Immunosuppressants reduce venous thrombosis relapse in Behçet's disease

• Published in: Arthritis & rheumatology (Hoboken, N.J.) Vol. 64; no. 8; pp. 2753 - 2760
• Main Authors: Desbois, A. C., Wechsler, B., Resche-Rigon, M., Piette, J. C., Huong, D. Le Thi, Amoura, Z., Koskas, F., Desseaux, K., Cacoub, P., Saadoun, D.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-08-2012; Wiley; Wiley Subscription Services, Inc
• Subjects: Adult; Anticoagulants - therapeutic use; Behcet Syndrome - complications; Biological and medical sciences; Blood and lymphatic vessels; Budd-Chiari Syndrome - etiology; Budd-Chiari Syndrome - prevention & control; Cardiology. Vascular system; Cohort Studies; Diseases of the osteoarticular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Glucocorticoids - therapeutic use; Humans; Immunosuppressive Agents - therapeutic use; Male; Medical sciences; Multivariate Analysis; Retrospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Secondary Prevention; Treatment Outcome; Venous Thrombosis - etiology; Venous Thrombosis - prevention & control; Skin disease; Relapse; Stomatology; Rheumatology; Cardiovascular disease; Behçet syndrome; Genital diseases; Venous disease; Vascular disease; Eye disease; Vasculitis; Systemic disease; Venous thrombosis
• ISSN: 0004-3591; 2326-5191; 1529-0131; 2326-5205
• DOI: 10.1002/art.34450

Objective
To investigate and describe the long‐term outcome of venous thrombosis in patients with Behçet's disease (BD).
Methods
In a retrospective cohort of 807 BD patients, a reported 296 patients (36.7%) (73.3% male, median age 30 years [interquartile range 24–36 years]) met the international classification criteria for BD and had venous thrombosis. We assessed factors associated with thrombosis relapse and mortality.
Results
There were a total of 586 venous thrombosis events, including 560 cases of deep thrombosis and 26 cases of superficial thrombosis. Deep venous thrombosis events included 323 cases of limb thrombosis (55.1%), 77 cases of cerebral venous thrombosis (13.1%), 57 cases of pulmonary embolism (9.7%), 63 cases of vena cava lesions (10.7%), 14 cases of Budd‐Chiari syndrome (2.4%), and 13 cases of cervical vein thrombosis (2.2%). One hundred of 296 patients (33.8%) experienced at least 1 venous thrombosis relapse. The mortality rate was 6.4% (19 of 296 patients) after a median followup of 4.75 years (interquartile range 2–7 years). In univariate analysis, death was associated with cardiac involvement (P = 0.026) and Budd‐Chiari syndrome (P = 0.004). In multivariate analysis, the use of immunosuppressive agents was found to prevent relapse of venous thrombosis (hazard ratio 0.27 [95% confidence interval 0.14–0.52], P = 0.00021), and there was a trend toward prevention of relapse with the use of glucocorticoids (hazard ratio 0.62 [95% confidence interval 0.40–0.97], P = 0.058).
Conclusion
Immunosuppressive agents significantly reduce venous thrombosis relapse in BD.