Tocilizumab and azathioprine in the management of refractory macular edema associated with Behçet's disease: clinical experience.

A 32-year-old man of Maghrebi origin consulted for visual loss in both eyes (OU) with recurrent oral ulcers and erythematous lesions. The examination revealed panuveitis in the right eye, posterior uveitis in the left eye and cystic macular edema (CME) in OU. Along with mucocutaneous lesions and the presence of HLA B51 positive suggested a diagnosis of Behçet's disease. He was initially treated with pulses of Methylprednisolone followed by oral Prednisone and Azathioprine (AZA). Given the insufficient control, Adalimumab (ADA) was added. Due to the lack of visual improvement and worsening of the CME, it was decided to switch from ADA to Tocilizumab (TCZ) at a dose of 8 mg/kg/month. After three years of follow-up, he remained stable at the systemic and ocular levels with AZA and TCZ, and oral corticosteroids were discontinued. In cases where signs of ocular activity persist, a change in biological therapeutic target should be considered, with Tocilizumab being a beneficial option.