Behcet’s disease in Ireland: Patient Access and Response to Biologics
Fahd Adeeb (1,3), Wan Lin (1), Austin Stack (2), Joe Devlin (1), Alexander Duncan Fraser (1,3)
1. Rheumatology Department, University Hospital Limerick, Limerick, Ireland; 2. Renal Department, University Hospital Limerick, Limerick, Ireland; 3. Graduate Entry Medical School, University of Limerick
Current literature shows promising data of efficacy of anti TNF-?? biologics for Behcet’s disease (BD) patients.
The aim of the study was to investigate a cohort of BD patients in Ireland, the current prescription practice for anti tumour necrosis factor alpha (anti TNF-??) biologics, patient response, and the risk of serious infections associated with it.
All BD patients attending our rheumatology department and satisfied the ISGBD or ICBD criteria were included in the study. Response was evaluated depending on patient’s new clinical features, and improvement or resolution of clinical symptoms. Management was compared with the current European League Against Rheumatism (EULAR) guidelines published in 2009.
Out of a cohort of 22 patients, 18 (81.9%) received anti-TNF-?? biologic therapies (6 males, 12 females), with mean age of 38.9. 14 patients (77.8%) achieved complete remission and 4 patients (22.2%) achieved low disease activity while on anti-TNF-?? biologics. Among this, 3 patients (16.7%) were successfully switched to a different agent due to secondary failure, while 7 patients (38.8%) needed at least trial of 3 different anti-TNF-?? biological therapies before controlling their disease at least to a low disease activity. 5 allergic reactions were encountered, all with the administration of infliximab infusions. 5 serious infections were documented involving 3 patients (16.7%) requiring intravenous antimicrobials and hospitalization, all in patients aged 50 years or above.
Response rates to anti-TNF-?? therapy were excellent and treatment was well tolerated, but should be used with caution in patients aged above 50. BD patients who fail one anti TNF-?? due to intolerance, ineffectiveness or secondary failure may still benefit from switching to another drug from this group.