Risk factors and outcomes of acute lower gastrointestinal bleeding in intestinal Behçet’s disease

Park, Jihye; Cheon, Jae Hee; Park, Yongeun; Lee, Yoon Jee; Lee, Hyun Jung; Park, Soo Jung; Hong, Sung Pil; Kim, Tae Il

doi:10.1007/s00384-016-2728-x

Cited by 13 publications

(13 citation statements)

References 35 publications

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“…Our intestinal ABD patients with poor outcomes (non-healing intestinal ulcers) accounted for 34.86%, slightly lower than the rate of 58.3% reported in other studies of intestinal ABD patients [10, 13, 18]; no patients died during follow-up. Previously, the identified independent risk factors for poor prognosis in intestinal ABD were male gender, mucosal healing, volcano-shaped ulcers, larger size of intestinal ulcers (> 2 cm) and elevated CRP levels (≥ 44 mg/L )[10, 20–22].…”

Section: Discussioncontrasting

confidence: 66%

Poor prognostic factors in patients with newly diagnosed intestinal Adamantiades-Behçet’s disease in the Shanghai Adamantiades-Behçet’s disease database: a prospective cohort study

Zhang

Tian²,

et al. 2019

Orphanet J Rare Dis

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BackgroundAdamantiades-Behçet’s Disease (ABD) is an immunological recurrent systemic vasculitis with a chronic course. We investigated the predictors of long-term flare-ups, poor outcomes and event-free survival in Chinese non-surgical patients with intestinal ABD.MethodsThis was a prospective cohort study of 109 intestinal ABD patients seen in our institution between October 2012 and January 2019 who met the international criteria for ABD and had intestinal ulcers confirmed on colonoscopy. Predictors of relapses and poor outcomes, event-free survival were calculated using logistic regression models and Cox proportional hazard regression models, respectively.ResultsSixty-six intestinal ABD patients (60.55%) had ileocecal ulcers; 19 patients (17.43%) presented with colorectum ulcers; 24 patients (22.02%) showed both ileocecal and colorectum ulcers. 7 patients (6.42%) experienced at least 1 flare-up of intestinal ulcers. 38 patients (34.86%) complained of non-healing intestinal ulcers. In multivariate analysis, location of intestinal ulcers (ileocecal and colorectum) (odd ratio (OR) 7.498 [95% confidence interval [95% CI] 1.844–30.480]), erythrocyte sedimentation rate (ESR) > 24 mm/h (OR 5.966 [95% CI 1.734–20.528]), treatment with infliximab (IFX) (OR 0.130 [95% CI 0.024–0.715]), and poor compliance (OR 11.730 [95% CI 2.341–58.781]) were independently correlated with a poor outcome. After a median follow-up of 28 months, 45 intestinal ABD patients (41.28%) underwent adverse events. Factors independently associated with shorter event-free survival were early onset of ABD (< 7 years) (hazard ratio (HR) 2.431 [95% CI 1.240–4.764]) and poor compliance (HR 3.058 [95% CI 1.612–5.800]).ConclusionDistribution of intestinal ulcers (ileocecal and colorectum), ESR > 24 mm/h, treatment without IFX, and poor compliance were independent risk factors for poor outcomes in non-surgical intestinal ABD patients.

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Section: Discussioncontrasting

confidence: 66%

Poor prognostic factors in patients with newly diagnosed intestinal Adamantiades-Behçet’s disease in the Shanghai Adamantiades-Behçet’s disease database: a prospective cohort study

Zhang

Tian²,

et al. 2019

Orphanet J Rare Dis

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“…As shown in Fig. 4c, the CS dose, which is considered a risk factor for gastrointestinal bleeding and perforation [16–18], was reduced to 7.5 mg or less in the majority of patients in the TNF-i group; however, in many patients in the CS without TNF-i group, dose reduction of concomitant CS was difficult despite a significant decrease in the DAIBD. In other words, patients in the CS without TNF-i group exhibited CS dependency.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of corticosteroid monotherapy, and TNF inhibitors with or without corticosteroid in patients with refractory entero-Behcet’s disease

et al. 2019

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Background Tumor necrosis factor (TNF) inhibitors (TNF-i) are effective in the treatment of entero-Behcet’s disease (BD). However, there is no objective tool for assessment of disease activity in entero-BD; therefore, it is not easy to evaluate treatment effectiveness in the clinical setting. In addition, because corticosteroid (CS) is considered for standard therapy, the effectiveness of TNF-i without CS has not been well examined. In this retrospective study, the effectiveness of CS without TNF-i and the effectiveness of TNF-i with or without CS therapy were investigated and compared. Methods This study included 71 patients with entero-BD who were followed up for 1 year (CS without TNF-i group: n = 22; TNF-i group: n = 49 [with CS: n = 20, without CS: n = 29]). All patients had active ulcerative lesions. The primary endpoint was the ulcer cure rate evaluated by lower gastrointestinal endoscopy. Secondary endpoints were ulcer improvement rate, disease activity improvement based on the quantitative disease activity index for intestinal Behcet’s disease (DAIBD), and CS-sparing effect. Results Ulcer cure rates were 13.6% in the CS without TNF-i group, 60.0% in the TNF-i with CS group, and 44.8% in the TNF-i without CS group. Ulcer improvement rates were 27.2% in the CS without TNF-i group, 60.0% in the TNF-i with CS group, and 51.7% in the TNF-i without CS group. The multivariate analysis revealed that TNF-i was an independent predictive factor for cure of the ulcerative lesions. The DAIBD and concomitant CS dose were significantly decreased in both the CS without TNF-i group (DAIBD 85.2 → 40.5, CS 32.3 → 18.7 mg/day) and the TNF-i group (DAIBD 64.7 → 21.1. CS 18.7 → 3.88 mg/day). The ulcer cure and improvement rates were significantly higher in the TNF-i group. In addition, the proportion of concomitant CS dose less than 7.5 mg was significantly higher in the TNF-i group (CS without TNF-i group 18.2% vs. TNF-i group 85%, P < 0.01). There were no statistically significant differences between the TNF-i with CS group and the TNF-i without CS group in any of the endpoints. Conclusions This study demonstrated that compared to CS alone, TNF-i improve disease activity and possess a higher ulcer healing effect and CS tapering effect with or without concomitant CS.

