A Clinical Picture of the Visual Outcome in Adamantiades-Behçet's Disease

Adamantiades-Behçet's disease is a multisystemic vasculitis with multiorgan involvement. Ocular disorders occur often in this syndrome typically in the form of a relapsing-remitting panuveitis and vasculitis and can lead to blindness as one of its most disabling complications if left untreated. There are known risk factors related with the worst visual prognosis, which require early and intensive treatment in order to obtain a rapid suppression of inflammation and to prevent future relapses. The management strategy to avoid vision loss and blindness currently involves the use of local and systemic drugs including steroids and immunosuppressive and biologic agents. This review aims to demonstrate how the introduction and the use of biologic agents improves the visual outcome of patients with Adamantiades-Behçet's disease.

Adalimumab for the treatment of Behçet's disease: experience in 19 patients

OBJECTIVE

To describe the experience of two tertiary Spanish centres (Hospital Clínico San Cecilio, Granada and Hospital Clínic, Barcelona) with the use of adalimumab for the treatment of severe clinical manifestations in patients with Behçet's disease (BD) in whom immunosuppressive therapy had failed.

METHODS

Retrospective chart review from patients with BD treated with adalimumab in two specialized Spanish centres (Hospital Clínico San Cecilio, Granada and Hospital Clínic, Barcelona).

RESULTS

From November 2006 to February 2011, 19 patients with BD were treated with adalimumab. The reason to initiate adalimumab was refractory disease in 17 (89.5%) patients and adverse events to CSA and infliximab in two (10.5%) patients, respectively. The main clinical manifestations leading to adalimumab administration were panuveitis in eight patients, severe bipolar aphthosis in eight, retinal vasculitis in three and severe folliculitis in three. Overall, adalimumab achieved clinical improvement in 17 of the 19 patients. Of note, ocular manifestations (panuveitis and retinal vasculitis) responded rapidly in all cases. In addition to clinical improvement, treatment with adalimumab was associated with reduction in the number and dose of standard immunosuppressive agents. Of interest, seven patients had received TNF-α inhibitors before adalimumab, five infliximab and the remaining two etanercept. Adalimumab was withdrawn in only one patient due to severe infusional reaction in the form of urticaria and angioedema.

CONCLUSION

Adalimumab is a valid option for patients with BD and recalcitrant non-controlling manifestations with good safety profile.

Clinical experience with adalimumab in the treatment of ocular Behçet disease

PURPOSE

To describe the clinical outcome of refractory ocular Behçet disease with adalimumab therapy.

METHOD

Retrospective review of records.

RESULTS

Twenty-one eyes of 11 male patients with ocular Behçet disease received adalimumab therapy. Of the 21 eyes, 17 had improvement of visual acuity by more than 3 lines after the average follow-up of 10.8 months. Ten out of 11 patients showed complete resolution of inflammation by 4 weeks. The dosages of corticosteroids and immunosuppressive drugs were reduced in most of the patients and stopped altogether in 3 and 6 patients, respectively. One patient on infliximab showed improvement of inflammation after switching over to adalimumab. No serious side effects were observed in any of the patients.

CONCLUSION

Adalimumab appears to be effective in Behçet disease. It has been shown to improve visual acuity and also to have a corticosteroid and immunosuppressive sparing effect. It can induce and maintain sustained remission of the disease.

Late response to anti-TNF-α therapy in refractory mucocutaneous lesions of Behçet's disease

Behçet's disease (BD) is a multisystem chronic inflammatory disorder characterized by oral and genital ulceration and ocular involvement. Recurrent oral and genital ulcers are the most common symptoms of BD and occur in more than 80% of patients. The treatments of these disease manifestations include colchicine, corticosteroids and immunosuppressive drugs in severe cases. Anti-TNF-α therapy may be useful in refractory severe BD, particularly for ocular, central nervous system, gastrointestinal and refractory mucocutaneous lesions. During a 2-year period, 280 patients suffering from rheumatic diseases received anti-TNF-α agents at the infusion center of our University Hospital. Two patients (0.7%) presented BD; one of them had celiac disease as well, with recalcitrant mucocutaneous lesions that were not responsive to immunosuppressive drugs. We reported those patients who were successfully treated with infliximab and adalimumab, despite their late response.