Which immunosuppressive agents are reported to be successful in treating severe ocular Behcets disease?
• Topical (anterior uveitis), intraocular, and systemic corticosteroids (posterior involvement).
• Azathioprine, 2.5 mg/kg per day should be combined with corticosteroids for posterior involvement (uveitis, retina, optic nerve).
• Anti-TNFα therapy: Infliximab (5 mg/kg IV) is best. Use in combination with azathioprine or other disease-modifying antirheumatic drugs.
• Cyclosporine, 2 to 5 mg/kg per day, can be added to azathioprine and anti-TNFα therapy. Cyclosporine should be used with caution in patients with CNS Behçet’s disease because it can worsen CNS symptoms. Tacrolimus, 0.1 mg/kg per day, can be used as an alternative to cyclosporine.
• Interferon-α is a good alternative but should not be used with azathioprine due to additive myelotoxicity.
• Chlorambucil and cyclophosphamide are salvage therapies.
• Others: methotrexate, mycophenolate mofetil, anakinra, tocilizumab, and rituximab have been used successfully in a few patients.