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“…Caterina Vacchi 1 , Marcella Visentini 2 , Maria DI Cicco 3 , Francesca Angelotti 4 , Gianfranco Lauletta 5 , Andreina Manfredi 1 , Davide Filippini 3 , Antonio Tavoni 4 , Milvia Casato 2 , Laura Castelnovo 6 , Giuseppe Monti 7 , Maurizio Pietrogrande 8 , Carlo Salvarani 1 9 , Massimo Galli 8 , Marco Sebastiani 1 , on behalf of GISC (Italian Group for the study of Mixed Cryoglobulinemia). 1 University of Modena and Reggio Emilia, Modena, Italy; 2 Sapienza University of Rome, Rome, Italy; 3 ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy; 4 University of Pisa, Clinical Immunology Unit, Pisa, Italy; 5 University of Bari, Bari, Italy; 6 Saronno Hospital, Saronno, Italy; 7 Hospital of Saronno, Saronno, Italy; 8 University of Milan, Milan, Italy; 9 IRCCS Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy…”

Section: Safety Of Rituximab Biosimilar For the Treatment Of Cryoglobmentioning

confidence: 99%

Ab0625 experience in the Usual Practice of Patients With Behçet’s Disease Who Are in Follow-Up in the Uveitis Unit of the Donostia University Hospital

Jaimes

Maiz-Alonso

Esteban

et al. 2019

Abstracts Accepted for Publication

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Background:Behçet’s disease (BD) is an inflammatory, chronic, recurrent, multisystemic process of unknown origin, characterized by the simultaneous or sequential presence of oral aphthae, genital ulcers, uveitis, inflammatory skin lesions, arterial or venous thrombosis, arthritis, inflammatory bowel disease and involvement of the central nervous system (CNS). The highest incidence figures correspond to the countries of the Middle East and the Far East (prevalence’s of 20-42/100,000), decreases in the Western Mediterranean (<10) and is much less frequent in the rest of the world (<2). The uveitis unit was created in our hospital in 2007, where a rheumatologist and an ophthalmologist jointly visit, so our aim is to report our experience for almost 12 years with this rare disease.Objectives:To describe the demographic, clinical, and analytical characteristics, as well as immunosuppressive and biological treatments used, type of ocular and extra ocular involvement, presence of sequelae, and visual acuity (VA) affectation, of the patients that are in follow-up in the uveitis unit of the Donostia University Hospital (DUH).Methods:A retrospective search of all patients with BD and ocular involvement evaluated the uveitis unit since 2007. The computerized medical records were reviewed. The variables collected were: sex, age, immunosuppressive and biological treatments used, and complementary tests. The immunosuppressant’s sought were methotrexate (MTX), azathioprine (AZA), tacrolimus, sulfasalazine (SSZ), cyclosporine (CsA), leflunomide (LFN), cyclophosphamide (CFM); adalimumab (ADA); infliximab (IFX), golimumab (GLM), intravenous immunoglobulins (IVIG). The quantitative variables are shown with the median and interquartile range; the qualitative ones are shown with the absolute value and its percentage.Results:We found 22 patients diagnosed with BD, the average age was 42 years, with a predominance of women (59%). Table 1 shows the clinical characteristics, complementary tests and treatments used in these patients. The most frequent type of ophthalmological affectation was panuveitis with retinal vasculitis in 40%, followed by uveitis in 36%. The median VA at the first visit (RE 0.85 LE 0.85), and at the last follow-up visit (RE 1 LE 1), observing an improvement in VA after follow-up. The most common extra ocular involvement was the presence of oral aphthae in 90%, followed by erythema nodosum and arthritis in 45%. Positivity for HLA B51/B57 was observed in 81% of the patients. The most frequent immunosuppressant used was CsA 59%, followed by aDA 40%. Among the main aftermath, the presence of cataract was observed in 40% and synechia in 27%. The mean follow-up of these patients was 85 months.Conclusion:We observed an improvement in VA during the follow-up of these patients compared to VA at the beginning; 70% of patients continued with immunosuppressive treatment with good control of the disease at more than 85 months of follow-up.Disclosure of interests:Jesús alejandro Valero Jaimes: None declared, Olga Maiz-Alonso Spea...

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Risk factors and outcomes of acute lower gastrointestinal bleeding in intestinal Behçet’s disease

Cited by 13 publications

References 35 publications

Poor prognostic factors in patients with newly diagnosed intestinal Adamantiades-Behçet’s disease in the Shanghai Adamantiades-Behçet’s disease database: a prospective cohort study

Poor prognostic factors in patients with newly diagnosed intestinal Adamantiades-Behçet’s disease in the Shanghai Adamantiades-Behçet’s disease database: a prospective cohort study

Comparative study of corticosteroid monotherapy, and TNF inhibitors with or without corticosteroid in patients with refractory entero-Behcet’s disease

Ab0625 experience in the Usual Practice of Patients With Behçet’s Disease Who Are in Follow-Up in the Uveitis Unit of the Donostia University Hospital

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