Efficacy and predictor of anti-TNF alpha agents in patients with intestinal Behcet's disease

Background Behcet's disease (BD) is a recurrent multisystem inflammatory disease. Anti-tumor necrosis factor (TNF) alpha agents have been used to treat patients with intestinal BD with severe disease activity or those who are resistant to conventional treatments; however, the long-term efficacy of anti-TNF alpha agents in intestinal BD remains unclear. In the present study, we investigated the clinical outcomes and predictors of discontinuation of anti-TNF alpha agents in patients with intestinal BD. Methods We reviewed the medical records of patients with intestinal BD who received first-line anti-TNF alpha agents between January 2009 and June 2020. The primary outcome was the percentage of patients who continued anti-TNF alpha therapy for 48 weeks. Secondary outcomes included the percentage of patients who achieved marked improvement, complete remission, and mucosal healing, as well as predictors of discontinuation of anti-TNF alpha agents. Results A total of 29 patients were included in the study. Twenty-two (75.9%) patients continued anti-TNF alpha therapy for 48 weeks. The percentage of patients who achieved marked improvement, complete remission, and mucosal healing at week 48 was 48.3%, 37.9%, and 48.3%, respectively. At week 96, 11 (37.9%) patients achieved marked improvement, complete remission, and mucosal healing. A higher C-reactive protein level (CRP; >= 1 mg/dL) at baseline was a predictor of discontinuation of anti-TNF alpha agents. Conclusions The 48-week continuation rate of anti-TNF alpha agents was 75.9% in bio-naive patients with intestinal BD. However, a higher baseline CRP level (>= 1 mg/dL) was associated with discontinuation of anti-TNF alpha agents.