Predictors of anti-TNF treatment failure in intestinal Behçet's disease: a multicenter retrospective cohort study

Wenyan Xu, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310003, China.
Xiudi Wu, Department of Rheumatology and Immunology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China.
Qiuxia Yu, Department of Rheumatology and Clinical Immunology, Ningbo Medical Center Lihuili Hospital, Lihuili Hospital Affiliated to Ningbo University, Ningbo, Zhejiang, China.
Kefang Sun, Rochester Regional HealthFollow
Xinli Mao, Department of Gastroenterology, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China.
Hua Ye, Department of Gastroenterology, Lihuili Hospital Affiliated to Ningbo University, Ningbo, Zhejiang, China.
Lei Xu, Department of Gastroenterology, The First Affiliated Hospital of Ningbo University, Ningbo, Zhejiang, China.
Huogen Wang, Zhejiang Herymed Technology Co., LTD, Hangzhou, China.
Yidong Wan, Zhejiang Herymed Technology Co., LTD, Hangzhou, China.
Tejia Shen, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310003, China.
Chunxiao Chen, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310003, China.
Lan Li, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, 310003, China.

Department

Internal Medicine

Document Type

Article

Publication Title

Clinical Rheumatology

Abstract

Objective: Treatment options for intestinal Behçet's disease (BD) are limited. Despite the proven efficacy of infliximab and adalimumab, there is an urgent need to identify predictive factors for inadequate response or non-response to anti-TNF agents.

Methods: We conducted a retrospective cohort study involving 71 patients diagnosed with intestinal BD and treated with anti-TNF across four hospitals from August 2018 to December 2024. Demographic data, clinical symptoms, endoscopic findings, and laboratory parameters were collected at baseline and every 3 months after anti-TNF therapy until the latest follow-up appointment. The primary outcome was non-response or inadequate response to anti-TNF therapy, or presence of intestinal complications.

Results: During the study period, 35.2% (25/71) of patients met the primary outcome at a median follow-up time of 8.5 months. Pre-treatment endoscopic score greater than 2.5, presence of opportunistic infections, DAIBD score > 12.5, ESR > 14.50 mm/h, and CRP > 12.83 mg/L three months post-treatment were identified to be associated with anti-TNF treatment failure. ROC curve established by incorporating these variables demonstrated a strong predictive capacity for treatment failure (AUC = 0.930). An internal validation of ROC curve was performed by the bootstrap method, which demonstrated good accuracy and stability. We subsequently developed a nomogram model to calculate the risk of treatment failure based on the above variables.

Conclusions: Predictors of anti-TNF treatment failure in patients with intestinal BD included baseline endoscopic score, the occurrence of opportunistic infections, and DAIBD score, CRP and ESR at 3 months post-treatment. Our model can identify high-risk patients early, allowing for the timely optimization of treatment regimens.

First Page

3655

Last Page

3665

DOI

10.1007/s10067-025-07581-y

Volume

44

Issue

9

Publication Date

9-1-2025

Medical Subject Headings

Humans; Behcet Syndrome (drug therapy); Retrospective Studies; Female; Male; Treatment Failure; Adult; Adalimumab (therapeutic use); Infliximab (therapeutic use); Middle Aged; Intestinal Diseases (drug therapy); Tumor Necrosis Factor Inhibitors (therapeutic use); Tumor Necrosis Factor-alpha (antagonists & inhibitors)

PubMed ID

40668289

Link to Full Text

Share

COinS