Experience with anti-TNF-α therapy for orofacial granulomatosis
| Autor: | Carlo Nunes, Alexander J. Mentzer, Stephen Challacombe, Jonathon Brostoff, Penelope Shirlaw, Miranda Lomer, Helen Campbell, Pritash Patel, Timothy Poate, Tim Elliott, Michael Escudier, Jeremy D. Sanderson |
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| Rok vydání: | 2010 |
| Předmět: |
Cancer Research
medicine.medical_specialty Crohn's disease business.industry medicine.medical_treatment Immunosuppression medicine.disease Gastroenterology Infliximab Pathology and Forensic Medicine Surgery Clinical trial Otorhinolaryngology Internal medicine Concomitant medicine Adalimumab Periodontics Orofacial granulomatosis Oral Surgery Adverse effect business medicine.drug |
| Zdroj: | Journal of Oral Pathology & Medicine. 40:14-19 |
| ISSN: | 0904-2512 |
| DOI: | 10.1111/j.1600-0714.2010.00976.x |
| Popis: | J Oral Pathol Med (2011) 40: 14–19 Background: Orofacial granulomatosis (OFG) can be challenging to treat and experience with anti-TNF-α therapy is limited. We report our experience with infliximab (IFX) and adalimumab (ADA) for OFG in 14 patients, the largest reported series to date. Methods: A review of patients receiving induction and maintenance IFX for OFG +/− Crohn’s disease (CD) for active oral disease failing other therapies was performed. Clinical response defined by global physician assessment, aided by oral disease activity scores, was assessed at 2 months, 1 and 2 years. ADA was considered for patients failing IFX. Adverse events were recorded. Predictors of need for anti-TNF-α therapy were determined by comparison with OFG patients not requiring anti-TNF-α from our overall OFG database (n = 207). Results: Fourteen patients (9 men) were treated with IFX [OFG only (n = 7), OFG with CD (n = 7)]. Nine patients received concomitant immunosuppression. Median duration of treatment was 18 months. Short-term response was achieved in 10/14 (71%) patients. Eight of 14 (57%) and 4/12 (33%) patients remained responsive at 1 and 2 years, respectively. Two patients who failed IFX responded to ADA. Factors predicting need for anti-TNF-α therapy were oral sulcal involvement, intestinal CD and a raised C-reactive protein (CRP). Oral sulcal involvement predicted response at 1 and 2 years. Intestinal CD did not predict response. The only significant adverse event was an IFX infusion reaction. Conclusion: IFX provided good short-term response for most OFG patients; however, a significant proportion lost response long term. Adverse events were uncommon. Patients failing IFX may respond to ADA. |
| Databáze: | OpenAIRE |
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