Management of skin, mucosa and joint involvement of Behçet’s syndrome: A systematic review for update of the EULAR recommendations for the management of Behçet’s syndrome

Leccese, Pietro; Özgüler, Yeşim; Christensen, Robin; Esatoğlu, Sinem Nihal; Bang, Dongsik; Bodaghi, Bahram; Çelık, Aykut Ferhat; Fortune, Farida; Gaudric, Julien; Gül, Ahmet; Kötter, Ina; Mahr, Alfred; Moots, Robert J.; Richter, Jutta; Saadoun, David; Salvarani, Carlo; Scuderi, Francesco; Sfikakis, Petros P.; Síva, Aksel; Stanford, Miles; Tuğal-Tutkun, İlknur; West, Roy; Yurdakul, Sebahattin; Olivieri, Ignazio; Yazıcı, Hasan; Hatemi, Gülen

doi:10.1016/j.semarthrit.2018.05.008

Cited by 59 publications

(56 citation statements)

References 42 publications

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“…Overall, it is not possible to draw solid conclusions regarding the role of colchicine as a reliable treatment for BD‐related oral ulcers. This is in line with the findings of a Cochrane review on therapies for oral ulcers by Taylor et al 7 and with the latest EULAR recommendations by Leccese et al 8 …”

Section: Discussionsupporting

confidence: 90%

“…Additionally, colchicine might play a role in preventing oral aphthous‐like ulcers secondary to peculiar clinical entities, in the form of systemic vasculitis, such as Behçet disease (BD), 7,8 or unusual immune‐mediated disorders, such as periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome 9,10 and mouth and genitals ulcers with inflamed cartilage (MAGIC) syndrome 11…”

Section: Introductionmentioning

confidence: 99%

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Value of colchicine as treatment for recurrent oral ulcers: A systematic review

Cabras

Carrozzo

Gambino

et al. 2020

J Oral Pathology Medicine

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Background In oral medicine, colchicine is a therapeutic alternative for idiopathic recurrent aphthous stomatitis (RAS), Behçet disease (BD), periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome, and mouth and genitals ulcers with inflamed cartilage (MAGIC) syndrome. The present review aims to evaluate reliability of colchicine against recurrent oral ulcers. Methods A systematic review was conducted, with the following PICO (Patient, Intervention, Control, Outcome) question: “In populations with idiopathic or secondary recurrent oral ulcers, is colchicine more effective in improving pain and accelerating healing, compared to other intervention or placebo?” Results Seven RCTs and 3 OCTs were considered eligible. Four RCTs focused on BD, two RCTs and three OCTs on RAS, and one RCT on PFAPA syndrome. Heterogeneity between RCTs prevented from meta‐analysis. Regarding BD, no significant difference between colchicine and placebo was found in two of three placebo‐controlled RCTs, whereas the third RCT showed benefit. A comparative RCT found ciclosporin more effective than colchicine for oral lesions of BD. One open‐label RCT showed promising but partial results on colchicine in reducing PFAPA attacks, when compared to corticosteroids. Concerning RAS, colchicine appeared less effective than clofazimine, thalidomide and dapsone, and with outcomes similar to low‐dosage corticosteroids but higher gastric discomfort than prednisolone. One OCT reported positive results compared with no treatment but a RCT found no difference with placebo. Conclusion Role of colchicine as treatment for idiopathic or secondary recurrent oral ulcers is still controversial. Further standardized RCTs and crossover trials are needed.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Value of colchicine as treatment for recurrent oral ulcers: A systematic review

Cabras

Carrozzo

Gambino

et al. 2020

J Oral Pathology Medicine

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“…Behcet's syndrome was first identified in 1937 by Behcet with its great prevalence in the Middle East, and further studies showed that BS was characterized by multiple mucocutaneous manifestations, including aphthae, erythema nodosum, genital ulcers, skin lesions, uveitis, and thrombophlebitis (Leccese et al, 2018 ). Although the pathogenesis of BS is currently unclear, intractable inflammation has been considered as the main concept in the progression of BS.…”

