TY - JOUR
T1 - Experience with anti-TNF-α therapy for orofacial granulomatosis
AU - Elliott, Tim
AU - Campbell, Helen
AU - Escudier, Michael
AU - Poate, Tim
AU - Nunes, Carlo
AU - Lomer, Miranda
AU - Mentzer, Alex
AU - Patel, Pritash
AU - Shirlaw, Penelope
AU - Brostoff, Jonathon
AU - Challacombe, Stephen
AU - Sanderson, Jeremy
PY - 2011/1
Y1 - 2011/1
N2 - 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.
AB - 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.
U2 - 10.1111/j.1600-0714.2010.00976.x
DO - 10.1111/j.1600-0714.2010.00976.x
M3 - Article
VL - 40
SP - 14
EP - 19
JO - Journal of Oral Pathology and Medicine
JF - Journal of Oral Pathology and Medicine
IS - 1
ER -
