Eficacia del adalimumab en la enfermedad de Behçet: descripción de 6 casos

doi:10.1016/j.reuma.2010.10.003

Reumatología Clínica

Volume 7, Issue 4, July–August 2011, Pages 258-261

https://doi.org/10.1016/j.reuma.2010.10.003 Get rights and content

Resumen

La enfermedad de Behçet (EB) es una vasculitis sistémica, y afecta con mayor agresividad a varones jóvenes. Sus manifestaciones más frecuentes son las aftas orogenitales, la uveítis y las lesiones cutáneas.

Analizamos 6 pacientes con EB, que recibieron adalimumab para controlar la enfermedad. Todos habían recibido terapia inmunosupresora, además 2 de ellos recibieron infliximab. Observamos una buena respuesta clínica al fármaco. Actualmente, con un seguimiento medio de 26,8 meses, los pacientes siguen en tratamiento con adalimumab, con buen control clínico y sin que se hayan detectado efectos adversos relacionados con el anti-TNF.

Abstract

Behçet's disease (BD) is a systemic vasculitis, with a more aggressive course in young males. Orogenital ulcers, uveitis and cutaneous lesions are the most frequent manifestations.

We analyzed the effects of adalimumab on six patients with BD pretreated with inmunosupressive therapy, two of whom had received infliximab. We observed a good clinical response in all patients. To date, after a mean follow-up of 26.8 months, patients continue receiving adalimumab, with good clinical control, no adverse effects have been reported with adalimumab.

Section snippets

Introducción

La enfermedad de Behçet (EB) es una vasculitis sistémica. Sus manifestaciones más frecuentes son las aftas orogenitales, poliartritis, afectación ocular (uveítis) y afectación cutánea (eritema nudoso, foliculitis y fenómeno de patergia)1, 2.

La utilización de los agentes biológicos antagonistas del factor de necrosis tumoral (anti-TNF) como parte de la estrategia terapéutica para el manejo de las vasculitis sistémicas es cada vez más frecuente³.

Adalimumab (Humira^®), es un anticuerpo anti-TNF

Observación clínica

Los pacientes habían recibido tratamiento convencional: esteroides, azatioprina, ciclosporina, antiinflamatorios, colchicina y 2 además infliximab (tabla 1).

Debido a la falta de respuesta de control de los síntomas (una paciente con aftas orales y genitales recurrentes) y a la afectación ocular (5 pacientes con uveítis de repetición y empeoramiento visual), se decidió iniciar tratamiento con adalimumab (40 mg/14 días s.c.).

Dos pacientes con uveítis (una de ellas además presentaba

Discusión

La indicación de los anti-TNF como parte de la estrategia terapéutica para el manejo de las vasculitis sistémicas es cada vez más frecuente³. Siendo la EB una vasculitis de evolución crónica con recaídas donde, además, las opciones de tratamientos son limitadas y no exentas de efectos adversos, la utilización de los anti-TNF es una posibilidad para controlar los síntomas en estos pacientes.

Presentamos 6 pacientes con EB que recibieron adalimumab, observando una buena respuesta clínica y

Conclusiones

Según nuestra casuística y los datos previos, publicados en la literatura médica, consideramos que la terapia con anti-TNF, y especialmente adalimumab, es una buena opción terapéutica en los pacientes con EB resistentes a la terapia convencional. No se detectó ningún efecto adverso en los pacientes tratados con adalimumab, coincidiendo con los pocos casos descritos en la literatura científica revisada.

Conflicto de intereses

Los autores declaran no tener ningún conflicto de intereses.

