Behçet’s Syndrome Study Links Younger Age to Lower Adherence

Key Takeaways

• Among adults with Behçet’s syndrome seen in a tertiary referral clinic in Pisa, Italy, low medication adherence was reported in 21.6%.
• Intermediate adherence was reported in 48.8%, and high adherence was reported in 29.6%.
• Younger age was significantly associated with lower 8-item Morisky Medication Adherence Scale (MMAS-8) scores.
• No significant association was reported between medication adherence and sex, disease duration, disease activity indices, organ involvement, or treatment class.

Sustaining long-term medication adherence in Behçet’s syndrome can be difficult during routine specialty follow-up because treatment often changes with organ involvement, symptom burden, and a relapsing-remitting disease course. Regimens may include colchicine, conventional immunosuppressants, biologics, and other targeted agents, making day-to-day medication-taking behavior hard to judge in clinic. In a tertiary referral cohort in Pisa, Italy, adults with Behçet’s syndrome were assessed for self-reported adherence and for clinical features associated with lower adherence.

The monocentric cross-sectional observational cohort study enrolled 125 adults who met the International Classification Criteria for Behçet’s Disease between March 2025 and January 2026, with consecutive recruitment during scheduled outpatient visits. This design captured adherence and clinical assessment during routine care in a defined Italian tertiary-center setting.

Patients completed the validated 8-item Morisky Medication Adherence Scale (MMAS-8) during the same visit as clinical assessment and treatment review. Adherence was categorized as high (8), intermediate (6 to <8), or low (<6). Disease activity was assessed with the Behçet’s Disease Current Activity Form (BDCAF) from patient and clinician perspectives and with the Behçet’s Disease Activity Index, and exploratory analyses examined age quartiles, disease-activity quartiles, colchicine-treated patients, and anti-tumor necrosis factor (TNF) subgroups.

The cohort was middle-aged, predominantly female, and had longstanding disease. MMAS-8 scores centered in the intermediate range, with a mean of 6.82±1.32 and a median of 7 (IQR 6–8). Overall adherence appeared generally satisfactory, although a meaningful low-adherence subgroup remained present.

Age was the only variable clearly linked to adherence, with higher MMAS-8 scores in older adults (Spearman rho=0.225, p=0.012). Exploratory age-quartile analyses similarly suggested more frequent lower adherence in younger strata. Sex, disease duration, disease activity indices, organ involvement, and treatment class did not differ significantly by adherence status, although treatment categories were not mutually exclusive because some patients were receiving more than one medication simultaneously; exploratory colchicine-treated and anti-TNF subgroup analyses were likewise negative, although limited by sample size.

The authors noted that the monocentric design may limit generalizability beyond this tertiary referral clinic in Pisa, Italy. Because MMAS-8 was self-reported, adherence may have been overestimated by recall and social desirability bias, and the relatively small low-adherence subgroup prevented adequately powered multivariable analysis, so independent predictors were not established. Treatment burden and polypharmacy were not systematically collected, longitudinal flare frequency, remission status, and cumulative disease activity were not systematically captured, and the cross-sectional design does not support causal inference or assessment of adherence over time. 

Clinician Questions

How was medication adherence defined in this Behçet’s syndrome cohort?

Medication adherence was measured with the validated MMAS-8, a self-reported tool composed of seven yes/no items and one Likert-type item that yields a total score from 0 to 8.

In this study, high adherence was defined as 8, intermediate adherence as 6 to less than 8, and low adherence as less than 6.

What disease activity window was compared with medication adherence in this Behçet’s syndrome analysis?

Disease activity was assessed at the same outpatient visit in which adherence was recorded, with BDCAF covering the 4 weeks before the visit from both patient and clinician perspectives and the Behçet’s Disease Activity Index used alongside it. The comparison therefore reflects a single-visit snapshot rather than longitudinal disease control.

Did medication adherence differ by treatment type in this Behçet’s syndrome cohort?

No significant adherence differences were reported across treatment class in this cohort. The treatment categories described in the article included colchicine, conventional immunosuppressive agents, biologic therapies mainly TNF inhibitors, and other targeted therapies such as apremilast, and exploratory colchicine and anti-TNF subgroup analyses were also negative, although the authors noted limited sample size.

What does this Behçet’s syndrome adherence study not establish?

This single-center, cross-sectional analysis does not establish that younger age causes lower adherence or show how self-reported adherence relates to long-term outcomes over time. Independent predictors of poor adherence were not established because adequately powered multivariable analyses were not performed, and longitudinal flare, remission, and cumulative disease-activity data were not systematically collected.