Efficacy and safety of biological therapy compared to synthetic immunomodulatory drugs or placebo in the treatment of Behçet’s disease associated uveitis: a systematic review

Urruticoechea‐Arana, Ana; Cobo‐Ibáñez, Tatiana; Villaverde-García, Virginia; Gómez, Montserrat Santos; Loza, Estíbaliz; Vargas-Osorio, Kelly; Padron, Leslie Fariñas; Dı́az-González, Federico; Calvo-Río, V.; Blanco, Ricardo

doi:10.1007/s00296-018-4193-z

Cited by 20 publications

(16 citation statements)

References 27 publications

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“…The results mentioned above suggested that anti-TNF-α provided satisfactory control of ocular inflammation, improved visual prognosis and allowed good preservation of macular structural integrity. It was consistent with the results in a meta-analysis by Urruticoechea-Arana A et al ( Urruticoechea-Arana et al., 2018 ). He presented that patients treated with anti-TNF-α agents had a lower risk of uveitic flare or visual impairment over the long-term than those in conventional therapy group.…”

Section: Discussionsupporting

confidence: 92%

Effectiveness and Safety of Anti-Tumor Necrosis Factor-Alpha Agents Treatment in Behcets’ Disease-Associated Uveitis: A Systematic Review and Meta-Analysis

Huang

Yang

et al. 2020

Front. Pharmacol.

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Purpose: We conducted a systematic review and meta-analysis to determine the effectiveness and safety of anti-tumor necrosis factor-alpha (TNF-a) agents in the treatment of Behcets' disease (BD)-associated uveitis. Method: Three electronic databases, Embase, MEDLINE, and the Cochrane Library, were searched for eligible papers focusing on the anti-TNF-a agents treatment in BD-associated uveitis with at least 6 months follow-up time. A systematic review and meta-analysis was conducted on selected papers with appropriate clinical and methodological homogeneity. The effectiveness outcomes included inflammation remission, visual acuity (VA) improvement, central macular thickness (CMT) decrease, corticosteroid (CS)-sparing effects, and the safety outcomes included minor and severe drug-related adverse events (AEs). Result: From Jan 2010 to Dec 2019, there were 504 records produced in total, in which 18 clinical trials were selected for meta-analysis (15 trials were retrospective studies, and 3 were prospective studies). The number of patients in each study ranged from 11 to 163 and the mean follow-up time from 0.9 to 6.44 years. During the follow-up, the pooled inflammation remission rate was 68% with a 95% confidence interval (CI) of 0.59-0.79, VA improvement rate was 60% (95% CI 0.47-0.77), CMT decrease was 112.70 mm (95% CI 72.8-153.0 mm). The proportions of patients who had CS-suspended and CS-tapered reached 38% (95% CI 0.23-0.65) and 34% (95% CI 0.16-0.70), respectively. The severe AEs were reported but not common, which included severe infusion reactions, pneumonia, bacteremia, tuberculosis, melanoma, and lymphoma. Conclusion: Anti-TNF-a agents treatment has high effectiveness including efficient inflammation remission, satisfactory VA improvement, obvious CMT reduction, and significant CS-sparing effects. Although some drug-related AEs were reported, the incidence of severe AEs was acceptable. Anti-TNF-a agents treatment is a promising option for controlling BD-associated uveitis.

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Section: Discussionsupporting

confidence: 92%

Effectiveness and Safety of Anti-Tumor Necrosis Factor-Alpha Agents Treatment in Behcets’ Disease-Associated Uveitis: A Systematic Review and Meta-Analysis

Huang

Yang

et al. 2020

Front. Pharmacol.

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“…Prevention of visual loss, improvement of visual outcomes and decrease in flares of uveitis are the main treatment goals with IS and biologics. Yet, loss of visual acuity could be seen in spite of aggressive therapy protocols . Although limited information is available for work limitation in BS, weekly working hours is found to be lower in patients with ocular involvement in our previous study …”

Section: Discussionmentioning

confidence: 79%

“…Positive pathergy reaction was observed in 57.7% of the patients (n = 481). Treatment protocols were categorized as nonimmuno-suppressive (non-IS) medications regarding colchicine, sulphasalazine, nonsteroidal anti-inflammatory drugs, antibiotics (n = 501, 60.07%) for mild disease course or IS medications (n = 289, 34.65%) such as azathioprine, corticosteroids, anti-tumor necrosis factor-α and interferon-α for severe disease course in the previous year. However, 5.27% of the group (n = 44) were not using any medication.…”

