Use of non-TNF biologics for the treatment of neuro-Behçet's disease: Literature review and 2 refractory cases of monoclonal anti-TNFs treated with tocilizumab

Neurological complications of BD (neuro-Behçet's disease [NBD]) are life-threatening and disabling manifestations. Neurological involvement occurs in approximately 5% to 18% of patients with BD. Most patients with NBD respond well to glucocorticoids, cyclophosphamide, or anti-tumor necrosis factors (TNFs), but there are some resistant cases refractory to these drugs. This study aims to summarize the existing data on the management of NBD, with special focus on patients resistant to anti-TNFs. The study included a short review of early treatment steps. In addition to a literature review of treatment with non-TNF biologics, we present 2 NBD cases with neurological involvement that are resistant to standard high-dose steroid therapy and anti-TNF treatment. Both patients responded well to the tocilizumab therapy, and there was no serious adverse event.