Experience with anti-TNF-α therapy for orofacial granulomatosis

Tim Elliott, Helen Campbell, Michael Escudier, Tim Poate, Carlo Nunes, Miranda Lomer, Alex Mentzer, Pritash Patel, Penelope Shirlaw, Jonathon Brostoff, Stephen Challacombe, Jeremy Sanderson

Research output: Contribution to journalArticlepeer-review

39 Citations (Scopus)


Background: Orofacial granulomatosis (OFG) can be challenging to treat and experience with anti-TNF-alpha 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-alpha therapy were determined by comparison with OFG patients not requiring anti-TNF-alpha 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-alpha 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.
Original languageEnglish
Pages (from-to)14 - 19
Number of pages6
JournalJournal of Oral Pathology and Medicine
Issue number1
Publication statusPublished - Jan 2011


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