Biologic therapy in refractory neurobehçet's disease: a multicentre study of 41 patients and literature review. (15th February 2022)

• Record Type: Journal Article
• Authors: Herrero-Morant, Alba; Martín-Varillas, José Luis; Castañeda, Santos; Maíz, Olga; Sánchez, Julio; Ortego, Norberto; Raya, Enrique; Prior-Español, Águeda; Moriano, Clara; Melero-González, Rafael B; Graña-Gil, Jenaro; Urruticoechea-Arana, Ana; Ramos-Calvo, Ángel; Loredo-Martínez, Marta; Salgado-Pérez, Eva; Sivera, Francisca; Torre, Ignacio; Narváez, Javier; Andreu, José Luis; Martínez-González, Olga; Torre, Ricardo Gómez-de la; Fernández-Aguado, Sabela; Romero-Yuste, Susana; González-Mazón, Íñigo; Álvarez-Reguera, Carmen; Hernández, José Luis; González-Gay, Miguel Ángel; Blanco, Ricardo
• Is Part Of: Rheumatology. Volume 61:Number 11(2022)
• Page Start: 4427
• Page End: 4436
• Publication Date: 2022-02-15
• Subjects: Neurobehçet -- biologic therapy -- anti-TNF -- tocilizumab -- rituximab -- ustekinumab -- anakinra -- canakinumab; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keac097
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objectives: To assess efficacy and safety of biologic therapy (BT) in neurobehçet's disease (NBD) refractory to glucocorticoids and at least one conventional immunosuppressive drug. Methods: Open-label, national, multicentre study. NBD diagnosis was based on the International Consensus Recommendation criteria. Outcome variables were efficacy and safety. Main efficacy outcome was clinical remission. Other outcome variables analysed were glucocorticoid-sparing effect and improvement in laboratory parameters. Results: We studied 41 patients [21 women; age 40.6 (10.8) years]. Neurological damage was parenchymal ( n = 33, 80.5%) and non-parenchymal ( n = 17, 41.5%). First BTs used were infliximab ( n = 19), adalimumab ( n = 14), golimumab ( n = 3), tocilizumab ( n = 3) and etanercept ( n = 2). After 6 months of BT, neurological remission was complete ( n = 23, 56.1%), partial ( n = 15, 37.6%) and no response ( n = 3, 7.3%). In addition, median (IQR) dose of oral prednisone decreased from 60 (30–60) mg/day at the initial visit to 5 (3.8–10) mg/day after 6 months ( P < 0.001). It was also the case for mean erythrocyte sedimentation rate [31.5 (25.6)–15.3 (11.9) mm/1st h, P = 0.011] and median (IQR) C-reactive protein [1.4 (0.2–12.8) to 0.3 (0.1–3) mg/dl, P = 0.001]. After a mean follow-up of 57.5 months, partial or complete neurological remission persisted in 37 patients (90.2%). BT was switched in 22 cases (53.6%) due to inefficacy ( n = 16) or adverse events (AEs) ( n = 6) and discontinued due to complete prolonged remission ( n = 3) or severe AE ( n = 1). Serious AEs were observed in two patients under infliximab treatment. Conclusions: BT appears to be effective and relatively safe in refractory NBD.