Updated treatment strategies for intestinal Behçet’s disease

Park, Yongeun; Cheon, Jae Hee

doi:10.3904/kjim.2017.377

Cited by 34 publications

(27 citation statements)

References 106 publications

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“…[14,15] In 2015, ADa was approved for treatment of intestinal BD in Japan. [5] Therefore, more studies on anti-TNF-α agents for treatment of intestinal BD, [16] particularly information of the therapeutics effects, should be accumulated to expand the new treatment guidelines.…”

Section: Discussionmentioning

confidence: 99%

Successful closure of ileostomy in a patient with intestinal Behçet's disease after therapy with adalimumab

Yan¹,

Cui²,

Yu³

et al. 2019

Medicine

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Rationale:Behçet's disease (BD) is a chronic immune-mediated inflammatory disorder involving multiple organ systems. In BD, intestinal ulcers can present as a refractory lesion capable of perforation, which makes the choice of treatment difficult.Patient Concerns:A 34-year-old male who was diagnosed with intestinal BD and suffered with an ileocecal perforation. He underwent surgery for an ileostomy and was given corticosteroids as treatment. However, the ulcerative lesion remained resistant to the therapy that was provided which delayed the closure operation.Diagnosis:Intestinal BD with severe post-operative complication.Interventions:A course of adalimumab (ADa) therapy was started. Subsequently surgery was performed. And ADa and thalidomide were used as a maintenance therapy.Outcomes:In this case, a course of ADa therapy was given which healed the intestinal ulcers and allowed us to successfully perform the closure operation.Lessons:This case indicates that ADa may be an effective treatment option in future cases, minimizing complications and allowing the closure operation to be performed successfully.

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Section: Discussionmentioning

confidence: 99%

Successful closure of ileostomy in a patient with intestinal Behçet's disease after therapy with adalimumab

Yan¹,

Cui²,

Yu³

et al. 2019

Medicine

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“…Various other types of lesion have also been de- scribed, including punched-out esophageal ulcers, multiple erosions, and lesions resembling those of ulcerative colitis (8). Treatment of BD intestinal lesions includes 5aminosalicylic acid (5-ASA) formulations, prednisolone (PSL), colchicine, and various other immunosuppressive agents, including azathioprine (9). However, the clinical outcome is sometimes poor, especially in severe cases, leading to serious hemorrhaging or intestinal perforation that requires surgery in some cases (10).…”

Section: Introductionmentioning

confidence: 99%

“…In 2001, Travis et al (11) reported the efficacy of anti-TNF-α antibody-based therapy in the treatment of BD intestinal lesions. While the efficacy of infliximab (IFX) and adalimumab (ADA) in BD intestinal lesions has been demonstrated in Japan (12,13), there are only a few reports on the long-term efficacy of anti-TNF-α antibody-based therapy in BD intestinal lesions (9).…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Medium- to Long-term Anti-TNF-α Antibody-based Maintenance Therapy in Behçet's Disease Patients with Intestinal Lesions

et al. 2020

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Objective Anti-tumor necrosis factor (TNF)-α antibody-based regimens are effective in Behçet's disease (BD) with intestinal lesions. We therefore evaluated the efficacy of medium-to long-term anti-TNF-α antibody-based maintenance therapy of BD intestinal and non-intestinal lesions. Methods In this retrospective study, the response to the treatment was assessed endoscopically and clinically. Treatment responders were transferred to maintenance therapy. We evaluated the sustain rate of maintenance therapy, reductions in the dose of prednisolone (PSL), and the presence of non-intestinal BD involvement before and after the start of anti-TNF-α antibody-based the maintenance therapy. Patients We assessed 20 BD patients with intestinal lesions who underwent anti-TNF-α antibody-based therapy. Results Treatment was discontinued in 3 patients (18%). Loss of response was noted in 1 (5.9%) patient. Maintenance therapy was continued in 13 (76%) patients. The cumulative sustain rates to maintenance therapy after 2, 4, and 6 years were 94%, 87%, and 72%, respectively. In the 13 patients with remission of intestinal lesions, the mean PSL dose decreased from 13.4±2.16 mg/day before treatment to 0.92±0.47 after treatment (p<0.0001). PSL was discontinued in 9 (69%) patients. Five of the 13 (38%) patients developed clinical features of non-intestinal BD during the remission-maintenance treatment. Conclusion Our results demonstrated the efficacy of medium-to long-term anti-TNF-α antibody-based maintenance treatment against BD intestinal lesions. Nevertheless, some cases with well-controlled intestinal lesions developed active non-intestinal BD symptoms. The results highlight the importance of a carefully planned treatment strategy for BD patients with intestinal involvement.

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“…However, there is no objective tool for assessment of disease activity in entero-BD; therefore, it is not easy to evaluate disease activity and treatment efficacy in the clinical setting. In addition, because CS is considered for standard therapy in patients with severe symptoms and with deep ulcerative lesions [9, 10], the effectiveness of TNF-i without CS has not been well examined [11]. In the present study, we quantitatively investigated the effectiveness of 1-year treatment with TNF-i in 49 patients with entero-BD refractory to conventional therapy and compared the results to those achieved with CS without TNF-i, using the disease activity index for intestinal Behcet’s disease (DAIBD) developed in 2011 [12, 13].…”

Section: Introductionmentioning

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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Updated treatment strategies for intestinal Behçet’s disease

Cited by 34 publications

References 106 publications

Successful closure of ileostomy in a patient with intestinal Behçet's disease after therapy with adalimumab

Successful closure of ileostomy in a patient with intestinal Behçet's disease after therapy with adalimumab

The Efficacy of Medium- to Long-term Anti-TNF-α Antibody-based Maintenance Therapy in Behçet's Disease Patients with Intestinal Lesions

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

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