Kambayashi Harutaka, Omori Teppei, Saito Satomi, Murasugi Shun, Kashiwagi Hiroyuki, Ito Ayumi, Yonezawa Maria, Nakamura Shinichi, Tokushige Katsutoshi
Institute of Gastroenterology, Tokyo Women's Medical University, Japan.
Intern Med. 2020;59(19):2343-2351. doi: 10.2169/internalmedicine.5000-20. Epub 2020 Oct 1.
Objective Anti-tumor necrosis factor (TNF)-α antibody-based regimens are effective in Behçet's disease (BD) with intestinal lesions. We therefore evaluated the efficacy of medium- to long-term anti-TNF-α antibody-based maintenance therapy of BD intestinal and non-intestinal lesions. Methods In this retrospective study, the response to the treatment was assessed endoscopically and clinically. Treatment responders were transferred to maintenance therapy. We evaluated the sustain rate of maintenance therapy, reductions in the dose of prednisolone (PSL), and the presence of non-intestinal BD involvement before and after the start of anti-TNF-α antibody-based the maintenance therapy. Patients We assessed 20 BD patients with intestinal lesions who underwent anti-TNF-α antibody-based therapy. Results Treatment was discontinued in 3 patients (18%). Loss of response was noted in 1 (5.9%) patient. Maintenance therapy was continued in 13 (76%) patients. The cumulative sustain rates to maintenance therapy after 2, 4, and 6 years were 94%, 87%, and 72%, respectively. In the 13 patients with remission of intestinal lesions, the mean PSL dose decreased from 13.4±2.16 mg/day before treatment to 0.92±0.47 after treatment (p<0.0001). PSL was discontinued in 9 (69%) patients. Five of the 13 (38%) patients developed clinical features of non-intestinal BD during the remission-maintenance treatment. Conclusion Our results demonstrated the efficacy of medium- to long-term anti-TNF-α antibody-based maintenance treatment against BD intestinal lesions. Nevertheless, some cases with well-controlled intestinal lesions developed active non-intestinal BD symptoms. The results highlight the importance of a carefully planned treatment strategy for BD patients with intestinal involvement.
目的 基于抗肿瘤坏死因子（TNF）-α抗体的治疗方案对伴有肠道病变的白塞病（BD）有效。因此，我们评估了基于抗TNF-α抗体的中长期维持治疗对BD肠道和非肠道病变的疗效。方法 在这项回顾性研究中，通过内镜和临床评估治疗反应。治疗有反应者转为维持治疗。我们评估了维持治疗的持续率、泼尼松龙（PSL）剂量的减少情况以及基于抗TNF-α抗体的维持治疗开始前后非肠道BD受累情况。患者 我们评估了20例接受基于抗TNF-α抗体治疗的伴有肠道病变的BD患者。结果 3例患者（18%）停止治疗。1例患者（5.9%）出现反应丧失。13例患者（76%）继续维持治疗。2年、4年和6年后维持治疗的累积持续率分别为94%、87%和72%。在13例肠道病变缓解的患者中，PSL平均剂量从治疗前的13.4±2.16毫克/天降至治疗后的0.92±0.47毫克/天（p<0.0001）。9例患者（69%）停用PSL。13例患者中有5例（38%）在缓解维持治疗期间出现非肠道BD的临床特征。结论 我们的结果表明基于抗TNF-α抗体的中长期维持治疗对BD肠道病变有效。然而，一些肠道病变得到良好控制的病例出现了活动性非肠道BD症状。结果突出了为伴有肠道受累的BD患者制定精心计划的治疗策略的重要性。
