Risk Factors for Surgery in Patients with Intestinal Behcet's Disease During Anti-Tumor Necrosis Factor-Alpha Therapy

Abstract

Purpose: Behget's disease (BD) is a chronic inflammatory immune-mediated disease involving multiorgan systems. Gastrointes-tinal (GI) manifestations of BD include abdominal pain, vomiting, GI bleeding, fistula formation, obstruction, and perforation that might require surgery. Recently, anti-tumor necrosis factor-alpha (anti-TNF-alpha) therapy has been shown to have favorable out-comes in patients with intestinal BD who are refractory to conventional therapy. This study sought to figure out the risk factors for undergoing surgery during anti-TNF-alpha therapy in patients with intestinal BD.Materials and Methods: In this retrospective analysis of intestinal BD patients who were treated with anti-TNF-alpha, we collected the baseline patient data including comorbidities, clinical, endoscopic, and radiologic characteristics, and the Disease Activity Index for Intestinal Behget's Disease at the time of anti-TNF-alpha initiation. Each potential risk factor was compared. For multivariate analy-sis, Cox regression was used.Results: A total of 62 patients were considered eligible for analysis, and 15 of them (24.1%) underwent surgery. In univariate anal-ysis, the presence of extraintestinal manifestation, such as joint symptoms and erythrocyte sedimentation rate (ESR), were signifi-cantly associated with surgery during therapy. In multivariate analysis, drug response within 4 weeks [hazard ratio (HR), 64.59], skin and joint manifestation (HR, 10.23 and HR, 6.22), geographic ulcer (HR, 743.97), and ESR >42.5 mm/h (HR, 9.16) were found to be factors predictive of undergoing surgery during anti-TNF-alpha therapy. Conclusion: We found five risk factors predictive of surgery in patients with intestinal BD receiving anti-TNF-alpha therapy, which can guide physicians in selecting appropriate patients between anti-TNF-alpha therapy and early surgery.