Interferon alfa-2a, recombinant

Biologic therapy has been used for Behçet’s Syndrome after first-line immunomodulation, but in the absence of high-quality evidence or predictive biomarkers. BIO-BEHÇET’S was a randomized controlled clinical trial to compare the two most widely used biologics for Behçet’s Syndrome at that time, infliximab versus interferon-α2a, and identify potential biomarkers for response.

A total of 79 patients with active Behçet’s Syndrome were randomized to either infliximab (REMICADE) or interferon-α2a (ROFERON) according to the UK national treatment pathway, and follow-up with symptom-directed examination undertaken at Weeks 12 and 24. The head-to-head trial included an exploratory analysis on the potential role of single nucleotide polymorphisms (SNPs) and urinary metabolomic to act as biomarkers for drug response. Genotypic analysis was performed to determine whether four SNPs in IFNL3 and IFNL4 – selected based on known effects – impacted primary and secondary outcomes. For metabolomic analyses, urine samples were analyzed by nuclear magnetic resonance spectroscopy and principal component analysis.

Genetic data suggested potential association between outcomes and carriage of rs4803221 or rs7248668 variants in the IFNL3 (IL-28B) gene locus for interferon-α2a patients; however, with the relatively small sample, statistical significance was lost when corrected for multiple testing. Metabolomic analysis identified potential markers of metabolic response to infliximab.

BIO-BEHÇET’S suggests there is potential for a novel metabolomic biomarker that can identify response to infliximab in patients with Behçet’s Syndrome. Further work will characterize the appropriate metabolite (s) from existing samples to inform future prospective trials to study this in more detail clinically.

Conjunctival squamous cell carcinoma (SCC) is the most advanced form of ocular surface squamous neoplasia (OSSN), with varying incidence rates influenced by factors such as age, UV exposure, and occupation. Early detection is crucial, but misdiagnosis is common, especially when SCC mimics benign conditions like pterygium.

An 83-year-old Caucasian male farmer presented with a rapidly enlarging nasal limbal lesion, initially misdiagnosed as pterygium. Clinical evaluation suggested malignancy, and an excisional biopsy using the "No Touch" technique was performed to avoid tumor seeding. Histopathology confirmed conjunctival SCC, with 10 % of the lesion remaining post-excision due to its large size. Adjuvant treatment with topical Interferon alpha-2a (1 MIU/cc) targeted the residual tumor. Amniotic membrane grafting was employed to manage the wound, and topical Mitomycin C was used to reduce the risk of recurrence. Follow-ups at 1 month, 3 months, 6 months, and 1 year showed no signs of recurrence.

This case underscores the importance of distinguishing conjunctival SCC from benign lesions. The combined approach of surgical excision, topical immunotherapy, and chemoprophylaxis was effective in treating this advanced SCC case, preventing tumor recurrence.

A multidisciplinary treatment strategy can effectively manage advanced conjunctival SCC, as seen in this case, where no recurrence occurred after one year of follow-up. Early detection and comprehensive care are essential for positive outcomes.