OBJECTIVES: The TNF-blocker adalimumab can be effective in Behçet's disease (BD), a multisystem auto-inflammatory disorder. Unfortunately, the therapeutic efficacy of TNF-blockers can be hampered by the formation of anti-drug antibodies. We present an observational study of adalimumab in refractory BD with measurement of anti-drug antibodies. METHODS: The effect of fortnightly 40mg adalimumab in nine patients with therapy refractory mucocutaneous, non-ocular or organ threatening BD was studied up to 60 months. Primary endpoint was a decrease in disease activity, measured by the BD Current Activity Form (BDCAF) within 6 months. Secondary endpoints included serum cytokines and the long-term formation of anti-adalimumab antibodies. RESULTS: BDCAF improved significantly in all nine patients from 5.4 (SD=1.4) to 2.4 (SD=1.4) (p=0.007) within one month up to 6 months and after prolonged follow up of 5 years. All patients could either taper or stop concomitant therapy. Symptoms of mucocutaneous lesions, erythema nodosum and joint involvement decreased or disappeared. Serum TNF-alpha levels were elevates in five patients and decreased upon treatment (p=0.017). Adalimumab was save and none of the patients experienced therapy failure or antibodies against adalimumab. CONCLUSIONS: We present an observational study on patients with BD treated with adalimumab and provide a basis for long-term use in refractory mucocutaneous BD. These findings show that adalimumab can safely be administered yielding sustainable clinical effects in refractory BD patients with mucocutaneous disease without formation of anti-adalimumab antibodies, even after long follow up.

Additional Metadata
Keywords Behçet’s disease, adalimumab, antidrug antibodies, TNF-blockers
Persistent URL hdl.handle.net/1765/123019
Journal Clinical and Experimental Rheumatology
Citation
Verboom, D.M. (Diana M.), van der Houwen, T.B. (Tim B.), Kappen, J.H, van Daele, P.L.A, Dik, W.A, Schreurs, M.W.J, … van Laar, J.A.M. (2019). Adalimumab provides long-lasting clinical improvement in refractory mucocutaneous Behçet's disease without formation of antidrug antibodies. Clinical and Experimental Rheumatology, 37(6), 43–47. Retrieved from http://hdl.handle.net/1765/123019