Immunomodulators, Immunosuppressives May Not Increase COVID-19 Risk in Patients With Behçet’s Disease

mouth ulcer or canker sore or aphthous stomatitis or aphthous ulcer
A novel study examines the treatment of patients with Behçet's disease prescribed immunosuppressive and immunomodulatory agents during the COVID-19 pandemic.

The use of immunosuppressive and immunomodulatory agents to manage Behçet’s disease, a chronic vasculitis disorder characterized by skin lesions and sores, does not appear to increase the risk for coronavirus disease 2019 (COVD-19), data from a case study published in Dermatologic Therapy suggests.

Patient files and medical records of 54 patients with Behçet’s disease who were admitted to a dermatology outpatient clinic between March 11 and July 14, 2020 were retrospectively analyzed by researchers from Turkey. Specific variables identified in the retrospective analysis included age, sex, clinic findings, symptoms, prior therapies, and recommended treatments. The investigators followed patients for treatment complications and the development of COVID-19.

The mean age of these patients was 32.2±7.9 (range, 18-45 years), and 51.9% of the population were women. Recorded clinical signs of Behçet’s disease included oral ulcers (100%), genital ulcers (77.8%), papulopustular lesions (55.6%), arthritis (51.9%), uveitis (48.1%), erythema nodosum (40.7%), pathergy positivity (37%), thrombophlebitis (20.4%), epididymitis (3.7%), extragenital ulcers (3.7%), and central nervous system involvement (3.7%).

Treatments in this cohort were colchicine (68.5%), colchicine plus azathioprine (7.4%), azathioprine (7.4%), penicillin (5.6%), colchicine plus systemic corticosteroid (3.7%), anti-TNF (3.7%), cyclosporin (1.9%), and dapsone therapy (1.9%). Overall, approximately 79.6% of patients in this study used colchicine, whereas the second most frequently used therapy was azathioprine in 14.8% of patients. Almost all patients (81.5%) were recommended to continue their previous therapy. In all, 13% of patients had their treatment doses reduced during the study period, and 5.6% of patients had their treatment changed.

No evidence of life-threatening activation and morbidity was reported in this study population; however, a total of 3 patients experienced thrombophlebitis. There were no cases of COVID-19 during the study period, either, but 1 patient did develop “a strong suspicion of COVID-19.” The patient with possible COVID-19 had a negative PCR test for the disease and recovered following initiation of azithromycin and colchicine.

The researchers theorized that the isolating effects of Behçet’s disease may be shield these patients from COVID-19, as patients with the chronic inflammatory disorder may be less likely to engage in social interactions on a regular basis.

A limitation of this study was the lack of PCR testing for all patients, which may have resulted in missed asymptomatic COVID-19 cases.

Although the researchers suggest that their findings offer insight as to the treatment of Behçet’s disease during the COVID-19 era, they acknowledge that “daily practice changes frequently during this period” and recommend personalizing treatment approaches for these patients.


Dursun R, Temiz SA, Özer İ, Daye M, Ataseven A. Management of patients with Behçet’s disease during the COVID-19 pandemic. Dermatol Ther. 2020 Jul 25. doi:10.1111/dth.14063