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GOOD MORNING

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yas hadi

on 23 January 2017

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Transcript of GOOD MORNING

Behc¸et’s disease ocular attack score 24: evaluation of ocular
disease activity before and after initiation of infliximab
GOOD MORNING
1394. 07. 28
Y. Hadi. MD

2014
Toshikatsu Kaburaki • Kenichi Namba • Koh-hei Sonoda • Takeshi Kezuka • Takako Fukuhara • Koju Kamoi • Kei Nakai • Nobuhisa Mizuki

The Ocular Behc ¸et Disease Research Group of Japan

Introduction
Evaluations of disease activity and the efficacy of drugs for ocular disease related to BD are
primarily based on the frequency of
ocular attacks

Because frequency does not reflect the severity of ocular attacks, it also may not represent the exact activities of the ocular disease

The Behc¸et’s Disease Current Activity Form
(BDCAF),one of the most popular methods, uses a 5-point scale (0–4) to classify clinical features (oral ulcers, genital ulcers, skin lesions, etc.)

The definition of each point is obscure, especially regarding ocular disease activity

Purpose
Developed a novel scoring system for uveitis
due to Behc¸et’s disease (BD), termed Behc¸et’s disease ocular attack score 24 (BOS24)




Examined its validity and usefulness by estimating changes in ocular disease activities both before and after initiation of infliximab therapy.
Methods
BOS24 consists of a total 24 points
Divided into 6 parameters of ocular inflammatory symptoms


To examine the validity of our scoring system, 5 uveitis specialists examined the severity of 50 ocular attacks in clinical charts using both our system and a physician’s impression score
The concepts of BOS24
(1) Used to indicate the severity of each ocular attack

(2) Judged as the most severe period of inflammation during an exacerbation stage.
If the ocular attack is binocular, the score is separately determined in both eyes.

(3) Only
objective
ocular findings, and does not include patient complaints or subjective examination tests such as BCVA.

(4) Only based on
new emerging
signs and is not influenced by chronic signs, such as flaring in the AC, chronic vitreous opacity and macular edema.

(5) Designed for use in both prospective and retrospective studies, therefore, the items utilized are simple and can be checked in usual clinical practice for eyes with uveitis.

(6) High scores are assigned for retinal inflammatory signs

7) As a total sum of BOS24 for each attack in both eyes during a 6-month period, BOS24-6M presents disease activity for the patient during that period of time.
BOS24 scoring before and after infliximab therapy
190 patients who had received infliximab therapy

40 were excluded
No ocular attacks during the observation period
The scores of their attacks from 6 months before the initiation of infliximab could not be determined


Have ocular attacks, despite the use of systemic anti-inflammatory/immunosuppressive drugs or were intolerant of such treatment.
Numbers of ocular attacks per eye

During the 6 months before initiation of infliximab
Every 6 months during the 3 years after initiation of infliximab therapy
The average BOS24 for the 5 doctors was highly
correlated with the average physician’s impression score (p‹ 0.0001)

The coefficient of variance for BOS24 among doctors was much
lower
than that for the physician’s impression score (p‹ 0.0001).

Summation of BOS24 over a 6-month period (BOS24-6M) was
significantly reduced
after starting infliximab therapy (p‹ 0.0001).

The average BOS24 for individual attacks was also
significantly

decreased
after starting infliximab, with scores for the
posterior pole
and
fovea
notably improved.
Results
Conclusion
BOS24 was highly related to severity noted by the physician’s impression and had a low level of variability among the examined doctors.

Using our novel scoring system, infliximab therapy was shown to reduce not only the frequency of ocular attacks, but also the severity of each attack.

thank you... :)
Limmitation
Some
observer

bias
was noted when the same patients were scored by the two systems, which might have been reduced by the use of a
masked
independent physician scoring method.

Fairness
in the comparison of the two systems may have also been reduced, because different doctors evaluated each of the scoring systems. Thus, it seems impossible to completely negate the bias due to the limitations of the study design.

It is difficult to score
retinal

lesions
if ocular fundus lesions are invisible due to vitreous opacity, VH, cataract.
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