CB-01-12

Inflammatory bowel diseases, including Crohn's disease and ulcerative colitis, raise ongoing challenges in clinical management due to their variable courses and impact on patient quality of life. The emergence of advanced therapies, from biologics to small molecules, has prompted the need for effective sequencing strategies to optimize patient outcomes. To this date, there is no algorithm for treatment sequencing and physicians must select the safest and most effective treatment according to each individual patient. This review aims to explore the latest insights in treatment sequencing according to multiple criteria, such as prior use of anti-TNF alpha agents, prior surgery, disease phenotype and location, but also patient characteristics, such as age or history of malignancy. Treatment sequencing in IBD should be part of a clinical medicine approach and be tailored to individual patient characteristics, disease severity, and therapeutic response history. Indeed, a personalized approach of therapeutic management in inflammatory bowel diseases can improve long-term outcomes and quality of life. Ongoing research is essential to refine sequencing strategies, and better incorporate these advances into clinical practice.

Evidence from randomised controlled trials on anti-tumour necrosis factor (TNF) agents in patients with Behçet’s syndrome (BS) is low.

We conducted a phase 3, multicentre, prospective, randomised, active-controlled, parallel-group study to evaluate the efficacy and safety of either infliximab (IFX) or adalimumab (ADA) in patients with BS. Adults patients with BS presenting with active mucocutaneous manifestations, occurring while on therapy with either azathioprine or cyclosporine for at least 3 months prior to study entry, were eligible. Participants were randomly assigned (1:1) to receive IFX or ADA for 6 months. The primary study outcome was the time to response of manifestations over 6-month anti-TNF alpha agents’ treatment.

42 patients underwent screening visits, of whom 40 were randomly assigned to the IFX group (n=22) or to the ADA group (n=18). All patients at the time of randomisation had active mucocutaneous manifestations and a smaller proportion had concomitant vital organ involvement (ie, six and three patients with ocular and neurological involvement, respectively). A total of 14 (64%) responders in the IFX group and 17 (94%) in the ADA group were observed. Retention on treatment was 95% and 94% in the IFX and in the ADA group, respectively. Quality of life resulted to be significantly improved in both groups from baseline, as well as Behçet’s Disease Current Activity Form assessment. We registered two adverse events (one serious) in the ADA group and three non-serious adverse events in the IFX group.

The overall results of this study confirm the effectiveness of both IFX and ADA in achieving remission in patients with BS affected by mucocutaneous involvement.