APREMILAST IN NON-ULCER MANIFESTATIONS IN BEHçET’S DISEASE. MULTICENTER STUDY OF 32 CASES IN CLINICAL PRACTICE

Background: Behçet’s disease (BD) is a variable vessel vasculitis with a wide and heterogeneous set of signs and symptoms. The inhibitor of phosphodiesterase-4 Apremilast (APR) has demonstrated efficacy in the treatment of oral and/or genital ulcers. Objectives: To assess the efficacy and safety of APR in BD patients with manifestations different from mucocutaneous ulcers. Methods: National multicenter retrospective study on 32 BD patients treated with APR at maintained standard dose of 30 mg twice daily. Results: From a cohort of 49 patients with oral and/or genital ulcers related to BD and refractory to conventional and/or biological treatment, we selected the cases with another clinical manifestation/s (n=32, 23 women/9 men), mean age of 46.35±15.05 years. Non-aphthous manifestations present at apremilast onset were: arthralgia/arthritis (15), folliculitis/pseudofolliculitis (12), asthenia (7), erythema nodosum (3), furunculosis (2), paradoxical psoriasis by TNFi (2), ileitis (2), deep venous thrombosis (2), erythematosus and scaly skin lesions (1), fever (1), eating disorder (1), fibromyalgia (1), unilateral anterior uveitis (1) and neurobehçet (1). APR was used in monotherapy (n=3) or combined (n=29) with oral corticosteroids (20), colchicine (17), methotrexate (5), azathioprine (3), dapsone (1), tocilizumab (1), hydroxychloroquine (1) and/or mesalazine (1). The outcome of the different clinical symptoms is shown in TABLE. The patient with neurobehçet kept stable (paresthesias) during the 6 months of follow-up. The 2 cases of deep venous thrombosis and the case of anterior uveitis resolved with anticoagulants and adjuvant topical treatment, respectively. Furunculosis, folliculitis/pseudofolliculitis and ileitis were the manifestations that improved completely and rapidly. The cases of arthritis experienced improvement, while those with arthromyalgias presented a torpid evolution. Conclusion: Our data show an improvement of the cutaneous follicular and intestinal clinic with APR and a stability of the neurological clinic, while the musculoskeletal manifestations were mostly refractory. REFERENCES: [1] Davatchi F et al. The International Criteria for Behçet’s Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatology Venereol. 2014;28(3):338–47. [2] Atienza-Mateo B et al. Anti-interleukin 6 receptor tocilizumab in refractory uveitis associated with Behçet’s disease: multicentre retrospective study. Rheumatology (Oxford). 2018 May 1;57(5):856-864. [3] Santos-Gómez M et al. The effect of biologic therapy different from infliximab or adalimumab in patients with refractory uveitis due to Behçet’s disease: results of a multicentre open-label study. Clin Exp Rheumatol 2016; 34 (6 Suppl 102): S34-40. [4] Gulen Hatemi et al. Apremilast for Behçet’s Syndrome — A Phase 2, Placebo-Controlled Study. N Engl J Med 2015; 372:1510-1518. Disclosure of Interests: Belén Atienza-Mateo: None declared, José Luis Martín-Varillas: None declared, J. Loricera: None declared, Vanesa Calvo-Río: None declared, Jenaro Graña: None declared, Gerard Espinosa: None declared, Clara Moriano: None declared, Trinidad Pérez-Sandoval: None declared, Manuel Martín-Martínez: None declared, Elvira Diez Alvarez: None declared, María Dolores García-Armario: None declared, Esperanza Martínez: None declared, Ivan Castellví Consultant for: I received fees less than 5000USD as a consultant for Kern and Actelion, Paid instructor for: I received fees less than 2000USD as a instructor for Boehringer -Ingelheim, Novartis and Gebro, Speakers bureau: ND, Patricia Moya: None declared, Francisca Sivera: None declared, Jaime Calvo Consultant for: Bristol-Myers Squibb, Janssen, Celgene, Sanofi Genzyme, Speakers bureau: Bristol-Myers Squibb, Isabel de la Morena Speakers bureau: Abbvie, Celgene, Pfzier, UCB, Ghebro, Roche, Sanofi, Janssen., Francisco Ortiz-Sanjuán: None declared, José Andrés Román-Ivorra: None declared, Ana Pérez Gómez: None declared, Sergi Heredia: None declared, Alejandro Olive: None declared, Águeda Prior-Español: None declared, Carolina Díez: None declared, Juanjo J Alegre-Sancho: None declared, D Ybáñez-García: None declared, Ángels Martínez-Ferrer: None declared, J. Narváez Consultant for: Bristol-Myers Squibb, Ignasi Figueras: None declared, Ana Isabel Turrión : None declared, Susana Romero-Yuste: None declared, Pilar Trénor: None declared, Soledad Ojeda Grant/research support from: AMGEN, Speakers bureau: AMGEN, Santos Castañeda Consultant for: Amgen, BMS, Pfizer, Lilly, MSD, Roche, Sanofi, UCB, D. Prieto-Peña: None declared, Monica Calderón-Goercke: None declared, Lara Sánchez Bilbao: None declared, Iñigo González-Mazón: None declared, Miguel Á. González-Gay: None declared, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant for: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD DOI: 10.1136/annrheumdis-2019-eular.5965Citation: Ann Rheum Dis, volume 78, supplement 2, year 2019, page A815Session: Vasculitis (Scientific Abstracts)