751
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Magro F, Estevinho MM. Is tofacitinib a game-changing drug for ulcerative colitis? United European Gastroenterol J 2020; 8:755-763. [PMID: 32552501 PMCID: PMC7435001 DOI: 10.1177/2050640620935732] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 05/26/2020] [Indexed: 12/26/2022] Open
Abstract
The increasing knowledge on ulcerative colitis' pathophysiology has contributed to the expansion of the therapeutic arsenal for this condition. However, to date, 25-40% of patients with ulcerative colitis remain primary or secondary non-responders to therapy, and up to 10% need to eventually undergo a colectomy. Janus kinase inhibitors block cytokine signalling involved in the pathogenesis of several inflammatory conditions. Tofacitinib is the first drug of this class approved for moderate-to-severely active ulcerative colitis in patients for whom disease worsened and those who did not improve with conventional therapy (aminosalicylates, corticosteroids and immunosuppressants) or monoclonal antibodies. We aimed to review the main aspects and concerns related to the current use of tofacitinib and to explore its future application.
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Affiliation(s)
- Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, São João Hospital Center, Porto, Portugal
- MedInUP, Center for Drug Discovery and Innovative Medicines, Porto, Portugal
- Clinical Pharmacology Unit, São João Hospital University Center, Porto, Portugal
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, Vila Nova de Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal
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752
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Zhang S, Cho WJ, Jin AT, Kok LY, Shi Y, Heller DE, Lee YAL, Zhou Y, Xie X, Korzenik JR, Lennerz JK, Traverso G. Heparin-Coated Albumin Nanoparticles for Drug Combination in Targeting Inflamed Intestine. Adv Healthc Mater 2020; 9:e2000536. [PMID: 32597571 PMCID: PMC7482138 DOI: 10.1002/adhm.202000536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/12/2020] [Indexed: 12/18/2022]
Abstract
Targeting areas of inflammation offers potential therapeutic and diagnostic benefits by maximizing drug and imaging marker on-target effects while minimizing systemic exposure that can be associated with adverse side effects. This strategy is particularly beneficial in the management of inflammatory bowel disease (IBD). Here an inflammation-targeting (IT) approach based on heparin-coated human serum albumin nanoparticles (HEP-HSA NPs) that utilize the increased intestinal permeability and changes in electrostatic interaction at the site of intestinal inflammation is described. Using small-molecule and biologic drugs as a model for drug combination, the HEP-HSA NPs demonstrate the capacity to load both drugs simultaneously; the dual-drug loaded HEP-HSA NPs exhibit a higher anti-inflammatory effect than both of the single-drug loaded NPs in vitro and selectively bind to inflamed intestine after enema administration in vivo in a murine model of colitis. Importantly, analyses of the physicochemical characteristics and targeting capacities of these NPs indicate that HEP coating modulates NP binding to the inflamed intestine, providing a foundation for future IT-NP formulation development.
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Affiliation(s)
- Sufeng Zhang
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Won Joon Cho
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Amy T. Jin
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Lie Yun Kok
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Yunhua Shi
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - David E. Heller
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Young-Ah Lucy Lee
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Yixuan Zhou
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Xi Xie
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Joshua R. Korzenik
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jochen K. Lennerz
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Giovanni Traverso
- Dr. S. Zhang, A. T. Jin, Prof. J. R. Korzenik, Prof. G. Traverso Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA 02115, USA. Dr. S. Zhang, W. J. Woo, A. T. Jin, L. Y. Kok, Dr. Y. Shi, D. E. Heller, Y.-A. L. Lee, Y. Zhou, Dr. X. Xie Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA. Dr. S. Zhang, Prof. J. R. Korzenik, Prof. J. K. Lennerz, Prof. G. Traverso Harvard Medical School, Boston, MA 02115, USA. Prof. J. K. Lennerz Center for Integrated Diagnostics, Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA. Prof. G. Traverso Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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753
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Barnes EL, Jiang Y, Kappelman MD, Long MD, Sandler RS, Kinlaw AC, Herfarth HH. Decreasing Colectomy Rate for Ulcerative Colitis in the United States Between 2007 and 2016: A Time Trend Analysis. Inflamm Bowel Dis 2020; 26:1225-1231. [PMID: 31634390 PMCID: PMC7365804 DOI: 10.1093/ibd/izz247] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Improved treatment approaches for ulcerative colitis (UC), including novel medications, might reduce the need for colectomy. We performed a retrospective cohort study of adult patients (age 18-64) with UC in the United States to examine time trends for colectomy and biologic use from 2007 to 2016. METHODS We estimated quarterly rates for colectomy and biologic use using the IQVIA Legacy PharMetrics Adjudicated Claims Database. We used interrupted time series methods with segmented regression to assess time trends with 95% confidence intervals (CIs) for biologic use and colectomy before and after the emergence of newly available biologic therapies in 2014. RESULTS Among 93,930 patients with UC, 2275 (2.4%) underwent colectomy from 2007 to 2016. Biologic use rates increased significantly from 2007 to 2016, from 131 per 1000 person-years in 2007 (95% CI, 121 to 140) to 589 per 1000 person-years in 2016 (95% CI, 575 to 604; P < 0.001). Colectomy rates decreased significantly between 2007 and 2016, from 7.8 per 1000 person-years (95% CI, 7.4 to 8.2) to 4.2 per 1000 person-years in 2016 (95% CI, 3.2 to 5.1; P < 0.001). An interruption in 2014 was associated with a positive trend deflection for biologic use (+72 treatments per 1000 person-years per year (95% CI, 61 to 83) and a negative trend deflection for colectomy (-0.76 per 1000 person-years per year; 95% CI, -1.47 to -0.05). CONCLUSIONS Among commercially insured patients in the United States from 2007 to 2016, biologic use rates increased, colectomy rates decreased, and both trends were impacted by the interruption in 2014. These findings suggest that new biologic therapies may have contributed to decreased colectomy rates.
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Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Address correspondence to: Edward L. Barnes, MD, MPH, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Bioinformatics Building, CB #7080, Chapel Hill, NC 27599-7080 ()
| | - Yue Jiang
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael D Kappelman
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Division of Pediatric Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert S Sandler
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Alan C Kinlaw
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hans H Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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754
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Singh S, Kim J, Zhu W, Dulai PS, Sandborn WJ, Jairath V. No benefit of continuing vs stopping 5-aminosalicylates in patients with ulcerative colitis escalated to anti-metabolite therapy. Aliment Pharmacol Ther 2020; 52:481-491. [PMID: 32573825 PMCID: PMC8015755 DOI: 10.1111/apt.15876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/28/2020] [Accepted: 05/21/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Whilst continuation of 5-aminosalicylates (5-ASA) after escalation to biologic therapy is considered ineffective in patients with ulcerative colitis (UC), their role in patients escalated to anti-metabolites is unclear. AIM To compared patterns and outcomes of continuing vs stopping 5-ASA in patients with UC who escalated to anti-metabolite monotherapy, using a de-identified administrative claims database. METHODS We identified patients with UC who were new users of anti-metabolite monotherapy who were receiving 5-ASA, and were followed for at least 12 months after starting anti-metabolite therapy. We evaluated patterns of 5-ASA use (stopped 5-ASA, short-term 5-ASA use for <6 months after starting anti-metabolites, persistent 5-ASA use for >6 months after starting anti-metabolites). We compared outcomes (risk of UC-related hospitalisation and/or surgery, need for corticosteroids, treatment escalation to biologic therapy) by pattern of 5-ASA use, using Cox proportional hazard analysis adjusting for age, sex, race, comorbidity burden, and hospitalisation or emergency department visit, abdominal surgery and corticosteroid use in the previous 12 months (as measures of disease severity), with a 12-month immortal time period. RESULTS Of 4068 patients with UC who were new-users of anti-metabolite monotherapy, 578 (14.2%), 782 (19.2%) and 2708 (66.6%) stopped 5-ASA, used 5-ASA transiently or persistently, respectively. Compared to patients who stopped 5-ASA after starting anti-metabolites, persistent 5-ASA use was associated with a higher risk of UC-related hospitalisation (HR, 1.40 [1.07-1.83]) and corticosteroid use (HR, 1.48 [1.28-1.70]), without an increase in risk of UC-related surgery (HR, 1.32 [0.86-2.00]) or treatment escalation (HR, 0.80 [0.53-1.20]). Sensitivity analyses using a 3 months window after initiation of anti-metabolites to classify patients as continuing vs stopping 5-ASA showed similar results. Residual confounding by disease severity could not be excluded. CONCLUSION 5-ASA are usually continued long-term even after escalating to anti-metabolite therapy in patients with UC without clinical benefit.
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Affiliation(s)
- Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California,Division of Biomedical Informatics, University of California San Diego, La Jolla, California,Visting Fellow, OptumLabs, Cambridge, Massachusetts
| | - Jihoon Kim
- Division of Biomedical Informatics, University of California San Diego, La Jolla, California,Visting Fellow, OptumLabs, Cambridge, Massachusetts
| | - Wenhong Zhu
- Visting Fellow, OptumLabs, Cambridge, Massachusetts,Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, California
| | - Parambir S. Dulai
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - William J. Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Vipul Jairath
- Robarts Clinical Trials, Inc. London, Ontario, Canada,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada,Division of Gastroenterology, Department of Medicine, University Hospital, Ontario, Canada
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755
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Pilon D, Ding Z, Muser E, Obando C, Voelker J, Manceur AM, Kinkead F, Lafeuille MH, Lefebvre P. Long-term direct and indirect costs of ulcerative colitis in a privately-insured United States population. Curr Med Res Opin 2020; 36:1285-1294. [PMID: 32427006 DOI: 10.1080/03007995.2020.1771293] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective: Prior evaluations of ulcerative colitis (UC)-related costs are dated or encompassed limited follow-up. This study assessed the incremental direct and indirect work loss-related costs of privately-insured patients with UC in the United States, overall and in specific subgroups.Methods: In this retrospective matched cohort study, the OptumHealth Care Solutions, Inc (formerly Optum Health Reporting and Insights employer) database (01 January 1999-31 March 2017) was used to identify adult patients with ≥2 claims for UC, who were matched 1:5 to patients with no claims for inflammatory bowel disease (IBD). UC subgroups were identified based on indicators during the observation period (i.e. use of biologics, opioids, or corticosteroids; UC-related surgery; moderate-to-severe disease; UC-related comorbidities). Healthcare resource utilization (HRU), work loss days, and direct and work loss-related costs were compared between matched cohorts. Descriptive analyses of direct and work loss-related costs were conducted within each UC subgroup.Results: Compared to the non-IBD cohort (n = 46,765), the UC cohort (n = 9353) incurred higher HRU, including 128% more inpatients visits, resulting in $11,029 higher direct costs per patient per year (PPPY; $7170 vs. $18,198; p < .001). Patients in the UC cohort also incurred more work loss days, resulting in $2142 higher work loss-related costs PPPY ($3165 vs. $5307; p < .001). Direct and work loss-related costs were particularly high in the UC subgroups, with patients undergoing UC-related surgery incurring the highest costs.Conclusions: Over ∼5 years follow-up, patients with UC had significantly higher all-cause direct healthcare and indirect work loss-related costs compared to matched patients without IBD.
