Efficacy and Safety of Anti-Tumor Necrosis Factor-Alpha Agents for Patients with Intestinal Behcet’s Disease: A Systematic Review and Meta-Analysis

Abstract

Purpose Intestinal Behcet’s disease (BD) is a systemic autoimmune disease for which treatment options are limited. As a prospective therapeutic strategy for intestinal BD, anti-tumor necrosis factor-alpha (anti-TNF-α) agents have received increasing attention. In this study, we conducted a systematic review and meta-analysis to evaluate the efficacy and safety of anti-TNF-α agents for patients with intestinal BD. Materials and Methods We searched PubMed, Embase, and Cochrane Library databases up to July 1, 2021 and articles that met the eligibility criteria were further assessed. Pooled rates were synthesized by a randomized effects model using Stata software. Results Eleven clinical trials covering 671 patients with intestinal BD were included. According to compositive data, the pooled rate for remission was 39% [95% confidence interval (CI) 26–52] in patients receiving anti-TNF-α agents. Intestinal symptoms were cured in 70% (95% CI 53–84) of the patients, and the rate for endoscopic healing was 65% (95% CI 52–78). Corticosteroid discontinuation was achieved in 43% (95% CI 28–58) of the patients, and the dose reduction of corticosteroid was 20.43 mg (95% CI 13.4–27.46). There were 239 adverse events and 80 serious adverse events during follow-up. Conclusion Our study indicated that anti-TNF-α agents may serve as an effective treatment with acceptable safety for patients with intestinal BD. However, more robust evidence from randomized controlled trials is urgently needed to assess the long-term efficacy and safety of anti-TNF-α agents for those patients.

Long‐term clinical outcomes of intestinal Behçet's disease: A 30‐year cohort study at a tertiary hospital in South Korea

“…Based on reports of the 5‐year course of intestinal BD, 74.6% of patients experience remission or mild disease activity, and 16.2% have multiple relapses or chronic symptoms 8 . Similar to inflammatory bowel disease (IBD), intestinal BD can present with perforation, peritonitis, or severe lower gastrointestinal bleeding requiring medical acceleration, intestinal surgery, hospitalization, or emergency room visits 9–13 . In a 10‐year follow‐up study, there were no differences in the cumulative probabilities of intestinal surgery, hospitalization, recurrence, and reoperation rates between Crohn's disease (CD) ( n = 332) and intestinal BD ( n = 276) 14 .…”

“…8 Similar to inflammatory bowel disease (IBD), intestinal BD can present with perforation, peritonitis, or severe lower gastrointestinal bleeding requiring medical acceleration, intestinal surgery, hospitalization, or emergency room visits. [9][10][11][12][13] In a 10-year follow-up study, there were no differences in the cumulative probabilities of intestinal surgery, hospitalization, recurrence, and reoperation rates between Crohn's disease (CD) (n = 332) and intestinal BD (n = 276). 14 Conversely, several studies have reported that prognosis is worse in intestinal BD than in CD.…”

Behçet's yndrome: one year in review 2023

“…Response to infiximab was evident within 2 weeks and was maintained thereafter and repeat colonoscopies showed significant mucosal healing. Three different meta-analyses coming from China provide further support for the efficacy and acceptable safety of adalimumab and infliximab in the treatment of intestinal involvement of BS (95)(96)(97).…”

Intestinal Behçet's disease: A review of clinical diagnosis and treatment

“…Nevertheless, there remains a risk of disease recurrence, exacerbation of gastrointestinal bleeding, venous thrombosis, and infection[ 58 , 59 ]. Tumour necrosis factor-α (TNF-α) inhibitors, such as infliximab and adalimumab, are often used to treat severe and refractory cases of intestinal BD[ 60 , 61 ]. Patients with intestinal BD localized outside the ileocecal region may also have a greater need for anti-TNF-α immunotherapy[ 56 ].…”