State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, China.
Front Immunol. 2023 May 23;14:1205046. doi: 10.3389/fimmu.2023.1205046. eCollection 2023.
Behçet's Disease (BD) is an intractable systemic vasculitis. When accompanied by intestinal symptoms, the prognosis is usually poor. 5-Aminosalicylic acid (5-ASA), corticosteroids, immunosuppressive drugs, and anti-tumor necrosis factor-α (anti-TNF-α) biologics are standard therapies to induce or maintain remission for intestinal BD. However, they might not be effective in refractory cases. Safety should also be considered when patients have an oncology history. Regarding the pathogenesis of intestinal BD and the specific targeting effect of vedolizumab (VDZ) on the inflammation of the ileum tract, previous case reports suggested that VDZ might be a potential treatment for refractory intestinal BD.
We report a 50-year-old woman patient with intestinal BD who had oral and genital ulcers, joint pain, and intestinal involvement for about 20 years. The patient responds well to anti-TNF-α biologics but not to conventional drugs. However, biologics treatment was discontinued due to the occurrence of colon cancer.
VDZ was intravenously administered at a dose of 300 mg at 0, 2, and 6 weeks and then every eight weeks. At the 6-month follow-up, the patient reported significant improvement in abdominal pain and arthralgia. We observed complete healing of intestinal mucosal ulcers under endoscopy. However, her oral and vulvar ulcers remained unresolved, which disappeared after adding thalidomide.
VDZ may be a safe and effective option for refractory intestinal BD patients who do not respond well to conventional treatments, especially those with an oncology history.
贝赫切特病（BD）是一种难治性系统性血管炎。当伴有肠道症状时，通常预后较差。5-氨基水杨酸（5-ASA）、皮质类固醇、免疫抑制剂和抗肿瘤坏死因子-α（抗-TNF-α）生物制剂是诱导或维持肠 BD 缓解的标准治疗方法。然而，在难治性病例中它们可能无效。对于有肿瘤病史的患者，还应考虑安全性。鉴于肠 BD 的发病机制和 vedolizumab（VDZ）对回肠炎症的特定靶向作用，之前的病例报告表明 VDZ 可能是一种治疗难治性肠 BD 的潜在方法。
我们报告了一例 50 岁女性患者，患有肠 BD，有口腔和生殖器溃疡、关节痛和肠道受累约 20 年。该患者对抗-TNF-α 生物制剂反应良好，但对常规药物反应不佳。然而，由于结肠癌的发生，生物制剂治疗被停止。
VDZ 以 300mg 的剂量静脉给药，分别在 0、2 和 6 周以及之后每 8 周一次。在 6 个月的随访中，患者报告腹痛和关节痛明显改善。我们观察到内镜下肠黏膜溃疡完全愈合。然而，她的口腔和外阴溃疡仍未解决，加用沙利度胺后消失。
对于对常规治疗反应不佳的难治性肠 BD 患者，尤其是有肿瘤病史的患者，VDZ 可能是一种安全有效的选择。
