Long‐term efficacy and safety of anakinra in a patient with Behçet's disease and concomitant tuberculosis infection

Behc et’s disease (BD) is a systemic vasculitis with mucocutaneous, gastrointestinal, ocular, vascular, and neurological involvement. Ocular manifestations represent one of major organ involvement, with a high rate of recurrences potentially resulting in partial or total blindness. Treatments may range from the topical approach to disease-modifying antirheumatic drugs and biological agents. Tumor necrosis factor (TNF)-a inhibitors and interferon-a are usually effective in the majority of patients with severe ocular disease. Recent clinical observations with the interleukin (IL)-1 inhibiting agents anakinra, canakinumab, and gevokizumab have suggested their potential role in the treatment of refractory Behc et’s uveitis. Accordingly, in a multicenter retrospective study, we found that treatment with anakinra and canakinumab was effective and safe in 30 patients with BD, with an overall acceptable retention on treatment. Unlike anti-TNFa treatment, IL-1 inhibition has shown a good safety profile regarding the risk of severe infections, particularly in relation to tuberculosis (TB) reactivation. Indeed, interfering with the IL-1 pathway seems safer in comparison with blocking TNFa. This consideration is relevant for patients with BD because of the high prevalence of this disease in geographical areas where TB is a social concern. In this regard, we report herein a patient with BD with concomitant latent TB infection successfully treated with anakinra as first-line biological therapy. A 41-year-old man was diagnosed with BD in 2008 based on recurrent oral aphthosis, genital ulcerations, and pseudofolliculitis. His medical history was also relevant for monthly fever attacks, spontaneously resolved 1 year after the onset of symptoms, hip arthralgia, and