A SYSTEMATIC LITERATURE REVIEW OF HEALTHCARE BURDEN IN PATIENTS WITH BEHÇET’S DISEASE

Background: Behçet’s disease (BD) is a chronic, multisystem, inflammatory disorder primarily characterized by recurrent oral ulcers (OU) and other key features, such as genital ulcers, skin lesions and articular and ocular inflammation. The prevalence of BD is typically reported as higher in Silk Road countries (e.g., Turkey, Jordan); however, it has increased in developed countries (e.g. Europe), likely due to migration. Given the diagnoses across geographic regions, we sought to understand the prevalence of BD manifestations, related symptoms and the impact on comorbidities, treatments, and quality of life (QoL). Objectives: To understand the clinical and humanistic burden among patients (pts) with BD based on a systematic literature review (SLR). Methods: An SLR was performed to identify real-world BD studies reporting symptom, comorbidities, treatments or QoL. Articles and conference abstracts indexed in Embase/MEDLINE describing pts with BD and published from Jan 1, 2003–May 1, 2018 were included. An independent reviewer extracted, reviewed and analyzed the data and another performed standard quality check. Studies with <10 pts and those only including pts with ocular, neurologic, or vascular involvement were excluded. For categorical outcomes, the number (#) of studies, median, interquartile range (IQR) and/or min-max range of prevalence are reported; for continuous outcomes, the # of comparisons with significance ( P ≤0.05) are reported. Results: A total of 2656 citations were identified, of which 66 citations (55 manuscripts; 11 abstracts) describing >21,000 pts with BD were reviewed. The most common manifestation was OU, with 19 of 27 studies reporting 100% prevalence (IQR: 84%-100%). One study reported an average of 12.7 OU per patient per year; in another study, OU were the only manifestation currently or previously experienced by all pts. Frequently reported symptoms included fatigue/sleep-related issues (7; 70%), pain (4; 59%), and headache (5; 58%); skin lesions were also common (19; 58%). Several comorbidities, e.g. emotional issues (4; 24%–44%), fibromyalgia (4; 8%–24%), hearing loss (3; 10%–59%), etc. were significantly increased in pts with BD vs healthy controls. Most pts reported using colchicine (20; 52%) and/or corticosteroids (21; 41%), with fewer reporting use of immunosuppressants, such as azathioprine (7; 15%) and anti-TNF biologics (6; 6%). Compared to healthy controls, pts with BD had significantly worse QoL overall (5/6), as well as in specific domains, such as symptom severity (1/2), physical functioning (13/13), sleep (4/5), fatigue (4/7), pain (8/8), cognition (2/3), mental health (29/40), and social functioning (6/6). Two studies reported significant impairments in QoL associated with OU, including oral health (e.g., plaques) as well as overall QoL. Pts with BD had similar (11/19) or significantly worse (5/19) QoL vs. other chronic inflammatory conditions (e.g., rheumatoid arthritis). Conclusion: Patients with BD experience an increased symptom, comorbidity, and QoL burden vs. healthy controls, and their QoL is comparable or worse than patients with other chronic inflammatory conditions. Findings suggest oral ulcers are highly prevalent and can directly contribute to poor QoL, reflecting the need to improve oral ulcer management. Further research is needed to better understand the impact of treatment on oral ulcer occurrence, associated pain, QoL and healthcare burden. Disclosure of Interests: Oriol Sola-Morales Grant/research support from: EUCOPE, Consultant for: Celgene; all 10 major pharma; more than 50 pharma & device companies, Paid instructor for: Celgene, all 10 major pharma; more than 50 pharma & device companies, Speakers bureau: Pfizer, Novartis, Bayer, Sanofi, Sandhya Mehta Shareholder of: Celgene Corporation, Employee of: Celgene Corporation, Sarah Ronnebaum Employee of: Pharmerit International, Dipen Patel Employee of: Pharmerit International, Tara Nazareth Shareholder of: Celgene Corporation, Employee of: Celgene Corporation, Angela Padula Speakers bureau: Lilly Italia EMS DOI: 10.1136/annrheumdis-2019-eular.1974Citation: Ann Rheum Dis, volume 78, supplement 2, year 2019, page A1379Session: Public health, health services research, and health economics (Scientific Abstracts)