Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Alemtuzumab (CAMPATH-1H) as Remission Induction Therapy in Behcet's Disease.

Smith1,  Rona M., Chow2,  Yok W., Jayne1,  David R. W.

Addenbrooke's Hospital, Cambridge, United Kingdom
Hospital Pantai Ayer Keroh Melaka, Malaysia

Introduction:

Behcet's Disease is a chronic, relapsing inflammatory disorder, characterised by recurrent oral and genital ulceration, but the more severe, life threatening manifestations are neurological, gastrointestinal or vascular in nature. The precise aetiology and pathogenesis are unclear, but there is increasing evidence that T cells play a key role in the development of disease, and thus T cell depleting agents, such as the anti-CD52 humanised monoclonal antibody, alemtuzumab (CAMPATH-1H) are a potential therapeutic strategy.

Methods:

We present a retrospective review of 20 patients treated with alemtuzumab since 1998 in Addenbrooke's Hospital, Cambridge, UK. Two dose schedules were used in this time period; a total dose of 134mg was administered prior to 2003, and 95mg in total in the latter years. Disease activity was measured using the Birmingham Vasculitis Activity Score (BVAS), and sequential evaluation of haematological and biochemical markers were performed.

Results:

Patient Characteristics

15/20 (75%) of patients were female, and the mean age at the time of alemtuzumab therapy was 36.2 years (range 18–59 years). All patients had oral and genital ulceration. 19 (95%) and 18 (90%) of patients had joint and skin involvement respectively. 11 (55%) had eye involvement, 13 (65%) gastrointestinal involvement and 9 (45%) central nervous system disease. Less common features included vascular manifestations (25%), peripheral nervous system involvement (10%) and lung disease (1 patient). Prior to alemtuzumab, the average disease duration was 59.8 months (range 1–203 months), and the mean duration of steroid exposure was 22.7 months (range 1–84 months). 17/20 (85%) of patients had received one or more immunosuppressive agents (including anti-TNF agents, cyclophosphamide, anti-metabolites, calcineurin inhibitors and thalidomide) in addition to corticosteroids prior to receiving alemtuzumab The average duration of follow up was 85.47 months (range 20–134 months).

Outcomes

Six months after treatment, 74% of patients were in complete remission. Many of these remissions have been sustained over years, but in those that did relapse, re-treatment with alemtuzumab was effective. There were significant reductions in prednisolone dose and BVAS after treatment (Figure 1).

Figure 1. Prednisolone doses, BVAs, and relapse free survival post alemtuzumab.

Adverse events

Alemtuzumab was well tolerated. 25% of patients experienced infusion reactions, but in only one did the reaction necessitate termination of the treatment. There were no infectious complications directly attributable to alemtuzumab, but six patients developed new autoimmune thyroid dysfunction. Autoimmune diseases following alemtuzumab, including thyroid disease and ITP, have also been reported in multiple sclerosis.

Conclusions:

Alemtuzumab is a safe and effective therapy for the treatment of Behcet's Disease, particularly in those cases which prove to be refractory or life threatening.

To cite this abstract, please use the following information:
Smith, Rona M., Chow, Yok W., Jayne, David R. W.; Alemtuzumab (CAMPATH-1H) as Remission Induction Therapy in Behcet's Disease. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1278
DOI: 10.1002/art.29044

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