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Cited by (17)

Successful Optimization of Adalimumab Therapy in Refractory Uveitis Due to Behçet's Disease
2018, Ophthalmology
Citation Excerpt :
Fortunately, several studies have confirmed the efficacy of biologic therapy in the treatment of refractory uveitis associated with BD.14,26 However, in most cases this information comes from small series or case reports.26–33 In our study we describe the largest series of patients with refractory uveitis due to BD undergoing ADA therapy.
To assess efficacy, safety, and cost-effectiveness of adalimumab (ADA) therapy optimization in a large series of patients with uveitis due to Behçet disease (BD) who achieved remission after the use of this biologic agent.
Open-label multicenter study of ADA-treated patients with BD uveitis refractory to conventional immunosuppressants.
Sixty-five of 74 patients with uveitis due to BD, who achieved remission after a median ADA duration of 6 (range, 3–12) months. ADA was optimized in 23 (35.4%) of them. This biologic agent was maintained at a dose of 40 mg/subcutaneously/2 weeks in the remaining 42 patients.
After remission, based on a shared decision between the patient and the treating physician, ADA was optimized. When agreement between patient and physician was reached, optimization was performed by prolonging the ADA dosing interval progressively. Comparison between optimized and nonoptimized patients was performed.
Efficacy, safety, and cost-effectiveness in optimized and nonoptimized groups. To determine efficacy, intraocular inflammation (anterior chamber cells, vitritis, and retinal vasculitis), macular thickness, visual acuity, and the sparing effect of glucocorticoids were assessed.
No demographic or ocular differences were found at the time of ADA onset between the optimized and the nonoptimized groups. Most ocular outcomes were similar after a mean ± standard deviation follow-up of 34.7±13.3 and 26±21.3 months in the optimized and nonoptimized groups, respectively. However, relevant adverse effects were only seen in the nonoptimized group (lymphoma, pneumonia, severe local reaction at the injection site, and bacteremia by Escherichia coli, 1 each). Moreover, the mean ADA treatment costs were lower in the optimized group than in the nonoptimized group (6101.25 euros/patient/year vs. 12 339.48; P < 0.01).
ADA optimization in BD uveitis refractory to conventional therapy is effective, safe, and cost-effective.
Effectiveness of Infliximab and Interferon Alpha-2a for the Treatment of Behçet’s Uveitis: Customizing Therapy according to the Clinical Features
2022, Ocular Immunology and Inflammation
Comparative Study of Infliximab Versus Adalimumab in Refractory Uveitis due to Behçet's Disease: National Multicenter Study of 177 Cases
2019, Arthritis and Rheumatology
Evaluation of uveitis activity using bos24 in patients with Behcet's disease
2017, Nauchno-Prakticheskaya Revmatologiya
Efficacy and safety of adalimumab in Behçet’s disease-related uveitis: a multicenter retrospective observational study
2017, Clinical Rheumatology
Effectiveness of infliximab, adalimumab and golimumab for non-infectious refractory uveitis in adults
2015, International Journal of Clinical Pharmacology and Therapeutics

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Caso clínicoEficacia del adalimumab en la enfermedad de Behçet: descripción de 6 casosEfficacy of adalimumab in Behçet's disease. Description of 6 cases

Resumen

Abstract

Section snippets

Introducción

Observación clínica

Discusión

Conclusiones

Conflicto de intereses

Autoimmun Rev

Reumatol Clin

J Neuroimmunol

Surv Ophthalmol

Influence of age of onset and patient's sex on the prevalence and severity of manifestations of Behçet's syndrome

Ann Rheum Dis

The long-term mortality and morbidity of Behçet syndrome: a 2-decade outcome survey of 387 patients followed at a dedicated center

Medicine (Baltimore)

Adalimumab for sight-threatening uveitis in Behçet's disease

Eye

Treatment of Behçet's disease with adalimumab

Med Clin (Barc)

Efficacy of infliximab and adalimumab in the treatment of a patient with severe neuro-Behçet's disease

Clin Exp Rheumatol

Caso clínico
Eficacia del adalimumab en la enfermedad de Behçet: descripción de 6 casosEfficacy of adalimumab in Behçet's disease. Description of 6 cases