Background The efficacy and safety of biosimilar infliximab has been studied in several inflammatory conditions and biosimilar was approved for all indications of the reference product in several countries. However, to the best of our knowledge, there was no published reports on its use in Behçet's syndrome (BS).
Objectives We aimed to report our experience with biosimilar infliximab for the treatment of 3 different types of organ involvements in BS.
Methods We reviewed the charts of all BS patients who were prescribed infliximab in our multidisciplinary BS clinic. Among the 88 patients who were prescribed infliximab, 4 had used biosimilar infliximab (5 mg/kg) due to refractory disease despite conventional immunosuppressives.
Results Case 1: The first patient was a 28-year-old man who had received azathioprine (AZA), cyclosporine-A and methotrexate for 6 years for ocular involvement. Six months after the immunosuppressives were stopped due to sustained remission he had a stroke with right hemiparesis. Cranial MRI revealed venous infarct extending from posterior limb of left internal capsule to pons and mesencephalon, involving corpus callosum. Cervical MRI revealed a hyperintense lesion between C3-C8 segments. His cranial MR venography excluded sinus thrombosis. He received intravenous pulse corticosteroid followed by biosimilar infliximab. He achieved clinical remission and his MRI at month 3 showed almost total regression of the lesions. He is still in remission at 7th month of therapy. Case 2: The second patient was a 24-year-old man using AZA 2,5 mg/kg/day for refractory skin lesions when he developed bilateral external iliac vein and right common iliac vein thrombosis. Biosimilar infliximab was added to AZA. His abdominal superficial collateral vein distension regressed and Doppler ultrasonography at month 4 showed recanalization in bilateral external iliac veins and residual thrombosis only in the right common iliac vein. Case 3: The third patient was a 41-year-old man who had used colchicine, AZA, sulfasalazine, interferon-alpha and adalimumab for refractory arthritis. Biosimilar infliximab was started, with only a partial response. After one year treatment was switched to etanercept 50 mg/week and is attack-free for the last 7 months. Case 4: The fourth one was a 26-year-old man who was prescribed infliximab for panuveitis refractory to AZA, cyclosporine-A and interferon-alpha. The first infusion was biosimilar infliximab, but the following infusions were reference infliximab due to reimbursement policy of the hospital. There were no adverse events after switching to reference infliximab and the patient is doing well at 8 months of therapy.
Conclusions Our limited experience showed that biosimilar infliximab may be effective for BS patients refractory to conventional immunosuppressives.
Disclosure of Interest None declared
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