FRI0332 Etanercept therapy in patients with refractory behcet’s disease: uveitis and beyond.
Authors: R. H. A. Mohammed
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Behcet’s disease (BD) is a chronic relapsing multisystem inflammatory where Tumor necrosis factor alpha is believed to play a pivotal role.[1-3] <h3>Objectives</h3> Investigate the benefit of one year treatment with etanercept, a TNF- receptor fusion protein in ameliorating disease intensity and reducing relapses in patient refractory to conventional immunosuppressive drugs. <h3>Methods</h3> Single center prospective study over a period of one year. Patients with the established diagnosis of BD based on the criteria of the international study group [4] who were classified as having refractory ocular or muco-cutaneous disease while on conventional immuno-suppressive therapy were enrolled. Laboratory workup including markers of acute inflammatory disease including erythrocyte sedimentation rate ESR and C- reactive protein CRP. <h3>Results</h3> The study included 15 patients with the established diagnosis of BS, they included 14 males and 1 female, their ages ranged between 24-45 (mean 36.5+-6.75years), disease duration 2-7 years (mean 3.86+-1.30years). Baseline clinical assessment showed recurrent oro-genital ulcers in 100% of patients, pathergy test was positive in 17.6%, recurrent uveitis (&gt; 1attack/year) and refractory retinitis in 86.7% of cases, acne lesions in 73.3%, deep venous thrombosis in 33.3%. Laboratory investigations showed ESR a mean of (22+-16.97) a range from 4-65mm/hr, mean CRP 6.87+-4.44 mg/l, medication history showed 100% of the patients were on oral prednisolone 10-60mg/day (mean 20.16+-11.81mg/day), azathioprine 100-150mg/day (mean126.66+-25.81mg/day) and oral colchicine 1-1.2mg/day (1.08+-0.10), 20% were on cyclophosphamide pulse therapy (750 mg), 17.6% were on oral cyclosporine (5-10mg/kg/day) in addition to topical steroids, oral anticoagulants in 33,3%. Etanercept was initiated at regular weekly dose of 50mg subcutaneously over a period of one year. Assessment at the end of study period showed 86.6% (13 patients) to have &lt;1 attack of recurrent oro-genital ulcers, acne lesions, arthralgias/arthritis, with 100% of the patients having 0 recurrences of uveitis and remission of retinal vasculitic lesions. Laboratory markers of inflammation revealed a mean ESR of 6.2+-3.82 mm/hr(2-14mm/hr), a mean CRP 2.90+-2.11mg/l (0.2-5.6mg/l). The dose of oral prednisolone was successfully reduced with etanercept reaching a mean of 6.66+-2.24 mg/day (5-10mg/day) with a statistically significant difference between the pre-post TNF-I therapy inflammatory markers including mean ESR (t= 4.13, P= 0.001), mean CRP (t= 3.9, P= 0.008), and mean prednisolone dose (t= 4.39, P= 0.001). <h3>Conclusions</h3> Patient with refractory BD received a 12-month treatment with etanercept achieved a good therapeutic response. No serious infections or drug related adverse events reported. <h3>References</h3> Salvatore Gulli, Carlo Arrigo, Loredana Bocchino, Lucia Morgante, Donatella Sangari, Irene Castagna and Gian Filippo Bagnato. Remission of Behcet’s disease with anti-tumor necrosis factor monoclonal antibody therapy: a case report. BMC Musculoskeletal Disorders 2003, 4:19. Sakane T, Takeno M, Suzuki N and Inaba G: Behcet’s disease. N Engl J Med 1999, 341:1284-1291. Gul A: Behcet’s disease: an update on the pathogenesis. Clin Exp Rheumatol 2001, 19(suppl):S6-S12. -International Study Group for Behcet’s Disease: Criteria for diagnosis of Behcet’s disease. Lancet 1990, 335:1078-1080. <b>Disclosure of Interest</b>: None Declared