title: Tocilizumab in severe and refractory Behcet's disease: Four cases and literature review.
abstract: In Behcet's disease (BD), interleukin (IL)-6 drive the immune-mediated inflammatory process. The IL-6 receptor can be targeted using tocilizumab. As an off-label treatment, we tested its efficacy in patients with BD.
  
  
  
  Overall, 4 patients with refractory BD were treated with tocilizumab, 8mg/kg/4 weeks. Patients were clinically and biologically assessed before administering each dose and the literature was reviewed.
  
  
  
  Tocilizumab was found to be safe and well tolerated. BD activity decreased significantly in all patients, and prednisone dose was reduced in all cases (up to 50% of the baseline dose). Treatment appeared effective in alleviating skin/mucosal effects, neurological involvement, and uveitis, but less effective for arthralgia and abdominal pain. A very short time lag between the onset of treatment with tocilizumab and the clinical response was observed. The literature review revealed 11 previous cases reporting improvement to BD with this treatment, and 3 previous cases without efficacy.
  
  
  
  We reported the most important study treating refractory BD with tocilizumab; this treatment could be safe and efficient, but will require further evaluation by randomized clinical trials.
authors.affiliation: Department of Internal Medicine, University Hospital of Grenoble, CS 10217, F-38043 Grenoble Cedex 09, France; Department of Ophtalmology, University Hospital of Grenoble, F-38043, Grenoble Cedex 09, France. Electronic address: ADeroux@chu-grenoble.fr.
authors.forename: Alban
authors.initials: A
authors.lastname: Deroux
authors.affiliation: Department of Ophtalmology, University Hospital of Grenoble, F-38043, Grenoble Cedex 09, France; UJF-Grenoble 1, F-38041 Grenoble, France.
authors.forename: Chistophe
authors.initials: C
authors.lastname: Chiquet
authors.affiliation: Department of Internal Medicine, University Hospital of Grenoble, CS 10217, F-38043 Grenoble Cedex 09, France; UJF-Grenoble 1, F-38041 Grenoble, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Bouillet
mesh_terms: D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D018771:Arthralgia / Q000209:etiology / Q000503:physiopathology; D001528:Behcet Syndrome / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D003078:Colchicine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D011241:Prednisone / Q000627:therapeutic use; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000209:etiology / Q000503:physiopathology; D016896:Treatment Outcome; D050257:Tubulin Modulators / Q000627:therapeutic use; D014605:Uveitis / Q000209:etiology / Q000503:physiopathology; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D005938:Glucocorticoids; D050257:Tubulin Modulators; C502936:tocilizumab; D003078:Colchicine; D011241:Prednisone
keywords: Behcet’s disease; Corticosteroids; Interleukin-6; Tocilizumab; Uveitis