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Affiliation(s)
| | - Zhijie Ding
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Erik Muser
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Camilo Obando
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Horsham, PA, USA
| | - Jennifer Voelker
- Real World Value and Evidence, Janssen Scientific Affairs, LLC, Horsham, PA, USA
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756
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Crohn's Disease. Dis Colon Rectum 2020; 63:1028-1052. [PMID: 32692069 DOI: 10.1097/dcr.0000000000001716] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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757
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Yang X, Geng J, Meng H. Glucocorticoid receptor modulates dendritic cell function in ulcerative colitis. Histol Histopathol 2020; 35:1379-1389. [PMID: 32706033 DOI: 10.14670/hh-18-241] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ulcerative colitis (UC) is a serious form of inflammatory bowel disease (IBD) occurring worldwide. Although anti-TNF therapy is found to be effective in over 70% of patients with UC, nearly one-third are still deprived of effective treatment. Because glucocorticoids (GC) can effectively inhibit granulocyte-recruitment into the mucosa, cytokine secretion and T cell activation, they are used widely in the treatment of UC. However, remission is observed in only 55% of the patients after one year of steroid use due to a condition known as steroid response. Additionally, it has been noted that 20%-40% of the patients with UC do not respond to GC treatment. Researchers have revealed that the number of dendritic cells (DCs) in patients with UC tends to increase in the colonic mucosa. Many studies have determined that the removal of peripheral DCs through the adsorption and separation of granulocytes and monocytes could improve tolerance of the intestine to its symbiotic flora. Based on these results, further insights regarding the beneficial effects of Adacolumn apheresis in patients subjected to this treatment could be revealed. GC can effectively inhibit the activation of DCs by reducing the levels of major histocompatibility complex class II (MHC II) molecules, which is critical for controlling the recruitment of granulocytes. Therefore, alternative biological and new individualized therapies based on these approaches need to be evaluated to counter UC. In this review, progress in research associated with the regulatory effect of glucocorticoid receptors on DCs under conditions of UC is discussed, thus providing insights and identifying potential targets which could be employed in the treatment strategies against UC.
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Affiliation(s)
- Xinxin Yang
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jingshu Geng
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hongxue Meng
- Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, China.,Department of Pathology, Harbin Medical University, Harbin, China.
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758
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Primary Humoral Immune Deficiencies: Overlooked Mimickers of Chronic Immune-Mediated Gastrointestinal Diseases in Adults. Int J Mol Sci 2020; 21:ijms21155223. [PMID: 32718006 PMCID: PMC7432083 DOI: 10.3390/ijms21155223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022] Open
Abstract
In recent years, the incidence of immune-mediated gastrointestinal disorders, including celiac disease (CeD) and inflammatory bowel disease (IBD), is increasingly growing worldwide. This generates a need to elucidate the conditions that may compromise the diagnosis and treatment of such gastrointestinal disorders. It is well established that primary immunodeficiencies (PIDs) exhibit gastrointestinal manifestations and mimic other diseases, including CeD and IBD. PIDs are often considered pediatric ailments, whereas between 25 and 45% of PIDs are diagnosed in adults. The most common PIDs in adults are the selective immunoglobulin A deficiency (SIgAD) and the common variable immunodeficiency (CVID). A trend to autoimmunity occurs, while gastrointestinal disorders are common in both diseases. Besides, the occurrence of CeD and IBD in SIgAD/CVID patients is significantly higher than in the general population. However, some differences concerning diagnostics and management between enteropathy/colitis in PIDs, as compared to idiopathic forms of CeD/IBD, have been described. There is an ongoing discussion whether CeD and IBD in CVID patients should be considered a true CeD and IBD or just CeD-like and IBD-like diseases. This review addresses the current state of the art of the most common primary immunodeficiencies in adults and co-occurring CeD and IBD.
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759
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Long-Term Follow-Up of Targeted Biopsy Yield (LOFTY Study) in Ulcerative Colitis Surveillance Colonoscopy. J Clin Med 2020; 9:jcm9072286. [PMID: 32708456 PMCID: PMC7408776 DOI: 10.3390/jcm9072286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 12/12/2022] Open
Abstract
We previously performed a randomized controlled trial (RCT) comparing targeted and random biopsy in neoplasia detection in patients with ulcerative colitis (UC), which showed the short-term effectiveness of targeted biopsy with one-time colonoscopy. In this retrospective cohort study, we investigated the long-term effectiveness of targeted biopsy in tertiary care hospitals, using the follow-up data from patients with UC for ≥ 8 years who had enrolled in the initial RCT. The primary outcome was death from colorectal cancer (CRC). Secondary outcomes were advanced neoplasia (CRC or high-grade dysplasia) and colectomy due to neoplasia after the RCT. We compared these outcomes between target and random groups. Data on 195 of the 221 patients (88.2%) enrolled in the previous RCT were collected from 28 institutions between 2008 and 2019. No patients died of CRC in either group, with a median 8.8-year follow-up demonstrating a robustness for targeted biopsy in terms of CRC death prevention. Advanced neoplasia was detected in four and three patients in the target and random groups, respectively. Colectomy was required due to neoplasia in three patients in each group. The chance of developing CRC in patients with a negative colonoscopy was low, and the targeted biopsy appeared effective in this population. Conversely, patients found with low-grade dysplasia at initial RCT have 10-fold higher risk of progression to high-grade dysplasia and/or CRC. Ten extracolonic malignancies were observed during the follow-up, resulting in four deaths. Panchromoendoscopy was used only in 4.6% and targeted biopsy was only performed in 59.1% of colonoscopies. We recommend targeted biopsy rather than > 33 random biopsies in real-world settings under adequate observation by specialists.
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760
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Palchaudhuri S, Albenberg L, Lewis JD. Diet Recommendations for Hospitalized Patients With Inflammatory Bowel Disease: Better Options Than Nil Per Os. CROHN'S & COLITIS 360 2020; 2:otaa059. [PMID: 33954288 PMCID: PMC8096188 DOI: 10.1093/crocol/otaa059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hospitalizations are a time when providers often have uncertainty about what to feed patients with inflammatory bowel disease (IBD). While there are many trials evaluating the role of diet in the management of IBD, the role of diet for the hospitalized patient is less clear. The hospitalization may serve as an opportunity to educate patients about the role of diet, try different diets, and develop dietary recommendations for after discharge. Here, we review the literature for dietary considerations during hospitalizations and acute settings, as well as upon discharge. Patients with IBD benefit from screening and nutritional support for malnutrition and nutritional deficiencies. Enteral nutrition and exclusion diets are promising as induction and maintenance therapies, but no specific recommendations during hospitalization for adult patients are available currently. There are very few reasons to enforce bowel rest or clear liquids other than bowel obstruction, uncontrolled sepsis, or need for urgent or emergent surgery; most patients - including many with penetrating or stricturing disease - benefit from feeding in whichever capacity is tolerated, with enteral and parenteral nutrition used as needed to reach nutritional goals. Future studies are needed to define how the use of different diets can influence the outcomes of patients hospitalized for IBD.
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Affiliation(s)
- Sonali Palchaudhuri
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA,Address correspondence to: Sonali Palchaudhuri, MD, Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104 ()
| | - Lindsey Albenberg
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James D Lewis
- Division of Gastroenterology and Hepatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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761
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Barnhill MS, Steinberg JM, Jennings JJ, Lewis JH. Hepatotoxicty of Agents Used in the Management of Inflammatory Bowel Disease: a 2020 Update. Curr Gastroenterol Rep 2020; 22:47. [PMID: 32671616 DOI: 10.1007/s11894-020-00781-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW As treatment options for inflammatory bowel disease (IBD) continue to expand, the opportunity for hepatotoxicity remains a clinical concern. This review looks to update the current literature on drug-induced liver injury (DILI) and liver-related complications from current and emerging treatments for Crohn's disease (CD) and ulcerative colitis (UC). RECENT FINDINGS An extensive literature review on currently used medications to treat IBD and their liver-related side effects that includes mesalamine, thiopurines, certain antibiotics, methotrexate, anti-TNF agents including recently introduced biosimilars, anti-integrin therapy, anti-IL 12/IL 23 therapy, and small molecule JAK inhibitors. Hepatotoxicity remains an important clinical issue when managing patients with IBD. Clinicians need to remain aware of the potential for liver-related adverse events with various medication classes and adjust their clinical monitoring as appropriate based on the agents being used.
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Affiliation(s)
- Michele S Barnhill
- Department of Gastroenterology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW 2 Main, Washington, DC, 20007, USA
| | - Joshua M Steinberg
- Department of Gastroenterology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW 2 Main, Washington, DC, 20007, USA
| | - Joseph J Jennings
- Department of Gastroenterology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW 2 Main, Washington, DC, 20007, USA. .,Georgetown University School of Medicine, Washington, DC, USA.
| | - James H Lewis
- Department of Gastroenterology, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW 2 Main, Washington, DC, 20007, USA.,Georgetown University School of Medicine, Washington, DC, USA
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762
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Yen HH, Chen MW, Chang YY, Huang HY, Hsu TC, Chen YY. Predictive values of stool-based tests for mucosal healing among Taiwanese patients with ulcerative colitis: a retrospective cohort analysis. PeerJ 2020; 8:e9537. [PMID: 32742803 PMCID: PMC7367046 DOI: 10.7717/peerj.9537] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
Background/Purpose Over the past two decades, ulcerative colitis (UC) has emerged in the Asia Pacific area, and its treatment goal has shifted from symptom relief to endoscopic remission. Endoscopy is the gold standard for the assessment of mucosal healing; however, it is an invasive method. Fecal calprotectin (FC) is a non-invasive stool-based inflammatory marker which has been used to monitor mucosal healing status, but it is expensive. By contrast, the immune fecal occult blood test (iFOBT) is a widely utilized stool-based screening tool for colorectal cancer. In this study, we compared the predictive values of iFOBT and FC for mucosal healing in Taiwanese patients with UC. Methods A total of 50 patients with UC identified via the electronic clinical database of Changhua Christian Hospital, Taiwan, were retrospectively enrolled from January 2018 to July 2019. Results of iFOBT, FC level, and blood tests as well as Mayo scores were reviewed and analyzed. Colonic mucosa was evaluated using the endoscopic Mayo subscore. Results The average age of the patients was 46 years, and 62% of the patients were men. Disease distribution was as follows: E1 (26%), E2 (40%), and E3 (34%). Complete mucosal healing (Mayo score = 0) was observed in 30% of patients. Endoscopic mucosal healing with a Mayo score of 0 or 1 was observed in 62% of the patients. Results of FC and iFOBT were compared among patients with and without mucosal healing. Predictive cutoff values were analyzed using receiver operating characteristics curves. iFOBT and FC had similar area under the curve for both complete mucosal healing (0.813 vs. 0.769, respectively, p = 0.5581) and endoscopic mucosal healing (0.906 vs. 0.812, respectively, p = 0.1207). Conclusion In daily clinical practice, FC and iFOBT do not differ in terms of predictive values for mucosal healing among Taiwanese patients with UC.
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Affiliation(s)
- Hsu-Heng Yen
- Division of Gastroenterology, Department of Internal Medicine, Changhua christian Hospital, Changhua, Taiwan.,Institute of Medicine, Chung Shan Medical and Dental College, Taichung, Taiwan.,General Education Center, Chienkuo Technology University, Changhua, Taiwan
| | - Mei-Wen Chen
- Department of Tumor Center, Changhua Christian Hospital, Changhua, Taiwan.,Information Management, Chienkuo Technology University, Changhua, Taiwan
| | - Yu-Yao Chang
- Department of Colorectal Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsuan-Yuan Huang
- Department of Colorectal Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Tsui-Chun Hsu
- Division of Gastroenterology, Department of Internal Medicine, Changhua christian Hospital, Changhua, Taiwan
| | - Yang-Yuan Chen
- Division of Gastroenterology, Department of Internal Medicine, Changhua christian Hospital, Changhua, Taiwan
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763
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Johnson LM, White SK, Schmidt RL. Are calprotectin and lactoferrin equivalent screening tests for inflammatory bowel disease? Clin Chim Acta 2020; 510:191-195. [PMID: 32673669 DOI: 10.1016/j.cca.2020.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Lactoferrin and calprotectin are frequently ordered stool tests used to screen patients for inflammatory bowel disease versus functional bowel disease. Current guidelines recommend using either one to screen for inflammation in the GI tract; however, little information is available on how these 2 assays compare and their use in different clinical specialties. METHODS We compared order patterns for lactoferrin and calprotectin using data from a large reference laboratory over a 10-y period (2009-2019). We also studied the concordance of lactoferrin and calprotectin in cases where both tests were ordered concurrently. Finally, we reviewed the records at a university hospital to determine which clinicians ordered each test and the indications associated with orders. RESULTS Orders for calprotectin are increasing relative to lactoferrin. The relative proportion of calprotectin orders have increased from 60% to nearly 90% over the past decade. Results for lactoferrin and calprotectin show concordance (90%). Calprotectin and lactoferrin are ordered by different clinical specialties for different indications. Calprotectin is most often ordered by gastroenterologists in the context of abdominal pain. Lactoferrin is most often ordered by primary care providers in the context of acute diarrhea. CONCLUSION Lactoferrin and calprotectin are not treated as equivalent tests by clinicians.
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Affiliation(s)
- Lisa M Johnson
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT, United States
| | - Sandra K White
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT, United States
| | - Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City, UT, United States.
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764
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Lu M, Zhang T, Lu Z, Wang W, Chen T, Cao Z. A comparison of the efficacy and safety of complementary and alternative therapies for ulcerative colitis: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21219. [PMID: 32664174 PMCID: PMC7360321 DOI: 10.1097/md.0000000000021219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The incidence of ulcerative colitis (UC) is increasing year by year worldwide, and it is listed as one of the refractory diseases by World Health Organization. In addition to typical intestinal manifestations such as abdominal pain, diarrhea, mucus, pus, and bloody stool, it can also accompany multiorgan and multisystem extraintestinal manifestations, seriously affecting the life and work of patients. Furthermore, UC patients with a tremendous psychological pressure and affects their physical and mental health. In recent years, many complementary and alternative therapies have been used for treatment of UC, but only pair-wised drugs have been evaluated in the traditional meta-analyses and some results are inconsistent. Consequently, it is essential to propose a protocol for systematic review and meta-analysis to discuss the efficacy and safety of complementary and alternative therapies in the treatment of UC. METHODS We will search Chinese and English databases comprehensively and systematically from the establishment of databases to May 2020, free of language or publication restrictions. All randomized controlled trials on complementary and alternative therapies for UC will be included. Two researchers will independently screen titles, abstracts, full texts, and extract data, then assess the bias risk of each study. We will conduct pairwise meta-analyses and Bayesian network meta-analyses to the relative outcomes of the efficacy and safety. Data analysis will use STATA and WinBUGs 1.4.3 software in this meta-analysis. RESULTS This study will evaluate the efficacy and safety of complementary and alternative therapies for UC based on changes in symptoms, clinical efficacy, quality of life and adverse events. CONCLUSION This study will provide evidence for whether complementary and alternative therapies are beneficial to the treatment of UC. In order to provide reliable evidence-based medicine for clinical practice. INPLASY REGISTRATION NUMBER INPLASY202060015.
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Affiliation(s)
- Meiqi Lu
- The First Clinical College, Shandong University of Traditional Chinese Medicine
| | - Ting Zhang
- Department of Pharmacy, Shandong Rehabilitation Hospital
| | - Zhen Lu
- Department of Pharmacy, Shandong Rehabilitation Hospital
| | - Wei Wang
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Ting Chen
- The First Clinical College, Shandong University of Traditional Chinese Medicine
| | - Zhiqun Cao
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
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765
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Di Jiang C, Raine T. IBD considerations in spondyloarthritis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20939410. [PMID: 32695235 PMCID: PMC7350041 DOI: 10.1177/1759720x20939410] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/12/2020] [Indexed: 12/18/2022] Open
Abstract
Spondyloarthritis (SpA) may be regarded a family of auto-inflammatory conditions with inflammation focused on the joints. These form part of a wider family of immune-mediated inflammatory diseases, which include inflammatory bowel diseases (IBD). These conditions share common elements of pathophysiology and it is perhaps unsurprising, therefore, that individuals with SpA frequently manifest gastrointestinal inflammation, to which the physician managing the patient with SpA must be alert. In this article, we review the shared epidemiology and pathophysiology of these conditions, before discussing approaches to diagnosis and management of inflammatory gastrointestinal pathology in patients seen in rheumatology clinics. In particular, we discuss the difference between non-specific gastrointestinal inflammation commonly described in this patient group and the more specific diagnosis of Crohn's disease or ulcerative colitis. We describe the appropriate diagnostic workup for patients suspected of having IBD. In addition, we discuss how a diagnosis of IBD can inform treatment selection, highlighting important differences in treatment choice, drug dosing, monitoring and drug safety for this particular comorbid patient population.
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Affiliation(s)
- Caroline Di Jiang
- Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge CB2 0QQ, UK
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766
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Kotze PG, Steinwurz F, Francisconi C, Zaltman C, Pinheiro M, Salese L, Ponce de Leon D. Review of the epidemiology and burden of ulcerative colitis in Latin America. Therap Adv Gastroenterol 2020; 13:1756284820931739. [PMID: 32695230 PMCID: PMC7350039 DOI: 10.1177/1756284820931739] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/12/2020] [Indexed: 02/04/2023] Open
Abstract
The incidence and prevalence of ulcerative colitis (UC) has been reported to be rising in newly industrialised regions, such as Latin America. Here, we review data from published studies reporting demographics and clinical aspects of UC in Latin America to further understand epidemiology and disease burden. The incidence and prevalence of UC in Latin America varied between regions and studies, ranging between 0.04 to 8.00/100,000 and 0.23 to 76.1/100,000, respectively, and generally increased over the period from 1986 to 2015. The majority of patients with UC were female (53.6-72.6%) and urban residents (77.8-97.4%). Extraintestinal manifestations were reported in approximately 26-89.4% of patients. Use of biologic therapies was generally low (0.8-16.2%), with the exception of Mato Grosso do Sul, Brazil, with a greater proportion of patients tending to receive 5-aminosalicylates, immunosuppressants or corticosteroids; colectomy rates varied between studies (1.5-22%). A high proportion of patients had moderate to severe UC (45.9-73.0%) and, in 11 of 19 studies, the greatest proportion of patients had extensive disease (pancolitis). Colorectal cancer (0-1.7%) and mortality rates (0-7.6%) were low. This evaluation of published studies may influence therapeutic approaches and the development of strategies to improve healthcare access and patient outcomes, although further high-quality studies are required in patients with UC in Latin America.
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Affiliation(s)
| | - Flavio Steinwurz
- Unit of Inflammatory Bowel Disease, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Cyrla Zaltman
- IBD Outpatient Clinic, Division of Gastroenterology, Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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767
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Magro F, Cordeiro G, Dias AM, Estevinho MM. Inflammatory Bowel Disease - Non-biological treatment. Pharmacol Res 2020; 160:105075. [PMID: 32653651 DOI: 10.1016/j.phrs.2020.105075] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022]
Abstract
Nowadays, non-biological treatments remain valuable approaches among the therapeutic armamentarium of inflammatory bowel disease (IBD). Mesalamine is the core treatment of mild‑to‑moderate ulcerative colitis (UC) and corticosteroids are crucial for the induction of remission of moderate‑to‑severe flares in both UC and Crohn's disease (CD). Even approaches as cyclosporine, tacrolimus, azathioprine, methotrexate, and surgery still have a nuclear position as strategies to induce and/or maintain remission in IBD. Due to their particularities and to the accumulated evidence, each of these strategies conquered peculiar roles in the overall IBD strategy, all of them contributing to better outcomes. This review emphasizes the particular roles that non-biological treatments gained over time: recent mesalamine formulations to increase adhesion rates, higher doses of 5-ASA for high-risk patients, MMX technology to improve drug release and attain higher bowel concentrations, cyclosporine as a bridge to vedolizumab, tacrolimus as a potential alternative to thiopurines or infliximab, azathioprine in combination therapy with infliximab and dubious in monotherapy, and surgery as a mean to a "better end".
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Affiliation(s)
- Fernando Magro
- Clinical Pharmacology Unit, São João Hospital University Centre, Porto, Portugal; Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; Service of Gastroenterology, São João Hospital University Centre, Porto, Portugal.
| | - Gonçalo Cordeiro
- Clinical Pharmacology Unit, São João Hospital University Centre, Porto, Portugal
| | - Andreia Martins Dias
- Clinical Pharmacology Unit, São João Hospital University Centre, Porto, Portugal
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
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768
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Dubois E, Moens A, Geelen R, Sabino J, Ferrante M, Vermeire S. Long-term outcomes of patients with ulcerative proctitis: Analysis from a large referral centre cohort. United European Gastroenterol J 2020; 8:933-941. [PMID: 32631177 DOI: 10.1177/2050640620941345] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Long-term outcomes of patients with ulcerative proctitis (UP) have been poorly investigated, since these patients are excluded from participation in randomized controlled clinical trials. OBJECTIVE The aim of this study was to investigate the prognostic and therapeutic long-term outcomes of patients with UP. METHODS A retrospective study of patients with UP followed at our referral centre between 1 January 1998 and 1 January 2019 was performed. Treatment success was defined as clinical response (significant improvement in UP-related symptoms) and endoscopic response (mayo endoscopic sub-score of 0 or 1) if available at last follow-up. RESULTS From a total of 1561 patients with ulcerative colitis, 118 patients with UP were identified. A total of 36 (31%) patients were refractory to rectal and oral therapy with 5-ASA and corticosteroids, necessitating azathioprine as monotherapy in 19 (16%) patients and/or biological therapies in 33 (28%) patients. After a median follow-up of 71 months (interquartile range 29-149 months), treatment success was observed in 103/118 (87%) UP patients and in 25/36 (69%) patients with refractory UP. Clinical response rates were significantly higher for refractory UP patients treated with biologicals (23/33; 70%) compared to ones treated with azathioprine (2/19; 11%; p = 0.001). CONCLUSION Good clinical outcomes were recorded in UP, with treatment success in 87% of patients. Nevertheless, 28% needed escalation to biologicals. Long-term outcome in patients on biologicals was superior to azathioprine.
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Affiliation(s)
- Evelyne Dubois
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Annick Moens
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Rob Geelen
- Department of Gastroenterology and Hepatology. Antwerp University Hospital, Edegem, Belgium
| | - João Sabino
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
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769
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Goold E, Pearson L, Johnson LM. Can fecal calprotectin serve as a screen for necrotizing enterocolitis in infants? Clin Biochem 2020; 84:51-54. [PMID: 32628920 DOI: 10.1016/j.clinbiochem.2020.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 06/01/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Researchers are debating if fecal calprotectin results are useful for infant patients, especially in screening for necrotizing enterocolitis (NEC). Currently, none of the FDA-approved calprotectin assays provide a cut-off for infant patients. We retrospectively analyzed data from a reference laboratory and university hospital to investigate if a cut-off could be established for infant patients. METHODS Data from a national reference laboratory of 5144 test results for fecal calprotectin were analyzed for infant patients, and a cut-off was estimated based on the distribution of results. Additionally, a literature proposed cut-off of 226 μg/g was also considered. Validation of either cut-off was attempted by review of the electronic medical record of our university hospital for 110 infant patients with results for fecal calprotectin. RESULTS Infants had a high percentage of elevated fecal calprotectin results when using the adult cut-offs set by the manufacturer. A cut-off of 247 μg/g was estimated based on the reference laboratory results for infants 0-2 months old, which is similar to a literature proposed cut-off of 226 μg/g. However, the positive predictive value (PPV) for both cut-offs was <0.6 when retrospectively analyzing data from a university hospital. CONCLUSION Due to the low PPVs, the two infant-specific cut-offs for fecal calprotectin would not be useful to screen for NEC in infants at our university hospital.
