Therapeutic Effect of Infliximab in the Treatment of Severe/Refractory Intestinal Behcet's Disease: A Single-center Retrospective Study

  Objective  The aim of this study was to explore the efficacy and safety of infliximab (IFX) for severe/refractory intestinal Behcet's disease (BD).

  Methods  The clinical data of intestinal BD patientstreated with IFX from September 2012 to November 2018 in Peking Union Medical College Hospital were retrospectively collected and analyzed, including clinical manifestations, endoscopic manifestations and pathology, imaging examinations, medication before and after IFX treatment, treatment response and prognosis. The clinical symptoms and endoscopic ulcer healing before and after treatment were analyzed and compared. Meanwhile, the changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), disease activity index for intestinal BD (DAIBD), and the dosage of glucocorticoid before and after IFX treatment were compared by paired t-test.

  Results  Twelve patients (10 males and 2 females) were enrolled, with a mean age of (29.5±10.5) years old; all were active with intestinal BD. The median time between diagnosis of BD and initiation of IFX therapy was 27.0(4.3, 109.5)months. All patients had abdominal pain and gastrointestinal ulcer, in which 8 cases with diarrhea, 11 with gastrointestinal bleeding, 4 with intestinal obstruction, and 3 with intestinal perforation were documented. After using IFX, the symptoms of all the patients were improved; the ulcers gradually healed; the gastrointestinal bleeding stopped. One patient with intestinal perforation was conducted surgery at the same time, and another with colonic stenosis after remission received ileus segmentectomy. The ESR level4.0(2.0, 6.8)mm/h vs. 28.5(10.3, 52.3)mm/h, P < 0.01, CRP level0.6(0.5, 1.7)mg/dl vs. 26.8(9.1, 47.1)mg/dl, P < 0.01, DAIBD(37.5±27.3 vs. 126.7±49.0, P < 0.01, and the dosage of glucocorticoid13.8(1.9, 16.9)mg/d vs. 40.0(16.3, 56.3)mg/d, P < 0.01 were significantly decreased. Furthermore, the types of immunosuppressants being used were gradually decreased or unchanged. No serious infectious and adverse events were observed.

  Conclusion  IFX, in combination with corticosteroids and immunosuppressants, is safe, effective, and well tolerated for severe/refractory intestinal BD.