INFLUENCES OF TIME OF INTRODUCTION OF INFLIXIMAB ON THE FUNCTIONAL DISABILITY AND JOB STATUS OF PATIENTS WITH CHRONIC PROGRESSIVE NEURO-BEHCET'S DISEASE

Background: Chronic progressive neuro-Behcet’s disease (CPNBD) is characterized by progressive neurobehaviour changes leading to disability and death. It has been appreciated that methotrexate is effective for CPNBD. Notably, recent studies have demonstrated that infliximab is effective for patients with CPNBD who had inadequate responses to methotrexate. However, the appropriate timing for introduction of infliximab remains unclear. Objectives: The current studies examined the effects of intervals before introduction of infliximab on the functional disability and job status of patients with CPNBD. Methods: Eleven patients (8 males, 3 females, ages 35.2±9.3 [mean±SD]), who met the international classification criteria for BD with CPNBD and received infliximab, were retrospectively followed up. The functional disability of the patients was evaluated by Steinbrocker functional classification as is used in rheumatoid arthritis. Correlation between the patients’ functional outcome and the intervals before the introduction of infliximab was analyzed by Spearman’s rank correlation test. Results: All the 11 patients had received methotrexate prior to infliximab. The intervals from the onset to the introduction of infliximab and the follow-up periods were 26.6±35.1 months and 65.2±43.6 months [mean±SD], respectively. Among the 11 patients, 9 patients did not show progression after the introduction of infliximab, whereas 2 patients still progressed and lost job. In the latter 2 patients, infliximab had been discontinued before the final follow-up. No patients improved from the functional disability or gained job even after infliximab treatment. The functional disability grades of the patients after the introduction of infliximab were significantly correlated with the intervals from the onset of CPNBD to the introduction of infliximab (r=0.6177, p=0.0476). Conclusion: The results indicate that the delay of the introduction of infliximab leads to the irreversible functional disability and job loss of the patients with CPNBD. Thus, it is recommended that infliximab should be administered as soon as possible for the patients with CPNBD with inadequate response to methotrexate. References: [1]Kikuchi H, Aramaki K, Hirohata S. Effect of infliximab in progressive Neuro-Behcet’s syndrome. J Neurol Sci 2008; 272: 99-105 Disclosure of Interests: : Shunsei Hirohata Speakers bureau: Tanabe Mitsubishi, Hirotoshi Kikuchi Speakers bureau: Tanabe Mitsubishi, Tetsuji Sawada: None declared, Masataka Kuwana Grant/research support from: Acetelion, Consultant of: Acetelion, Bayer, Chugai, Corbus Pharmaceuticals, CSL Behring and Reata Pharmaceuticals. He was a member of the SENSCIS trial Steering Committee (Boehringer Ingelheim), Yohei Kirino: None declared, Mitsuhiro Takeno Speakers bureau: Esai, Tanabe-Mitsubishi – speaker; Celgene Corporation – advisory board, Yoshiaki Ishigatsubo: None declared