■Behçet病(BD)是一种顽固性系统性血管炎。当伴有肠道症状时,预后通常较差。5-氨基水杨酸(5-ASA),皮质类固醇,免疫抑制药物,抗肿瘤坏死因子-α(抗TNF-α)生物制剂是诱导或维持肠道BD缓解的标准疗法。然而,它们在难治性病例中可能无效。当患者有肿瘤病史时,还应考虑安全性。关于肠道BD的发病机制和维多珠单抗(VDZ)对回肠炎症的特异性靶向作用,以前的病例报告表明,VDZ可能是难治性肠道BD的潜在治疗方法。
我们报告了一名50岁的女性肠道BD患者,患有口腔和生殖器溃疡,关节痛,和肠道受累约20年。患者对抗TNF-α生物制剂反应良好,但对常规药物反应不佳。然而,由于结肠癌的发生,生物制剂治疗被终止。
■在0、2和6周以300mg的剂量静脉内施用VDZ,然后每八周施用一次。在6个月的随访中,患者报告腹痛和关节痛明显改善。我们在内窥镜下观察到肠粘膜溃疡完全愈合。然而,她的口腔和外阴溃疡仍未解决,加入沙利度胺后消失。
■VDZ可能是对常规治疗反应不佳的难治性肠道BD患者的安全有效选择,尤其是那些有肿瘤史的人.
Behçet\'s Disease (BD) is an intractable systemic vasculitis. When accompanied by intestinal symptoms, the prognosis is usually poor. 5-Aminosalicylic acid (5-ASA), corticosteroids, immunosuppressive drugs, and anti-tumor necrosis factor-α (anti-TNF-α) biologics are standard therapies to induce or maintain remission for intestinal BD. However, they might not be effective in refractory cases. Safety should also be considered when patients have an oncology history. Regarding the pathogenesis of intestinal BD and the specific targeting effect of vedolizumab (VDZ) on the inflammation of the ileum tract, previous
case reports suggested that VDZ might be a potential treatment for refractory intestinal BD.
We report a 50-year-old woman patient with intestinal BD who had oral and genital ulcers, joint pain, and intestinal involvement for about 20 years. The patient responds well to anti-TNF-α biologics but not to conventional drugs. However, biologics treatment was discontinued due to the occurrence of colon cancer.
VDZ was intravenously administered at a dose of 300 mg at 0, 2, and 6 weeks and then every eight weeks. At the 6-month follow-up, the patient reported significant improvement in abdominal pain and arthralgia. We observed complete healing of intestinal mucosal ulcers under endoscopy. However, her oral and vulvar ulcers remained unresolved, which disappeared after adding thalidomide.
VDZ may be a safe and effective option for refractory intestinal BD patients who do not respond well to conventional treatments, especially those with an oncology history.