Dermatologic Aspects of Behcet Disease Medication

Updated: May 13, 2019
  • Author: Amira M Elbendary, MBBCh, MSc; Chief Editor: William D James, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Corticosteroids have been used for all of the various clinical manifestations of Behçet disease. Anti-inflammatory and immunosuppressive agents are used to treat mucocutaneous lesions and arthritis associated with this disease.

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Corticosteroids

Class Summary

These agents modify the body's immune response to diverse stimuli and therefore have anti-inflammatory properties. In addition, they cause profound and varied metabolic effects. Corticosteroids are immunosuppressive and affect the replication, movement, and activity of virtually all cells involved with inflammation.

Prednisone (Deltasone, Meticorten, Orasone, Sterapred)

Prednisone is an immunosuppressant used for the treatment of autoimmune disorders. It may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Prednisone stabilizes lysosomal membranes and suppresses lymphocytes and antibody production.

Hydrocortisone (Solu-Cortef)

Hydrocortisone decreases inflammation by suppressing migration of PMN leukocytes and reversing increased capillary permeability.

Methylprednisolone (Medrol, Medrol Dosepak, Depo Medrol, Solu-Medrol)

Methylprednisolone exerts anti-inflammatory effects by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Methylprednisolone sodium succinate (Solu-Medrol) is highly soluble and has a rapid effect by intramuscular and intravenous routes. Depo Medrol is available as intramuscular, intra-articular, and intralesional injections.

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Nonsteroidal anti-inflammatory drugs

Class Summary

Although most NSAIDs are used primarily for their anti-inflammatory effects, they are effective analgesics and used to treat mild to moderate pain.

Ibuprofen (Ibuprin, Advil, Motrin)

Ibuprofen is the drug of choice for mild to moderate pain. It inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Antibiotics

Class Summary

These agents may be immunomodulatory.

Tetracycline (Sumycin)

Tetracycline inhibits bacterial protein synthesis by binding with 30S and, possibly, 50S ribosomal subunit(s). It has anti-inflammatory activity.

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Antiulcer agents

Class Summary

These agents are used for topical treatment for aphthae.

Amlexanox (Aphthasol)

Amlexanox is a topical mucosal anti-inflammatory agent paste at 5% concentration. The exact mechanism of action remains unknown. Begin treatment as soon as the patient notices symptoms.

Sucralfate (Carafate, Sulcrate)

Sucralfate forms a viscous adhesive substance that protects the GI lining against pepsin, peptic acid, and bile salts. Use it for short-term management of ulcers.

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Immunosuppressive agents

Class Summary

These agents are indicated for autoimmune diseases.

Azathioprine (Imuran)

Azathioprine antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. It may decrease proliferation of immune cells, which results in lower autoimmune activity.

Chlorambucil (Leukeran)

Chlorambucil alkylates and cross-links strands of DNA, inhibiting DNA replication and RNA transcription.

Tacrolimus (Prograf, Tacrine, FK506)

Tacrolimus suppresses humoral immunity (T lymphocyte) activity.

Cyclosporine (Sandimmune, Neoral)

Cyclosporine is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions such as delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft versus host disease for a variety of organs. For children and adults, base dosing on ideal body weight.

Cyclophosphamide (Cytoxan)

Cyclophosphamide is an alkylating agent that prevents cell division by cross-linking DNA strands and thus interfering with DNA replication. It has potent immunosuppressive activity. Cyclophosphamide is a prodrug that must be metabolized by the liver into active metabolites.

Cyclophosphamide has serious adverse effects, including bladder cancer, hemorrhagic cystitis, acute myeloid leukemia, and permanent infertility.

Closely monitor the CBC count with differential and platelets, BUN, and serum creatinine for signs and symptoms of hemorrhagic cystitis; also monitor liver function test results.

Colchicine (Colcrys, Mitigare)

Colchicine prevents activation, degranulation, and migration of neutrophils. It is contraindicated in patients with renal and hepatic impairment. Aplastic anemia and myelosuppression (eg, leukopenia, granulocytopenia, thrombocytopenia, pancytopenia) have been reported in patients receiving therapeutic doses.

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Immunomodulators

Class Summary

Immunomodulators are anti-inflammatory agents that modulate the immune system through a variety of mechanisms.

Thalidomide (Thalomid)

Thalidomide is an immunomodulatory agent that may suppress excessive production of TNF-alpha and may down-regulate selected cell-surface adhesion molecules involved in leukocyte migration.

Infliximab (Remicade)

Infliximab neutralizes cytokine TNF-alpha and inhibits its binding to the TNF-alpha receptor. Mix in 250 mL normal saline for infusion over 2 hours. It must be used with a low protein-binding filter (≥ 1.2 µm). It has been used off label for treating BD.

Etanercept (Enbrel)

Etanercept is a soluble p75 TNF receptor fusion protein (sTNFR-Ig). It inhibits TNF binding to cell surface receptors, which, in turn, decreases inflammatory and immune responses. It is off-label use for Behçet disease.

Adalimumab (Humira)

Adalimumab is a recombinant human anti-TNF-α IgG1 monoclonal antibody. It specifically binds to TNF-α and blocks its interaction with p55 and p75 cell surface TNF receptors and, accordingly, decreases the inflammatory and immune response. It is off-label use for Behçet disease.

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