Condition category
Musculoskeletal Diseases
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims
Behçet’s disease (BD) is a rate and poorly understood condition that causes inflammation (swelling) throughout the body. The inflammation associate with BD can cause a wide range of symptoms, including genital and mouth ulcers, eye problems (which can lead to blindness), skin rashes and inflammation of the blood vessels, which increases a person’s risk of developing blood clots and stroke. The exact cause of BD is unknown however many believe it is an autoimmune disorder (in which the body’s immune system mistakenly attacks the body’s own, healthy tissue). Traditional treatments include corticosteroids (anti-inflammatory medicine) and immunosuppressant drugs (medications that reduce the activity of the immune system), but they can have unpleasant side effects. Biologic therapies are a newer type of medication, which target the biological processes involved in the process of inflammation more selectively. Recently, the biologic drugs infliximab and interferon alpha (aIFN) have been used successfully in treating BD however they are expensive (£16,000/year and £4,000/year, respectively), not always effective and there have been very few studies looking at their effectiveness. The Department of Health has recently commissioned three national Centres of Excellence for BD in London, Birmingham and Liverpool, with the remit to deliver care for the approximate 500 UK patients currently with this condition. The aim of this study is to compare the effectiveness of infliximab with aIFN at treating patients with BD.

Who can participate?
Adults with BD who are suitable to receive biological therapy.

What does the study involve?
Participants are randomly allocated to one of two groups. Those in the first group are treated with infliximab. This is given through a drip (intravenous infusion) at the standard dose of 5mg/kg at the start of the study, week 2, week 6 and then every 8 weeks until the end of the study. Those in the second group are treated with aIRN. This is given as an injection under the skin (subcutaneous injection) starting at a dose of 3 million units one a day for 3 days, then 6 million units (for men who weight more than 80kg) or 4.5 million units (for women or men weighing less than 80kg) every day. This dose can be reduced down every 2-4 weeks if necessary to 3 million units twice a week over the course of the study. After 3 and 6 months of treatment, participants in both groups are assessed in order to find out if there has been any improvement to their condition.

What are the possible benefits and risks of participating?
Not provided at time of registration.

Where is the study run from?
University of Liverpool (UK)

When is the study starting and how long is it expected to run for?
April 2016 to June 2021 (updated 10/11/2020, previously: November 2020) (updated 09/01/2020, previously: December 2019)

Who is funding the study?
Medical Research Council (UK)

Who is the main contact?
Miss Elizabeth Blennerhassett

Trial website

Contact information



Primary contact

Dr Diane Carlton


Contact details

Liverpool Clinical Trials Centre (LCTC)
University of Liverpool
1st Floor Block C
Waterhouse Building
Brownlow Street
L69 3GL
United Kingdom
+44 (0)151 795 7323

Additional identifiers

EudraCT number

2014-005390-36 number

Protocol/serial number


Study information

Scientific title

BIO BEHÇET’S: Optimal utilisation of biologic drugs in Behçet’s Disease: a randomised controlled trial of infliximab vs alpha interferon, with genotyping and metabolomic profiling, towards a stratified medicines approach to treatment



Study hypothesis

The aim of the study is to create the evidence base to underpin clinically effective prescribing of the biologic drugs infliximab and alpha interferon for Behçet’s Disease.

The objectives of the study are to:
1. Undertake a randomised controlled trial to compare IFX versus aIFN in patients with BD who are unresponsive to standard oral therapy
2. Examine whether IFNL3 and IFNL4 SNPs can predict response to aIFN and/or IFX in BD
3. Examine the potential for urine metabolomics to act as biomarker for drug response to IFX and/or aIFN in BD

Ethics approval

North West - Liverpool Central Research Ethics Committee, 17/02/2015, 15/NW/0008

Study design

Randomised two-arm parallel open-label design

Primary study design


Secondary study design

Randomised controlled trial

Trial setting


Trial type


Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet


Behçet disease


Participants are randomly allocated to one of two groups.

Group 1: Participants will receive infliximab at a standard dose of 5mg/kg at week 0, week 2 and week 6 as loading then every 8 weeks for the length of the trial.

Group 2: Interferon alpha (Roferon) subcutaneous injection in tapering dose starting at 3 million units once daily for three days, then 6** million units once daily (male with body weight more than 80 kg) or 4.5 million units once daily (female, or male with weight less than 80 kg). Dose tapered down every 2-4 weeks according to defined clinical criteria to 3 million units twice a week, over the period of the trial.

