Biotherapies in Behçet's disease.

Behçet's disease (BD) is a systemic large-vessel vasculitis characterized by a wide clinical spectrum including recurrent oral and genital ulcerations, uveitis, vascular, neurological, articular, renal and gastrointestinal manifestations. Therapeutic management of BD depends on the clinical presentation and organ involved. Although colchicine, nonsteroidal antiinflammatory agents and topical treatments with corticosteroids are often sufficient for mucocutaneous and joint involvements, more aggressive approach with immunosuppressive agents is warranted for severe manifestations such as posterior uveitis, retinal vasculitis, vascular, and neurological and gastrointestinal involvements. However, some patients still have refractory disease, relapse, sight threatening eye disease, or irreversible organ damage. Recent improvements in the understanding of the pathogenic mechanisms have led to the identification of potential targets and future biological therapies for BD. In contrast to current non-specific immunosuppressive agents, the emergence of biotherapies provides the possibility of interfering with specific pathogenic pathways. Novel targeted biotherapies might be used in the future for BD.

Efficacy of interferon-alpha for the treatment of Kaposi's sarcoma herpesvirus-associated uveitis.

PURPOSE: To report cases of uveitis that are associated with human herpesvirus-8 (HHV-8) and the impact of interferon-alpha therapy on their visual outcome. DESIGN: Interventional case reports. METHODS: Extensive examination was performed in patients with chronic and severe uveitis to exclude a viral cause that requires specific therapy. After histopathologic, molecular, and/or serologic confirmation of HHV-8 uveitis, interferon-alpha2a therapy (3 millions IU/d, 3 days per week, subcutaneously) was initiated. RESULTS: Two patients of Mediterranean origin were included. HHV-8 serologic result was positive in both cases. Histopathologic examination of conjunctival biopsy specimens confirmed Kaposi's sarcoma in the second case, and quantitative polymerase chain reaction identified HHV-8 DNA in the biopsy specimen. Disease was controlled by interferon-alpha2a in both cases, but maintenance therapy was mandatory to prevent relapses. CONCLUSION: HHV-8-associated uveitis is a rare condition in immunocompetent hosts. Severe and chronic conditions may require antiviral and immunomodulatory therapies. Interferon alpha seems to be a good candidate and may be proposed in these cases.