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    TNF-alpha antagonists and thalidomide for the management of gastrointestinal Behcet's syndrome refractory to the conventional treatment modalities: a case series and review of the literature
    (Clinical & Exper Rheumatology, 2015) Hatemi, I.; Hatemi, G.; Pamuk, O. N.; Erzin, Y.; Celik, A. F.
    Objective. Gastrointestinal involvement of Behcet's syndrome is usually treated with glucocorticoids, 5-aminosalicylic acid compounds and azathioprine. However, some patients are refractory to these conventional therapy modalities. In this paper we report our experience on 13 patients with gastrointestinal involvement of Behcet's syndrome who were refractory to the conventional therapy and who were treated with TNFalpha antagonists and/or thalidomide. Methods. We reviewed the charts of our Behcet's syndrome patients with gastrointestinal involvement and identified those who were treated with TNF alpha antagonists and/or thalidomide. Demographic features, previous and concomitant drugs, previous surgery, time to remission and duration of remission were tabulated. We also performed a systematic review of publications on gastrointestinal involvement of Behcet's syndrome patients treated with TNFalpha antagonists and/or thalidomide. Results. Among our 64 patients with gastrointestinal involvement of Behcet's syndrome, we identified 13 (20%) (7 women, 6 men, mean age 27.4 +/- 9.4) who had been treated with TNF-alpha antagonists and/or thalidomide. Their previous medications were glucocorticoids (13113), azathioprine (13113), 5-aminosalicylic acid derivatives (3113) and budesonide (1113). Clinical and endoscopic remission was obtained in 10 patients. One patient died with sepsis. The systematic literature search revealed 91 cases who had used TNFalpha antagonists and 15 who had used thalidomide. Among the patients who had received TNF-alpha antagonists, clinical remission was obtained in 47191 patients (51%), while endoscopic remission was observed in 21/46(45%) who had a control colonoscopy. Conclusion. One fifth of our Behcet's syndrome patients with gastrointestinal involvement were refractory to conventional treatment modalities. Remission was obtained with TNF-alpha antagonists and/or thalidomide in about 75 % of the cases.