Behcet's disease and etanercept: eighty weeks of experience

Behcet's disease (BD) is a chronic, relapsing inflammatory disease that involves multiple organs. Besides standard therapy, some patients with severe, non-responding disease experienced therapeutic blockage of the activity of TNF with encouraging results. We report the case of a patient affected with BD refractory to ciclosporin, azathioprine and corticosteroid therapy with orogenital ulcerations, optic nerve ischemia, arthritis and erythema nodosum. The patient was treated with etanercept, a TNF-alpha blocker, 25 mg twice a week. From the second administration of etanercept, the patient showed an improvement in oral and genital ulcers, of erythema nodosum,,and in visual acuity. ESR and CRP also showed a dramatic reduction returning to normal, and after eight weeks immunosuppressive therapy could be discontinued because of complete remission of oral-genital ulcers and of erythema nodosum. From week 24 to the last control carried out at week 80, the patient showed clinical and laboratory disease remission. Etanercept long-term therapy was demonstrated to be safe and effective in our patient with refractory BD, and allowed to spare steroids and other immunosuppressive drugs, thus preventing the related side-effects.