Introduction
Intestinal Behçet’s disease (BD) is a rare chronic intestinal vasculitic disorder and it is often refractory to conventional therapies such as corticosteroids and immunomodulators. We aimed to assess the efficacy and tolerability of anti-tumor necrosis factor alpha (TNF ɑ) in intestinal BD.
Aims & Methods
We retrospectively reviewed 667 patients with intestinal BD registered at the Inflammatory Bowel Disease Clinic of Severance Hospital, Seoul, Korea. Response rates of anti-TNF ɑ treatment, predictive factors of sustained response and relapse were analyzed.
Results
A total of 46 patients with refractory moderate to severe intestinal BD were selected for the anti-TNF ɑ therapy. According to the intention-to-treat (ITT) principle, clinical remission rates were 8.7%, 21.7%, 6.5%, and 8.7%, clinical response rates were 76.1%, 71.7%, 39.1%, and 26.1%, and biological response rates were 60.9%, 60.9%, 39.1%, and 26.1%, respectively. According to the per-protocol (PP) principle, clinical remission rates were 8.7%, 25.6%, 13.0%, and 28.6%, clinical response rates were 76.1%, 84.6%, 78.3%, and 85.7%, and biological response rates were 60.9%, 71.8%, 78.2%, and 85.7%, respectively. Previous corticosteroid use more than 20 mg per day (HR: 4.781) and multiple number of ulcers (HR: 8.599) were more likely to have relapse of intestinal BD, and clinical response at 1 month (HR: 0.189) was associated with lowering the relapse. One patient had severe sepsis, 1 patient was diagnosed pneumonia and herpes zoster, and 1 patient experienced otitis externa.
Conclusion
Anti-TNF ɑ therapy could be a useful therapeutic option for refractory intestinal BD with an acceptable efficacy and tolerability profiles.
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