombinant interferon alfa-2a for the treatment of Behçet’s disease with sight threatening posterior or panuveitis. Br J Ophthalmol 87:423–431

    Article  PubMed  Google Scholar 

  13. Kotake S, Higashi K, Yoshikawa K et al (1999) Central nervous system symptoms in patients with Behçet disease receiving cyclosporine therapy. Ophthalmology 106:586–589

    Article  PubMed  CAS  Google Scholar 

  14. Krause L, Altenburg A, Pleyer U et al (2008) Longterm visual prognosis of patients with ocular Adamantiades-Behçet’s disease treated with interferon-α-2a. J Rheumatol 35:896–903

    PubMed  CAS  Google Scholar 

  15. Masuda K, Nakajima A, Urayama A et al (1989) Double-masked trial of cyclosporine versus colchicine and long-term open study of cyclosporin in Behçet’s disease. Lancet 1:1093–1096

    Article  PubMed  CAS  Google Scholar 

  16. Ozyazgan Y, Yurdakul S, Yazici H et al (1992) Low dose cyclosporine A versus pulsed cyclophosphamide in Behçet’s syndrome: a single masked trial. Br J Ophthalmol 76:241–243

    Article  PubMed  CAS  Google Scholar 

  17. Saddredini S, Noshad H, Molaeefard M, Noshad R (2008) Treatment of retinal vasculitis in Behçet’s disease with rituximab. Mod Rheumatol 18:306–308

    Article  Google Scholar 

  18. Sfikakis PP, Markomichelakis N, Alpsoy E et al (2007) Anti-TNF therapy in the management of Behçet’s disease – review and basis for ecommendations. Rheumatology (Oxford) 46:736–741

    Google Scholar 

  19. Sfikakis PP, Theodossiadis PG, Katsiari CG et al (2001) Effect of infliximab on sight-threatening panuveitis in Behçet’s disease. Lancet 358:295–296

    Article  PubMed  CAS  Google Scholar 

  20. Sobaci G, Erdem U, Durukan AH et al (2010) Safety and effectiveness of interferon alpha-2a in treatment of patients with Behçet’s uveitis refractory to conventional treatments. Ophthalmology 117:1430–1435

    Article  PubMed  Google Scholar 

  21. Tugal-Tutkun I, Mudun A, Urgancioglu M et al (2005) Efficacy of infliximab in the treatment of uveitis that is resistant to treatment with the combination of azathioprine, cyclosporine, and corticosteroids in Behçet’s disease. Arthritis Rheum 52:2478–2484

    Article  PubMed  CAS  Google Scholar 

  22. Yamada Y, Sugita S, Tanaka H et al (2010) Comparison of infliximab versus ciclosporin during the initial 6-month treatment period in Behçet disease. Br J Ophthalmol 94:284–288

    Article  PubMed  Google Scholar 

  23. Yazici H, Ozyagan Y (1999) Medical management of Behçet’s syndrome. Dev Ophthalmol 31:118–131

    Article  PubMed  CAS  Google Scholar 

  24. Yazici H, Pazarli H, Barnes CG et al (1990) A controlled trial of azathioprine in Behçet’s syndrome. N Engl J Med 322:281–285

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Department für Augenheilkunde, Universitäts-Augenklinik, Universitätsklinikum Tübingen, Schleichstr. 12–16, 72076, Tübingen, Deutschland

    C.M.E. Deuter, M. Zierhut & D. Doycheva

  2. Medizinische Klinik Abteilung II, Universitätsklinikum Tübingen, Tübingen, Deutschland

    I. Kötter

  3. Zentrum für Interdisziplinäre Klinische Immunologie, Rheumatologie und Autoimmunerkrankungen (INDIRA), Universitätsklinikum Tübingen, Tübingen, Deutschland

    C.M.E. Deuter, M. Zierhut, D. Doycheva & I. Kötter

Authors
  1. C.M.E. Deuter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Zierhut
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Doycheva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Kötter
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C.M.E. Deuter.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Deuter, C., Zierhut, M., Doycheva, D. et al. Therapie des Morbus Behçet gestern und heute. Ophthalmologe 109, 568–574 (2012). https://doi.org/10.1007/s00347-011-2504-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00347-011-2504-9

Schlüsselwörter

Keywords

Search

Navigation