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

• Published in: Journal of gastroenterology Vol. 49; no. 1; pp. 156 - 162
• Main Authors: Hisamatsu, Tadakazu, Ueno, Fumiaki, Matsumoto, Takayuki, Kobayashi, Kiyonori, Koganei, Kazutaka, Kunisaki, Reiko, Hirai, Fumihito, Nagahori, Masakazu, Matsushita, Mitsunobu, Kobayashi, Kenji, Kishimoto, Mitsumasa, Takeno, Mitsuhiro, Tanaka, Masanori, Inoue, Nagamu, Hibi, Toshifumi
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Tokyo Springer Japan 01.01.2014
• Subjects: Abdominal Surgery; Antibodies, Monoclonal - therapeutic use; Behcet Syndrome - diagnosis; Behcet Syndrome - drug therapy; Colorectal Surgery; Delphi Technique; Gastroenterology; Gastrointestinal Agents - therapeutic use; Hepatology; Humans; Intestinal Diseases - diagnosis; Intestinal Diseases - drug therapy; Medicine; Medicine & Public Health; Practice Guidelines as Topic; Rapid Communication; Surgical Oncology; Tumor Necrosis Factor-alpha - antagonists & inhibitors; Intestinal Behçet’s disease; Anti-TNFα mAb; Consensus statements
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-013-0872-4

Background Clinical 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. Methods An 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. Results Fifteen 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. Conclusions In 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.