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Aghdashi MA, Khadir M, Dinparasti-Saleh R. Antinuclear Antibodies and Lupus-like Manifestations in Rheumatoid Arthritis and Ankylosing Spondylitis Patients at 4 Months' Follow-up After Treatment with Infliximab and Etanercept. Curr Rheumatol Rev 2020; 16:61-66. [DOI: 10.2174/1573397115666190506152729] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 03/30/2019] [Accepted: 04/17/2019] [Indexed: 12/26/2022]
Abstract
Background:
Up to 44% of patients treated with infliximab and 7% of patients treated
with etanercept reported to have anti-drug antibodies within the first 6 months of treatment. Recently,
anti-TNF-α therapies have been reported to be employed in the induction of the druginduced
lupus erythematous.
Objective:
The aim of the present study was to investigate the relationship between anti-TNFα antibodies
and various manifestations of lupus erythematous.
Methods:
We enrolled a total of 56 cases divided into 28 known cases of rheumatoid arthritis and
28 cases of ankylosing spondylitis patients and 56 controls. The case group was divided into 4
groups according to the underlying disease (RA or AS) and treatment regimen (infliximab or etanercept).
ANA and anti-dsDNA levels and lupus criteria were assessed at the beginning of the study
and 4 months after the initiation of anti-TNFα.
Results:
36% and 21% of RA patients treated with infliximab, were ANA and anti-dsDNA positive
after 4 months (P=0.003, P=0.025). 28% and 7% of RA patients treated with etanercept, were ANA
and anti-dsDNA positive after 4 months (P=0.009, P=0.15). 21% and 7% of AS patients treated
with infliximab, were ANA and anti-dsDNA positive, respectively (P=0.025, P=0.15). 14% and 7%
of AS patients treated with etanercept, were ANA and anti-dsDNA positive, respectively (P=0.63,
P=0.15). Three patients who were positive for auto-antibodies developed three criteria for SLE.
Conclusions:
Infliximab potentially may increase both ANA and anti-dsDNA levels in rheumatoid
arthritis, but only ANA in ankylosing spondylitis patients. In general, clinicians should consider
different clinical symptoms of ATIL, which may be present as a lupus-like syndrome similar to
idiopathic SLE or classical DIL.
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Affiliation(s)
- Mir Amir Aghdashi
- Department of Rheumatology, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Mohsen Khadir
- Department of Internal Medicine, Faculty of Medicine, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
| | - Roshan Dinparasti-Saleh
- Department of Internal Medicine, Faculty of Medicine, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran
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Unmet Medical Needs in the Management of Ulcerative Colitis: Results of an Italian Delphi Consensus. Gastroenterol Res Pract 2019; 2019:3108025. [PMID: 31565051 PMCID: PMC6745180 DOI: 10.1155/2019/3108025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background The lifelong and remitting nature of ulcerative colitis results in considerable disability and a substantial negative impact on quality of life. The major goal of the therapy of ulcerative colitis is considered to be the modification of the course of the disease, so that the patient's quality of life can be improved while minimising disease-related disability. Although considerable progress in understanding the molecular pathways involved in ulcerative colitis has led to improved treatment options, there is currently no definitive cure for ulcerative colitis, there remain considerable unmet needs in terms of long-term efficacy and safety, and there are many patients who continue to be burdened by physical and psychological symptoms. Defining unmet needs can help to increase the awareness of the shortcomings of current therapeutic management and highlight the need to achieve not only a control of clinical symptoms but also control of mucosal healing, in order to attain the best possible long-term outcomes. Methods With the aim of providing a better understanding of the unmet needs of patients towards improving overall care, a Delphi process was used to obtain consensus among a group of Italian ulcerative colitis experts. The consensus group met with a major focus of delineating the unmet needs of current treatment strategies and overall management of ulcerative colitis, while also focusing on quality of life and patient care. Results Three main areas were identified: (i) treatment, (ii) monitoring and risk management, and (iii) patient-related issues. A high level of consensus was reached on all but one of the statements identified. Conclusions The findings arising from the Delphi process provide valuable insights into the unmet needs in the management of moderate-to-severe ulcerative colitis from the clinician's perspective, while emphasising the benefits of therapeutic individualization and suggesting areas that need additional study with the aim of optimising the treatment of patients with ulcerative colitis.
