title: Switching of anti-TNF-α agents in Behçet's disease.
abstract: OBJECTIVE
  Recent reports suggest efficacy of anti-tumour necrosis factor-alpha (TNF-α) therapy in Behçet's disease. However, the switching of anti-TNF-α agents for treatment failure remains unexplored. Our aims were to describe the efficacy and safety of a second anti-TNF-α agent in Behçet's disease patients after failure of a first agent.
  
  
  METHODS
  In this retrospective case series, 34 Behçet's disease patients receiving anti-TNF-α agents, 19 of whom switched to a second anti-TNF-α agent, were identified. We assessed the response to anti-TNF-α agents, the duration of anti-TNF-α therapy, the reasons for withdrawal, adverse events, the Behçet's Disease Current Activity Form (BDCAF), C-reactive protein (CRP), ESR and concomitant therapies at the onset of the first and second anti-TNF-α therapies, and after 6, 12 and 24 months.
  
  
  RESULTS
  Clinical improvements were seen in 26/34 (76%) after the first and 18/19 (95%) after the second anti-TNF-α agent. Continuation rates at 24 months were 14.4% after the first and 22.3% after the second anti-TNF-α agent. The most frequent reason for discontinuation was secondary failure in both groups (12 after the first anti-TNF-α agent and 8 after the second). Adverse events leading to treatment withdrawal were seen in 10 after the first anti-TNF-α agent and three after the second.
  
  
  CONCLUSIONS
  [corrected] The second anti-TNF-α agent in Behçet's disease demonstrated similar efficacy to that seen with the first agent without new safety concerns, supporting switching to a second anti-TNF-α agent. However, long-term continuation rates for anti-TNF-α therapy were low after both the first and second agents.
authors.affiliation: Lupus and Vasculitis Clinic, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge CB2 2QQ, UK. shunsuke.furuta@addenbrookes.nhs.uk
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Furuta
authors.forename: Yok Wai
authors.initials: YW
authors.lastname: Chow
authors.forename: Afzal N
authors.initials: AN
authors.lastname: Chaudhry
authors.forename: David
authors.initials: D
authors.lastname: Jayne
mesh_terms: D000328:Adult; D001528:Behcet Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D057915:Drug Substitution; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha