Review Article

Update on the Medical Management of Gastrointestinal Behçet’s Disease

Table 2

Overview of studies derived from the medical literature reporting treatment indications of gastrointestinal lesions in Behçet’s disease.

DrugsDoseAuthors (year)Number of patientsType of studyOutcomes

5-ASA/SSZ2.4–4 g/dayJung et al.
(2012)
143/292Retrospective cohort studyPositive effect in maintaining remission

THD2-3 mg/kg/dayYasui et al.
(2008)
7Case seriesDramatic improvement in clinical symptoms
Lee et al.
(2010)
4Case series3/4 patients had a clinical improvement and all discontinued steroid therapy

THD/IFX/ADA/
ETA
THD 50–100 mg/day
IFX 5 mg/kg every 8 weeks
ADA 160 mg at week 0 and 80 mg at week 2, followed by 40 mg every other week
ETA 25 mg twice a week
Hatemi et al. (2015)13/64Observational studyRemission obtained with TNF-α antagonists and/or THD in about 75% of cases.

AZA or 6-MPAZA 2–2.5 mg/kg/day
6-MP 0.5–1.5 mg/kg/day
Jung et al.
(2012)
67/272Retrospective studyRelative good effect for maintenance of remission

AZA or 6-MP
vs
5-ASA
AZA 2–2.5 mg/kg/day
or
6-MP 1–1.5 mg/kg/day
vs
5-ASA 3-4 g/day
Lee et al.
(2015)
77Retrospective observational studyThe rates of reoperation, readmission, and death were not significantly different between the 5-ASA and thiopurine groups

MTX + IFXMTX -
FX 3–5 mg/kg every 8 weeks
Iwata et al.
(2011)
10Observational studyLong-term alleviation of entero-BD and excellent tolerability with combination of IFX and MTX

INF-6 × 106 IU per day for 14 daysGrimbacher et al.
(1997)
1Case reportComplete remission of Behçet’s retinal infiltrates and BD-related colitis
3 × 106 IU/day 3 times/week increased to 6 × 106 IU/day 3 times/weekMonastirli et al.
(2010)
1Case reportComplete remission of all clinical manifestations

IVIg400 mg/kg/day for 5 days per monthCantarini et al.
(2016)
1/4Case seriesComplete disease remission of gastrointestinal, manifestations

IFXIdeguchi et al.
(2014)
7/43Retrospective observational studyGood response in two patients, remission in one, partial response in two, and unchanged GI lesions in two patients
5 mg/kg/every 8 weeksLee et al.
(2013)
28Multicenter retrospective studyIFX efficacy for patients with moderate-to-severe intestinal BD
5 mg/kg every 8 weeksKinoshita et al.
(2013)
15/43Retrospective cohort studyAcceptable efficacy of IFX in BD patients refractory to conventional treatments
5 mg/kg every 8 weeksHibi et al.
(2016)
11/18Open-label studyIFX efficacy in the treatment of intestinal BD

ADA160 mg at week 0 and 80 mg at week 2, followed by 40 mg every other weekTanida et al.
(2015)
20Multicenter, open-label, uncontrolled studyADA effectiveness in inducing and maintaining clinical improvement and remission in patients with intestinal BD
160 mg at week 0 and 80 mg at week 2, followed by 40 mg every other weekTanida et al.
(2016)
8Retrospective observational studyLong-term efficacy and safety of ADA for the treatment of intestinal BD in the clinical setting

ETA25 mg twice a weekMa et al.
(2014)
19/35Observational studyThe relapse rate for etanercept therapy was reduced significantly when compared with conventional therapy

ANA100 mg/day
2 mg/kg/day increased to 2.5 mg/kg/day
Cantarini et al.
(2013)
3/9Case seriesComplete resolution of abdominal pain in two patients,
relapse in one patient

CANA150 mg every 8 weeks
150 mg every six weeks
Vitale et al.
(2013)
2/3Case seriesComplete resolution of abdominal pain

TCZ8 mg/kg/ every 4 weeksDeroux et al.
(2015)
3/4Case seriesLess effective for arthralgia and abdominal pain

ADA, adalimumab; ANA, anakinra; anti-TNF-α, anti-tumor necrosis factor-α; 5-ASA, 5-aminosalicylic acid; AZA, azathioprine; CANA, canakinumab; ETA, etanercept; INF-α, interferon α; IFX, infliximab; IVIg, intravenous immunoglobulins; 6-MP, 6-mercaptopurine; MTX, methotrexate; SSZ, sulfasalazine; TCZ, tocilizumab; THD, Thalidomide.