Behcet's disease is a classic example of the trade-offs involved in treating any inflammatory or autoimmune disease with the new class of drugs called TNF blockers. These drugs are FDA approved to treat rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, ankylosing spondylitis, juvenile idiopathic arthritis, Crohn's disease, and ulcerative colitis.
(Not all of the drugs have been approved for each condition.)
The medical literature reports that these drugs have been tried for similar conditions, including Behcet's disease, with varying degrees of success.
Behcet's disease was described by Hippocrates 2500 years ago, according to a British research team. It can affect many parts of the body, including the eyes, mouth, skin, genitals, nervous system, heart, and joints. Inflammatory lesions and ulcers cause tissue damage and pain. Blindness is the result for up to 25% of the cases involving eye inflammation.
Dr. Leonard Calabrese of the Cleveland Clinic reported TNF inhibitors have revolutionized the treatment of autoimmune diseases. Unfortunately, they do not always work as expected, and sometimes have serious side effects. In August 2009, the FDA issued updated warnings for the following drugs in this class:
1. Enbrel (etanercept)
2. Remicade (infliximab)
3. Humira (adalimumab)
4. Cimzia (certolizumab pegol)
5. Simponi (golimumab)
The manufacturers of these drugs have provided detailed information, including the FDA warnings, on their web sites. I think enbrel.com provides one of the best lists of these adverse effects, which include:
1. Tuberculosis and other serious infections;
2. Multiple sclerosis and other nervous system problems, such as seizures and inflammation of the nerves of the eyes;
3. Rare reports of serious blood problems (some fatal);
4. Heart failure, including new heart failure or worsening of heart failure you already have;
5. Allergic reactions;
6. Immune reactions, including a lupus-like syndrome and lymphoma (a type of cancer).
Of course, not everyone will experience these adverse effects. You may want to consider these drugs if you have an autoimmune disease that puts you at risk for blindness or other disability. Doctors are supposed to evaluate the risks and benefits of drugs before prescribing them, but in many cases the decision is a value judgment. We need to educate ourselves to make sure our medical care fits our own values.
References:
Calabrese L, “The yin and yang of tumor necrosis factor inhibitors”, Cleveland Clinic Journal of Medicine 2006 March; 73(3):251-256.
Verity DH et al, “Behcet's disease: from Hippocrates to the third millennium”, Br J Opthalmol 2003;87:1175-1183.
Enbrel web site:
http://enbrel.com/index.jsp
Remicade web site:
http://www.remicade.com/remicade/global/index.html
Humira web site:
http://www.humira.com/Default.aspx
Cimzia web site:
http://cimzia.com/
Simponi web site:
http://www.simponi.com/simponi/index.html
Linda Fugate is a scientist and writer in Austin, Texas. She has a Ph.D. in Physics and an M.S. in Macromolecular Science and Engineering. Her background includes academic and industrial research in materials science. She currently writes song lyrics and health articles.