Background/Purpose: To assess the long-term efficacy and safety of tumour necrosis factor (TNF) antagonists (infliximab [IFX], adalimumab [ADA] and golimumab) for the treatment of patients with Behçet’s disease (BD) with uveitis who failed to respond or did not tolerate conventional treatment.

Methods: Retrospective study of patients with BD and uveitis treated with anti-TNF therapy in a tertiary reference hospital. Data analyzed were: demographic characteristics; disease duration and type of uveitis; visual acuity; previous treatments; dosage, type and duration of biological agent used; outcome (remission, loss of efficacy, adverse events). The characteristics of uveitis, including the degree of inflammation and disease course, were analyzed according to the definitions of the Standardization of Uveitis Nomenclature (SUN) criteria. 

Results: We included 15 patients (8 male, mean age 36.9 ± 8.3 years) with BD and severe intraocular inflammation. Mean disease duration was 9.6 ± 5.7 years; 66.6% had panuveitis and 26.6% posterior uveitis. All patients had previously received oral glucocorticoids (GC) and 60% had received > 2 immunosuppressive (IMS) drugs. Thirteen patients were treated with IFX and 2 with ADA as initial anti-TNF therapy. Six of 13 patients treated with IFX were switched to another anti-TNF agent due to adverse events or loss of efficacy: 5/13 were switched to ADA and 1/13 was switched to golimumab. Globally, 7/15 patients were treated with ADA. IFX was infused at a dose of 5 mg/kg for a mean of 10.4 months (range: 2-24). ADA 40 mg was administered subcutaneously every 2 weeks for a mean of 29 months (range: 9-44). The mean follow-up was 37 months (range: 10-72). Twelve (80%) patients achieved remission. Three patients were able to discontinue all systemic IMS and GC drugs. Best corrected visual acuity remained stable or improved in 27/29 eyes. Three serious adverse events requiring IFX withdrawal were reported: 1 severe infusion reaction, 1 disseminated tuberculosis, and 1 prostatitis. 

Conclusion: Infliximab and adalimumab are effective biologic agents for the treatment of uveitis in patients with Behçet’s disease, achieving remission in 80% of patients. The treatments were, generally, well tolerated and only three patients required withdrawal.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-efficacy-and-safety-of-tumour-necrosis-factor-antagonists-for-patients-with-behcets-disease-with-uveitis-as-main-involvement/