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Affiliation(s)
- Eric Goold
- Department of Pathology, University of Utah, Salt Lake City, UT 84108, USA
| | - Lauren Pearson
- Department of Pathology, University of Utah, Salt Lake City, UT 84108, USA
| | - Lisa M Johnson
- Department of Pathology, University of Utah, Salt Lake City, UT 84108, USA; ARUP Laboratories, Salt Lake City, UT 84108, USA.
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770
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Bajaj JS, Brenner DM, Cai Q, Cash BD, Crowell M, DiBaise J, Gallegos-Orozco JF, Gardner TB, Gyawali CP, Ha C, Holtmann G, Jamil LH, Kaplan GG, Karsan HA, Kinoshita Y, Lebwohl B, Leontiadis GI, Lichtenstein GR, Longstreth GF, Muthusamy VR, Oxentenko AS, Pimentel M, Pisegna JR, Rubenstein JH, Russo MW, Saini SD, Samadder NJ, Shaukat A, Simren M, Stevens T, Valdovinos M, Vargas H, Spiegel B, Lacy BE. Major Trends in Gastroenterology and Hepatology Between 2010 and 2019: An Overview of Advances From the Past Decade Selected by the Editorial Board of The American Journal of Gastroenterology. Am J Gastroenterol 2020; 115:1007-1018. [PMID: 32618649 DOI: 10.14309/ajg.0000000000000709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J S Bajaj
- Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA
| | - D M Brenner
- Northwestern University, Chicago Illinois, USA
| | - Q Cai
- Emory University, Atlanta, Georgia, USA
| | - B D Cash
- McGovern Medical School, Houston, Texas, USA
| | - M Crowell
- Mayo Clinic, Scottsdale, Arizona, USA
| | - J DiBaise
- Mayo Clinic, Scottsdale, Arizona, USA
| | | | - T B Gardner
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - C P Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C Ha
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - G Holtmann
- University of Queensland, Brisbane, Australia, USA
| | - L H Jamil
- Beaumont Health-Royal Oak, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - G G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - H A Karsan
- Atlanta Gastroenterology Associates and Emory University, Atlanta, Georgia, USA
| | - Y Kinoshita
- Steel Memorial Hirohata Hospital and Himeji Brain and Heart Center, Himeji, Japan
| | - B Lebwohl
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - G F Longstreth
- Kaiser Permanente Southern California, San Diego, California, USA
| | - V R Muthusamy
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - M Pimentel
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - J R Pisegna
- Department of Veterans Affairs, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA Los Angeles, California, USA
| | - J H Rubenstein
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - M W Russo
- Carolinas Medical Center-Atrium Health, Charlotte, North Carolina, USA
| | - S D Saini
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - A Shaukat
- Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - M Simren
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - T Stevens
- Cleveland Clinic, Cleveland, Ohio, USA
| | - M Valdovinos
- Instituto Nacional de Ciencias Médicas y Nutricion S.Z., Mexico City, Mexico
| | - H Vargas
- Mayo Clinic, Scottsdale, Arizona, USA
| | - B Spiegel
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - B E Lacy
- Mayo Clinic, Jacksonville, Florida, USA
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771
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Barnes EL. Are Nutrition Interventions to Augment Treatment Plans the Most Personalized Approach to Inflammatory Bowel Disease Therapy? CROHN'S & COLITIS 360 2020; 2:otaa043. [PMID: 36776502 PMCID: PMC9802482 DOI: 10.1093/crocol/otaa043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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772
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Papamichael K, Cheifetz AS. Therapeutic drug monitoring in patients on biologics: lessons from gastroenterology. Curr Opin Rheumatol 2020; 32:371-379. [PMID: 32412995 PMCID: PMC8294174 DOI: 10.1097/bor.0000000000000713] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW To give an overview on the role of therapeutic drug monitoring (TDM) of biologics in patients with inflammatory bowel disease (IBD). RECENT FINDINGS Numerous prospective exposure-response relationship studies and post-hoc analyses of randomized controlled trials (RCTs) show a positive correlation between biologic drug concentrations and favorable clinical outcomes in IBD. These studies also demonstrate that higher drug concentrations appear to be needed to achieve more stringent objective therapeutic outcomes. Reactive TDM rationalizes the management of primary nonresponse and secondary loss of response to antitumor necrosis factor (anti-TNF) therapy and is more cost-effective when compared with empiric dose optimization. Furthermore, recent data suggest that proactive TDM, with the goal of targeting a threshold drug concentration, is associated with better therapeutic outcomes when compared with empiric dose escalation and/or reactive TDM of infliximab or adalimumab. Finally, proactive TDM can also efficiently guide infliximab de-escalation or discontinuation in patients with IBD in remission. SUMMARY Reactive TDM is currently considered as standard of care, whereas proactive TDM is emerging as a new therapeutic strategy for better optimizing anti-TNF therapy in IBD. However, more data from prospective studies are needed before a wide implementation of TDM-based algorithms in real life clinical practice for newer biologics.
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Affiliation(s)
- Konstantinos Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adam S. Cheifetz
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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773
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Abstract
PURPOSE OF REVIEW Multiple new medications with novel mechanisms of action are now available to treat inflammatory bowel disease (IBD). Identifying the appropriate patients in whom to use these therapies is critical in maximizing benefit and reducing unnecessary risks. Once the appropriate therapy is selected, using a treat-to-target algorithm including symptomatic, biochemical, and endoscopic monitoring can improve clinical outcomes. If symptoms recur, these same principles, coupled with therapeutic drug monitoring, should be considered to confirm inflammation and determine next therapeutic steps. RECENT FINDINGS Multiple network meta-analyses can assist clinicians in determining the ideal biologic or small molecule therapy for patients with moderate-to-severe IBD. Once selected, several clinical trials have demonstrated that follow-up in 3 to 4 months, coupled with fecal calprotectin or C-reactive protein monitoring, can improve clinical remission and mucosal healing rates. Structural assessment should be performed via colonoscopy, enterography, or capsule endoscopy, dependent on disease location, at 9--12 months to confirm healing. SUMMARY Appropriate disease stratification, coupled with biologic or small molecule medication selection and treat-to-target follow-up, can greatly assist clinicians who are managing patients with IBD in achieving the greatest potential benefits of medical therapy.
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774
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Judge C, McGettigan N, Ryan T, Hazel K, Singh P, Parihar V, Stack R, O'Connor A, Dunne C, Cullen G, Egan L, Harewood G, MacCarthy F, McKiernan S, Mulcahy H, Murray F, Patchett S, Sheridan J, Cheriyan D, Farrell R, Keohane J, Kelly O, McNamara D, Ryan B, O'Morain C, Sengupta S, O'Toole A, Buckley M, McCarthy J, Doherty G, Kevans D, Slattery E. Irish data on the safety and efficacy of vedolizumab in the treatment of inflammatory bowel disease. Scand J Gastroenterol 2020; 55:786-794. [PMID: 32544012 DOI: 10.1080/00365521.2020.1779340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This study reviews the safety and efficacy of treatment with vedolizumab for patients with inflammatory bowel disease across 9 Irish hospitals. It generates valuable and timely real-world data on treatment outcomes to add to the existing evidence base. Our population represents a refractory cohort with most patients previously exposed to at least one anti-TNFa agent and expressing an inflammatory phenotype. Results are reassuringly similar to larger international studies with additional insights into potential predictors of treatment response. This study further supports the safety and efficacy of vedolizumab in the treatment of inflammatory bowel disease. Key SummaryVedolizumab has growing real world data on its safety and efficacy in the treatment of IBD. Data on predictors of response are lacking. Studies such as VARSITY require new real-world data to help identify the place VDZ will occupy in the treatment algorithm for IBDThis study provides national Irish data on the safety and efficacy of VDZ in the treatment of IBD. It gives insight into various predictors of response for both UC and CD. It strengthens the available body of evidence on the use of VDZ and helps us determine its position on the treatment algorithm.
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Affiliation(s)
- Ciaran Judge
- Department of Gastroenterology, St James' Hospital, Dublin, Ireland.,INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland
| | - Neasa McGettigan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Galway University Hospital, Galway, Ireland
| | - Timothy Ryan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Karl Hazel
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Pamla Singh
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Vikrant Parihar
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Roisin Stack
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Anthony O'Connor
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Cara Dunne
- Department of Gastroenterology, St James' Hospital, Dublin, Ireland.,INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland
| | - Garret Cullen
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Laurence Egan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Galway University Hospital, Galway, Ireland
| | - Gavin Harewood
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Finbar MacCarthy
- Department of Gastroenterology, St James' Hospital, Dublin, Ireland.,INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland
| | - Susan McKiernan
- Department of Gastroenterology, St James' Hospital, Dublin, Ireland.,INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland
| | - Hugh Mulcahy
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Frank Murray
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Stephen Patchett
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Juliette Sheridan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - Danny Cheriyan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Richard Farrell
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - John Keohane
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Orlaith Kelly
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - Deirdre McNamara
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Barbara Ryan
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Tallaght University Hospital, Dublin, Ireland
| | - Colm O'Morain
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beacon Hospital, Dublin, Ireland
| | - Subhasish Sengupta
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - Aoibhlinn O'Toole
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland
| | - Martin Buckley
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Mercy University Hospital, Cork, Ireland
| | - Jane McCarthy
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Mercy University Hospital, Cork, Ireland
| | - Glen Doherty
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology and Centre for Colorectal Disease, St Vincent's University Hospital, Dublin, Ireland
| | - David Kevans
- Department of Gastroenterology, St James' Hospital, Dublin, Ireland.,INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland
| | - Eoin Slattery
- INITIative, Investigator Network for Inflammatory Bowel Disease Therapy in Ireland, Dublin, Ireland.,Department of Gastroenterology, Galway University Hospital, Galway, Ireland
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775
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The management of the hospitalized ulcerative colitis patient: the medical-surgical conundrum. Curr Opin Gastroenterol 2020; 36:265-276. [PMID: 32487850 DOI: 10.1097/mog.0000000000000637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW In this review article, we address emerging evidence for the medical and surgical treatment of the hospitalized patient with ulcerative colitis. RECENT FINDINGS Ulcerative colitis is a chronic inflammatory disease involving the colon and rectum. About one-fifth of patients will be hospitalized from ulcerative colitis, and about 20-30%, experiencing an acute flare will undergo colectomy. Because of the significant clinical consequences, patients hospitalized need prompt evaluation for potential complications, stratification of disease severity, and a multidisciplinary team approach to therapy, which involves both the gastroenterologist and surgeon. Although corticosteroids remain first-line therapy, second-line medical rescue options, primarily infliximab or cyclosporine, are considered within 3-5 days of presentation. In conjunction, an early surgical consultation to present the possibility of a staged proctocolectomy as one of the therapeutic options is equally important. SUMMARY A coordinated multidisciplinary, individualized approach to treatment, involving the patient preferences throughout the process, is optimal in providing patient-centered effective care.