Section: Pde4 Inhibitors Under Development For the Treatment Of Inflamentioning

confidence: 99%

Phosphodiesterase-4 Inhibitors for the Treatment of Inflammatory Diseases

2018

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Phosphodiesterase-4 (PDE4), mainly present in immune cells, epithelial cells, and brain cells, manifests as an intracellular non-receptor enzyme that modulates inflammation and epithelial integrity. Inhibition of PDE4 is predicted to have diverse effects via the elevation of the level of cyclic adenosine monophosphate (cAMP) and the subsequent regulation of a wide array of genes and proteins. It has been identified that PDE4 is a promising therapeutic target for the treatment of diverse pulmonary, dermatological, and severe neurological diseases. Over the past decades, numerous PDE4 inhibitors have been designed and synthesized, among which roflumilast, apremilast, and crisaborole were approved for the treatment of inflammatory airway diseases, psoriatic arthritis, and atopic dermatitis, respectively. It is regrettable that the dramatic efficacies of a drug are often accompanied by adverse effects, such as nausea, emesis, and gastrointestinal reactions. However, substantial advances have been made to mitigate the adverse effects and obtain better benefit-to-risk ratio. This review highlights the dialectical role of PDE4 in drug discovery and the disquisitive details of certain PDE4 inhibitors to provide an overview of the topics that still need to be addressed in the future.

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“…It is recommended to use systematic corticosteroids (CSs) together with immunosuppressive agents, such as azathioprine (AZA), cyclosporin (CsA), and methotrexate (MTX) for the treatment of BD-associated uveitis (Hatemi et al, 2018;Leccese et al, 2019). Despite successfully decreasing inflammation in some BD-associated uveitis, the combined treatment often fails to prevent relapses in a majority of those patients.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and Safety of Anti-Tumor Necrosis Factor-Alpha Agents Treatment in Behcets’ Disease-Associated Uveitis: A Systematic Review and Meta-Analysis

Huang

Yang

et al. 2020

Front. Pharmacol.

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Purpose: We conducted a systematic review and meta-analysis to determine the effectiveness and safety of anti-tumor necrosis factor-alpha (TNF-a) agents in the treatment of Behcets' disease (BD)-associated uveitis. Method: Three electronic databases, Embase, MEDLINE, and the Cochrane Library, were searched for eligible papers focusing on the anti-TNF-a agents treatment in BD-associated uveitis with at least 6 months follow-up time. A systematic review and meta-analysis was conducted on selected papers with appropriate clinical and methodological homogeneity. The effectiveness outcomes included inflammation remission, visual acuity (VA) improvement, central macular thickness (CMT) decrease, corticosteroid (CS)-sparing effects, and the safety outcomes included minor and severe drug-related adverse events (AEs). Result: From Jan 2010 to Dec 2019, there were 504 records produced in total, in which 18 clinical trials were selected for meta-analysis (15 trials were retrospective studies, and 3 were prospective studies). The number of patients in each study ranged from 11 to 163 and the mean follow-up time from 0.9 to 6.44 years. During the follow-up, the pooled inflammation remission rate was 68% with a 95% confidence interval (CI) of 0.59-0.79, VA improvement rate was 60% (95% CI 0.47-0.77), CMT decrease was 112.70 mm (95% CI 72.8-153.0 mm). The proportions of patients who had CS-suspended and CS-tapered reached 38% (95% CI 0.23-0.65) and 34% (95% CI 0.16-0.70), respectively. The severe AEs were reported but not common, which included severe infusion reactions, pneumonia, bacteremia, tuberculosis, melanoma, and lymphoma. Conclusion: Anti-TNF-a agents treatment has high effectiveness including efficient inflammation remission, satisfactory VA improvement, obvious CMT reduction, and significant CS-sparing effects. Although some drug-related AEs were reported, the incidence of severe AEs was acceptable. Anti-TNF-a agents treatment is a promising option for controlling BD-associated uveitis.

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Management of skin, mucosa and joint involvement of Behçet’s syndrome: A systematic review for update of the EULAR recommendations for the management of Behçet’s syndrome

Cited by 59 publications

References 42 publications

Value of colchicine as treatment for recurrent oral ulcers: A systematic review

Value of colchicine as treatment for recurrent oral ulcers: A systematic review

Phosphodiesterase-4 Inhibitors for the Treatment of Inflammatory Diseases

Effectiveness and Safety of Anti-Tumor Necrosis Factor-Alpha Agents Treatment in Behcets’ Disease-Associated Uveitis: A Systematic Review and Meta-Analysis

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