The three Behcet’s Syndrome Centres of Excellence receive national funding for biologic drugs.
The Behcet’s Syndrome Drug Pathway documents the approach to standard and biologic therapy and should be followed.
Steroids may be used topically or systemically. Doses may vary depending on local protocols.
Triple mouthwash is a solution of 1 x doxycycline 100mg (soluble tablet), 1 x betamethasone 0.5mg (soluble tablet), 1 ml nystatin 100,000 units (oral suspension), combined in 10 ml of water. To be rinsed round mouth for 3 minutes then expectorated. Administered QDS.
Behcet’s syndrome is not currently a labelled indication for biologic agents.
The biologic drugs covered are currently:
- TNF alpha inhibitors (infliximab 5mg/kg intravenous infusion at day 0, and then 2, 6 and 8 weeks later* (In eye disease, dosing is once every 6 weeks after initial loading doses); etanercept 50mg sc injection once a week, adalimumab 40mg sc once a fortnight); there are currently insufficient data to support the use of certolizumab or golimumab, which may be used only in exceptional circumstances. Duration of therapy before reassessment/discontinuation depends upon organ involvement (see drug pathway). An immunosuppressive eg azathioprine should be coadministered to minimise development of neutralising antibody.
- Interferon (interferon alpha, viraferon peg. Dosed once a week sc injection calculated by weight: 50 to 100kg 30mcg; 101 to 116kg 35 mcg; 117 to 133kg 40mcg; 134 to 149kg 45mcg; 150 to 165kg 50mcg once a week). A total of 16 weeks usage will be covered at any one time
- CD 20 depletor (rituximab: 1000mg intravenous infusion at day 0 and 15, covered by intravenous methyl prednisolone and chorpheniramine). A cycle of two infusions will be approved. Further cycles may be approved, normally after no less than 6 months.
- CD52 depletor (alemtuzumab: Two weeks of intravenous infusion; 3mg day one, 10mg (if tolerated) on day two, 30mg (if tolerated) on day three followed the next week by 30mg Monday, Wednesday and Friday. If the patient does not tolerate a dose well, that dose should be repeated the following day until tolerated. It is unlikely that more than one two-week course of alemtuzumab will be administered. (Withdrawn.)
Unless in exceptional circumstances, infliximab is the first choice biologic drug.
Approval is for a six month period only unless otherwise stated by the centre.
Approval (and therefore funding) for a biologic drug will only be considered on completion of the biologics drug request form and outcome record – baseline form (whether patient is seen by at a National Centre of Excellence or at a satellite site).
The Behcet’s Syndrome Centres of Excellence will provide ready access by email, telephone and fax for funding requests and will provide an answer no later than one working day after the request. Contact details for the different centres:
Clinical trials (with research funding) will be considered as appropriate.
This protocol will be reviewed and updated as required and no less frequently than once a year.