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Iborra M, Beltrán B, Fernández-Clotet A, Gutiérrez A, Antolín B, Huguet JM, De Francisco R, Merino O, Carpio D, García-López S, Mesonero F, Navarro P, Ferreiro-Iglesias R, Carbajo AY, Rivero M, Gisbert JP, Piñero-Pérez MC, Monfort D, Bujanda L, García-Sepulcre MF, Martín-Cardona A, Cañete F, Taxonera C, Domènech E, Nos P. Real-world short-term effectiveness of ustekinumab in 305 patients with Crohn's disease: results from the ENEIDA registry. Aliment Pharmacol Ther 2019; 50:278-288. [PMID: 31222872 DOI: 10.1111/apt.15371] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/30/2019] [Accepted: 05/22/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND There are limited data of ustekinumab administered according to the doses recommended in the UNITI studies. AIM To assess the real-world, short-term effectiveness of ustekinumab in refractory Crohn's disease (CD) METHODS: Multicentre study of CD patients starting ustekinumab after June 2017 at the recommend dose (260, 390 or 520 mg based on weight ~6 mg/kg IV week 0 and 90 mg subcutaneously week 8). Values for Harvey-Bradshaw Index (HBI), C-reactive protein (CRP) and faecal calprotectin (FC) were recorded at baseline and at weeks 8 and 14. Demographic and clinical data, previous treatments, AEs and hospitalisations were documented. Possible predictors of clinical remission were examined. RESULTS Three hundred and five patients were analysed (≥2 previous anti-TNFα therapies 64% and vedolizumab 29%). At baseline, 217 (72%) had an HBI >4 points. Of these, 101 (47%) and 126 (58%) achieved clinical remission at weeks 8 and 14, respectively. FC levels returned to normal (<250 µg/g) in 46% and 54% of the patients at weeks 8 and 14 respectively. CRP returned to normal (<3 mg/L) in the 35% and 41% of the patients at week 8 and 14 respectively. AEs were recorded in 38, and 40 patients were hospitalised. Intolerance to the most recent anti-TNF agent and fewer previous anti-TNF agents were associated with clinical remission at week 14. Endoscopic severity was associated with poor response. CONCLUSION This is the first study to show the real-world effectiveness and safety of ustekinumab administered according to the recommended induction regimen in a cohort of highly refractory CD patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - P Nos
- Valencia, Spain.,Madrid, Spain
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Grossi V, Gulli F, Infantino M, Stefanile A, Napodano C, Benucci M, Pocino K, Li Gobbi F, Damiani A, Di Pino A, Manfredi M, Marino M, Basile V, Rapaccini GL, Basile U. The Laboratory Role in anti-TNF Biological Therapy Era. Immunol Invest 2019; 49:317-332. [DOI: 10.1080/08820139.2019.1637434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Valentina Grossi
- Immunology and Allergology Laboratory Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Francesca Gulli
- Department of Laboratory Medicine, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Annunziata Stefanile
- Laboratory Diagnostics Area - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cecilia Napodano
- Department of Internal Medicine and Gastroenterology - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Benucci
- Rheumatology Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Krizia Pocino
- Department of Internal Medicine and Gastroenterology - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Li Gobbi
- Rheumatology Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Arianna Damiani
- Rheumatology Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Antonella Di Pino
- Laboratory Diagnostics Area - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Mariapaola Marino
- Istituto di Patologia Generale - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Basile
- Department of Experimental Medicine and Surgery, “Tor Vergata” University Hospital, Rome, Italy
| | - Gian Ludovico Rapaccini
- Laboratory Diagnostics Area - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Basile
- Istituto di Patologia Generale - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Franca R, Curci D, Lucafò M, Decorti G, Stocco G. Therapeutic drug monitoring to improve outcome of anti-TNF drugs in pediatric inflammatory bowel disease. Expert Opin Drug Metab Toxicol 2019; 15:527-539. [PMID: 31177858 DOI: 10.1080/17425255.2019.1630378] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Medical treatment of pediatric inflammatory bowel diseases (IBD) has been greatly changed by the introduction of a number of biologic agents that are able to target various players of the immune response. In particular, monoclonal antibodies against the pro-inflammatory cytokine TNF-alpha (TNF) such as infliximab, adalimumab, and golimumab are now in the clinics both in induction and maintenance therapy, and several efforts are currently ongoing to optimize the use of these drugs in children. Areas covered: This review focuses on therapeutic drug monitoring (TDM) of anti-TNF levels and antidrug antibodies (ADAs), in IBD children. A revision of the analytical assays used for assessing anti-TNF plasma levels is also provided. Expert opinion: Although there is a consensus across studies that higher anti-TNF trough levels are associated with a better clinical outcome, and that early anti-TNF serum measurements could be predictive of long-term response, it is still not clear what the best predictive time of sampling is and what the ideal target drug plasma concentration to achieve. Indeed, there are a number of published studies, particularly in pediatric cohorts, limited by the population size analyzed and more prospective large studies are needed to examine the value of these predictive markers.
