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FRI0332 Etanercept therapy in patients with refractory behcet’s disease: uveitis and beyond.
  1. R. H. A. Mohammed1
  1. 1Department of Rheumatology and rehabilitation, FACULTY OF MEDICINE, CAIRO UNIVERSITY HOSPITALS, Egypt., Taief, Saudi Arabia

Abstract

Background Behcet’s disease (BD) is a chronic relapsing multisystem inflammatory where Tumor necrosis factor alpha is believed to play a pivotal role.[1-3]

Objectives Investigate the benefit of one year treatment with etanercept, a TNF- receptor fusion protein in ameliorating disease intensity and reducing relapses in patient refractory to conventional immunosuppressive drugs.

Methods Single center prospective study over a period of one year. Patients with the established diagnosis of BD based on the criteria of the international study group [4] who were classified as having refractory ocular or muco-cutaneous disease while on conventional immuno-suppressive therapy were enrolled. Laboratory workup including markers of acute inflammatory disease including erythrocyte sedimentation rate ESR and C- reactive protein CRP.

Results The study included 15 patients with the established diagnosis of BS, they included 14 males and 1 female, their ages ranged between 24-45 (mean 36.5+-6.75years), disease duration 2-7 years (mean 3.86+-1.30years). Baseline clinical assessment showed recurrent oro-genital ulcers in 100% of patients, pathergy test was positive in 17.6%, recurrent uveitis (> 1attack/year) and refractory retinitis in 86.7% of cases, acne lesions in 73.3%, deep venous thrombosis in 33.3%. Laboratory investigations showed ESR a mean of (22+-16.97) a range from 4-65mm/hr, mean CRP 6.87+-4.44 mg/l, medication history showed 100% of the patients were on oral prednisolone 10-60mg/day (mean 20.16+-11.81mg/day), azathioprine 100-150mg/day (mean126.66+-25.81mg/day) and oral colchicine 1-1.2mg/day (1.08+-0.10), 20% were on cyclophosphamide pulse therapy (750 mg), 17.6% were on oral cyclosporine (5-10mg/kg/day) in addition to topical steroids, oral anticoagulants in 33,3%. Etanercept was initiated at regular weekly dose of 50mg subcutaneously over a period of one year. Assessment at the end of study period showed 86.6% (13 patients) to have <1 attack of recurrent oro-genital ulcers, acne lesions, arthralgias/arthritis, with 100% of the patients having 0 recurrences of uveitis and remission of retinal vasculitic lesions. Laboratory markers of inflammation revealed a mean ESR of 6.2+-3.82 mm/hr(2-14mm/hr), a mean CRP 2.90+-2.11mg/l (0.2-5.6mg/l). The dose of oral prednisolone was successfully reduced with etanercept reaching a mean of 6.66+-2.24 mg/day (5-10mg/day) with a statistically significant difference between the pre-post TNF-I therapy inflammatory markers including mean ESR (t= 4.13, P= 0.001), mean CRP (t= 3.9, P= 0.008), and mean prednisolone dose (t= 4.39, P= 0.001).

Conclusions Patient with refractory BD received a 12-month treatment with etanercept achieved a good therapeutic response. No serious infections or drug related adverse events reported.

References

  1. Salvatore Gulli, Carlo Arrigo, Loredana Bocchino, Lucia Morgante, Donatella Sangari, Irene Castagna and Gian Filippo Bagnato. Remission of Behcet’s disease with anti-tumor necrosis factor monoclonal antibody therapy: a case report. BMC Musculoskeletal Disorders 2003, 4:19.

  2. Sakane T, Takeno M, Suzuki N and Inaba G: Behcet’s disease. N Engl J Med 1999, 341:1284-1291.

  3. Gul A: Behcet’s disease: an update on the pathogenesis. Clin Exp Rheumatol 2001, 19(suppl):S6-S12.

  4. -International Study Group for Behcet’s Disease: Criteria for diagnosis of Behcet’s disease. Lancet 1990, 335:1078-1080.

Disclosure of Interest: None Declared

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