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. 2014 Jan;49(1):156-62.
doi: 10.1007/s00535-013-0872-4. Epub 2013 Aug 18.

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

Tadakazu Hisamatsu  1 , Fumiaki Ueno, Takayuki Matsumoto, Kiyonori Kobayashi, Kazutaka Koganei, Reiko Kunisaki, Fumihito Hirai, Masakazu Nagahori, Mitsunobu Matsushita, Kenji Kobayashi, Mitsumasa Kishimoto, Mitsuhiro Takeno, Masanori Tanaka, Nagamu Inoue, Toshifumi Hibi
Affiliations

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

Tadakazu Hisamatsu et al. J Gastroenterol. 2014 Jan.

Abstract

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.

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