Bozkurt Tugce, Karabacak Murat, Karatas Hakan, Kutluğ Ağaçkıran Seda, Ergun Tulin, Direskeneli Haner, Alibaz-Oner Fatma
Department of Internal Medicine, Marmara University, School of Medicine, Istanbul, Turkey.
Department of Internal Medicine, Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey.
Clin Immunol. 2023 Mar;248:109263. doi: 10.1016/j.clim.2023.109263. Epub 2023 Feb 14.
Immunosuppressives (IS) are the choice of treatment for major organ involvement in Behçet's disease (BD). In this study, we aimed to investigate the relapse rate and new major organ development in BD under ISs during long-term follow-up.
The files of 1114 BD patients followed in Marmara University Behçet's Clinic were analyzed retrospectively. Patients with a follow-up less than 6 months were excluded. Conventional IS and biologic treatment courses were compared. 'Events under IS' were defined as a relapse of the same organ and/or new major organ development in patients receiving ISs.
Among 806 patients included in the final analysis (male: 56%, age at diagnosis: 29 (23-35) years, median follow-up time: 68 (33-106) months). Major organ involvement was present in 232 (50.5%) patients at diagnosis, and 227 (49.5%) developed new major organ involvement during follow-up. Major organ involvement developed earlier in males (p = 0.012) and in patients with a first-degree relative history of BD (p = 0.066). ISs were given mostly for major organ involvement (86.8%, n = 440). Overall, 36% of the patients had a relapse or new major organ involvement under ISs (relapse: 30.9%, new major organ involvement: 11.6%.) 'Events under IS' (35.5% vs 20.8%, p = 0.004), and relapses (29.3% vs 13.9%, p = 0.001) were more common with conventional ISs compared to biologics.
Any major event under ISs was less common with biologics compared to conventional ISs in patients with BD. These results suggest that earlier and more aggressive treatment may be an option in BD patients who had the highest risk for severe disease course.
免疫抑制剂（IS）是白塞病（BD）主要器官受累的治疗选择。在本研究中，我们旨在调查长期随访期间接受IS治疗的BD患者的复发率和新的主要器官受累情况。
回顾性分析马尔马拉大学白塞病诊所随访的1114例BD患者的病历。排除随访时间少于6个月的患者。比较了传统IS和生物治疗疗程。“IS治疗期间的事件”定义为接受IS治疗的患者同一器官复发和/或新的主要器官受累。
最终分析纳入806例患者（男性：56%，诊断时年龄：29（23 - 35）岁，中位随访时间：68（33 - 106）个月）。诊断时232例（50.5%）患者存在主要器官受累，227例（49.5%）在随访期间出现新的主要器官受累。男性（p = 0.012）和有BD一级亲属病史的患者（p = 0.066）主要器官受累出现得更早。IS主要用于治疗主要器官受累（86.8%，n = 440）。总体而言，36%的患者在接受IS治疗期间出现复发或新的主要器官受累（复发：30.9%，新的主要器官受累：11.6%）。与生物制剂相比，传统IS治疗下“IS治疗期间的事件”（35.5%对20.8%，p = 0.004）和复发（29.3%对13.9%，p = 0.001）更常见。
与传统IS相比，BD患者接受生物制剂治疗时，IS治疗期间的任何重大事件都较少见。这些结果表明，对于疾病进程风险最高的BD患者，早期和更积极的治疗可能是一种选择。
