Effects of azithromycin on intracellular cytokine responses and mucocutaneous manifestations in B ehçet's disease

Summary Objective The aim of this study was to investigate the effects of azithromycin on mucocutaneous manifestations and ex vivo intracellular cytokine responses in patients with B ehçet's disease ( BD ). Methods Ten BD patients with active manifestations and nine healthy controls ( HC s) were included in the study. Patients were treated with azithromycin (1500 mg/week) for four weeks. Clinical and immunological responses were evaluated in the pre‐ and post‐azithromycin treatment periods. Peripheral blood mononuclear cells ( PBMC s) of patients and controls were stimulated by S treptococcus sanguinis , lipopolysaccharide (LPS), lipoteichoic acid ( LTA ), and heat shock protein‐60 (HSP‐60) for three hours. Ex vivo intracellular interferon‐γ ( IFN ‐γ) and tumor necrosis factor‐α ( TNF ‐α) levels were measured. Results Follicular lesions and genital ulcers completely healed, and the number of oral ulcers decreased after treatment ( P  = 0.000). The stimulated intracellular IFN ‐γ response to S. sanguinis was higher in BD patients (5.75%) than in HC s (3.9%) before treatment ( P  = 0.05). Likewise, the pretreatment IFN ‐γ response was significantly higher than the post‐treatment response (1.95%). In BD patients, pretreatment stimulated intracellular IFN ‐γ responses to LTA (5.8%) were also higher than post‐treatment responses (3.15%), but the difference did not reach statistical significance ( P  = 0.07). Conclusions Azithromycin treatment decreased the mucocutaneous manifestations in BD patients and suppressed the intracellular IFN ‐γ responses of PBMC s to S. sanguinis ex vivo , which suggests this treatment has an immunomodulatory effect.