Background Due to a small number of clinical studies, treatment of Behçet's syndrome (BS) mainly depends on the type and severity of symptoms and may vary substantially. In 2008, EULAR recommendations were published, aiming for an evidence-based approach for the management of BS .
Objectives To assess guideline adherence in treatment of BS in two different geographic areas.
Methods We extracted guideline statements from the 2008 EULAR recommendations . Adherence to these statements in both New York (USA) and Amsterdam (The Netherlands) was evaluated retrospectively by reviewing records from patients fulfilling the ISG criteria. We analyzed data per statement and event, and divided the data according to the year in which an event occurred. We compared events prior to 2009 to those in 2009 or later (after publication of the EULAR recommendations).
Results 474 patients were evaluated, 24 of whom were from Amsterdam (Table 1).
Adherence in posterior uveitis was relatively low in clinical practice. However, secondary analysis of the patients in the second time frame showed that 66% of cases with partial- and 77% with non-adherence were on cyclosporine or a biologic DMARD.
Colchicine in treatment of arthritis was hardly ever used as monotherapy (3 cases <2009, 9 cases ≥2009). Other drugs used included prednisone (n=197), Plaquenil (n=63), methotrexate (n=67), azathioprine (n=133) and anti-TNF agents (n=124).
Conclusions Adherence to the guidelines varies substantially across type of events. Adherence in treatment of posterior uveitis was low and a variety of other drugs were used in its treatment, which are also considered DMARDs for this condition. The extensive use of anti-TNF agents might indicate a shift towards more aggressive treatment and acceptance of TNF inhibitors for the treatment of other rheumatic and inflammatory eye conditions in the countries studied.
In patients with neuro-Behçet, adherence to the recommendation is quite good in clinical practice.
In the majority of patients with arthritis, colchicine is either used in combination with other (biological) DMARDs or not at all. This might indicate that colchicine alone is not sufficient as treatment of arthritis in BS or that arthritis is often combined with other manifestations implying a need for more combination treatment.
Our results suggest that a revision of the current guidelines may be due, given widespread use of other immunosuppressive medications and newly available studies of these medications.
Hatemi, G., et al. EULAR recommendations for the management of Behçet disease. Ann Rheum Dis, 2008. 67(12): p1656-62
Disclosure of Interest F. Kerstens: None declared, F. Turkstra: None declared, S. Atalay: None declared, R. van Vugt: None declared, C. Swearingen: None declared, Y. Yazici Grant/research support from: BMS, Celgene, Genentech, Consultant for: BMS, Celgene, Genentech