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Affiliation(s)
- Raffaella Franca
- a University of Trieste, Department of Medical , Surgical and Health Sciences , Trieste , Italy
| | - Debora Curci
- b University of Trieste, PhD Course in Reproductive and Developmental Sciences , Trieste , Italy
| | - Marianna Lucafò
- c Centro di Riferimento Oncologico (CRO) , Aviano , Italy.,d Institute for Maternal and Child Health I.R.C.C.S. Burlo Garofolo , Trieste , Italy
| | - Giuliana Decorti
- a University of Trieste, Department of Medical , Surgical and Health Sciences , Trieste , Italy.,d Institute for Maternal and Child Health I.R.C.C.S. Burlo Garofolo , Trieste , Italy
| | - Gabriele Stocco
- e University of Trieste , Department of Life Sciences , Trieste , Italy
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Gole B, Potočnik U. Pre-Treatment Biomarkers of Anti-Tumour Necrosis Factor Therapy Response in Crohn's Disease-A Systematic Review and Gene Ontology Analysis. Cells 2019; 8:cells8060515. [PMID: 31141991 PMCID: PMC6628089 DOI: 10.3390/cells8060515] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 12/15/2022] Open
Abstract
The most prominent treatment for the serious cases of Crohn’s disease (CD) are biological tumour necrosis factor (TNF) inhibitors. Unfortunately, therapy nonresponse is still a serious issue in ~1/3 of CD patients. Accurate prediction of responsiveness prior to therapy start would therefore be of great value. Clinical predictors have, however, proved insufficient. Here, we integrate genomic and expression data on potential pre-treatment biomarkers of anti-TNF nonresponse. We show that there is almost no overlap between genomic (annotated with tissue-specific expression quantitative trait loci data) and transcription (RNA and protein data) biomarkers. Furthermore, using interaction networks we demonstrate there is little direct interaction between the proposed biomarkers, though a majority do have common interactors connecting them into networks. Our gene ontology analysis shows that these networks have roles in apoptotic signalling, response to oxidative stress and inflammation pathways. We conclude that a more systematic approach with genome-wide search of genomic and expression biomarkers in the same patients is needed in future studies.
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Affiliation(s)
- Boris Gole
- Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Taborska ulica 8, SI-2000 Maribor, Slovenia.
| | - Uroš Potočnik
- Centre for Human Molecular Genetics and Pharmacogenomics, Faculty of Medicine, University of Maribor, Taborska ulica 8, SI-2000 Maribor, Slovenia.
- Laboratory for Biochemistry, Molecular biology and Genomics, Faculty of Chemistry and Chemical Engineering, University of Maribor, Smetanova ulica 17, SI-2000 Maribor, Slovenia.
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Bon L, Scharl S, Vavricka S, Rogler G, Fournier N, Pittet V, Scharl M, Greuter T, Schreiner P, Frei P, Misselwitz B, Biedermann L, Zeitz J. Association of IBD specific treatment and prevalence of pain in the Swiss IBD cohort study. PLoS One 2019; 14:e0215738. [PMID: 31022217 PMCID: PMC6483222 DOI: 10.1371/journal.pone.0215738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 04/08/2019] [Indexed: 01/06/2023] Open
Abstract
Background Extraintestinal manifestations (EIM) contribute significantly to the burden of disease in inflammatory bowel disease (IBD). Pain is a leading symptom in IBD and could be seen as an EIM itself. Treatment of IBD associated pain is challenging and insufficiently studied. A better knowledge on the association of pain and IBD specific treatment is warranted to improve the management of IBD patients. Methods All patients of the Swiss IBD Cohort Study (SIBDCS) (n = 2152) received a questionnaire regarding pain localization, pain character, and the use of IBD specific medication. Results 1263 completed questionnaires were received. Twenty-one out of 184 patients (10%) receiving anti-TNF treatment compared to 142 out of 678 patients (21%) not receiving anti-TNF medication reported elbow pain (p = 0.002) while 28 out of 198 patients (14%) receiving steroid treatment significantly more often reported elbow pain compared to 59 from 696 patients (8%) not receiving steroids (p = 0.021). Furthermore, we found significantly more female patients under anti-TNF treatment to report knee/ lower leg pain and ankle/ foot pain compared to their male counterparts (36% vs. 20% and 22% vs. 10%, respectively, p = 0.015 for both comparisons). The frequency of knee, lower leg, ankle and foot pain was especially low in male patients under anti-TNF treatment, indicating a high benefit of male patients from anti-TNF therapy regarding EIM. Conclusions The frequency of elbow pain was lower in IBD patients treated with anti-TNF but higher in patients treated with steroids.