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776
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Grossberg LB, Farraye FA, Papamichael K, Cheifetz AS, Feuerstein JD. A Survey Study of Gastroenterologists' Views on Dysplasia Surveillance and Chromoendoscopy in IBD. Inflamm Bowel Dis 2020; 26:e59-e61. [PMID: 32304571 DOI: 10.1093/ibd/izaa079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Laurie B Grossberg
- Lahey Hospital & Medical Center, Tufts Medical School, Burlington, Massachusetts, USA
| | | | | | - Adam S Cheifetz
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph D Feuerstein
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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777
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Conrad MA, Kelsen JR. The Treatment of Pediatric Inflammatory Bowel Disease with Biologic Therapies. Curr Gastroenterol Rep 2020; 22:36. [PMID: 32542562 DOI: 10.1007/s11894-020-00773-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Biologics for the treatment of inflammatory bowel disease (IBD) have been transformative to the therapeutic goals in the pediatric population. We review the biologics used to treat IBD, highlighting the importance of patient selection, dosing considerations, and therapeutic drug monitoring in children. RECENT FINDINGS Infliximab is well-established as a safe and efficacious therapy for Crohn's disease and ulcerative colitis. Both dose escalation strategies and therapeutic drug monitoring increase the likelihood of response to anti-TNFα therapies. Early real-world experience of vedolizumab and ustekinumab in pediatric IBD shows promising results, including clinical response rates comparable to what is seen in adults, but there are limited data using them as first-line therapies. Biologic therapies have improved outcomes in pediatric IBD, including achieving mucosal healing as well as improved growth and pubertal development. Therapeutic drug monitoring improves likelihood of response to anti-TNFα therapies, but further studies for vedolizumab and ustekinumab are necessary.
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Affiliation(s)
- Máire A Conrad
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Judith R Kelsen
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA. .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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778
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AlAskar D, AlSardi M, Al Sulais E, Mosli M, AlAmeel T. Risk of neutropenia in inflammatory bowel disease patients treated with TNF inhibitors: A single-center, retrospective cohort study. Saudi J Gastroenterol 2020; 26:286002. [PMID: 32496224 PMCID: PMC7580728 DOI: 10.4103/sjg.sjg_41_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/AIM Tumor necrosis factor inhibitors (TNFi) have become the mainstay of treatment in moderate-to-severe cases of inflammatory bowel disease (IBD). Neutropenia has been reported in patients receiving TNFi for IBD and other diseases. In this study, we aimed to ascertain the relationship between the use of TNFi and the development of neutropenia in patients with IBD. PATIENTS AND METHODS This is a retrospective cohort study including all adult patients with IBD receiving TNFi at a tertiary care center over an 11-year period. The primary outcome was the development of any neutropenic episode after starting a TNFi. For our secondary outcomes, we evaluated the impact of concomitant use of 5-aminosalicylic acid (5-ASA) or an immunomodulator on the risk of developing neutropenia. RESULTS The final analysis included 281 patients. Of those included, 34.2% developed at least one episode of neutropenia while on a TNFi. The majority of these episodes (67.7%) were mild with ANC between 1000 and 1500/mm3. No significant difference was observed in the age, gender, agent used or type of IBD between those who developed neutropenia and those who did not. Concomitant use of azathioprine (OR = 2.32, 95% CI: 1.26-4.28; P = 0.007) or 5-ASA (OR = 3.15, 95% CI: 1.55-6.39; P = 0.001) were significant independent predictors of developing neutropenia. CONCLUSIONS In this study, mild neutropenia was common among patients with IBD on TNFi. Future prospective studies are required to further clarify the significance of neutropenia in patients with IBD receiving TNFi.
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Affiliation(s)
- Dimah AlAskar
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Mais AlSardi
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Eman Al Sulais
- Department of Medicine, Royal Commission Hospital, Jubail, Saudi Arabia
| | - Mahmoud Mosli
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Turki AlAmeel
- Department of Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia
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779
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Inglet S, Winter B, Yost SE, Entringer S, Lian A, Biksacky M, Pitt RD, Mortensen W. Clinical Data for the Use of Cannabis-Based Treatments: A Comprehensive Review of the Literature. Ann Pharmacother 2020; 54:1109-1143. [DOI: 10.1177/1060028020930189] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective: To compile and synthesize the available literature describing medical cannabis use across various disease states. Data Sources: PubMed, EBSCO, and Google Scholar searches were conducted using MeSH and/or keywords. Study Selection and Data Extraction: Studies were included if they described the use of cannabis-based products and medications in the treatment of a predefined list of disease states in humans and were published in English. The extraction period had no historical limit and spanned through April 2019. Data Synthesis: Evidence was compiled and summarized for the following medical conditions: Alzheimer disease, amyotrophic lateral sclerosis, autism, cancer and cancer-associated adverse effects, seizure disorders, human immunodeficiency virus, inflammatory bowel disease, multiple sclerosis (MS), nausea, pain, posttraumatic stress disorder, and hospice care. Relevance to Patient Care and Clinical Practice: Based on identified data, the most robust evidence suggests that medical cannabis may be effective in the treatment of chemotherapy-induced nausea and vomiting, seizure disorders, MS-related spasticity, and pain (excluding diabetic neuropathy). Overall, the evidence is inconsistent and generally limited by poor quality. The large variation in cannabis-based products evaluated in studies limits the ability to make direct comparisons. Regardless of the product, a gradual dose titration was utilized in most studies. Cannabis-based therapies were typically well tolerated, with the most common adverse effects being dizziness, somnolence, dry mouth, nausea, and euphoria. Conclusions: As more states authorize medical cannabis use, there is an increasing need for high-quality clinical evidence describing its efficacy and safety. This review is intended to serve as a reference for clinicians, so that the risks and realistic benefits of medical cannabis are better understood.
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Affiliation(s)
| | | | | | | | - Anh Lian
- Intermountain Healthcare, Taylorsville, UT, USA
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780
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Soulakova JN, Su LC, Crockett LJ. Smokers’ reports on receiving a doctor’s advice to quit smoking; receiving the advice is more prevalent among smokers with Crohn’s Disease relative to smokers with Ulcerative Colitis. Prev Med Rep 2020; 18:101091. [PMID: 32300517 PMCID: PMC7153293 DOI: 10.1016/j.pmedr.2020.101091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/20/2020] [Accepted: 04/04/2020] [Indexed: 11/25/2022] Open
Abstract
Receiving a doctor’s advice to quit smoking is an important predictor for improving smokers’ intentions to quit smoking and successful smoking cessation. We examined reports of smokers with Crohn’s Disease (CD) and Ulcerative Colitis (UC) regarding receiving a doctor’s advice to quit smoking in the past 12 months, and evaluated the differences in the rates of receiving the advice between the CD and UC patients. The data were retrospectively reported by CD and UC patients (n = 453) who self-identified as current smokers in online assessments conducted by IBD Partners in the period from 2011 to 2014 in the USA. Statistical methods included chi-square tests and a multiple logistic regression model for the logit of the probability of receiving the advice as a function of patient’s characteristics and assessment year. Overall, about 77% of smokers reported receiving a doctor’s advice to quit smoking. The percentage was significantly (p < 0.001) higher among smokers with CD (80%) than it was among smokers with UC (63%). While the specific differences by CD/UC depended on smoking initiation age, the overall effect of disease type on the odds of receiving the advice remained significant: the odds of receiving the advice were higher for smokers with CD relative to smokers with UC (OR = 3.6, p < 0.001). Although the majority of CD and UC patients report receiving a doctor’s advice to quit smoking, the encountered difference associated with the disease type is concerning. Because long-term smoking increases cancer and mortality risks, doctors should address smoking cessation with all patients who smoke.
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781
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de Jong ME, Kanne H, Nissen LHC, Drenth JPH, Derikx LAAP, Hoentjen F. Increased risk of high-grade dysplasia and colorectal cancer in inflammatory bowel disease patients with recurrent low-grade dysplasia. Gastrointest Endosc 2020; 91:1334-1342.e1. [PMID: 31923409 DOI: 10.1016/j.gie.2019.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/22/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The impact of recurrent low-grade dysplasia (LGD) on the risk of advanced neoplasia (high-grade dysplasia and colorectal cancer) in inflammatory bowel disease (IBD) patients is unknown. In addition, it is unclear how a neoplasia-free period after index LGD impacts this risk. We aimed to determine whether recurrent LGD is a risk factor for advanced neoplasia development and to evaluate the impact of a neoplasia-free time period after initial LGD diagnosis on the advanced neoplasia risk. METHODS This is a nationwide cohort study using data from the Dutch National Pathology Registry to identify all IBD patients with LGD and ≥1 follow-up colonoscopy between 1991 and 2010 in the Netherlands. Follow-up data were collected until January 2016. We compared the cumulative advanced neoplasia incidence between patients with and without recurrent LGD at first follow-up colonoscopy using log-rank analysis. We subsequently studied the impact of a neoplasia-free period after initial LGD on the advanced neoplasia incidence. RESULTS We identified 4284 IBD patients with colonic LGD with a median follow-up of 6.4 years. Recurrent LGD was a risk factor for advanced neoplasia (hazard ratio, 1.66; 95% confidence interval, 1.22-2.25; P = .001). A neoplasia-free period of at least 3 years after LGD protected against advanced neoplasia. CONCLUSIONS Recurrent LGD at follow-up colonoscopy after initial LGD was a risk factor for advanced neoplasia. A neoplasia-free period of at least 3 years after initial LGD was associated with a reduced subsequent risk of advanced neoplasia.
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Affiliation(s)
- Michiel E de Jong
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Heleen Kanne
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Loes H C Nissen
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Joost P H Drenth
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lauranne A A P Derikx
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Frank Hoentjen
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
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782
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Long MD, Smith TW, Dibonaventura M, Gruben D, Bargo D, Salese L, Quirk D. Real-world Effectiveness of Advanced Therapies Among Patients With Moderate to Severe Ulcerative Colitis in the United States. Inflamm Bowel Dis 2020; 26:941-948. [PMID: 31560046 PMCID: PMC7216775 DOI: 10.1093/ibd/izz204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Ulcerative colitis (UC) treatment aims to induce response and maintain steroid-free remission. For patients with moderate to severe UC and/or nonresponse to conventional treatment, advanced therapies (immunosuppressants and biologics) are available. We assessed real-world effectiveness of advanced UC therapies. METHODS This retrospective analysis of claims data included adult patients with UC initiating immunosuppressant or biologic therapy, with 12 months' continuous enrollment pre- and postinitiation. Patients had no prescription for biologic therapy (and/or immunosuppressant if initiating immunosuppressant) in the previous 12 months. Proportion of patients remaining steroid-free (excluding 14-week tapering period), hospitalizations, and costs in the 12 months postinitiation were assessed. RESULTS In total, 3562 patients were included in the analysis. Most patients (83.0%) used steroids in the 12 months before initiating advanced therapy. Overall, 47.8% remained steroid-free after 12 months (excluding tapering). After adjusting for patient characteristics, remaining steroid-free was significantly more likely with infliximab (43.9%) than with adalimumab (39.4%; P < 0.05); golimumab (38.2%) and vedolizumab (41.4%) were not significantly different vs adalimumab. Overall, 12.2% of patients had a UC-related hospitalization within 12 months of initiation, with a mean (SD) total length of stay of 8.2 (8.9) days and no significant differences between biologic therapies. Mean, unadjusted, UC-related costs in the 12 months postinitiation were $42,579 and were similar between therapies. CONCLUSIONS Patients with UC initiating advanced therapy frequently continued using steroids for at least a year. Some patients experienced extended UC-related hospitalizations, with high UC-related costs overall. This suggests an ongoing challenge in managing patients with moderate to severe UC.
