When to use apremilast and biologics and how to deal with vascular involvement were some of the main areas to be updated in forthcoming EULAR recommendations for Behçet's disease.
and how to deal with vascular involvement are some of the main changes to the forthcoming update of the Europe an Alliance of Associations for Rheumatology Recommendations for the Management of Behçet's Syndrome, which were presented at the organization'sHatemi, one of the two co-convenors of the EULAR task force behind the revised recommendations, said there had been changes not just to the content but also to the wording of the recommendations to make them shorter to meet EULAR's current standard operating procedures.
"The content was modified with seven recommendations only. The wording was modified with four recommendations, and we developed one new recommendation," she said. There are still five overarching principles, and the first still recognizes the"relapsing and remitting course" of Behçet's, which could be"organ- or life-threatening," although"disease manifestations may ameliorate over time," Hatemi said. The second overarching principle, however, now states that"the goal of treatment is to prevent irreversible organ damage and to maximize health-related quality of life," and the third states that"organ involvement should be evaluated throughout the disease course and mimickers should be ruled out with appropriate modalities." The fourth overarching principle states that"treatment should be individualized according to age, sex, type, and severity of organ involvement, disease duration, and patient preferences," which was included from the prior iteration. And finally, the fifth overarching principle expands on what is necessary for optimal care: a multidisciplinary approach, patient education, shared decision-making, adherence to treatment, and lifestyle changes.There are now seven rather than 10 recommendations, updated according to the results of a large-scale systematic literature review and expert opinion. Out of more than 7000 published papers that had come up in the literature review, 83 articles were used for the update. in 2019 and showed apremilast resulted in a greater reduction in the number of oral ulcers than placebo. The second trial was, we recommended the use of first-line monoclonal anti-TNF inhibitors, preferably infliximab for sight-threatening inflammation, and we advised against the use of glucocorticoids as monotherapy." Immunosuppressive therapy is recommended in all patients with Behçet's uveitis with the aim of inducing and maintaining clinical and angiographic remission. As for joint involvement, colchicine is the recommended first-line treatment, with immunosuppressants to be considered a back-up in recurrent or chronic cases.. And we also advised the use of TNF inhibitors for long-term maintenance in order to avoid relapses," Hatemi said. Infliximab is also preferred for parenchymal nervous system involvement, although immunosuppressants and high-dose glucocorticoids could be used. Slow glucocorticoid tapering is advised, with immunosuppressants continued as maintenance.However,"in some of our complex cases that are refractory, that we sometimes do see, then we do have to scratch our heads and go a little bit outside the scope of the guidelines," Andev said. Treatment options are"still changing," he noted, and gave an example of different infliximab preparations used to treat the various organ manifestations that can occur. "We're trying to get some more harmonization" across the national centers and in line with both British and European guidelines, Andev said. Although there are commonalities,"big data" from registries are perhaps needed to enable the outcomes of treatments to be compared, he suggested. Hatemi has disclosed receiving research support from AbbVie, Soligenix, and UCB Pharma. She has also disclosed acting as a speaker or advisor for AbbVie, Amgen, Johnson & Johnson, MSD Pharmaceuticals, Novartis, Soligenix, and UCB Pharma. Andev has reported no relevant financial relationships. Sara Freeman, MSc, is a freelance medical journalist based in London, UK. She has been reporting for specialist healthcare news organizations for more than 20 years.All material on this website is protected by copyright, Copyright © 1994-2025 by WebMD LLC. This website also contains material copyrighted by 3rd parties.
Biologics Europe European Clinical Guidelines Guidelines Uveitis Stroke Cerebrovascular Accident CVA Cerebrovascular Accident (CVA) Glucocorticosteroids Glucocorticoid Therapy Glucocorticoid Anti-TNF Anti-Tumor Necrosis Factor Anti-Tumour Necrosis Factor Anti-Tumor Necrosis Factor (Anti-TNF) Otolaryngology ENT Specialty ENT Speciality Thromboembolism Refractory
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