The purpose of this study is to evaluate the proof of concept of efficacy of ustekinumab in subjects with Behçet disease, including patients with oral ulcers (STELABEC-1) and patients with active posterior uveitis or panuveitis (STELABEC-2)
Behçet disease (BD) is a chronic systemic inflammatory disorder at the crossroad between autoimmune and autoinflammatory syndromes. Two recent large genome-wide association studies (GWAS) conducted in Turkey and Japan reported association between single nucleotide polymorphism (SNP) of interleukin (IL)-10 and IL-23R/IL-12RB2 genes and BD. Interleukin-12 and interleukin-23, cytokines that induce naive CD4+ lymphocytes to differentiate into type 1 helper T cells (Th1 cells) and type 17 helper T cells (Th17 cells), respectively, have been identified as key mediators of BD. Promotion of Th1 and Th17 responses and suppression of regulatory T cells correlate with BD activity. Due to the lack of an etiologic agent, the treatment is symptomatic without consensus. The goals are the functional recovery of a visceral involvement (eye, central nervous system) and prevention of relapse(s). The risks of BD are an increased mortality especially in case of arterial involvement, and a high morbidity due to the cumulative sequelae of ocular and neurological involvement. Steroids are the corner stone of the antiinflammatory agents administered topically or systemically. Relapses are frequently seen after discontinuation of steroids, and corticodependence is frequently observed leading to the use of immunosuppressive drugs. Biologic agents that selectively block steps in the inflammatory cascade could provide additional therapies for BD.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
16
Injections of ustekinumab at 90 mg at week 0, week 4 and week 16. Patients in treatment failure at week 24 will terminate the study. Responder patients at week 24 will receive additional 2 injections of ustekinumab at week 28 and week 40 with a final evaluation at week 52.
Hôpital Cochin, Department of Internal Medicine, National Reference Center for Autoimmune and Systemic Diseases
Paris, Paris, France
Number of oral ulcers at week 24 compared to baseline
Treatment efficacy at week 24 for STELABEC-1 study on oral ulcers
Time frame: 24 weeks
Number of uveitis or retinal vasculitis remission
Treatment efficacy at week 24 for STELABEC-2 study on eye involvement
Time frame: 24 weeks
Number of oral and genital ulcers
Time frame: at baseline visit (week 0)
Number of oral and genital ulcers
Time frame: 4 weeks
Number of oral and genital ulcers
Time frame: 8 weeks
Number of oral and genital ulcers
Time frame: 12 weeks
Number of oral and genital ulcers
Time frame: 16 weeks
Number of oral and genital ulcers
Time frame: 24 weeks
Number of oral and genital ulcers
Time frame: 28 weeks
Number of oral and genital ulcers
Time frame: 40 weeks
Number of oral and genital ulcers
Time frame: 52 weeks
Pain Visual Analog Scales of oral and genital ulcers
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Time frame: at baseline visit (week 0)
Pain Visual Analog Scales of oral and genital ulcers
Time frame: 4 weeks
Pain Visual Analog Scales of oral and genital ulcers
Time frame: 8 weeks
Pain Visual Analog Scales of oral and genital ulcers
Time frame: 12 weeks
Pain Visual Analog Scales of oral and genital ulcers
Time frame: 16weeks
Pain Visual Analog Scales of oral and genital ulcers
Time frame: 24 weeks
Pain Visual Analog Scales of oral and genital ulcers
Time frame: 28 weeks
Pain Visual Analog Scales of oral and genital ulcers
Time frame: 40 weeks
Pain Visual Analog Scales of oral and genital ulcers
Time frame: 52 weeks
Number of chorioretinal and/or inflammatory retinal vascular lesions, inflammation in anterior chamber and in vitreous haze
Time frame: baseline visit (week 0)
Number of chorioretinal and/or inflammatory retinal vascular lesions, inflammation in anterior chamber and in vitreous haze
Time frame: 4 weeks
Number of chorioretinal and/or inflammatory retinal vascular lesions, inflammation in anterior chamber and in vitreous haze
Time frame: 8 weeks
Number of chorioretinal and/or inflammatory retinal vascular lesions, inflammation in anterior chamber and in vitreous haze
Time frame: 12 weeks
Visual acuity by Early Treatment Diabetic Retinopathy Study (ETDRS)
Time frame: 16 weeks
Number of chorioretinal and/or inflammatory retinal vascular lesions, inflammation in anterior chamber and in vitreous haze
Time frame: 24 weeks
Number of chorioretinal and/or inflammatory retinal vascular lesions, inflammation in anterior chamber and in vitreous haze
Time frame: 28 weeks
Number of chorioretinal and/or inflammatory retinal vascular lesions, inflammation in anterior chamber and in vitreous haze
Time frame: 40 weeks
Number of chorioretinal and/or inflammatory retinal vascular lesions, inflammation in anterior chamber and in vitreous haze
Time frame: 52 weeks
Behçet Syndrome Activity Score (BSAS)
Time frame: 12 weeks
Behçet Disease Current Activity Form (BDCAF)
Time frame: 12 weeks
Behçet Syndrome Activity Score (BSAS)
Time frame: 24 weeks
Behçet Disease Current Activity Form (BDCAF)
Time frame: 24 weeks
Behçet Syndrome Activity Score (BSAS)
Time frame: 52 weeks
Behçet Disease Current Activity Form (BDCAF)
Time frame: 52 weeks
Behçet Disease Quality of Life Measure : Short Form-36 (SF- 36)
Time frame: 12 weeks
Behçet Disease Quality of Life Measure : Routine Assessment of Patient Index Data 3 (RAPID3)
Time frame: 12 weeks
Behçet Disease Quality of Life Measure : Short Form-36 (SF- 36)
Time frame: 24 weeks
Behçet Disease Quality of Life Measure : Routine Assessment of Patient Index Data 3 (RAPID3)
Time frame: 24 weeks
Behçet Disease Quality of Life Measure : Short Form-36 (SF- 36)
Time frame: 52 weeks
Behçet Disease Quality of Life Measure : Routine Assessment of Patient Index Data 3 (RAPID3)
Time frame: 52 weeks
Number of adverse events
adverse events including headache, arthralgia, infection (pneumonia and bronchitis),skin infections, shingles, depression, dizziness, diarrhea, pruritus, myalgia, asthenia
Time frame: from baseline visit up to 52 weeks