Tumor necrosis factor alpha inhibitors in Behçet’s disease: indications, efficacy, and safety of two widely used agents

OBJECTIVES: Behçet's disease (BD) is characterized by relapsing mucocutaneous and major organ involvement. Although conventional immunosuppressants and CSs remain the mainstay of therapy, severe or refractory cases often require biologics. TNF-α inhibitors, particularly infliximab (IFX) and adalimumab (ADA), have become central to BD management. We compared the efficacy, safety, and drug retention of IFX and ADA in a real-world single-centre cohort. METHODS: Eighty-seven BD patients receiving IFX (n = 45) or ADA (n = 42) as their first anti-TNF therapy between April 2020 and 2025 were retrospectively reviewed. Baseline demographics, organ involvement, laboratory parameters, treatment regimens, and outcomes were recorded. RESULTS: Except for a tendency of male predominance in the IFX group, baseline demographics were comparable. Vascular (51.1% vs 26.2%) and neurological (15.6% vs 2.4%) involvement were more frequent in the IFX group, while ocular disease predominated in the ADA group (45.2% vs 28.9%). Complete remission was achieved in 75.6% (IFX) and 78.6% (ADA) initially, increasing to 88.9% and 76.5%, respectively, at the last visit. Concomitant AZA use exceeded 60% in both groups, while pulse glucocorticoids, CYC, and anticoagulants were more common with IFX. Relapses occurred more often and earlier with IFX (37.8% vs 16.7%, median 8 vs 13 months). Drug retention and adverse event rates were comparable (IFX 80% vs ADA 85.7%; ∼16% adverse events). No severe events occurred. CONCLUSION: Both IFX and ADA were highly effective and well tolerated in severe or refractory BD. ADA provided durable control in mucocutaneous and ocular phenotypes, whereas IFX offered rapid remission in vascular and neurological disease. Phenotype-oriented and individualized treatment strategies may optimize anti-TNF use in BD.