The 2nd edition of consensus statements for the diagnosis and management of intestinal Behçet’s disease: indication of anti-TNFα monoclonal antibodies

Abstract

BackgroundClinical evidence regarding intestinal Behçet’s disease (BD) management is lacking and intestinal lesions are a poor prognostic factor. In 2007, the Japan consensus statement for diagnosis and management of intestinal BD was developed. Recently, the efficacy of anti-tumor necrosis factor (TNF)α monoclonal antibodies (mAbs), and infliximab (IFX) was reported and adalimumab (ADA) was approved for intestinal BD in Japan. This study renewed consensus-based practice guidelines for diagnosis and treatment of intestinal BD focusing on the indication of anti-TNFα mAbs.MethodsAn expert panel of Japanese gastroenterology and rheumatology specialists was involved. Clinical statements for ratings were extracted from the literature, a professional group survey, and by an expert panel discussion, which rated clinical statements on a nine-point scale. After the first round of ratings, a panelist meeting discussed areas of disagreement and clarified areas of uncertainty. The list of clinical statements was revised after the panelist meeting and a second round of ratings was conducted.ResultsFifteen relevant articles were selected. Based on the first edition consensus statement, improved clinical statements regarding indications for anti-TNFα mAbs use were developed. After a two-round modified Delphi approach, the second edition of consensus statements was finalized.ConclusionsIn addition to standard therapies in the first edition, anti-TNFα mAbs (ADA and IFX) should be considered as a standard therapy for intestinal BD. Colchicines, thalidomide, other pharmacological therapy, endoscopic therapy, and leukocytapheresis were deemed experimental therapies.

Juvenile Behсet's Disease: Clinical Observation

“…Во втором издании консенсуса по этой проблеме (2014) [58] стандартная терапия интестинальной формы болезни Бехчета дополнена анти-TNF ␣ моноклональны-ми антителами (адалимумаб и инфликсимаб). Остальные методы лечения (колхицин, талидомид, эндоскопическая терапия и плазмаферез) так и остались в качестве экс-периментальных.…”

The Histomorphology of Colonic Behcet's Disease

“…Ulcers are mostly wider than 1 cm, round-oval shaped (77%), single (67%) or several located seperately (27%), sharply circumscribed, staple hole-like or perforated (Figures 1A and 1B). Abdominal pain, diarrhea and bleeding are the most common clinical symptoms [10,13,33]. These symptoms are often the result of mucosal ulcerations [2].…”

“…However, presence of intestinal lesions can be considered as a poor prognostic factor [33]. In a 20-year retrospective study conducted by Istanbul University, 10.9% of patients with Behçet's disease had died [43].…”

“…Novel treatment approaches focuse on targeted cytokines such as TNF-α, IL-21 and IL-17 [12]. In the consensus that has been achieved in 2013 on the diagnosis and treatment approach of BD, anti-TNFα monoclonal antibody therapy was recommended as a standard treatment [33]. Sever bleeding, perforation, fistula, obstruction, abdominal mass and unresponsiveness to medical therapy are the endications for surgical intervention [2,6,10,13].…”

Trisomy 8-Associated Intestinal Behcet’s Disease That Achieved Complete Remission With Mesalazine

“…Conventionally, the pharmacological treatments of BD include 5-aminosalicylic acid, systemic corticosteroids and immunosuppressive agents, such as thiopurines [7][8][9]. However, many patients fail to respond to these treatments [10].…”