Tocilizumab in Behçet Disease: A Multicenter Study of 30 Patients
Mohamed-Yacine Khitri, Alessandra Bartoli, Georgina Maalouf, Alban Deroux, Carlo Salvarani, Giacomo Emmi, Ömer Karadağ, Gerard Espinosa, Mathilde Leclercq, Gabriele Simonini, Mathieu Vautier, P. Cacoub, David Saadoun
Abstract
Objective To evaluate tocilizumab (TCZ) efficacy in patients with refractory Behçet disease (BD). Methods This is a multicenter study of 30 patients fulfilling the international criteria for BD and treated with TCZ at different European referral centers. The clinical response was evaluated at 6 months from TCZ initiation. Results Ninety percent of patients with BD were refractory or intolerant to anti–tumor necrosis factor (anti-TNF) agents. Overall, TCZ was effective in 25 (83%) patients with BD of whom 18 (60%) and 7 (23%) were complete and partial responders, respectively. The complete response was 67%, 60%, and 42% in patients with uveitis (18/30), neurological manifestations (5/30), and mucocutaneous and/or articular (7/30) manifestations, respectively. TCZ had a significant steroid-sparing effect allowing patients to decrease their median daily prednisone dose from 20 (IQR 10-40) mg/day to 9 (IQR 5-13) mg at 6 months ( P < 0.001). The number of patients with BD needing concomitant disease-modifying antirheumatic drug therapy fell from 7 (23%) to 4 (13%) at 6 months. Mild to moderate side effects were observed in 6 (20%) patients, and 3 (10%) presented with serious adverse events (pneumonia, intestinal perforation, and septicemia) requiring therapy discontinuation in 2 cases. Conclusion TCZ seems to be an effective alternative to anti-TNF agents in treating BD-related uveitis and neurological manifestations.