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Affiliation(s)
- Millie D Long
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
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783
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Axelrad JE, Shah SC. Diagnosis and management of inflammatory bowel disease-associated neoplasia: considerations in the modern era. Therap Adv Gastroenterol 2020; 13:1756284820920779. [PMID: 32523622 PMCID: PMC7236570 DOI: 10.1177/1756284820920779] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/19/2020] [Indexed: 02/04/2023] Open
Abstract
Patients with inflammatory bowel disease (IBD) are at an increased risk of developing intestinal neoplasia-particularly colorectal neoplasia, including dysplasia and colorectal cancer (CRC)-as a primary consequence of chronic inflammation. While the current incidence of CRC in IBD is lower compared with prior decades, due, in large part, to more effective therapies and improved colonoscopic technologies, CRC still accounts for a significant proportion of IBD-related deaths. The focus of this review is on the pathogenesis; epidemiology, including disease- and patient-related risk factors; diagnosis; surveillance; and management of IBD-associated neoplasia.
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Affiliation(s)
- Jordan E. Axelrad
- Inflammatory Bowel Disease Center at NYU Langone Health, Division of Gastroenterology and Hepatology, NYU School of Medicine, New York, USA
| | - Shailja C. Shah
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, 10th floor Rm 1030-C, 2215 Garland Avenue, Medical Research Building IV, Nashville, TN 37203, USA
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784
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Siegel CA, Bernstein CN. Identifying Patients With Inflammatory Bowel Diseases at High vs Low Risk of Complications. Clin Gastroenterol Hepatol 2020; 18:1261-1267. [PMID: 31778805 DOI: 10.1016/j.cgh.2019.11.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/10/2019] [Accepted: 11/19/2019] [Indexed: 02/07/2023]
Abstract
People with Crohn's disease and ulcerative colitis have varying presentations and clinical consequences of their disease. Patients commonly ask about their prognosis, and what this diagnosis means for them. They are asking their clinicians to predict the future. The importance of predicting the course of any disease is to guide patient expectations and to guide treatment decisions. In the past decade the strategy of inflammatory bowel disease (IBD) treatment has shifted to treat patients earlier in the course of their disease, before irreversible damage occurs. Treatment approaches for disease categorized as mild, moderate or severe has most often been based on a current assessment of symptoms or disease activity without including a longitudinal assessment of a patient's disease course including past disease complications and surgeries. While a patient's current disease activity most typically drives these treatment decisions, optimally, treatment decisions would be made accounting for past disease activity and complications and the predicted future disease course. When developing a treatment plan for an individual patient, the immediate goal is to treat the current disease activity for relief of symptoms, and the long-term goal is to prevent progression of their disease due to complications. Since not all patients will progress to a complicated disease course, it is important to be able to select the right patients for the right therapy. Therefore, developing methods of stratifying patients into low-risk versus high-risk of complications will be an important aspect of treating IBD now and in the future.
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Affiliation(s)
- Corey A Siegel
- Dartmouth-Hitchcock Inflammatory Bowel Disease Center, Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Charles N Bernstein
- Section of Gastroenterology, Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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785
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Hendler SA, Barber GE, Okafor PN, Chang MS, Limsui D, Limketkai BN. Cytomegalovirus infection is associated with worse outcomes in inflammatory bowel disease hospitalizations nationwide. Int J Colorectal Dis 2020; 35:897-903. [PMID: 32124046 DOI: 10.1007/s00384-020-03536-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection may complicate ulcerative colitis (UC) or Crohn's disease (CD) hospitalizations. Studies examining this relationship are often single-center examining short time periods. AIMS To quantify the prevalence of CMV and its impact on outcomes among UC and CD hospitalizations over time using nationwide administrative databases. METHODS The National Inpatient Sample and Nationwide Readmissions Database were analyzed to calculate CMV prevalence per 1000 UC and CD hospitalizations between 1998 and 2014. Univariable and multivariable logistic and linear regression were used to assess CMV's association with outcomes. Separate analyses examined effects from the introduction of anti-TNF therapy in UC in 2005, CD anatomic extent, and Clostridioides difficile infection. RESULTS Among UC, from 1998 to 2014, the prevalence of CMV infection rose from 1.4 to 6.3 per 1000 UC hospitalizations (p < 0.001), although this increase was not statistically significant for the years 2006 to 2014 (p = 0.07). Among CD, prevalence rose from 0.3 to 1.8 per 1000 CD hospitalizations (p < 0.001) from 1998 to 2014. CMV was independently associated with increased inpatient mortality (UC: odds ratio (OR) 2.3, 95% confidence interval (CI) 1.2-4.5; CD: OR 4.6, CI 1.5-13.7), colectomy in UC (OR 2.5, CI 1.9-3.3), and higher length of stay and costs. CONCLUSION CMV infection's prevalence among UC and CD hospitalizations is rising over time, but may have slowed after 2005 in UC. CMV is independently associated with increased inpatient mortality, length of stay, and hospital charges in UC and CD and with colectomy in UC.
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Affiliation(s)
- Steven A Hendler
- Division of Gastroenterology, Department of Medicine, Loyola University Medical Center, Maywood, IL, USA.
| | - Grant E Barber
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Philip N Okafor
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew S Chang
- Department of Gastroenterology, Kaiser Permanente-San Francisco, San Francisco, CA, USA
| | - David Limsui
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Berkeley N Limketkai
- UCLA Center for Inflammatory Bowel Diseases, UCLA Vatche & Tamar Manoukian Divison of Digestive Diseases, University of California Los Angeles, Los Angeles, CA, USA
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786
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Zhang B, Gulati A, Alipour O, Shao L. Relapse From Deep Remission After Therapeutic De-escalation in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2020; 14:1413-1423. [PMID: 32335670 PMCID: PMC7533897 DOI: 10.1093/ecco-jcc/jjaa087] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS We conducted a systematic review and meta-analysis evaluating the relapse rate after therapeutic de-escalation in inflammatory bowel disease [IBD] patients who achieved deep remission [DR]. METHODS We searched MEDLINE, EMBASE, and major gastroenterology conferences up to July 2019 for studies reporting relapse in adult patients with DR who subsequently underwent therapeutic de-escalation. Eligible studies defined DR as at least a combination of clinical remission and mucosal healing/endoscopic remission. The primary outcome was cumulative 1-year and 2-year relapse rates after therapeutic de-escalation. Secondary outcomes were relapse rates in ulcerative colitis [UC] and Crohn's disease [CD], relapse after anti-tumour necrosis factor-α [anti-TNFα] de-escalation, and the rate of disease response recapture following re-escalation. RESULTS Thirteen studies encompassing 837 patients were identified. The cumulative relapse rate after therapeutic de-escalation was 28.7% within 1 year [12 studies], and 38.4% within 2 years [eight studies]. Relapse rates within 1 year and 2 years were comparable between UC [five studies; 25.4% and 37.4%] and CD [seven studies; 34.1% and 39.9%]. Ten studies reported de-escalation of anti-TNFα, of which 29.8% patients relapsed within 1 year and 41.4% within 2 years. Response recapture following re-escalation [eight studies] was 75.4%. CONCLUSIONS Despite achieving deep remission, therapeutic de-escalation in this patient population is associated with significant relapse risk within 1 year and 2 years. This risk is more pronounced in patients requiring anti-TNFα for management, likely because of more severe disease. Similar rates of relapse were reported among UC and CD within these time periods. These findings suggest that combined clinical and endoscopic remission should not be an impetus to consider therapeutic de-escalation.
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Affiliation(s)
- Bing Zhang
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, CA, USA
| | - Alakh Gulati
- Department of Medicine, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Omeed Alipour
- Department of Medicine, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Ling Shao
- Department of Medicine, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Corresponding author: Ling Shao, MD PhD, Department of Medicine, Division of Gastrointestinal and Liver Diseases, Keck School of Medicine of the University of Southern California, 2011 Zonal Avenue, HMR 101, Los Angeles, CA 90033, USA, Tel.: 323-442-0248; fax: 323-442-5425;
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787
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Choi YI, Kim YJ, Chung JW, Kim KO, Kim H, Park RW, Park DK. Effect of Age on the Initiation of Biologic Agent Therapy in Patients With Inflammatory Bowel Disease: Korean Common Data Model Cohort Study. JMIR Med Inform 2020; 8:e15124. [PMID: 32293578 PMCID: PMC7191339 DOI: 10.2196/15124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/23/2019] [Accepted: 01/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Observational Health Data Sciences and Informatics (OHDSI) network is an international collaboration established to apply open-source data analytics to a large network of health databases, including the Korean common data model (K-CDM) network. OBJECTIVE The aim of this study is to analyze the effect that age at diagnosis has on the prognosis of inflammatory bowel disease (IBD) in Korea using a CDM network database. METHODS We retrospectively analyzed the K-CDM network database from 2005 to 2015. We transformed the electronic medical record into the CDM version 5.0 used in OHDSI. A worsened IBD prognosis was defined as the initiation of therapy with biologic agents, including infliximab and adalimumab. To evaluate the effect that age at diagnosis had on the prognosis of IBD, we divided the patients into an early-onset (EO) IBD group (age at diagnosis <40 years) and a late-onset (LO) IBD group (age at diagnosis ≥40 years) with the cutoff value of age at diagnosis as 40 years, which was calculated using the Youden index method. We then used the logrank test and Cox proportional hazards model to analyze the effect that age at diagnosis (EO group vs LO group) had on the prognosis in patients with IBD. RESULTS A total of 3480 patients were enrolled. There was 2017 patients with ulcerative colitis (UC) and 1463 with Crohn's disease (CD). The median follow up period was 109.5 weeks. The EO UC group was statistically significant and showed less event-free survival (ie, experiences of biologic agents) than the LO UC group (P<.001). In CD, the EO CD group showed less event-free survival (ie, experiences of biologic agents) than the LO CD group. In the Cox proportional hazard analysis, the odds ratio (OR) of the EO UC group on experiences of biologic agents compared with the LO UC group was 2.3 (95% CI 1.3-3.8, P=.002). The OR of the EO CD group on experiences of biologic agents compared with the LO CD group was 5.4 (95% CI 1.9-14.9, P=.001). CONCLUSIONS The EO IBD group showed a worse prognosis than the LO IBD group in Korean patients with IBD. In addition, this study successfully verified the CDM model in gastrointestinal research.
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Affiliation(s)
- Youn I Choi
- Department of Gastroenterology, Gil Medical Center, Gachon University College of Internal Medicine, Incheon, Republic of Korea
| | - Yoon Jae Kim
- Department of Gastroenterology, Gil Medical Center, Gachon University College of Internal Medicine, Incheon, Republic of Korea
| | - Jun-Won Chung
- Department of Gastroenterology, Gil Medical Center, Gachon University College of Internal Medicine, Incheon, Republic of Korea
| | - Kyoung Oh Kim
- Department of Gastroenterology, Gil Medical Center, Gachon University College of Internal Medicine, Incheon, Republic of Korea
| | - Hakki Kim
- Health IT Research Center, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | | | - Dong Kyun Park
- Department of Gastroenterology, Gil Medical Center, Gachon University College of Internal Medicine, Incheon, Republic of Korea
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788
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Li H, Tian F. Toxic Epidermal Necrolysis Because of Various Herpesviruses Infection After Accelerated Infliximab Induction in a Chinese Patient With Acute Severe Ulcerative Colitis. Inflamm Bowel Dis 2020; 26:e38-e40. [PMID: 32086936 DOI: 10.1093/ibd/izaa034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Hui Li
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Feng Tian
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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789
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Anti-inflammation of Erianin in dextran sulphate sodium-induced ulcerative colitis mice model via collaborative regulation of TLR4 and STAT3. Chem Biol Interact 2020; 324:109089. [PMID: 32272095 DOI: 10.1016/j.cbi.2020.109089] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/14/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022]
Abstract
Ulcerative colitis (UC) is a chronic, idiopathic and inflammatory disease of the rectal and colonic mucosa. Studies have shown that Toll-like receptors (TLR) 4 and Signal Transducer and Activator of Transcription 3 (STAT3)-mediated the decline in immune function and inflammatory infiltration are potential pathomechanism of UC occurrence and development. In this study, the anti-inflammation of Erianin, a natural bibenzyl compound with the antioxidant, antitumor, and anti-inflammatory activities, was investigated in a dextran sodium sulphate-induced UC mouse model. Three-week Erianin administration resulted in the increment on the body weight and colon length, and the reduction on the activity index score of UC mice. Liver, spleen, and renal organ indexes and pathological observations confirmed that Erianin was not cytotoxic and had an effect of improving immune organ function. The haematoxylin and eosin staining sections of colon tissue show Erianin's effect of reversing inflammation in the mucosal laye. Proteomic analysis and enzyme-linked immunosorbent assay indicated that Erianin regulated the levels of inflammatory and oxidative stress-related factors and immunochemokines in serum and colon tissues thereby reducing cell peroxidative damage and reducing immune inflammatory responses. Further data obtained by Western Blotting confirmed that Erianin's anti-UC activity was mediated by inhibiting the TLR4 and STAT3 signaling.
