Predictors of anti-TNF treatment failure in intestinal Behçet's disease: a multicenter retrospective cohort study

Treatment options for intestinal Behçet's disease (BD) are limited. Despite the proven efficacy of infliximab and adalimumab, there is an urgent need to identify predictive factors for inadequate response or non-response to anti-TNF agents.

We conducted a retrospective cohort study involving 71 patients diagnosed with intestinal BD and treated with anti-TNF across four hospitals from August 2018 to December 2024. Demographic data, clinical symptoms, endoscopic findings, and laboratory parameters were collected at baseline and every 3 months after anti-TNF therapy until the latest follow-up appointment. The primary outcome was non-response or inadequate response to anti-TNF therapy, or presence of intestinal complications.

During the study period, 35.2% (25/71) of patients met the primary outcome at a median follow-up time of 8.5 months. Pre-treatment endoscopic score greater than 2.5, presence of opportunistic infections, DAIBD score > 12.5, ESR > 14.50 mm/h, and CRP > 12.83 mg/L three months post-treatment were identified to be associated with anti-TNF treatment failure. ROC curve established by incorporating these variables demonstrated a strong predictive capacity for treatment failure (AUC = 0.930). An internal validation of ROC curve was performed by the bootstrap method, which demonstrated good accuracy and stability. We subsequently developed a nomogram model to calculate the risk of treatment failure based on the above variables.

Predictors of anti-TNF treatment failure in patients with intestinal BD included baseline endoscopic score, the occurrence of opportunistic infections, and DAIBD score, CRP and ESR at 3 months post-treatment. Our model can identify high-risk patients early, allowing for the timely optimization of treatment regimens. Key Points • We explored the predictive factors for inadequate response or non-response to anti-TNF agents in patients with intestinal Behçet's disease. • Treatment failure occurred in 35.2% of patients treated with anti-TNF at a median follow-up of 8.5 months. • Pre-treatment endoscopic score greater than 2.5, presence of opportunistic infections, DAIBD score over 12.5, ESR above 14.50 mm/h, and CRP above 12.83 mg/L at three months post-treatment are significant predictors of treatment failure.