Gerardo Di Scala

Predictors of sustained clinical response in patients with Behçet's disease-related uveitis treated with infliximab and adalimumab

To identify clinical variables capable of predicting long-term treatment duration of TNF-α inhibition in patients with Behçet’s disease (BD)-related uveitis. Demographic, clinical, and therapeutic data were retrospectively collected from BD patients treated with the tumor necrosis factor (TNF)-α blockers infliximab and adalimumab. Patients still continuing TNF-α inhibitors at 48-month follow-up visits were classified as long-term responders and were statistically compared to patients discontinuing treatment before the 48-month visit. Forty-five patients (75 eyes) were enrolled. Thirty-two patients continued anti-TNF-α treatment for more than 48xa0months; 13 patients discontinued the treatment after a mean time of 12.3u2009±u200910.44xa0months due to lack (61.5%) or loss (38.5%) of efficacy. Baseline value of BD current activity form was the only variable discriminating long- and short-term responsive patients (pu2009=u20090.048, ORu2009=u20090.656, C.I. 95% 0.433–0.996). Disease activity levels at the start of treatment predict duration of response to monoclonal TNF antagonists in ocular BD.

A large-scale genetic analysis reveals an autoimmune origin of idiopathic retroperitoneal fibrosis

In this large-scale immunogenetic study performed using the Immunochip array, we demonstrate that idiopathic retroperitoneal fibrosis is associated with HLA alleles (HLA-DRB1*03) and HLA-DRβ amino acid variants (Arg74) traditionally linked to typical autoimmune diseases.

The Presence of Uveitis Is Associated with a Sustained Response to the Interleukin (IL)-1 Inhibitors Anakinra and Canakinumab in Behçet’s Disease

ABSTRACT Purpose: To identify factors associated with sustained response to interleukin (IL)-1 inhibition among demographic, clinical and therapeutic data in patients with Behçet disease (BD). Methods: BD patients treated with anakinra or canakinumab were enrolled. Patients were divided into two groups according to the clinical response: group 1 included subjects showing a treatment duration of at least 52 weeks and no secondary inefficacy during the first follow-up year; the remaining patients were included in the group 2. Demographic, clinical and therapeutic data were analyzed to identify significant differences between groups. Results: Eighteen patients were included in group 1 and 18 patients in group 2. A better response to IL-1 inhibitors was significantly more common among patients with BD-related uveitis (p = 0.006) and patients with a longer disease duration (p = 0.03). Conclusion: IL-1 blockade is effective in BD, especially in the subset of patients presenting eye involvement and in those with long-lasting disease.

Efficacy of the anti-IL 17 secukinumab in refractory Behçet's syndrome: A preliminary study

OBJECTIVEnTo evaluate the efficacy and safety of secukinumab in Behçets patients with active mucocutaneous and articular manifestations refractory to previous treatments.nnnMETHODSnWe retrospectively evaluated 5 patients treated with the IL17-inhibitor secukinumab and diagnosed with Behçet according to ISG/ICBD criteria. All patients had active mucocutaneous and articular manifestations refractory to colchicine, conventional DMARDs and at least one anti-TNFα agent. Four patients received secukinumab in the dose of 150 mg/monthly since also fulfilling the criteria for ankylosing spondylitis, while the fifth patient received secukinumab 300 mg/monthly because she met psoriatic arthritis criteria. Achievement of response was based on the number of oral ulcers, BASDAI and ASDAS for articular involvement, and BDCAF for Behçet activity. Complete response was defined as: i) decrease ≥50% in the number of oral ulcers; ii) BASDAI index <4; iii) ASDAS index <1.4; iv) decrease of 50% or more in BDCAF index.nnnRESULTSnThe patient starting secukinumab 300u202fmg/month successfully achieved complete response within 3 months. Complete response was maintained during all 9-months follow-up. Among the 4 subjects starting secukinumab 150u202fmg/month, two achieved complete response at month 6, but one relapsed. This patient and the two who not achieved complete response at month 6 were switched to secukinumab 300u202fmg/month. Within 3 months from the dosage increase, all three subjects successfully (re)achieved complete response.nnnCONCLUSIONnOur study suggested for the first time that secukinumab (either 150u202fmg and 300u202fmg/month) improved active mucocutaneous manifestations refractory to previous treatments, while secukinumab 300 mg/monthly resulted superior in inducing articular and complete response in Behçets patients.

