P1079The Efficacy of Upadacitinib in Anti-TNF-Refractory Intestinal Behçet’s Disease

Background Behçet’s disease is a chronic systemic vasculitis that can affects multiple organs, with intestinal involvement referred to as intestinal Behçet’s disease. Anti-tumor necrosis factor (TNF) therapy is recommended for moderate to severe or refractory intestinal Behçet’s disease. However, managing patients unresponsive to anti-TNF-α therapy presents a significant clinical challenge. This study aims to evaluate the novel application of upadacitinib, a Janus kinase inhibitor, in patients with anti-TNF-refractory intestinal Behçet’s disease. Methods We retrospectively included patients with refractory intestinal Behçet’s disease treated who failed to respond adequately to anti-TNF therapy and subsequently received upadacitinib at the First Affiliated Hospital of Zhejiang University School of Medicine. Data collected included clinical manifestations, medication history, physical examination findings, laboratory results, and endoscopic evaluations before and after treatment. Results 14 patients with anti-TNF-α refractory intestinal BD receiving upadacitinib were included. After a median treatment duration of 20.3 weeks (IQR 13.8-29.0), 78.6% (11/14) achieved clinical CR, and 21.4% (3/14) achieved clinical MI. Among 8 patients who completed endoscopic follow-up, 62.5% (5/8) achieved endoscopic CR, and 37.5% (3/8) achieved endoscopic MI. The dosage of concomitant corticosteroids significantly decreased (P=0.008). The most common adverse event was dyslipidemia (21.4%), with no serious adverse events or events requiring discontinuation of treatment occurring. Conclusion Upadacitinib effectively improves clinical symptoms and promotes ulcer healing in patients with anti-TNF-α refractory intestinal BD, demonstrating a favorable safety profile, and may serve as a potential therapeutic option for refractory intestinal BD. References: [1] Zhang M, Liu J, Liu T, et al. The efficacy and safety of anti-tumor necrosis factor agents in the treatment of intestinal Behcet’s disease, a systematic review and meta-analysis[J]. Journal of Gastroenterology and Hepatology, 2022, 37(4): 608-619. [2] Zhao N, Tang Y, Wang S, et al. Case report: Refractory intestinal Behçet’s syndrome successfully treated with tofacitinib: A report of four cases[J]. Frontiers in Immunology, 2022, 13. [3] Liu J, Hou Y, Sun L, et al. A pilot study of tofacitinib for refractory Behçet’s syndrome[J]. Annals of the Rheumatic Diseases, 2020, 79(11): 1517-1520. [4] Sha S, Xu B, Wang K, et al. Case report: Successful remission with upadacitinib in a young patient with anti-TNF-refractory intestinal Behçet’s disease[J]. Frontiers in Immunology, 2024, 15: 1483993. Conflict of interest: Du, Juan: No conflict of interest Lu, Jiaoying: No conflict of interest Chen, Chunxiao: No conflict of interest