{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:46:07Z","timestamp":1785735967847,"version":"3.56.0"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Beh\u00e7et\u2019s disease (BD) is a complex, relapsing multisystem disorder characterized by autoinflammatory features. Because disease-specific diagnostic biomarkers are lacking and clinical presentation varies according to geographic background and organ involvement, diagnosis may be delayed, particularly in non-endemic regions and in patients with atypical manifestations. Therapeutic management is highly individualized and guided by disease severity and dominant organ involvement. Severe, refractory, or organ-threatening disease often requires aggressive immunosuppressive treatment, including targeted biologic therapy with monoclonal anti-tumor necrosis factor (anti TNF) alpha agents such as infliximab and adalimumab. Therapeutic drug monitoring (TDM), based on serum trough drug concentrations and anti-drug antibodies, is routinely used to optimize anti-TNF therapy in inflammatory bowel disease and is increasingly discussed in other immune-mediated inflammatory diseases treated with monoclonal antibodies. In Beh\u00e7et\u2019s disease, however, TDM is not yet standard practice, and Beh\u00e7et-specific therapeutic trough targets for infliximab and adalimumab have not been validated. Nevertheless, integrating TDM with clinical assessment may support more individualized decision-making by helping distinguish insufficient drug exposure, immunogenicity, and pharmacodynamic failure. In this article, we discuss the rationale for TDM in anti-TNF-treated BD, summarize the current direct and indirect evidence, and propose a cautious, clinically guided approach. Beh\u00e7et\u2019s disease; infliximab; adalimumab; anti-TNF therapy; therapeutic drug monitoring; trough levels; anti-drug antibodies; treatment optimization<\/jats:p>","DOI":"10.3389\/fimmu.2026.1930666","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T05:31:25Z","timestamp":1785735085000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimizing anti-TNF therapy in Beh\u00e7et\u2019s disease: the role of therapeutic drug monitoring"],"prefix":"10.3389","volume":"17","author":[{"given":"Marko","family":"Bare\u0161i\u0107","sequence":"first","affiliation":[{"name":"Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ljiljana","family":"Smiljani\u0107 Tomi\u010devi\u0107","sequence":"additional","affiliation":[{"name":"Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Kozmar","sequence":"additional","affiliation":[{"name":"Department of Laboratory Diagnostics, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]},{"name":"Faculty of Pharmacy and Biochemistry, University of Zagreb","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miroslav","family":"Mayer","sequence":"additional","affiliation":[{"name":"Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, University of Zagreb, School of Medicine, University Hospital Centre Zagreb","place":["Zagreb, Croatia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kez626","article-title":"Beh\u00e7et: the syndrome","volume":"59","author":"Bettiol","year":"2020","journal-title":"Rheumatology"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(23)02629\u20136","article-title":"Beh\u00e7et\u2019s syndrome","volume":"403","author":"Emmi","year":"2024","journal-title":"Lancet"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-025-05855-x","article-title":"Demographics and clinical manifestations in patients with Beh\u00e7et\u2019s disease: a retrospective observational study from a non-endemic country","volume":"45","author":"Prtenja\u010da","year":"2025","journal-title":"Rheumatol Int"},{"key":"B4","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.jaut.2015.06.005","article-title":"Efficacy of anti-TNF alpha in severe and\/or refractory Beh\u00e7et\u2019s disease: Multicenter study of 124 patients","volume":"62","author":"Vallet","year":"2015","journal-title":"J Autoimmun"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.01192","article-title":"Beh\u00e7et\u2019s disease under microbiotic surveillance? 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