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Clinical pharmacy and clinical trials (including case series)
Patient with refractory Neuro-BehÁet disease. Treatment with rituximab.
  1. B. Leboreiro Enriquez,
  2. C. Rey Barbosa,
  3. L. Esarte Lopez,
  4. E. Romero Ventosa,
  5. A. Cendón Otero,
  6. A. Mucientes Molina
  1. 1Hospital Xeral-Cies (CHUVI), Pharmacy, Vigo, Spain

Abstract

Background Behçet's disease is a multisystem vasculitis of unknown origin in which neurologic involvement has been reported in the range of 5% to 10%.

Purpose To assess the efficacy and safety of rituximab in a patient with Neuro-Behçet disease.

Materials and methods The authors used the report carried out by our pharmacotherapeutic information section, following the request for the off-label use of rituximab in a Neuro-Behçet disease patient.

The authors obtained effectiveness and safety data using the electronic medical record and the doses used in this patient from our program for intravenous mixtures.

Results The patient was 31 years old. He presented recurrent aphthae, erythema nodosum in the lower limbs, frequent skin folliculitis in the arms and head, and involvement of the central nervous system with multiple seizures, sequels in the form of ataxia and loss of strength in half his body. The symptoms were refractory to treatment with α-2a interferon, azathioprine, methotrexate, infliximab and steroids. The authors used rituximab at two 1000 mg doses, administered 15 days apart. This was the same dose as was used with the few cases reported for the treatment of ocular manifestations of Behçet's disease. The treatment was well tolerated. After the first dose, administered when The authors admitted the patient to hospital, The authors observed improvement in both the loss of strength in the lower limbs and the patient's frame of mind. Consequently, the second dose was given as an outpatient. 8 months after completion of the treatment, the patient is stable from the clinical and radiological points of view, and has evolved favourably with regard to gaining strength and balance.

Conclusions Despite the low number of cases in the literature, in which rituximab has been used mainly for the ocular manifestations of Behçet's disease, it appears to be a valid alternative in cases similar to ours. It produces an improvement in the disease, which is not only objective, but also highly valued subjectively by the patient.

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