Subclinical atherosclerosis in asymptomatic carriers of persistent antiphospholipid antibodies positivity: A cross-sectional study

BACKGROUNDnWhereas the relationship between subclinical atherosclerosis and antiphospholipid syndrome (APS) has been widely investigated, little is known about subclinical atherosclerosis in asymptomatic carriers with isolated antiphospholipid antibodies positivity (APP).nnnMETHODSnConsecutive APP carriers, APS subjects and matched controls were enrolled. Intima-media thickness of the common carotid artery (CCA-IMT) and of the Bulb (Bulb-IMT) and the prevalence of carotid plaques were assessed in all enrolled subjects.nnnRESULTSnA total of 104 APP carriers, 221 APS subjects, and 325 matched controls were recruited. As compared with controls, APP carriers and APS subjects showed a higher CCA-IMT (0.90u202f±u202f0.24 vs 0.82u202f±u202f0.12, pu202f=u202f0.014 and 0.93u202f±u202f0.42 vs 0.82u202f±u202f0.12, pu202f<u202f0.001, respectively), Bulb-IMT (1.10u202f±u202f0.44 vs 0.95u202f±u202f0.18, pu202f=u202f0.006 and 1.22u202f±u202f0.68 vs 0.95u202f±u202f0.18, pu202f<u202f0.001, respectively) and an increased prevalence of carotid plaques (33.7% vs 10.2%, pu202f<u202f0.001 and 38.5% vs 10.2%, pu202f<u202f0.001, respectively). These results were confirmed stratifying for antibody isotype, after excluding subjects with systemic lupus erythematosus or other autoimmune diseases and after adjusting for major clinical and demographic variables. CCA-IMT, Bulb-IMT and the prevalence of carotid plaques were higher in subjects with high-titer antibodies and progressively increased for an increasing number of positive antibodies.nnnCONCLUSIONSnSimilar to APS subjects, APP carriers have enhanced subclinical atherosclerosis, a more severe disease being observed in the presence of high-titer antibodies and multiple antibodies positivity. These data argue for a strict monitoring of subclinical signs of atherosclerosis and of cardiovascular risk factors in asymptomatic APP carriers.

Impact of cardiovascular and immunologic variables on subclinical carotid atherosclerosis in subjects with anti-phospholipid antibodies

Whereas some previous data on carriers with isolated antiphospholipid antibodies positivity (APP) suggested an increased risk of arterial events in this clinical setting, no data are available on subclinical atherosclerosis in this clinical setting. This article reports data on intima-media thickness of the common carotid artery (CCA-IMT) and of the Bulb (Bulb-IMT) and on the prevalence of carotid plaques in APP carriers and in subjects with antiphospholipid syndrome (APS) specifically stratifying for the presence of thrombotic manifestations, cardiovascular risk factors, antibody isotype and concomitant Systemic Lupus Erythematosus (SLE) or other autoimmune diseases.

Correction to: Long-term efficacy and safety of golimumab in the treatment of multirefractory Behçet’s disease

In the original version of this article the author name Gerardo Di Scala was originally presented incorrectly as ‘Di Scala Gerardo’; this has been corrected in this article.

Adalimumab-Based Treatment Versus Disease-Modifying Antirheumatic Drugs for Venous Thrombosis in Behçet's Syndrome: A Retrospective Study of Seventy Patients With Vascular Involvement

Since Behçets syndrome (BS) is the prototype of inflammation‐induced thrombosis, immunosuppressants are recommended in place of anticoagulants. We undertook this study to assess the clinical efficacy and the corticosteroid‐sparing effect of adalimumab (ADA)–based treatment versus disease‐modifying antirheumatic drug (DMARD) therapy in a large retrospective cohort of patients with BS‐related venous thrombosis.