Pv. Hassard et al., Anti-tumor necrosis factor monoclonal antibody therapy for gastrointestinal Behcet's disease: A case report, GASTROENTY, 120(4), 2001, pp. 995-999
Behcet's disease (BD) is a multisystem immune-mediated inflammatory disorde
r that involves the intestine in 3%-26% of cases. Corticosteroids, 5-aminos
alicylic acid derivatives, immunomodulators, and more recently thalidomide
and pentoxifylline have been used to treat ED with varying degrees of succe
ss. Tumor necrosis factor (TNF)-alpha is believed to play a pivotal role in
this T helper cell type 1 (Th1)-mediated disease. Infliximab, a chimeric m
onoclonal antibody to TNF-alpha, has been demonstrated to be an effective t
herapy for Crohn's disease and rheumatoid arthritis, 2 other Th1-mediated d
isorders. We describe a patient with chronically active, steroid-dependent
ED involving the gastrointestinal tract who received 4 doses of infliximab
during a 6-month period. Because most of her symptoms were gastrointestinal
, the Crohn's Disease Activity Index (CDAI) was used to assess response. A
rapid and dramatic improvement in both gastrointestinal and extraintestinal
symptoms was observed. The CDAI score decreased from 270 points (preinfusi
on) to 13 points by week 2, and remission was sustained despite complete wi
thdrawal of steroids. Colonoscopy performed 10 weeks after the first Infusi
on showed marked endoscopic and histologic improvement, This report suggest
s that infliximab may be an effective new therapy for gastrointestinal ED,
and perhaps other manifestations of ED as well.