322. Infliximab for Vascular Involvement in Behçet's Synome
Creators: name: Gulen Hatemi1
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background/ Objectives:</strong> Vascular involvement is an important cause of morbidity and mortality in patients with Behçet’s synome (BS). TNF inhibitors have been beneficial for the management of mucocutaneous, eye and gastrointestinal involvement of BS. Data on their efficacy in patients with vascular involvement is scarce. We aimed to survey the efficacy and safety of infliximab (IFX) in BS patients with vascular involvement followed in a dedicated tertiary center. <strong>Methods:</strong> We reviewed the charts of all BS patients who used IFX for vascular involvement between 2004 and June 2021. A standard form was used for extracting data on demographic and clinical features, type of vascular involvement, concomitant immunosuppressives, duration of IFX use, relapses, adverse events and outcome. The primary endpoint for patients with any vascular involvement was remission defined as lack of new clinical sympto/findings associated with vascular lesion, lack of worsening of the primary vascular lesion, lack of a new vascular lesion on imaging, and CRP&lt;10 mg/dL. For patients with venous ulcers, remission was defined as the complete healing of ulcers. Remission was assessed at month 6 and month 12. Relapse was defined as the development of a new vascular lesion or the recurrence of preexisting vascular lesion/s in patients who were in remission at or after month 6. <strong>Results:</strong> Among the 124 patients (102 men, mean age at IFX initiation: 36.5±8.9 years) treated with IFX, 106 (85%) received IFX for remission induction and 84/106 (79%) were refractory to conventional treatments. The main indication for IFX treatment was venous thrombosis in 62 patients (50%), pulmonary artery involvement in 36 (29%), non-pulmonary arterial involvement in 14 (11%), and venous ulcer in 12 (10%) (Table). At the time of IFX initiation, 108 patients (87%) were prescribed concomitant prednisolone and 97 (78%) concomitant immunosuppressives. Remission rate was 73% (90/124) at month 6 and 54% (67/124) at month 12. During IFX treatment, 13/93 (14%) patients experienced 16 relapses after remission had been achieved. Two of these patients had discontinued IFX. The reasons for discontinuation of IFX were remission in 23, adverse events in 14 patients, inefficacy in 12, patient non-compliance in 12, relapse in 2, and others in 7. The adverse events were allergic reactions in 5, tuberculosis, disseminated zona, lung adenocarcinoma, fibromyxoid sarcoma, heart failure, systemic lupus erythematosus, palmoplantar pustulosis, auricular chonitis, and aortic stent graft infection in 1 patient each. Eighteen (78%) of the 23 patients who discontinued IFX due to remission are still in remission while 5 had a relapse after 8, 13, 21, 38, and 79 months. Infliximab was initiated once again in a total of 12 patients. Eight of them discontinued IFX due to allergic reactions (n=3), remission (n=2), non-compliance (n=2), and frequent infection (n=1). At the end of the follow-up, 58 patients were still on IFX including 4 patients who had restarted IFX. Four patients had died and 2 of them were still on IFX treatment at the time of their death. Reasons for death were lung adenocarcinoma (n=1), sepsis (n=1), and pulmonary hypertension related right heart failure due to pulmonary artery thrombosis (n=2). <strong>Conclusions</strong>: IFX see to be effective in BS patients with vascular involvement, even in those who are refractory to immunosuppressives and corticosteroids. No further relapses occurred in 83% (77/93) of the patients during treatment and adverse events leading to discontinuation were observed in 15% (18/124). <strong>Disclosures:</strong> Sinem Nihal Esatoglu has received honorariu for presentations from UCB Pharma, Roche, Pfizer, and Merck Sharp Dohme. Gulen Hatemi has received grant/research support from Celgene and has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma. Yesim Ozguler has received honorariu for presentations from UCB Pharma, Novartis, and Pfizer. Vedat Hamuryudan has received grant/research support from Celgene and has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma. No other disclosures were reported.