Real-world efficacy of adalimumab and infliximab for refractory intestinal Behçet's disease

概要

Background: Gastrointestinal tract involvement in BD is followed by severe complications, including massive bleeding, bowel perforation, and fistulas, which can lead to significant morbidity and mortality. BD is treated conventionally with corticosteroids, immunomodulators such as azathioprine and 6-mercaptopurine (6-MP), and anti-tumor necrosis factor-α (TNF-α) agents. However, the management of intestinal BD has not yet been properly established. Recently, there has been evidence suggesting that biologics such as infliximab (IFX) and adalimumab (ADA) are effective in the treatment of intestinal BD. Anti-t TNF-α agents are important for managing refractory intestinal Behçet’s disease. Few studies have reported the efficacy of anti-tumor necrosis factor-α monoclonal antibodies for intestinal Behçet’s disease, since it is one of the rarest diseases.

Aims: We report the efficacy of anti-tumor necrosis factor-α antibodies for intestinal Behçet’s disease in real-world practice.

Methods: This was a retrospective review of medical records at 4 hospitals in Japan. Global gastrointestinal symptom and endoscopic assessment scores were analyzed in intestinal Behçet’s disease patients given anti-tumor necrosis factor-α agents at 3 and 12 months after the start of therapy.

Results: Of 53 intestinal Behçet’s disease patients, 22 received anti-tumor necrosis factor-α monoclonal antibody treatment. At the first line, 14 were given adalimumab and 8 were given infliximab. After 3 and 12 months of treatment, 7 and 11 patients showed complete remission of gastrointestinal symptom scores, respectively, and 5 and 9 showed complete remission of the endoscopic assessment score, respectively. Three patients switched anti-tumor necrosis factor-α agents.

Conclusion: Anti-tumor necrosis factor-α monoclonal antibodies are effective for refractory intestinal Behçet’s disease in real-world situations. Switching anti-tumor necrosis factor-α agents may be useful for failure of first-line anti-tumor necrosis factor-α therapy in some refractory cases.