title: Infliximab is a plausible alternative for neurologic complications of Behçet disease.
abstract: OBJECTIVE
  We evaluated the effectiveness of infliximab in patients with neuro-Behçet syndrome for whom other immunosuppressive medications had failed.
  
  
  METHODS
  Patients whose common immunosuppressive medications fail in recurrent neuro-Behçet syndrome need an alternative. We report our experience with the tumor necrosis factor α blocker infliximab for long-term treatment of neuro-Behçet syndrome. We recruited patients within a multidisciplinary referral practice of Behçet disease and prospectively followed everyone with a neurologic symptom(s). Patients (n = 16) with ≥2 neurologic bouts (excluding purely progressive disease) while on another immunosuppressive treatment were switched to and successfully sustained on infliximab (5 mg/kg in weeks 0, 2, and 6, then once every 8 weeks; minimum follow-up duration ≥12 months). Infliximab was stopped within 2 months after initiation in one patient because of pulmonary and CNS tuberculosis.
  
  
  RESULTS
  Patients had stepwise worsening due to relapses in the Expanded Disability Status Scale modified for neuro-Behçet syndrome before switching to infliximab (median score of 5.0, range 2.0-7.0; median neuro-Behçet syndrome duration 29.1 months, range 5.0-180.7). Median duration of preinfliximab immunosuppressive medication use was 20.0 months (range 3.0-180.7). In all 15 patients, during infliximab treatment (median score 4.0, range 2.0-7.0; median duration 39.0 months, range 16.0-104.9 months), neurologic relapses were completely aborted and there was no further disability accumulation.
  
  
  CONCLUSIONS
  We observed a significant beneficial effect of infliximab in neuro-Behçet syndrome.
  
  
  METHODS
  This study provides Class IV evidence that for patients with neuro-Behçet syndrome whose other immunosuppressive medications failed, infliximab prevents further relapses and stabilizes disability.
authors.affiliation: Departments of Neurology (B.Z., U.U., S.S., O.N.D., A.S.) and Rheumatology (E.S., S.U., V.H.), Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey; and Department of Neurology (B.Z., O.H.K.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Burcu
authors.initials: B
authors.lastname: Zeydan
authors.affiliation: Departments of Neurology (B.Z., U.U., S.S., O.N.D., A.S.) and Rheumatology (E.S., S.U., V.H.), Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey; and Department of Neurology (B.Z., O.H.K.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Ugur
authors.initials: U
authors.lastname: Uygunoglu
authors.affiliation: Departments of Neurology (B.Z., U.U., S.S., O.N.D., A.S.) and Rheumatology (E.S., S.U., V.H.), Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey; and Department of Neurology (B.Z., O.H.K.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Sabahattin
authors.initials: S
authors.lastname: Saip
authors.affiliation: Departments of Neurology (B.Z., U.U., S.S., O.N.D., A.S.) and Rheumatology (E.S., S.U., V.H.), Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey; and Department of Neurology (B.Z., O.H.K.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Onat N
authors.initials: ON
authors.lastname: Demirci
authors.affiliation: Departments of Neurology (B.Z., U.U., S.S., O.N.D., A.S.) and Rheumatology (E.S., S.U., V.H.), Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey; and Department of Neurology (B.Z., O.H.K.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Emire
authors.initials: E
authors.lastname: Seyahi
authors.affiliation: Departments of Neurology (B.Z., U.U., S.S., O.N.D., A.S.) and Rheumatology (E.S., S.U., V.H.), Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey; and Department of Neurology (B.Z., O.H.K.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Serdal
authors.initials: S
authors.lastname: Ugurlu
authors.affiliation: Departments of Neurology (B.Z., U.U., S.S., O.N.D., A.S.) and Rheumatology (E.S., S.U., V.H.), Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey; and Department of Neurology (B.Z., O.H.K.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Vedat
authors.initials: V
authors.lastname: Hamuryudan
authors.affiliation: Departments of Neurology (B.Z., U.U., S.S., O.N.D., A.S.) and Rheumatology (E.S., S.U., V.H.), Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey; and Department of Neurology (B.Z., O.H.K.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Aksel
authors.initials: A
authors.lastname: Siva
authors.affiliation: Departments of Neurology (B.Z., U.U., S.S., O.N.D., A.S.) and Rheumatology (E.S., S.U., V.H.), Istanbul University, Cerrahpasa School of Medicine, Istanbul, Turkey; and Department of Neurology (B.Z., O.H.K.), Mayo Clinic College of Medicine, Rochester, MN.
authors.forename: Orhun H
authors.initials: OH
authors.lastname: Kantarci