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790
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Blackwell J, Selinger C, Raine T, Parkes G, Smith MA, Pollok R. Steroid use and misuse: a key performance indicator in the management of IBD. Frontline Gastroenterol 2020; 12:207-213. [PMID: 33907617 PMCID: PMC8040510 DOI: 10.1136/flgastro-2019-101288] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/06/2020] [Accepted: 03/18/2020] [Indexed: 02/04/2023] Open
Abstract
Corticosteroids remain an important tool for inducing remission in inflammatory bowel disease (IBD) but they have no role in maintenance of remission. The significant adverse side effect profile of these drugs means their use should be avoided where possible or measures taken to reduce their risk. Despite an expanding array of alternative therapies, corticosteroid dependency and excess remain common. Appropriate steroid use is now regarded a key performance indicator in the management of IBD. This article aims to outline indications for corticosteroid use in IBD, their risks and strategies to reduce their use and misuse.
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Affiliation(s)
- Jonathan Blackwell
- Department of Gastroenterology, St George's Hospitals NHS Foundation Trust, London, UK
- School of Public Health, Imperial College London, London, UK
| | - Christian Selinger
- Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- The Leeds Institute of Research at St James’, University of Leeds, Leeds, UK
| | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gareth Parkes
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Melissa A Smith
- Digestives Diseases Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Department of Gastroenterology, Brighton and Sussex Medical School, Brighton, UK
| | - Richard Pollok
- Department of Gastroenterology, St George's Hospitals NHS Foundation Trust, London, UK
- Division of Infection and Immunity, St George’s University London, London, UK
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791
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Dignass A, Waller J, Cappelleri JC, Modesto I, Kisser A, Dietz L, DiBonaventura M, Wood R, May M, Libutzki B, Bargo D. Living with ulcerative colitis in Germany: a retrospective analysis of dose escalation, concomitant treatment use and healthcare costs. J Med Econ 2020; 23:415-427. [PMID: 31858853 DOI: 10.1080/13696998.2019.1707210] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims: To investigate treatment of moderate-to-severe ulcerative colitis (UC) using real-world German health insurance claims data.Materials and methods: A retrospective, longitudinal cohort study was conducted from a German statutory health insurance database for adult patients with UC indexed on biologic therapy initiation (2013-2015). Anonymized data were evaluated for 12 months prior to (baseline) through 24 months after (follow-up) indexing. Biologic dose escalations, steroid and immunosuppressant use, healthcare resource utilization (HCRU) and direct healthcare costs were evaluated, with significant differences assessed across and between index biologics. Descriptive statistics, chi-square or Fisher's exact tests, and analysis of variance were performed.Results: The analysis included 304 patients (adalimumab, n = 125; golimumab, n = 47; infliximab, n = 114; vedolizumab, n = 18). Demographic and clinical characteristics were similar across biologics. Dose escalations occurred in 58% of patients (73% of patients receiving adalimumab), with 41% receiving subsequent de-escalation. Steroids were used during follow-up by 74% of patients; 25% received steroids >14 weeks after indexing. Overall, 41% of patients received an immunosuppressant during follow-up. Steroid and immunosuppressant use were similar across biologics. Total direct healthcare costs were higher during follow-up than baseline and differed significantly across treatments (p < .05), with highest costs for golimumab. Biologic costs contributed to a major portion of follow-up costs. HCRU and costs for most resources were higher in the first 12-month follow-up period than baseline. All resource use except gastroenterology visits returned to, or below, baseline levels 13-24 months post-index date.Limitations: There was potential for inappropriate inclusion/exclusion due to miscoding. Patients may have received biologics >12 months prior to the index date. Biologic originators and biosimilars could not be differentiated.Conclusions: These data suggest that control with current biologics is suboptimal. Further treatment options that provide sustained steroid-free remission for this patient population without the need for dose escalations or concomitant therapies may be warranted.
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Affiliation(s)
- Axel Dignass
- Agaplesion Markus Hospital, Frankfurt/Main, Germany
| | | | | | | | | | | | | | | | - Melanie May
- HGC Healthcare Consultants GmbH, Dusseldorf, Germany
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792
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Takatsu N, Hisabe T, Higashi D, Ueki T, Matsui T. Vedolizumab in the Treatment of Ulcerative Colitis: An Evidence-Based Review of Safety, Efficacy, and Place of Therapy. CORE EVIDENCE 2020; 15:7-20. [PMID: 32280316 PMCID: PMC7131995 DOI: 10.2147/ce.s179053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 03/08/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Selective blockade of the integrins and mucosal adhesion molecules is a promising therapeutic strategy for ulcerative colitis (UC). Vedolizumab (VDZ), a humanized IgG1 monoclonal antibody against α4β7 integrin, selectively blocks the trafficking of the leukocytes into the gastrointestinal tract through its binding with the α4β7 integrin. AIM In this review, we provide an overview of the unique mechanism of VDZ, along with its efficacy, safety, and pharmacokinetic and pharmacodynamic data obtained from clinical trials, observational studies, and meta-analyses. EVIDENCE REVIEW A positive exposure-efficacy relationship with regard to clinical remission and clinical response was apparent in VDZ induction therapy. No drug-specific safety signals are currently available. PLACE IN THERAPY VDZ has been shown to be effective as first- or second-line induction and maintenance therapy in UC. CONCLUSION VDZ is a safe and effective treatment option for patients with UC. Prolonged VDZ induction therapy may contribute to improved outcomes in patients with UC, particularly those previously treated with tumor necrosis factor-α. Prospective head-to-head study of VDZ and other biologics would alter the positioning of VDZ much more clearly.
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Affiliation(s)
- Noritaka Takatsu
- Department Of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Takashi Hisabe
- Department Of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Daijiro Higashi
- Department Of Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Toshiharu Ueki
- Department Of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Toshiyuki Matsui
- Department Of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
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793
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Welty M, Mesana L, Padhiar A, Naessens D, Diels J, van Sanden S, Pacou M. Efficacy of ustekinumab vs. advanced therapies for the treatment of moderately to severely active ulcerative colitis: a systematic review and network meta-analysis. Curr Med Res Opin 2020; 36:595-606. [PMID: 31960724 DOI: 10.1080/03007995.2020.1716701] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: To compare the relative efficacy of ustekinumab (UST) vs. other therapies for 1-year response and remission rates in patients with moderate-severe UC.Methods: Randomized controlled trials reporting induction and maintenance efficacy of anti-TNFs (infliximab [IFX], adalimumab [ADA], golimumab [GOL]), vedolizumab (VDZ), tofacitinib (TOF) or UST were identified through a systematic literature review (SLR). Analyses were conducted for clinical response, clinical remission and endoscopic-mucosal healing for populations with and without failure of prior biologics (non-biologic failure [NBF]; biologic failure [BF]). Maintenance data from trials with re-randomized response designs were re-calculated to correspond to treat-through arms. Bayesian network meta-analyses (NMA) were conducted to obtain posterior distribution probabilities for UST to perform better than comparators.Results: Six trials included NBF patients and four included BF patients. In NBF patients, UST as a 1-year regimen showed higher probabilities of clinical response, remission and endoscopic-mucosal healing vs. all treatments: Bayesian probabilities of UST being better than active therapies ranged from 91% (VDZ) to 100% (ADA) for response; 82% (VDZ) to 99% (ADA) for remission and 82% (IFX) to 100% (ADA and GOL) for endoscopic-mucosal healing. In BF patients, UST was the most effective treatment (Q8W dose); however, effect sizes were smaller than in the NBF population.Conclusions: Results indicate a higher likelihood of response, remission and endoscopic-mucosal healing at 1 year with UST vs. comparators in the NBF population. In BF patients, a higher likelihood of response to UST vs. the most comparators was also observed, although results were more uncertain.
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Affiliation(s)
- Margaux Welty
- Amaris, Health Economics and Market Access, Toronto, Canada
| | - Laura Mesana
- Amaris, Health Economics and Market Access, Jersey City, NJ, USA
| | - Amie Padhiar
- Amaris, Health Economics and Market Access, London, UK
| | | | | | | | - Maud Pacou
- Amaris, Health Economics and Market Access, Paris, France
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794
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Israel A, Christensen B, Jurdi KE, Rai V, Ollech J, Cohen RD, Sakuraba A, Dalal S, Rubin DT. Follow-Up of Patients With Ulcerative Colitis and Histological Normalization. Clin Gastroenterol Hepatol 2020; 18:987-988.e1. [PMID: 31228567 PMCID: PMC6923607 DOI: 10.1016/j.cgh.2019.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/26/2019] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
Abstract
The natural history of ulcerative colitis (UC) follows a relapsing and remitting course of inflammation and is accompanied by associated mucosal injury and historically, microscopic features of chronicity that were the sine qua non for the diagnosis.1 As goals for the management of UC have evolved to include objectively measured endoscopic improvement of the mucosa, there also has been a move to include histological endpoints in assessment of disease activity.2,3 However, there remain a number of unanswered questions about histology in UC and this is not yet a specific treatment goal.4.