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Affiliation(s)
- Lorenz Bon
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sylvie Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephan Vavricka
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gerhard Rogler
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Fournier
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Valerie Pittet
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
| | - Thomas Greuter
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Schreiner
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pascal Frei
- Gastroenterology Bethanien, Zurich, Switzerland
| | - Benjamin Misselwitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Luc Biedermann
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jonas Zeitz
- Division of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Center of Gastroenterology, Clinic Hirslanden, Zurich, Switzerland
- * E-mail:
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Toxines urémiques de moyen poids moléculaire : un véritable regain d’intérêt. Nephrol Ther 2019; 15:82-90. [DOI: 10.1016/j.nephro.2018.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/02/2018] [Indexed: 01/20/2023]
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Atreya I, Kindermann M, Wirtz S. Innate lymphoid cells in intestinal cancer development. Semin Immunol 2019; 41:101267. [PMID: 30772139 DOI: 10.1016/j.smim.2019.02.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/25/2019] [Accepted: 02/05/2019] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is a highly prominent cause of cancer-related deaths worldwide. Although the functions of immune cells in the colorectal tumor microenvironment are complex and heterogeneous, dysregulated changes in the composition and activation state of immune cells are believed to represent key events supporting the establishment of pro- or anti-tumorigenic immune states. Recently, innate lymphoid cells (ILCs) emerged as central innate immune mediators during both gastrointestinal homeostasis and inflammatory pathologies. Hence, ILCs might also represent promising targets in the context of cancer therapy and are increasingly recognized as innate immune cells with potent immunomodulatory properties. In this review, we summarize the pleiotropic roles of the different ILC subsets for intestinal homeostasis and discuss the recent evidence on their potential involvement in the development and growth of intestinal cancers.
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Affiliation(s)
- Imke Atreya
- Department of Medicine 1, Friedrich-Alexander-University, Erlangen, Germany
| | - Markus Kindermann
- Department of Medicine 1, Friedrich-Alexander-University, Erlangen, Germany
| | - Stefan Wirtz
- Department of Medicine 1, Friedrich-Alexander-University, Erlangen, Germany.
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Laganà B, Zullo A, Scribano ML, Chimenti MS, Migliore A, Picchianti Diamanti A, Lorenzetti R, Scolieri P, Ridola L, Ortona E, Pierdominici M, Bruzzese V. Sex Differences in Response to TNF-Inhibiting Drugs in Patients With Spondyloarthropathies or Inflammatory Bowel Diseases. Front Pharmacol 2019; 10:47. [PMID: 30745872 PMCID: PMC6360251 DOI: 10.3389/fphar.2019.00047] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/15/2019] [Indexed: 12/18/2022] Open
Abstract
Spondyloarthritis (SpA) and inflammatory bowel diseases (IBD) are chronic inflammatory diseases characterized by an aberrant immune response and inflammation with a key role for TNF in their pathogenesis. Accordingly, TNF-inhibiting therapy (TNFi) has dramatically improved the management of these diseases. However, about 30% of patients discontinue TNFi for lack of response, loss of response, and side effects and/or adverse events. Thus, the possibility to identify in advance those patients who will have a good response to TNFi would be extremely beneficial. The aim of this study was to investigate differences between males and females with either SpA or IBD in response to TNFi molecules, i.e., infliximab (IFX) and adalimumab (ADA), considering the reasons for TNFi withdraw. Data of 594 patients, 349 with IBD (M/F: 194/155) and 245 with SpA (M/F: 123/122), previously unexposed to TNFi, were collected. In the IBD group, the rate of female patients discontinuing ADA was significantly higher than that of male patients (p = 0.03). No difference emerged according to the distribution of reason for discontinuation. Otherwise, a similar discontinuation rate between female and male patients receiving IFX therapy was observed. In the SpA group, the overall discontinuation rate was not different between males and females both for ADA and IFX. However, in patients treated with ADA, males interrupted therapy more frequently than females due to lack of response (p = 0.03). In conclusion, the assessment of sex differences in TNFi response could help physicians personalize the therapeutic approach in a sex-oriented perspective.
