期刊
JOURNAL OF THE NEUROLOGICAL SCIENCES
卷 272, 期 1-2, 页码 99-105出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jns.2008.05.002
关键词
Behcet's disease; cerebrospinal fluid; dementia; interleukin-6; methotrexate; TNF-alpha; treatment
资金
- Mitsubishi Tanabe Pharma Co., Ltd., Tokyo, Japan
Recent studies have shown the beneficial effect of infliximab in ocular manifestation of Behcet's disease. The current Studies examined the efficacy of infliximab in progressive neuro-Behcet's syndrome (NB) refractory to methotrexate (MTX). Five male patients with progressive NB with sustained elevation of cerebrospinal fluid (CSF) IL-6 (over 20 pg/ml) despite administration of MTX and steroid, were given intravenous infusion of 5 mg/kg infliximab at weeks 0, 2, 6, and 14 with MTX (10-17.5 mg/week) and prednisolone (< 10 mg/day) at the same doses. The clinical responses were judged by neuropsychiatric findings, revised Wechsler adult intelligence scale (WAIS-R), and brain magnetic resonance imaging (MRI) scans at 24 weeks. In all the 5 patients, CSF IL-6 were markedly decreased by 1/2-1/37 on the next day of the first infusion and remained below 20 pg/ml before the last infusion at 14 weeks, whereas CSF TNF-alpha were not significantly changed at any time point. At 24 weeks from the initial infusion, none of the 5 patients showed exacerbation (3 patients significantly improved). Nor did the atrophy in midbrain, pons and medulla on brain MRI scans show significant progression. These results suggest that infliximab might have a beneficial effect in the treatment of progressive NB by reducing CSF IL-6 levels but not TNF-a. Since infliximab has been shown to have cytotoxic effects on monocytes/macrophages, the rapid fall of CSF IL-6 after the infusion Suggest that infliximab might directly act on such inflammatory cells producing IL-6. (C) 2008 Elsevier B.V. All rights reserved.
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