Section: Re Sultsmentioning

confidence: 99%

Predictive factors for work‐day loss in Behçet's syndrome: A multi‐center study

et al. 2019

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Objective The aim of this multi‐center study was to assess predictive factors for work‐day loss as an indirect cost element in Behçet's syndrome (BS). Methods In this cross‐sectional, multi‐center study, 834 BS patients (F/M: 441/393, age mean: 38.4 ± 10.9 years) were included. Data were collected by a questionnaire regarding treatment protocols, disease duration, smoking pattern, frequency of medical visits during the previous year and self‐reported work‐day loss during the previous year. Results Work‐day loss was observed in 16.2% of patients (M/F: 103/32). The percentages of being a smoker (81.8%), using immunosuppressive (IS) medications (82%), and having disease duration <5 years (74%) were higher in male patients with work‐day loss (P < .05). The majority of males (90.9%) had more than four clinic visits during the previous year. Moreover, the mean work‐day loss (30.8 ± 57.7 days) was higher in patients with vascular involvement (56.1 ± 85.9) than those without (26.4 ± 50.6 days) (P = .046). In addition, increased frequency of ocular involvement (25.9%) was also observed in patients with work‐day loss compared to others (8.6%) (P = .059). Conclusion Work‐day loss was associated with both vascular and ocular involvement. Close associations were observed among male gender, early period of the disease, frequent medical visits, being a smoker and treatment with IS medications in patients with work‐day loss.

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“…Recently, azathioprine was considered as the first-line choice in patients with relapsing NBS together with initial high-dose steroid pulse therapy, followed by low-dose steroid maintenance therapy. 15 A high-dose steroid pulse associated with mycophenolate mofetil (1 g daily) and infliximab (5 mg/kg/day) is effective in treating NBS associated with severe retinal vasculitis. 16 However, none of the above-mentioned studies showed powerful evidence concerning the potential effect in preventing CNS involvement.…”

Section: Discussionmentioning

confidence: 99%

Neuro-Behçet’s syndrome with a severe ocular lesion

Han

Liu

et al. 2019

J Int Med Res

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Behçet’s syndrome (BS) is an idiopathic, chronic, relapsing, multisystem, vascular-inflammatory disease. Neuro-Behçet’s syndrome (NBS) is a subtype of BS that mainly involves the central nervous system. Because of the heterogeneous involvement of NBS and the limited yearly numbers of new cases of NBS, estimating its course, prognosis, and treatment effect is difficult. Therefore, the efficacy of treatment for any form of NBS is unclear. We experienced a male patient with NBS and severe right uveitis. He received high-dose intravenous methylprednisolone (1000 mg/day) pulse therapy for 3 days. Intravenous injection of cyclophosphamide (400 mg, twice a day) and oral administration of prednisone (40 mg in the morning, 20 mg in the evening) were applied. Uveitis was treated with retrobulbar injection of triamcinolone acetonide (40 mg per week). The patient’s response was rapid with improved symptoms and signs. The therapeutic regimen of patients with BS has greatly advanced, leading to evidence-based guidelines. Methylprednisolone pulse therapy is important in treatment of BS. Novel therapeutic options are currently being examined to improve the prognosis of BS. These efforts will undoubtedly shed new light on this complex syndrome.

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Efficacy and safety of biological therapy compared to synthetic immunomodulatory drugs or placebo in the treatment of Behçet’s disease associated uveitis: a systematic review

Cited by 20 publications

References 27 publications

Effectiveness and Safety of Anti-Tumor Necrosis Factor-Alpha Agents Treatment in Behcets’ Disease-Associated Uveitis: A Systematic Review and Meta-Analysis

Effectiveness and Safety of Anti-Tumor Necrosis Factor-Alpha Agents Treatment in Behcets’ Disease-Associated Uveitis: A Systematic Review and Meta-Analysis

Predictive factors for work‐day loss in Behçet's syndrome: A multi‐center study

Neuro-Behçet’s syndrome with a severe ocular lesion

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