Biologic therapy in refractory neurobehcet's disease: a multicentre study of 41 patients and literature review
Por:
Herrero-Morant, A, Martin-Varillas, JL, Castaneda, S, Maiz, O, Sanchez, J, Ortego, N, Raya, E, Prior-Espanol, A, Moriano, C, Melero-Gonzalez, RB, Grana-Gil, J, Urruticoechea-Arana, A, Ramos-Calvo, A, Loredo-Martinez, M, Salgado-Perez, E, Sivera, F, Torre, I, Narvaez, J, Andreu, JL, Martinez-Gonzalez, O, Gomez-de la Torre, R, Fernandez-Aguado, S, Romero-Yuste, S, Gonzalez-Mazon, I, Alvarez-Reguera, C, Hernandez, JL, Gonzalez-Gay, MA and Blanco, R
Publicada:
2 nov 2022
Ahead of Print:
1 feb 2022
Resumen:
Objectives To assess efficacy and safety of biologic therapy (BT) in neurobehcet's disease (NBD) refractory to glucocorticoids and at least one conventional immunosuppressive drug. Methods Open-label, national, multicentre study. NBD diagnosis was based on the International Consensus Recommendation criteria. Outcome variables were efficacy and safety. Main efficacy outcome was clinical remission. Other outcome variables analysed were glucocorticoid-sparing effect and improvement in laboratory parameters. Results We studied 41 patients [21 women; age 40.6 (10.8) years]. Neurological damage was parenchymal (n = 33, 80.5%) and non-parenchymal (n = 17, 41.5%). First BTs used were infliximab (n = 19), adalimumab (n = 14), golimumab (n = 3), tocilizumab (n = 3) and etanercept (n = 2). After 6 months of BT, neurological remission was complete (n = 23, 56.1%), partial (n = 15, 37.6%) and no response (n = 3, 7.3%). In addition, median (IQR) dose of oral prednisone decreased from 60 (30-60) mg/day at the initial visit to 5 (3.8-10) mg/day after 6 months (P < 0.001). It was also the case for mean erythrocyte sedimentation rate [31.5 (25.6)-15.3 (11.9) mm/1st h, P = 0.011] and median (IQR) C-reactive protein [1.4 (0.2-12.8) to 0.3 (0.1-3) mg/dl, P = 0.001]. After a mean follow-up of 57.5 months, partial or complete neurological remission persisted in 37 patients (90.2%). BT was switched in 22 cases (53.6%) due to inefficacy (n = 16) or adverse events (AEs) (n = 6) and discontinued due to complete prolonged remission (n = 3) or severe AE (n = 1). Serious AEs were observed in two patients under infliximab treatment. Conclusions BT appears to be effective and relatively safe in refractory NBD.
Filiaciones:
Herrero-Morant, A:
Univ Cantabria, IDIVAL, Hosp Univ Marques Valdecilla, Rheumatol, Santander, Spain
Martin-Varillas, JL:
Hosp Sierrallana, Rheumatol, Torrelavega, Torrelavega, Spain
Castaneda, S:
Hosp Univ La Princesa, IIS Princesa, Rheumatol, Madrid, Spain
Maiz, O:
Hosp Univ Donostia, Rheumatol & Ophthalmol, San Sebastian, Spain
Sanchez, J:
Hosp 12 Octubre, Rheumatol, Madrid, Spain
Ortego, N:
Hosp Univ Clin San Cecilio, Rheumatol & Internal Med, Granada, Spain
Raya, E:
Hosp Univ Clin San Cecilio, Rheumatol & Internal Med, Granada, Spain
:
Hosp Univ Germans Trias i Pujol, Rheumatol, Barcelona, Spain
Moriano, C:
Hosp Leon, Rheumatol, Leon, Spain
Melero-Gonzalez, RB:
Complejo Hosp Vigo, Rheumatol, Vigo, Spain
Grana-Gil, J:
Hosp Univ Coruna, Rheumatol, La Coruna, Spain
Urruticoechea-Arana, A:
Hosp Can Misses, Rheumatol, Ibiza, Spain
Ramos-Calvo, A:
Complejo Hosp Soria, Rheumatol, Soria, Spain
Loredo-Martinez, M:
Hosp Clin Lozano Blesa, Rheumatol, Zaragoza, Spain
Salgado-Perez, E:
Complejo Hosp Univ Ourense, Rheumatol, Orense, Spain
Sivera, F:
Hosp Gen Univ Elda, Rheumatol, Elda, Spain
Univ Miguel Hernandez, Medicina, Elche, Spain
Torre, I:
Hosp Basurto, Rheumatol, Bilbao, Spain
Narvaez, J:
Hosp Bellvitge Princeps Espanya, Rheumatol, Barcelona, Spain
Andreu, JL:
Hosp Univ Puerta Hierro Majadahonda, Rheumatol, Madrid, Spain
Martinez-Gonzalez, O:
Hosp Clin Univ Salamanca, Rheumatol, Salamanca, Spain
Gomez-de la Torre, R:
Hosp Univ Cent Asturias, Internal Med, Oviedo, Spain
Fernandez-Aguado, S:
Hosp Univ Cabuenes, Rheumatol, Gijon, Spain
Romero-Yuste, S:
Complejo Hosp Univ Pontevedra, Rheumatol, Pontevedra, Spain
Gonzalez-Mazon, I:
Univ Cantabria, IDIVAL, Hosp Univ Marques Valdecilla, Rheumatol, Santander, Spain
Alvarez-Reguera, C:
Univ Cantabria, IDIVAL, Hosp Univ Marques Valdecilla, Rheumatol, Santander, Spain
Hernandez, JL:
Hosp Univ Marqes Valdecilla, IDIVAL, Internal Med, Santander, Spain
Gonzalez-Gay, MA:
Univ Cantabria, IDIVAL, Hosp Univ Marques Valdecilla, Rheumatol, Santander, Spain
Blanco, R:
Univ Cantabria, IDIVAL, Hosp Univ Marques Valdecilla, Rheumatol, Santander, Spain
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