Rheumatology (Oxford, England) · 2025
Exploring relief for Behçet's disease refractory oral ulcers: a comparison of TNF inhibitors versus apremilast.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Lopalco Giuseppe, Morrone Maria, Venerito Vincenzo, Cantarini Luca, Emmi Giacomo, Espinosa Gerard, Lledó Gema Maria, Mosca Marta, Talarico Rosaria, Cauli Alberto, Piga Matteo, Sota Jurgen, Fabiani Claudia, Chiara Emanuele, Biancalana Edoardo, Mattioli Irene, Argolini Lorenza Maria, Di Cianni Federica, Caporali Roberto, Iannone Florenzo
Аннотация
OBJECTIVES: Oral and genital ulcers are the hallmark manifestation of Behçet's disease (BD), significantly impacting patients' quality of life. Our study focuses on comparing the effectiveness and safety of TNF inhibitors (TNFis) and apremilast in controlling oral ulcers of BD, aiming to provide evidence-based guidance for physicians in selecting appropriate treatment modalities.
METHODS: A retrospective analysis was performed on BD patients treated between December 2016 and December 2021 with TNFis or apremilast for refractory oral ulcers. The study assessed treatment response by the absence of oral ulcers at 3 and 6 months, with additional evaluations for genital ulcers and articular involvement.
RESULTS: The study included 78 patients, equally allocated between TNFis and apremilast treatments. Both groups showed significant oral ulcer reduction at 3 (P < 0.001) and 6 months (P = 0.01), with no significant difference between the treatments. Apremilast had a notable CS-sparing effect by the 3-month follow-up, persisting through 6 months. Both treatments were equally effective in reducing genital ulcers, with TNFis showing greater effectiveness in addressing articular involvement. Apremilast had a higher discontinuation rate due to gastrointestinal side effects.
CONCLUSION: TNFis and apremilast are both effective for treating BD refractory oral ulcers. While TNFis may offer broader benefits for other disease manifestations, apremilast is distinguished by its CS-sparing effect, especially for patients with a milder disease phenotype. Treatment selection should consider individual disease severity and clinical features to ensure a personalized and effective management strategy.
METHODS: A retrospective analysis was performed on BD patients treated between December 2016 and December 2021 with TNFis or apremilast for refractory oral ulcers. The study assessed treatment response by the absence of oral ulcers at 3 and 6 months, with additional evaluations for genital ulcers and articular involvement.
RESULTS: The study included 78 patients, equally allocated between TNFis and apremilast treatments. Both groups showed significant oral ulcer reduction at 3 (P < 0.001) and 6 months (P = 0.01), with no significant difference between the treatments. Apremilast had a notable CS-sparing effect by the 3-month follow-up, persisting through 6 months. Both treatments were equally effective in reducing genital ulcers, with TNFis showing greater effectiveness in addressing articular involvement. Apremilast had a higher discontinuation rate due to gastrointestinal side effects.
CONCLUSION: TNFis and apremilast are both effective for treating BD refractory oral ulcers. While TNFis may offer broader benefits for other disease manifestations, apremilast is distinguished by its CS-sparing effect, especially for patients with a milder disease phenotype. Treatment selection should consider individual disease severity and clinical features to ensure a personalized and effective management strategy.