Efficacy of anti-TNF alpha in severe and/or refractory Behcet's disease: Multicenter study of 124 patients
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Titre | Efficacy of anti-TNF alpha in severe and/or refractory Behcet's disease: Multicenter study of 124 patients |
Type de publication | Journal Article |
Year of Publication | 2015 |
Auteurs | Vallet H., Riviere S., Sanna A., Deroux A., Moulis G., Addimanda O., Salvarani C., Lambert M., Bielefeld P., Seve P., Sibilia J., Pasquali J, Fraison J, Marie I., Perard L., Bouillet L., Cohen F., Sene D., Schoindre Y., Lidove O., Le Hoang P., Hachulla E., Fain O., Mariette X., Papo T., Wechsler B., Bodaghi B., M. Rigon R, Cacoub P., Saadoun D., Network FBehcet |
Journal | JOURNAL OF AUTOIMMUNITY |
Volume | 62 |
Pagination | 67-74 |
Date Published | AUG |
Type of Article | Article |
ISSN | 0896-8411 |
Mots-clés | anti-TNF, Behcet's disease, Efficacy, Safety, vasculitis |
Résumé | Objective: To report the efficacy and safety of anti-TNF agents in patients with severe and/or refractory manifestations of Behcet's disease (BD). Methods: We performed a multicenter study of main characteristics and outcomes of anti-TNF alpha treatments [mainly infliximab (62%), and adalimumab (30%)1 in 124 BD patients [48% of men; median age of 33.5 (28-40) years]. Results: Overall response (i.e. complete and partial) rate was 90.4%. Clinical responses were observed in 963%, 88%, 70%, 77.8%, 923% and 66.7% of patients with severe and/or refractory ocular, mucocutaneous, joint, gastro-intestinal manifestations, central nervous system manifestations and cardiovascular manifestations, respectively. No significant difference was found with respect to the efficacy of anti-TNF used as monotherapy or in association with an immunosuppressive agent. The incidence of BD flares/patient/year was significantly lower during anti-TNF treatment (0.2 +/- 0.5 vs 1.7 +/- 2.4 before the use of anti-TNF, p < 0.0001). The prednisone dose was significantly reduced at 6 and 12 months (p < 0.0001). In multivariate analysis, retinal vasculitis was negatively associated with complete response to anti-TNF (OR = 0.33 [0.12-0.89]; p = 0.03). The efficacy and relapse free survival were similar regardless of the type of anti-TNF agent used. After a median follow-up of 21 [7-36] months, side effects were reported in 28% of patients, including infections (16.3%) and hypersensitivity reactions (4.1%). Serious adverse events were reported in 13% of cases. Conclusion: Anti-TNF alpha therapy is efficient in all severe and refractory BD manifestations. Efficacy appears to be similar regardless of the anti-TNF agent used (infliximab or adalimumab). (C) 2015 Elsevier Ltd. All rights reserved. |
DOI | 10.1016/j.jaut.2015.06.005 |