Adalimumab for the treatment of Behcet's disease: experience in 19 patients

Objective. To describe the experience of two tertiary Spanish centres (Hospital Clinico San Cecilio, Granada and Hospital Clinic, Barcelona) with the use of adalimumab for the treatment of severe clinical manifestations in patients with Behcet's disease (BD) in whom immunosuppressive therapy had failed. Methods. Retrospective chart review from patients with BD treated with adalimumab in two specialized Spanish centres (Hospital Clinico San Cecilio, Granada and Hospital Clinic, Barcelona). Results. From November 2006 to February 2011, 19 patients with BD were treated with adalimumab. The reason to initiate adalimumab was refractory disease in 17 (89.5%) patients and adverse events to CSA and infliximab in two (10.5%) patients, respectively. The main clinical manifestations leading to adalimumab administration were panuveitis in eight patients, severe bipolar aphthosis in eight, retinal vasculitis in three and severe folliculitis in three. Overall, adalimumab achieved clinical improvement in 17 of the 19 patients. Of note, ocular manifestations (panuveitis and retinal vasculitis) responded rapidly in all cases. In addition to clinical improvement, treatment with adalimumab was associated with reduction in the number and dose of standard immunosuppressive agents. Of interest, seven patients had received TNF-alpha inhibitors before adalimumab, five infliximab and the remaining two etanercept. Adalimumab was withdrawn in only one patient due to severe infusional reaction in the form of urticaria and angioedema. Conclusion. Adalimumab is a valid option for patients with BD and recalcitrant non-controlling manifestations with good safety profile.