327. Retention Rate, Reasons for Discontinuation and Outcome of Infliximab Use in Behçet's Synome

Background/ Objectives: Infliximab (IFX) plays a key role in the management of severe and refractory manifestations of Behçet’s synome (BS). We aimed to assess the retention rate of IFX, adverse events, causes of discontinuation and outcome after cessation of IFX in a larger group of BS patients who were followed in a tertiary center.

Methods: The charts of BS patients who were prescribed IFX between 2004 and 2020 were reviewed to determine demographic features, reasons for IFX use, previous and concomitant ugs, IFX duration, reasons for cessation of IFX and time to flare following cessation of IFX. Follow-up was censored on March 2021.

Results: A total of 282 patients (220 men, mean age at IFX initiation: 34.5 ± 9.6 years) received IFX for uveitis (n=137), vascular involvement (n=86), parenchymal neurologic involvement (n=40), arthritis (n=12), gastrointestinal involvement (n=10), mucocutaneous involvement (n=6), venous ulcers (n=5), and secondary amyloidosis (n=1). Fifteen patients had more than 1 involvement requiring IFX.During a median follow-up of 52 months (IQR: 30-88), 134 (48%) patients were still receiving IFX for a median period of 36 months (IQR: 13-58) while 142 (50%) patients had discontinued IFX after a median follow-up of 18 months (IQR: 7-30).  The remaining 6 patients were lost to follow-up. Reasons for discontinuation were adverse events in 44 (31%), remission in 27 (19%) patients, lack of efficacy in 33 (23%), lack of patient compliance in 31 (22%), pregnancy in 4, and preparation for surgery in 3 patients.

Adverse events (n=44) that required the cessation of IFX were infusion reaction (n=20), infection (n=8), hepatotoxicity (n=4), malignancy (n=4), palmoplantar psoriasis (n=3), lichen planus (n=1), ug induced lupus (n=1), splenic infarction (n=1), a decrease in left ventricular ejection fraction (n=1), and massive hemorrhage due to pulmonary hypertension (n=1).

Among the 27 patients who discontinued IFX due to remission, 5 (20%) had a relapse after 4, 21, 26, 29, 38 and 46 months. The remaining patients did not experience a relapse during a median follow-up of 35 months (IQR: 24-68). At the end of the follow-up, 2 patients had died due to lung adenocarcinoma and 1 with pulmonary artery involvement due to massive hemorrhage during IFX treatment and 3 patients had died 1 year, 3 and 8 years after IFX discontinuation. The causes of death were with right heart failure due to pulmonary hypertension in 1 patient and severe nervous system involvement in 2 patients.

Conclusions: Infliximab see to be effective for the treatment of organ and life-threatening manifestations in the majority of the patients. However, ug retention rate was not optimal, mainly due to adverse events, patient non-compliance, and inefficacy.

Disclosures: Sinem Nihal Esatoglu has received honorariu for presentations from UCB Pharma, Roche, Pfizer, and Merck Sharp Dohme. Gulen Hatemi has received grant/research support from Celgene and has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma. Yesim Ozguler has received honorariu for presentations from UCB Pharma, Novartis, and Pfizer. Emire Seyahi has received honorariu for presentations from Novartis, Pfizer, AbbVie, and Gliead. Vedat Hamuryudan has received grant/research support from Celgene and has served as a speaker for AbbVie, Celgene, Novartis, and UCB Pharma. No other disclosures were reported.