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Affiliation(s)
- Amanda Israel
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL
| | - Britt Christensen
- Department of Gastroenterology, Alfred Hospital and Monash University, Melbourne, Australia,Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Katia El Jurdi
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL
| | - Victoria Rai
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL
| | - Jacob Ollech
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL
| | - Russell D. Cohen
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL
| | - Atsushi Sakuraba
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL
| | - Sushila Dalal
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL
| | - David T. Rubin
- University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL
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795
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Moutinho BD, de Barros JR, Baima JP, Saad-Hossne R, Sassaki LY. Immunosuppression and Malignant Neoplasms: Risk-Benefit Assessment in Patients with Inflammatory Bowel Disease. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e920949. [PMID: 32218413 PMCID: PMC7138887 DOI: 10.12659/ajcr.920949] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Patient: Male, 70-year-old Final Diagnosis: Ulcerative colitis Symptoms: Abdominal pain • bloody diarrhea Medication: Azathioprine • infliximab Clinical Procedure: Clinical treatment • surgical treatment Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Bruna Damásio Moutinho
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Jaqueline Ribeiro de Barros
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Julio Pinheiro Baima
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Rogerio Saad-Hossne
- Department of Surgery, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
| | - Ligia Yukie Sassaki
- Department of Internal Medicine, São Paulo State University (Unesp), Medical School, Botucatu, São Paulo, Brazil
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796
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Bohossian HB, Lopes EW, Roller LA, Ananthakrishnan AN, Zukerberg LR. Case 8-2020: An 89-Year-Old Man with Recurrent Abdominal Pain and Bloody Stools. N Engl J Med 2020; 382:1042-1052. [PMID: 32160667 DOI: 10.1056/nejmcpc1913476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hacho B Bohossian
- From the Department of Medicine, Newton-Wellesley Hospital, Newton (H.B.B.), and the Department of Medicine, Tufts University School of Medicine (H.B.B.), the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Harvard Medical School, Boston - all in Massachusetts
| | - Emily W Lopes
- From the Department of Medicine, Newton-Wellesley Hospital, Newton (H.B.B.), and the Department of Medicine, Tufts University School of Medicine (H.B.B.), the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Harvard Medical School, Boston - all in Massachusetts
| | - Lauren A Roller
- From the Department of Medicine, Newton-Wellesley Hospital, Newton (H.B.B.), and the Department of Medicine, Tufts University School of Medicine (H.B.B.), the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Harvard Medical School, Boston - all in Massachusetts
| | - Ashwin N Ananthakrishnan
- From the Department of Medicine, Newton-Wellesley Hospital, Newton (H.B.B.), and the Department of Medicine, Tufts University School of Medicine (H.B.B.), the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Harvard Medical School, Boston - all in Massachusetts
| | - Lawrence R Zukerberg
- From the Department of Medicine, Newton-Wellesley Hospital, Newton (H.B.B.), and the Department of Medicine, Tufts University School of Medicine (H.B.B.), the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Massachusetts General Hospital, and the Departments of Medicine (E.W.L., A.N.A.), Radiology (L.A.R.), and Pathology (L.R.Z.), Harvard Medical School, Boston - all in Massachusetts
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797
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Sandborn WJ, Nguyen DD, Beattie DT, Brassil P, Krey W, Woo J, Situ E, Sana R, Sandvik E, Pulido-Rios MT, Bhandari R, Leighton JA, Ganeshappa R, Boyle DL, Abhyankar B, Kleinschek MA, Graham RA, Panes J. Development of Gut-Selective Pan-Janus Kinase Inhibitor TD-1473 for Ulcerative Colitis: A Translational Medicine Programme. J Crohns Colitis 2020; 14:1202-1213. [PMID: 32161949 PMCID: PMC7493219 DOI: 10.1093/ecco-jcc/jjaa049] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Oral systemic pan-Janus kinase [JAK] inhibition is effective for ulcerative colitis [UC] but is limited by toxicities. We describe preclinical to clinical translation of TD-1473-an oral gut-selective pan-JAK inhibitor-from in vitro characterization through a Phase 1b study in patients with UC. METHODS TD-1473 JAK inhibition potency was evaluated in vitro; plasma pharmacokinetics, safety and efficacy were assessed in mice. In a first-time-in-human study, plasma pharmacokinetics and safety were assessed after single and multiple [14 days] ascending doses administered orally to healthy subjects. The Phase 1b study randomized patients with moderately to severely active UC to receive once-daily oral TD-1473 20, 80 or 270 mg, or placebo for 28 days. Plasma and colonic tissue concentrations were measured; safety was assessed; and efficacy was evaluated by UC clinical parameters, disease-surrogate biomarkers, endoscopy, histology and colonic tissue JAK signalling. RESULTS TD-1473 exhibited potent pan-JAK inhibitory activity in vitro. Oral TD-1473 administration to mice achieved high, biologically active colonic tissue concentrations with low plasma exposure and decreased oxazolone-induced colitis activity without reducing blood cell counts vs placebo. TD-1473 administration in healthy human subjects and patients with UC yielded low plasma exposure and was generally well tolerated; treatment in patients with UC resulted in biologically active colonic tissue concentrations and descriptive trends toward reduced clinical, endoscopic and histological disease activity vs placebo. CONCLUSION Gut-selective pan-JAK inhibition with TD-1473 administration resulted in high intestinal vs plasma drug exposure, local target engagement, and trends toward reduced UC disease activity. [Clinicaltrials.gov NCT02657122, NCT02818686].
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA,Corresponding author: William J. Sandborn, MD, University of California San Diego, 9500 Gilman Drive, MC 0956, La Jolla, CA 92093, USA. Tel: 858-657-5331; Fax: 858-657-5022;
| | | | | | | | - Whitney Krey
- Theravance Biopharma US, Inc., South San Francisco, CA, USA
| | - Jacky Woo
- Theravance Biopharma US, Inc., South San Francisco, CA, USA
| | - Eva Situ
- Theravance Biopharma US, Inc., South San Francisco, CA, USA
| | - Reuben Sana
- Theravance Biopharma US, Inc., South San Francisco, CA, USA
| | - Erik Sandvik
- Theravance Biopharma US, Inc., South San Francisco, CA, USA
| | | | | | | | | | - David L Boyle
- Biomarker Laboratory, University of California San Diego, La Jolla, CA, USA
| | | | | | | | - Julian Panes
- Department of Gastroenterology, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
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798
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Yvellez OV, Rai V, Sossenheimer PH, Hart J, Turner JR, Weber C, El Jurdi K, Rubin DT. Cumulative Histologic Inflammation Predicts Colorectal Neoplasia in Ulcerative Colitis: A Validation Study. Inflamm Bowel Dis 2020; 27:203-206. [PMID: 32152624 PMCID: PMC7813748 DOI: 10.1093/ibd/izaa047] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic inflammation in ulcerative colitis (UC) is associated with the development of colorectal neoplasia (CRN). A group at St. Mark's Hospital reported a novel cumulative inflammatory index that predicted the development of CRN in UC patients that we validated with an independent, well-described, matched, case-controlled cohort from the University of Chicago. METHODS Cumulative inflammatory burden (CIB) was calculated by summing each histological inflammatory activity (HIA) score and multiplying it by the length of the surveillance interval. Persistency was defined by the number of surveillance episodes (with a severity score >2) divided by the total number of surveillance procedures. T tests compared the mean and maximum HIA scores, assessing mean and maximum severity, CIB, and persistency. RESULTS Sixty-two UC patients (26 patients with CRN, 36 control patients without CRN) were analyzed. Fifty-five percent were men, mean disease duration was 20.6 years, and mean age at CRN diagnosis was 43.9. Of the CRN patients, 6 (23%) had colorectal cancer, 16 (62%) had low-grade dysplasia, and 4 (15%) had indefinite dysplasia. Using mean HIA scores, we found CIB to be statistically greater in CRN patients (P = 0.04). Using maximum HIA scores, we found CIB (P = 0.02), mean severity (P = 0.03), and persistency (P = 0.01) to be significantly greater in CRN patients. Maximum severity was numerically greater for mean and maximum HIA scores but did not reach significance. CONCLUSION Cumulative histologic inflammation is significantly associated with the development of CRN in UC patients. This suggests a management strategy of controlling inflammation to reduce the risk of CRN and may influence the selection of surveillance intervals.
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Affiliation(s)
- Olivia V Yvellez
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Victoria Rai
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Philip H Sossenheimer
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - John Hart
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jerrold R Turner
- Brigham and Women’s Hospital, Pathology, Boston, Massachusetts, USA
| | - Christopher Weber
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Katia El Jurdi
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA,Address correspondence to: David T. Rubin, MD, 5841 South Maryland Avenue, MC 4076, Chicago, IL 60637 ()
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799
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Investigation of Potential Genetic Biomarkers and Molecular Mechanism of Ulcerative Colitis Utilizing Bioinformatics Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4921387. [PMID: 32190668 PMCID: PMC7073481 DOI: 10.1155/2020/4921387] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/28/2019] [Accepted: 12/11/2019] [Indexed: 12/12/2022]
Abstract
Objectives To reveal the molecular mechanisms of ulcerative colitis (UC) and provide potential biomarkers for UC gene therapy. Methods We downloaded the GSE87473 microarray dataset from the Gene Expression Omnibus (GEO) and identified the differentially expressed genes (DEGs) between UC samples and normal samples. Then, a module partition analysis was performed based on a weighted gene coexpression network analysis (WGCNA), followed by pathway and functional enrichment analyses. Furthermore, we investigated the hub genes. At last, data validation was performed to ensure the reliability of the hub genes. Results Between the UC group and normal group, 988 DEGs were investigated. The DEGs were clustered into 5 modules using WGCNA. These DEGs were mainly enriched in functions such as the immune response, the inflammatory response, and chemotaxis, and they were mainly enriched in KEGG pathways such as the cytokine-cytokine receptor interaction, chemokine signaling pathway, and complement and coagulation cascades. The hub genes, including dual oxidase maturation factor 2 (DUOXA2), serum amyloid A (SAA) 1 and SAA2, TNFAIP3-interacting protein 3 (TNIP3), C-X-C motif chemokine (CXCL1), solute carrier family 6 member 14 (SLC6A14), and complement decay-accelerating factor (CD antigen CD55), were revealed as potential tissue biomarkers for UC diagnosis or treatment. Conclusions This study provides supportive evidence that DUOXA2, A-SAA, TNIP3, CXCL1, SLC6A14, and CD55 might be used as potential biomarkers for tissue biopsy of UC, especially SLC6A14 and DUOXA2, which may be new targets for UC gene therapy. Moreover, the DUOX2/DUOXA2 and CXCL1/CXCR2 pathways might play an important role in the progression of UC through the chemokine signaling pathway and inflammatory response.
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800
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Ollech JE, Dwadasi S, Rai V, Peleg N, Normatov I, Israel A, Sossenheimer PH, Christensen B, Pekow J, Dalal SR, Sakuraba A, Cohen RD, Rubin DT. Efficacy and safety of induction therapy with calcineurin inhibitors followed by vedolizumab maintenance in 71 patients with severe steroid-refractory ulcerative colitis. Aliment Pharmacol Ther 2020; 51:637-643. [PMID: 31875986 DOI: 10.1111/apt.15616] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/14/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Following induction therapy with a calcineurin inhibitor (CNI) in severe ulcerative colitis, transitioning to vedolizumab as maintenance therapy could be an option. AIM To report on the largest cohort of patients successfully induced with CNIs who were transitioned to vedolizumab maintenance therapy. METHODS This is a retrospective observational study of adult patients with severe steroid-refractory ulcerative colitis. Patients were included if they were induced with a CNI followed by maintenance therapy with vedolizumab between January 2014 and December 2018. The primary endpoint was colectomy-free survival. Secondary endpoints included survival without vedolizumab discontinuation as well as clinical, steroid-free and biochemical remission at week 14. RESULTS A total of 71 patients (59% male) were treated with vedolizumab after induction therapy with CNIs for severe steroid-refractory colitis. Patients were followed for a median time of 25 months (IQR 16-36). Colectomy-free survival rates from vedolizumab initiation were 93% at 3 months, 67% at 1 year and 55% at 2 years. At the end of induction with vedolizumab at week 14, 50% of patients were in clinical remission, and 62% of patients had a normal CRP. At 1 and 2 years following vedolizumab initiation, 43% and 28% of patients were still on vedolizumab respectively. Vedolizumab was dose escalated to infusions every 4 weeks in 44% of patients. The median time to dose escalation was 5.6 months (IQR 4.1-8.2). No serious adverse events were recorded in our patient cohort. CONCLUSIONS Transitioning to vedolizumab following induction of remission with CNIs is effective and safe.
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Affiliation(s)
- Jacob E Ollech
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Sujaata Dwadasi
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Victoria Rai
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Noam Peleg
- Inflammatory Bowel Disease Center, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Inessa Normatov
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Amanda Israel
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | | | - Britt Christensen
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Joel Pekow
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Sushila R Dalal
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Atsushi Sakuraba
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - Russell D Cohen
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
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