Drug survival of adalimumab across different manifestations of Behçet’s syndrome: a retrospective analysis in 335 patients

OBJECTIVES: Studies on drug survival provide real-world data on efficacy as well as safety. We aimed to evaluate the long-term drug survival of adalimumab (ADA) in a large cohort of patients with Behçet's syndrome (BS). METHODS: We conducted a retrospective chart review of 335 BS patients who started ADA between 2008 and 2023. All treatment discontinuations were considered as events, regardless of the underlying reason, to reflect overall treatment persistence in a real-world setting. RESULTS: ADA retention rates at 6, 12, and 24 months were 88.9%, 78.3%, and 67.1%, respectively. Over a mean follow-up of 26.6 (23) months, 137 patients (41%) discontinued ADA. The most common reason for discontinuation was inefficacy, followed by adverse events, non-compliance, remission, and other reasons. No significant associations were observed between treatment discontinuation and age, sex, disease duration, prior tumor necrosis factor inhibitor exposure, concomitant disease-modifying antirheumatic drug use, or major organ involvement. Dose interval extension was performed in 36 patients, with relapse or flare occurring in 5 (14%), all of whom achieved remission after dose re-adjustment. Dose intensification was applied in 30 patients, resulting in remission in 17 (56.6%). CONCLUSION: ADA showed a good retention rate at month 6, followed by a gradual decline in drug retention over time. Secondary inefficacy was the most common reason for treatment discontinuation, followed by adverse events and non-compliance, whereas primary inefficacy was uncommon. Dose intensification to achieve active disease control and dose de-escalation in patients with sustained remission may be feasible management strategies.