The presence of uveitis predicts the response to the interleukin (IL)-1 inhibitors anakinra and canakinumab in Behçet's disease

Background: In recent times IL-1 inhibition has been proposed as an intriguing therapeutic option in Behçet disease (BD) patients with multi-drug resistant manifestations.1 However, despite the good clinical results obtained during the last years, cases of BD nonresponsive to anakinra (ANA) and canakinumab (CAN) have also been identified. This evidence has induced to suspect the existence of specific subsets of patients characterised by a more pronounced IL-1 driven pathogenesis.2,3 Objectives: To identify predictive factors of response to interleukin (IL)−1 inhibition among demographic, clinical and therapeutic data in patients with (BD). Methods: BD patients treated with ANA or CAN were enrolled. Patients were divided into 2 groups according to the clinical response: group 1 included subjects showing a treatment duration of at least 52 weeks and no secondary inefficacy during the first follow-up year; the remaining patients were included in the group 2. Demographic, clinical and therapeutic data were analysed to identify significant differences between groups. Results: Eighteen patients (50%) were included in group 1 and 18 (50%) in group 2. A better response to IL-1 inhibitors was significantly more common among patients with BD-related uveitis (p=0.006) and patients with a longer disease duration (p=0.03). Conclusions: IL-1 blockade is effective in BD, especially in the subset of patients presenting ocular involvement and in those with long-lasting disease.