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Affiliation(s)
- Bruno Laganà
- Autoimmune Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | | | | | - Alberto Migliore
- Rheumatology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | | | - Roberto Lorenzetti
- Gastroenterology and Digestive Endoscopy, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Palma Scolieri
- Rheumatology Unit, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Lorenzo Ridola
- Gastroenterology Unit, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Elena Ortona
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - Marina Pierdominici
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, Rome, Italy
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Abstract
PURPOSE OF REVIEW The medical management of inflammatory bowel disease (IBD) remains problematic with a pressing need for innovation in drug development as well as delivery of personalized therapies. Both the disease's inherent pathophysiologic complexity and heterogeneity in its etiology conspire in making it difficult to accurately model for either the purposes of basic research or drug development. Multiple attempts at creating meaningful experimental models have fallen short of adequately recapitulating the disease and most do not capture any aspect of the cause or the effects of patient heterogeneity that underlays most of the difficulties faced by physicians and their patients. In vivo animal models, tissue culture systems, and more recent synthetic biology approaches are all too simplistically reductionist for the task. However, ex vivo culture platforms utilizing patient biopsies offer a system that more closely mimics end-stage disease processes that can be studied in detail and subjected to experimental manipulations. RECENT FINDINGS Recent studies describe further optimization of mucosal explant cultures in order to increase tissue viability and maintain a polarized epithelial layer. Current applications of the platform include studies of the interplay between the epithelial, immune and stromal compartment of the intestinal tissue, investigation of host-microbial interactions, preclinical evaluation of candidate drugs and uncovering mechanisms of action of established or emerging treatments for IBD. SUMMARY Patient explant-based assays offer an advanced biological system in IBD that recapitulates disease complexity and reflects the heterogeneity of the patient population. In its current stage of development, the system can be utilized for drug testing prior to the costlier and time-consuming evaluation by clinical trials. Further refinement of the technology and establishment of assay readouts that correlate with therapeutic outcomes will yield a powerful tool for personalized medicine approaches in which individual patient responses to available treatments are assessed a priori, thus reducing the need for trial and error within the clinical setting.
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Villanacci V, Cadei M, Lanzarotto F, Ricci C, Antonelli E, Cannatelli R, Gulotta T, Fontana L, Pasquali V, Sigala S, Salviato T, Nascimbeni R, Bassotti G. Localization of TNF alpha in ileocolonic biopsies of patients with inflammatory bowel disease. Ann Diagn Pathol 2018; 38:20-25. [PMID: 30388432 DOI: 10.1016/j.anndiagpath.2018.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/08/2018] [Accepted: 10/25/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Although antitumor necrosis factor alfa (TNFα) agents are widely used to treat patients with inflammatory bowel diseases (IBD) - both Crohn's disease (CD) and ulcerative colitis (UC) - there is still some uncertainty in the cell type expressing TNFα in human ileo-colonic segments. AIMS We investigated the immunohistochemical (IHC) expression of TNFα in the ileo-colonic segments of patients with both active CD and UC, to establish its anatomic and cellular localization in the inflamed sites. Our aim was to identify patients potentially resistant to anti TNFα agents. PATIENTS AND METHODS Ileo-colonic slides of complete histological mapping of patients with CD and UC before any treatment was started were obtained, and serial sections assessed for TNFα expression, together with IHC markers for lymphocytes, macrophages, and plasma cells. RESULTS TNFα was expressed in almost all inflamed segments of IBD patients, albeit with different strength, and was present, in addition to lymphocytes and, to a lesser extent, to macrophages, in plasma cells, where it had a strong positivity, as also demonstrated by colocalization of specific IHC staining. The expression of TNFα was mostly focal in CD patients and more diffuse in UC patients, likely due to the different patterns of inflammation (transmural and mucosal) of the two entities. CONCLUSIONS In IBD, TNFα is strongly expressed also in plasma cells, and it is easily evidenced by conventional IHC techniques. It remains to be established whether this observation might be useful in future to establish in routine biopsy samples whether patients may be responsive to treatments toward this cytokine.
