Medication Summary
Treatment is aimed toward individual symptoms as they occur. Medication is given to reduce the inflammatory response.
Anti-inflammatory agents
Class Summary
Systemically interfere with events leading to inflammation.
Colchicine
Decreases leukocyte motility and phagocytosis in inflammatory responses. Used to prevent recurrent attacks.
Corticosteroids
Class Summary
Systemic corticosteroids are not useful in the long-term management of Behçet disease. Some authors use corticosteroids as initial therapy, especially in mild cases. However, other authorities state that corticosteroids have no role in the treatment of Behçet disease. Systemic corticosteroids should be used only for short periods and probably in combination with immunosuppressive therapy. Topical or sub-Tenon corticosteroids have proven effective.
Prednisone (Deltasone, Orasone, Meticorten)
May decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Use smallest dose for shortest duration to achieve therapeutic effect. Use in combination with immunosuppressive therapy. Also may use pulse IV therapy over a 3-d period.
Prednisolone acetate 1% (Pred Forte)
Treats acute inflammations following eye surgery or other types of insults to eye. Decreases inflammation and corneal neovascularization. Suppresses migration of polymorphonuclear leukocytes and reverses increased capillary permeability. In cases of bacterial infections, concomitant use of anti-infective agents is mandatory; if signs and symptoms do not improve after 2 days, reevaluate patient. Dosing may be reduced, but advise patients not to discontinue therapy prematurely.
Useful for acute iritis. Frequent dosing (q1-2h) useful initially, followed by gradual taper.
Immunosuppressive agents
Class Summary
Used to treat acute attacks and reduce frequency of recurrences.
Cyclophosphamide (Cytoxan, Neosar)
Chemically related to nitrogen mustards. As an alkylating agent, the mechanism of action of the active metabolites may involve cross-linking of DNA, which may interfere with growth of cells. DOC for severe Behçet disease. Must be administered by an experienced clinician.
Chlorambucil (Leukeran)
Aromatic nitrogen mustard derivative that acts as a bifunctional alkylating agent. Alkylation takes place through the formation of a highly reactive ethylenimonium radical. Probable mode of action involves cross-linkage of the ethylenimonium derivative between 2 strands of helical DNA and subsequent interference with replication.
Cyclosporine (Sandimmune)
Potent immunosuppressive agent with narrow therapeutic range, shown to decrease number and severity of attacks of Behçet disease.
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Treatment modalities currently used in Behçet disease according to clinical symptoms.
