Background Behçet’s disease (BD) is an inflammatory disease characterised by recurrent oral aphthous ulcers and numerous potential systemic manifestations.
Purpose To describe the experience of our centre with the use of adalimumab, etanercept and infliximab for the treatment of severe clinical manifestations in patients with BD in whom immunosuppressive treatment had failed.
Material and methods Retrospective review of medical records of 36 months (January 2010–December 2013) from patients with BD treated with adalimumab, etanercept or infliximab as compassionate use. Demographic and clinical data included age, sex, previous treatment, indication, side effects, concomitant drugs and clinical outcome.
Results 12 patients were included (5/7 women/men) 3/12 treated with infliximab, 2/12 etanercept, and 7/12 adalimumab; with a mean age of 36 years (range 21–55). We decided to start treatment due to the lack of response in the control of symptoms (3/12 patients had cutaneous lesions), and ocular involvement (9/12 patients with uveitis of repetition and visual deterioration). The patients had received conventional treatment: 4/12 had received two drugs, 4/12 three drugs, 2/12 four drugs, 1/12 five drugs and one had received six drugs previously. The most prescribed drugs were corticosteroids, azathioprine and cyclosporine. 1/12 patient had received previous treatment with infliximab before adalimumab with relapse of symptoms. We did not detect any adverse effects in patients treated. In all patients, clinical improvement was evident from the first administration. 8/12 patients showed reduction of symptoms, while 4/12 patients became asymptomatic. They continue in treatment.
Conclusion Anti-TNF agents are a good option for patients with severe BD who are resistant to steroid and immunosuppressive treatment, with a good safety profile. The benefit of this treatment supports the hypothesis that TNF-a is an important factor in the pathogenesis of BD. Moreover, no adverse effects were detected in the treated patients, in agreement with the few cases described in the literature reviewed.
References and/or Acknowledgements No conflict of interest.
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