OC 22.1 - The role of anticoagulation and immunosuppressive therapy for the treatment of thrombotic complications in Behcet’s Syndrome: a systematic review and meta-analysis

Sunday, June 23, 2024

14:45 – 15:00 ICT

Room: Ballroom B2

Presenting Author(s)

Arisa Chuklin

Medical Student
Faculty of Medicine, Chulalongkorn University
Bangkok, Krung Thep, Thailand

Co-Author(s)

Thita Chiasakul, MD

Hematologist
King Chulalongkorn Memorial Hospital
Bangkok, Krung Thep, Thailand
Noppacharn Uaprasert, MD

Professor
King Chulalongkorn Memorial Hospital
Bangkok, Krung Thep, Thailand

Background: Behcet’s syndrome (BS) is a systemic vasculitis with common thrombotic manifestations. The primary treatment of vascular Behcet involves immunosuppression (IS); the role of anticoagulation (AC) is unestablished.

Aims: We conducted a systematic review and meta-analysis to evaluate the effectiveness of IS only, AC only, and IS+AC in preventing the relapse of thrombosis in BS.

Methods: A systematic search was conducted using PubMed, EMBASE, and Cochrane Library from inception until January 9th, 2023. Original studies enrolling ≥10 BS patients with venous or arterial thrombosis were included when they provided intervention-specific recurrence or relapse rate of thrombotic complications. The primary outcome was the pooled relapse rate in each intervention group (IS only, AC only, and IS+AC). The pooled rates of relapse with respective 95% CI were calculated using random-effects model. Subgroup analyses were performed to compare the pooled rates of each group. This study protocol was registered on PROSPERO (CRD42023462353).

Results: A total of 18 studies (17 retrospective and 1 prospective studies) were included (Figure 1). The majority of these studies were conducted in Turkey (47.4%) and France (26.3%). The immunosuppressants commonly used in the included studies were: colchicine, AZA, corticosteroids, infliximab, cyclophosphamide, and IFN-a. Anticoagulants used in these studies included: heparin, LMWH, vitamin K antagonists, and DOACs. Eight studies provided disaggregated data that were included in the meta-analysis. The pooled relapse rate in the IS+AC group (14.5%, 95% CI, 8.3-24.2, I2=0%) is significantly lower than those who received IS alone (37.5%, 95% CI, 21.2-57.2%, I2=62%, p = .025) or AC alone (46.2%, 95% CI, 28.8-64.6%, I2=0%, p<.001) (Figure 2).

Conclusion(s): Treatment of patients with vascular Bechet with IS+AC results in a lower risk of relapse than either IS or AC alone.