The real-world use of different anti-tumor necrosis factor agents in a Northern European population of patients with Behçet’s disease

Abstract

Objective: The aim of this study was to evaluate prescription practices, treatment responses, and serious adverse events of anti-tumor necrosis factor (anti-TNF) therapies in Behçet's disease (BD). Material and Methods: Patients with BD satisfying the International Study Group for Behçet's Disease or the International Criteria for Behçet's Disease criteria were recruited from a regional rheumatology program. The choice of anti-TNF, treatment response, and adverse events were specified. Response to treatment was evaluated by the detection of new, worsening, or improving clinical features, and management was benchmarked against current The European League against Rheumatism recommendations published in 2008. Results: Out of the total of 22 patients, 18 (81.9%) received anti-TNF therapies, resulting in 14 (77.8%) complete and 4 (22.2%) partial remissions. Eleven (61.1%) patients switched to a second anti-TNF, seven patients (38.9%) required three different anti-TNFs, and one required a fourth anti-TNF to achieve remission. Two patients required retrials before their disease was controlled. Anti-TNF therapy included infliximab (IFX): n=15, 83.3%; adalimumab (ADA): n=9, 50%; golimumab: n=6, 33.3%; etanercept: n=5, 27.8%; and certolizumab pegol: n=2, 11.1%. Secondary failure was observed with IFX (4/15; 26.7%) and ADA (2/9; 22.2%), and these (100%) were manifested after at least 2 years of treatment. Five patients with potentially life-threatening laryngeal involvement received anti-TNFs successfully halting disease progression. Five allergic reactions were encountered, and five serious infections were documented involving three patients aged ≥ 50 years, all with the use of IFX. Conclusion: Anti-TNF therapy induced a clinical response in 100% patients and achieved complete remission in 78% patients. It provides an effective alternative option for first-line therapy in severe BD where many conventional immunosuppressive therapies fail. Patients with BD who do not respond to one or more anti-TNFs because of intolerance, ineffectiveness, or secondary failure might benefit from switching to another drug from this group or even a retrial of a previously administered anti-TNF because unsatisfactory results with one biologic is not predictive of response to another anti-TNF. For those with potentially life-threatening destructive laryngeal manifestation, anti-TNF as a first choice may be considered.

A 10-year follow-up of infliximab monotherapy for refractory uveitis in Behçet’s syndrome

“…One possible reason for the increased inflammatory attacks at year 4 might be due to a loss of efficacy and a secondary failure caused by the induction of an anti-IFX antibody. A previous study reported finding that an anti-IFX antibody was produced at 2 years after the administration of IFX in European BS patients 25 . Therefore, these differences between our study and the previous study could potentially be explained by a delay in the production of anti-IFX antibody in the Japanese BS patients as compared to that found in the European population.…”

Indications, response, and side effects of biologic treatment in Behçet’s disease: an 8-year study with follow-up

“…In the study, we found high rates of remission and complete remission in patients with ophthalmic activity. Various studies have also shown significant improvement with IFX and ADA treatments in patients with uveitis and Behçet's disease [2,5,[13][14][15][16][17].…”

“…In addition, our study found high remission rates for oral and skin lesions at 6-month follow-up. Adeeb et al [ 15 ] also found anti-TNF highly effective against mucocutaneous oral and laryngeal manifestations. Moreover, for less common Behçet’s symptoms, such as arthritis, central nervous system (CNS) parenchymal involvement, and vascular lesions, 80.0–100% of patients had remission at 6 or 12-month follow-up.…”

“…In our study, 25.0% of patients needed to switch to a second biologic agent due to severe disease, side effects, or refractory disease. Anti-biologic agent antibodies can cause secondary inefficacy and there is a need to switch to a second biologic agent [ 15 ], but we did not assess them in our study.…”

Behçet’s disease: An immunogenetic perspective

“…A study conducted in 2017 showed that the use of anti-TNF-α leads to the induction of clinical responses in 100% of the patients and absolute remission in 78% of the patients. These biological agents can be used as an alternative treatment option in BD patients, who have failed to respond to formal immunosuppressive treatments (Adeeb et al, 2017). Additionally, TNF-α inhibitor therapy prevents T-cell differentiation in BD patients, who suffer from uveitis (Sugita et al, 2012).…”