Background/Purpose:

Anti-TNF treatment has been shown to be effective in inducing complete remission in many Behcet’s disease (BD) patients with eye, large vessel, intestine and central nervous system involvement, but data on patients’ outcomes after their discontinuation are currently lacking. We examined whether remission of BD with severe vital organ involvement is maintained after withdrawal of successful anti-TNF treatment.

Methods:

In this retrospective longitudinal outcome study we examined the records of all patients with BD who have been followed up in our center at least once yearly since 2000. The final follow-up visit and review of flow-charts was conducted during the first trimester of 2017. Patients eligible for the study’s analysis were those who, a) achieved complete and sustained remission during long-term anti-TNF treatment given for refractory to conventional immunosuppressive therapy disease, b) discontinued anti-TNF treatment at some point, and, c) were followed-up at least 3 years after discontinuation. The study’s endpoint was the proportion of patients achieving complete remission of BD, sustained for at least 3 years after withdrawal of the anti-TNF agent.

Results: Of our BD cohort comprising 87 patients, 29 were eligible for analysis (median anti-TNF treatment of 2 years, IQR 1.1-2.0). Of them, 12 (41%) achieved the study’s end-point. The remaining patients relapsed within 1 year (median, IQR 0.6-1.5) after discontinuation. Re-treatment with anti-TNF was safe and effective in the long-term in 14/17 (82%); 4 of them have also achieved the study’s end-point, so far. Overall, 16/29 patients (55%) remain currently in complete remission lasting for a median of 6.5 years (IQR 5.5-8); 34% are any drug-free, all treated with anti-TNF mainly for sight-threatening disease, and 21% are on low-dose maintenance with azathioprine only, treated initially with anti-TNF for ocular (n=4), intestinal and central nervous system involvement. Notably, patients remaining in drug-free remission were younger (p<0.03) and had shorter (p<0.03) BD duration at anti-TNF treatment initiation than patients on azathioprine maintenance.

Conclusion:

Drug-free, long-term remission after withdrawal of successful anti-TNF treatment is feasible in patients with severe BD. Since an anti-TNF-induced ‘cure’ cannot be differentiated from a spontaneous remission by natural history, prospective studies should examine whether anti-TNF should be used first-line for remission induction in every patient with vital organ involvement.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/long-term-remission-in-severe-behcets-disease-following-withdrawal-of-successful-anti-tnf-treatment/