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Real-world effectiveness of apremilast in multirefractory mucosal involvement of Behçet’s disease
  1. Giuseppe Lopalco1,
  2. Vincenzo Venerito1,
  3. Pietro Leccese2,
  4. Giacomo Emmi3,
  5. Luca Cantarini4,
  6. Nancy Lascaro2,
  7. Gerardo Di Scala5,
  8. Claudia Fabiani6,
  9. Donato Rigante7,
  10. Florenzo Iannone1
  1. 1Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Bari, Italy
  2. 2Rheumatology Institute of Lucania (IRel), Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza, Italy
  3. 3Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
  4. 4Research Centre of Systemic Autoinflammatory Diseases, Behçet's Disease Clinic and Rheumatology-Ophthalmology Collaborative Uveitis Centre, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
  5. 5Department of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
  6. 6Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
  7. 7Institute of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
  1. Correspondence to Dr Giuseppe Lopalco, Department of Emergency and Organ Transplantation, Rheumatology Unit, University of Bari, Bari 70124, Italy; glopalco{at}

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Relapsing oral and genital ulcers (OGUs) represent the stigmata of Behçet’s disease (BD) and may be very painful, affecting both quality of life and relationships. A wide number of topical and immunosuppressive drugs can be used to treat ulcers,1 but failures are commonly reported. The efficacy of the phosphodiesterase-4 inhibitor apremilast has been proven in OGUs of BD in two randomised clinical trials (RCTs),2 3 whereas only two case reports are available until now.4 5 We aimed at evaluating the real-world effectiveness of apremilast in BD patients with OGUs refractory to conventional and/or biological treatments.

We retrospectively evaluated patients classified as BD, according to International Criteria for BD6 and International Study Group7 criteria, who underwent apremilast (30 mg two times per day) for multirefractory OGUs from November 2017 to January 2019. The number of OGUs was assessed at baseline and either at 3 and 6 months. Pain from ulcers and BD activity were …

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