H2(T)
ALEMTUZUMAB (CAMPATH-1H) AS REMISSION INDUCTION THERAPY IN
BEHCET'S DISEASE
Smith, R1, Chow, Y2, Jayne, D1
1
Addenbrooke's Hospital, Cambridge, 2Hospital Pantai Ayer Keroh Melaka, Malaysia
Behcet’s Disease is a chronic, relapsing inflammatory disorder, characterised by recurrent oral
and genital ulceration, but the more severe, life threatening manifestations are neurological,
gastrointestinal or vascular in nature. The precise aetiology and pathogenesis are unclear, but
there is increasing evidence that T cells play a key role in the development of disease, and thus
T cell depleting agents, such as the anti-CD52 humanised monoclonal antibody, alemtuzumab
(CAMPATH-1H) are a potential therapeutic strategy.
We present a retrospective review of 20 patients treated with alemtuzumab since 1998 in
Addenbrooke’s Hospital, Cambridge, UK. 15/20 patients were female, with a mean age of 36.2
years (range 18-59 years) and an average disease duration of 59.8 months (range 1-203 months)
at the time of first alemtuzumab infusion. In addition to oral and genital ulceration, 95% had
joint, 90% skin, 55% ocular, 65% gastrointestinal, 45% central nervous system and 25%
vascular involvement. The majority of patients had received multiple immunosuppressive
agents prior to alemtuzumab, including azathioprine, cyclosporine, mycophenolate mofetil and
anti-TNF agents in those treated more latterly.
Six months after treatment, 74% of patients were in complete remission. Many of these
remissions have been sustained over years; the average duration of follow up is 85.47 months
(range 20-134 months). In those that did relapse, re-treatment with alemtuzumab was effective.
There were significant reductions in prednisolone dose and BVAS (a measure of disease
activity) after treatment. Alemtuzumab was well tolerated. 25% of patients experienced
infusion reactions, but in only one did the reaction necessitate termination of the treatment.
There were no infectious complications directly attributable to alemtuzumab, but six patients
developed new autoimmune thyroid dysfunction.
Autoimmune diseases following
alemtuzumab, including thyroid disease and ITP, have also been reported in multiple sclerosis.
Alemtuzumab is a safe and effective therapy for the treatment of Behcet’s Disease, particularly
in those cases which prove to be refractory or life threatening.