Abstract: Objectives. To assess efficacy and safety of biologic therapy (BT) in neurobehc¸et?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 ¼ 33, 80.5%) and non-parenchymal (n ¼ 17, 41.5%). First BTs used were infliximab (n ¼ 19), adalimumab (n ¼ 14), golimumab (n ¼ 3), tocilizumab (n ¼ 3) and etanercept (n ¼ 2). After 6 months of BT, neurological emission was complete (n ¼ 23, 56.1%), partial (n ¼ 15, 37.6%) and no response (n ¼ 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 ¼ 0.011] and median (IQR) C-reactive protein [1.4 (0.2-12.8) to 0.3 (0.1-3) mg/dl, P ¼ 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 ¼ 16) or adverse events (AEs) (n ¼ 6) and discontinued due to complete prolonged remission (n ¼ 3) or severe AE (n ¼ 1). Serious AEs were observed in two patients under infliximab treatment. Conclusions. BT appears to be effective and relatively safe in refractory NBD.

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