Experience with anti-TNF-α therapy for orofacial granulomatosis

• Published in: Journal of oral pathology & medicine Vol. 40; no. 1; pp. 14 - 19
• Main Authors: Elliott, Tim, Campbell, Helen, Escudier, Michael, Poate, Tim, Nunes, Carlo, Lomer, Miranda, Mentzer, Alex, Patel, Pritash, Shirlaw, Penelope, Brostoff, Jonathon, Challacombe, Stephen, Sanderson, Jeremy
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2011; Wiley
• Subjects: Adalimumab; Anti-Inflammatory Agents - therapeutic use; anti-TNF-α; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Crohn Disease - complications; Crohn Disease - drug therapy; Crohn Disease - immunology; Crohn's disease; Dentistry; Female; Gastroenterology. Liver. Pancreas. Abdomen; Granulomatosis, Orofacial - complications; Granulomatosis, Orofacial - drug therapy; Granulomatosis, Orofacial - immunology; Humans; Infliximab; Male; Medical sciences; orofacial granulomatosis; Other diseases. Semiology; Otorhinolaryngology. Stomatology; Pharmacology. Drug treatments; Statistics, Nonparametric; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Time Factors; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Stomatology; anti-TNF-α; orofacial granulomatosis; Cytokine; Antipsoriatic agent; Granulomatosis; ENT; Crohn's disease; Monoclonal antibody; Anti-Tumor Necrosis Factor-alpha; Inflammatory disease; Immunomodulator; Oral cavity; Crohn disease; Treatment; Infliximab; Anticytokine; Digestive diseases; Intestinal disease; Antirheumatic agent; Immunosuppressive agent; Adalimumab; Face; Tumor necrosis factor α
• ISSN: 0904-2512; 1600-0714
• DOI: 10.1111/j.1600-0714.2010.00976.x

J Oral Pathol Med (2011) 40: 14–19 Background:  Orofacial granulomatosis (OFG) can be challenging to treat and experience with anti‐TNF‐α 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‐α therapy were determined by comparison with OFG patients not requiring anti‐TNF‐α 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‐α 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.