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01-06-2019 | Anakinra | Systematic Review

The right place of interleukin-1 inhibitors in the treatment of Behçet’s syndrome: a systematic review

Authors: Alessandra Bettiol, Elena Silvestri, Gerardo Di Scala, Amedeo Amedei, Matteo Becatti, Claudia Fiorillo, Giuseppe Lopalco, Carlo Salvarani, Luca Cantarini, Alessandra Soriano, Giacomo Emmi

Published in: Rheumatology International | Issue 6/2019

Abstract

Behçet’s syndrome (BS) is a chronic (auto)-inflammatory disorder characterized by different clusters of symptoms, including mucocutaneous and ocular involvements. Interleukin-1 inhibitors anakinra (ANA), canakinumab (CAN), and gevokizumab (GEV) represent a promising therapeutic alternative in BS. To date, evidence on the use of ANA, CAN, and GEV is mainly based on small isolated studies or case series, and the real place of anti-IL1 agents in the treatment of BS is still unclear. We performed a systematic review of current evidence on the efficacy and safety of anti-IL1 agents in BS. The PubMed search yielded a total of 398 references, from which we retrieved 24 studies for inclusion (4 clinical trials, 6 observational studies, 14 case reports, case series or letters to the editor). Four studies evaluated the overall efficacy of IL-1 inhibitors, 15 studies focused on the specific efficacy of ANA, whereas efficacy of CAN and GEV was evaluated in 8 and 3 studies, respectively. Both ANA and CAN were associated with good control of mucocutaneous and ocular manifestations. ANA resulted effective also for osteoarticular manifestations. GEV was studied only for ocular manifestations, but gave contrasting results. Discordant evidence supports the use of ANA and CAN in pediatric setting and for first-line treatment of general BS manifestations. Most frequent side effects were local or diffuse cutaneous reactions and injection site reactions, particularly for ANA treatment. Blocking the IL-1 pathway could be an effective therapeutic strategy in particular BS involvements.

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Title: The right place of interleukin-1 inhibitors in the treatment of Behçet’s syndrome: a systematic review
Authors: Alessandra Bettiol
Elena Silvestri
Gerardo Di Scala
Amedeo Amedei
Matteo Becatti
Claudia Fiorillo
Giuseppe Lopalco
Carlo Salvarani
Luca Cantarini
Alessandra Soriano
Giacomo Emmi
Publication date: 01-06-2019
Publisher: Springer Berlin Heidelberg
Keywords: Anakinra
Disease Modifying Anti-Rheumatic Drug
Published in: Rheumatology International / Issue 6/2019
Print ISSN: 0172-8172
Electronic ISSN: 1437-160X
DOI: https://doi.org/10.1007/s00296-019-04259-y

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