** The six million units dose will only be administered to males of over 80 kg with major organ threatening disease (e.g., severe eye involvement). Males of less than 80kg or females will start with 4.5 million.

Intervention type



Drug names

Primary outcome measure

Disease severity is measured using the Behcet's disease activity index (BDAI) after 3 months of treatment.

Secondary outcome measures

1. Disease severity is measured using the Behcet's disease activity index (BDAI) after six months of treatment,
2. Significant improvement in organ involvement within the primary organ system that resulted in the decision to start a biologic agent and other organ systems assessed by:
2.1. Ocular: reduction in vitreous haze using the SUN consensus group grading scale and visual acuity change from baseline
2.2. Oral ulcer activity: change in ulcer severity score (USS)
2.3. Change in number of genital ulcers
2.4. Musculoskeletal: Likert pain score
3. Adverse events in each group
4. Reduction in dose of prednisolone (or equivalent glucocorticoid) at three months: a clinically meaningful reduction is considered to be 50% of baseline or dose of <15mg/day prednisolone
5. Reduction in dose of prednisolone (or equivalent glucocorticoid) at six months: a clinically meaningful reduction is considered to be 50% of baseline or dose of <7.5mg/day prednisolone
6. Quality of life is measured using EQ-5D and BD-QoL at baseline, 3 and 6 months
7. Disease activity is measured using the Physician’s Global Assessment of disease activity (a 7 point Likert Scale completed as part of (but assessed independently of) the BDAI) at 3 and 6 months

Overall trial start date


Overall trial end date


Reason abandoned (if study stopped)


Participant inclusion criteria

1. Diagnosed to have BD by International Study Group (ISG) criteria or International Criteria for BD (ICBD)
2. Have refractory disease as defined by the UK Centres of Excellence criteria (failure to respond to steroid and/or immunosuppressive therapy with significant or major organ­threatening disease) and therefore qualify for biologic therapy with either IFX or aIFN
3. Able to give informed consent
4. Have not previously received a biologic agent
5. Aged over 18 years

Participant type


Age group




Target number of participants

Planned Sample Size: 100; UK Sample Size: 100

Total final enrolment


Participant exclusion criteria

1. Have a contraindication to either IFX or aIFN (eg active infection, severe liver disease, neutropenia, previous malignancy)
2. Are likely to not comply: for example cannot attend assessments because of excessive travel requirements
3. Are already, or likely to become, pregnant during the study
4. Express a strong preference for one of the two potential therapies
5. Have heart disease or severe heart failure
6. Have been diagnosed with Multiple sclerosis
7. Have evidence of infection with HIV

Recruitment start date


Recruitment end date



Countries of recruitment

United Kingdom

Trial participating centre

University of Liverpool
Department of Health Services Research 1-3 Brownlow Street
L69 3GL
United Kingdom

Sponsor information


University of Liverpool

Sponsor details

Whelan Building
Brownlow Hill
L69 3GB
United Kingdom

Sponsor type

Hospital/treatment centre



Funder type


Funder name

National Institute for Health Research

Alternative name(s)


Funding Body Type

government organisation

Funding Body Subtype

National government


United Kingdom

Results and Publications

Publication and dissemination plan

Not provided at time of registration

Intention to publish date


Participant level data

Not provided at time of registration

Basic results (scientific)

Publication list

Publication citations

Additional files

Editorial Notes

10/11/2020: The following changes were made to the trial record: 1. The overall end date was changed from 06/11/2020 to 30/06/2021. 2. The plain English summary was updated to reflect these changes. 11/03/2020: The following changes were made to the trial record: 1. The scientific contact was changed. 2. The total final enrolment was added. 09/01/2020: The following changes were made to the trial record: 1. The recruitment end date was changed from 31/12/2019 to 28/02/2020. 2. The overall end date was changed from 31/12/2019 to 06/11/2020. 3. The intention to publish date was changed from 31/12/2020 to 30/06/2021. 4. The plain English summary was updated to reflect these changes. 02/04/2019: The condition has been changed from "Topic: Musculoskeletal; Subtopic: Musculoskeletal (all Subtopics); Disease: Musculoskeletal" to "Behçet disease" following a request from the NIHR. 11/03/2019: Internal review. 01/11/2017: Internal review.