Anti-TNF Agents for Behçet's Disease: Analysis of Published Data on 369 Patients

Arida, Aikaterini; Fragiadaki, Kalliopi; Giavri, Eirini; Sfikakis, Petros P.

doi:10.1016/j.semarthrit.2010.09.002

Cited by 291 publications

(176 citation statements)

References 74 publications

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“…In line with this hypothesis is growing evidence for a central role of tumor necrosis factor ␣ (TNF␣) reflected by proposed treatment algorithms (5). Although there is a growing list of patients treated with TNF␣-blocking agents for various manifestations, only incomplete data exist regarding severe vasculitis in BD (6). Therefore, we retrospectively describe the course of 7 patients with severe vasculitic BD lesions treated in our academic center using infliximab.…”

Section: Introductionmentioning

confidence: 93%

Behçet's disease: Successful treatment with infliximab in 7 patients with severe vascular manifestations. A retrospective analysis

Adler¹,

Baumgartner²,

Villiger³

2012

Arthritis Care & Research

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Objective. To evaluate the therapeutic effect of infliximab in patients with inflammatory vascular lesions due to Behçet's disease (BD). Methods. Seven patients with clinical evidence of severe vascular BD were analyzed: 3 patients with aortic involvement, 1 with recurrent venous thrombosis of the pelvic veins, 1 with recurrent venous and arterial thromboses of the thigh, and 2 with retinal vasculitis. Infliximab was initiated with 3-5 mg/kg of body weight and infusions were repeated in intervals of 4 weeks as either first-line therapy in 3 patients or add on after failure of conventional immunosuppression in the remaining 4. Ongoing immunosuppression consists of a various combination of azathioprine (n ‫؍‬ 2), methotrexate (n ‫؍‬ 3), cyclosporine (n ‫؍‬ 3), and low-dose glucocorticoids (n ‫؍‬ 3). Results. Control of inflammation was seen 1-5 days after infliximab induction in all patients. C-reactive protein level was reduced from a mean of 89 mg/liter prior to infliximab to 9 mg/liter thereafter. Vision increased rapidly in patients with retinal vasculitis. Vascular grafts remained patent. The inflamed and dissected aortic wall healed over a period of 6 months. Infliximab could be stopped in 2 patients; intervals could be extended in 4 to a maximum of 8 weeks. Infliximab and basic immunosuppression were well tolerated; no drug-induced side effects were recorded. Conclusion. Infliximab is effective in inducing and maintaining remission of vasculitic activity in patients with BD. The rapid effect together with excellent tolerability suggests that infliximab should be considered as a first-line agent in severe vascular BD.

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Section: Introductionmentioning

confidence: 93%

Behçet's disease: Successful treatment with infliximab in 7 patients with severe vascular manifestations. A retrospective analysis

Adler¹,

Baumgartner²,

Villiger³

2012

Arthritis Care & Research

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“…IL-8 secretion is also increased in CD4+ T lymphocytes of BD (24). The increase of TNF-α in BD has also been shown in many studies and the inhibition of TNF-a with anti-TNFa agents is currently one of the major progresses in BD treatment (25).…”

Section: Discussionmentioning

confidence: 75%

Immune and inflammatory gene expressions are different in Behçet’s disease compared to those in Familial Mediterranean Fever

et al. 2017

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Objective: The immune classification of Behçet's disease (BD) is still controversial. In this study, we aimed to compare the immune/ inflammatory gene expressions in BD with those in familial Mediterranean fever (FMF), an autoinflammatory disorder with innate immune activation.Material and Methods: CD4+ T cells and CD14+ monocytes were isolated from the peripheral blood mononuclear cells of Behçet's disease patients (n=10), FMF (n=6) patients, and healthy controls (n=4) with microbeads, and then, the mRNA was isolated. The expressions of 440 genes associated with immune and inflammatory responses were studied with a focused DNA microarray using a chemiluminescent tagging system. Changes above 1.5-fold and below 0.8-fold were accepted to be significant. Results:In BD patients, in the CD4+ T-lymphocyte subset, interleukin 18 receptor accessory protein (1.7-fold), IL-7 receptor (1.9-fold), and prokineticin 2 (2.5-fold) were all increased compared to those in FMF patients, whereas chemokine (C-X3-C motif ) receptor-1 (CX3CR1) (0.7-fold) and endothelial cell growth factor-1 (0.6-fold) were decreased. In the CD14+ monocyte population, the V-fos FBJ murine osteosarcoma viral oncogene homolog (1.5-fold), Interleukin-8 (IL-8) (2.1-fold), and Tumor Necrosis Factor alpha (TNF-α) (1.8-fold) were all increased, whereas the chemokine (C-C motif ) ligand 5 (CCL5) (0.6-fold), C-C chemokine receptor type 7 (0.6-fold), and CX3CR1 (0.7-fold) were decreased, again when compared to those in FMF. Compared to healthy controls in the CD4+ T-lymphocyte population, in both BD and FMF patients, pro-platelet basic protein and CD27 had elevated expression. In BD and FMF patients, 24 and 19 genes, respectively, were downregulated, with 15 overlapping genes between both disorders. In the CD14+ monocytes population, chemokine (C-C motif ) receptor-1 (CCR1) was upregulated both in BD and FMF patients compared to that in the controls, whereas CCL5 was downregulated. Conclusion:Immune and inflammatory gene expressions seem to be variable in both the innate (CD14+) and adaptive (CD4+) immune responses in BD and FMF patients compared to those in controls, suggesting differences in immune regulation between the two disorders.

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“…Conventional immunosuppressive agents such as azathioprine, cyclosporine-A, and corticosteroid as well as second-line agents such as interferon α-2a have proven to be effective in BD management. However, these agents could be inadequate for controlling inflammation in severe cases or side effects could limit their use [10]. An open label study reported that IFX is superior to conventional therapy for reducing inflammatory attacks in patients with refractory uveitis [11].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Infliximab in Patients with Refractory Uveitis Associated with Behcet Disease

F¹

2014

J Clin Exp Ophthalmol

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Anti-TNF Agents for Behçet's Disease: Analysis of Published Data on 369 Patients

Cited by 291 publications

References 74 publications

Behçet's disease: Successful treatment with infliximab in 7 patients with severe vascular manifestations. A retrospective analysis

Behçet's disease: Successful treatment with infliximab in 7 patients with severe vascular manifestations. A retrospective analysis

Immune and inflammatory gene expressions are different in Behçet’s disease compared to those in Familial Mediterranean Fever

Efficacy of Infliximab in Patients with Refractory Uveitis Associated with Behcet Disease

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