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Affiliation(s)
- Vincenzo Villanacci
- Pathology Section, Department of Molecular and Translational Medicine, Spedali Civili and University of Brescia, Italy.
| | - Moris Cadei
- Pathology Section, Department of Molecular and Translational Medicine, Spedali Civili and University of Brescia, Italy
| | - Francesco Lanzarotto
- Gastroenterology Section, 1st Medical Clinic, Spedali Civili and University of Brescia, Italy
| | - Chiara Ricci
- Gastroenterology Section, 1st Medical Clinic, Spedali Civili and University of Brescia, Italy
| | | | - Rosanna Cannatelli
- Gastroenterology Section, 1st Medical Clinic, Spedali Civili and University of Brescia, Italy
| | - Tiziana Gulotta
- Pathology Section, Department of Molecular and Translational Medicine, Spedali Civili and University of Brescia, Italy
| | - Lucia Fontana
- Pathology Section, Department of Molecular and Translational Medicine, Spedali Civili and University of Brescia, Italy
| | - Valentina Pasquali
- Pathology Section, Department of Molecular and Translational Medicine, Spedali Civili and University of Brescia, Italy
| | | | - Tiziana Salviato
- Department of Pathology, University of Trieste School of Medicine, Trieste, Italy
| | | | - Gabrio Bassotti
- Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia School of Medicine, Perugia, Italy
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Rundquist S, Eriksson C, Nilsson L, Angelison L, Jäghult S, Björk J, Grip O, Hjortswang H, Strid H, Karlén P, Montgomery S, Halfvarson J. Clinical effectiveness of golimumab in Crohn's disease: an observational study based on the Swedish National Quality Registry for Inflammatory Bowel Disease (SWIBREG). Scand J Gastroenterol 2018; 53:1257-1263. [PMID: 30353751 DOI: 10.1080/00365521.2018.1519597] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The effectiveness of golimumab in Crohn's disease (CD) is largely unknown as it is not approved for the treatment of the disease. We aimed to identify the population of CD patients treated with golimumab in Sweden, to assess the effectiveness of golimumab (defined as the drug retention rate), and to identify predictors of drug discontinuation. METHODS Patients with CD who received at least one injection of golimumab were identified through the Swedish National Quality Registry for Inflammatory Bowel Disease, which includes prospectively collected clinical information. Cox regression models were used to identify predictors of golimumab discontinuation. RESULTS The study cohort involved 94 patients of whom the majority (96.8%) had previously discontinued at least one anti-tumour necrosis factor (anti-TNF) agent. The drug retention rate at 12 weeks was 85.1%. Predictors of golimumab discontinuation at 12 weeks were previous surgery (adjusted HR = 7.52, 95% CI: 1.12-50.36), concomitant corticosteroid use at baseline (adjusted HR = 5.70, 95% CI: 1.13-28.68) and female sex (adjusted HR = 6.59; 95% CI: 1.04-41.62). The median duration of follow-up was 89 (IQR: 32-158) weeks. The drug retention at the most recent follow-up was 35.1%. Predictors of golimumab discontinuation at the most recent follow-up were corticosteroid use at baseline (adjusted HR = 2.60, 95% CI: 1.17-5.79) and female sex (adjusted HR = 2.24; 95% CI: 1.19-4.23). CONCLUSION Patients with CD treated with golimumab were a treatment-refractory group. Despite this, more than one-third of the patients appeared to have had clinical benefit after a median follow-up of more than 1.5 years.
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Affiliation(s)
- Sara Rundquist
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Carl Eriksson
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Linda Nilsson
- b Department of Internal Medicine , Danderyd Hospital , Stockholm , Sweden
| | - Leif Angelison
- c Department of Internal Medicine , Helsingborg Hospital , Helsingborg , Sweden
| | - Susanna Jäghult
- d Stockholm Gastro Center, Karolinska Institutet , Danderyd Hospital , Stockholm , Sweden
| | - Jan Björk
- e Department of Medicine, Center for Digestive Diseases , Karolinska University Hospital , Stockholm , Sweden
| | - Olof Grip
- f Department of Gastroenterology , Skåne University Hospital Malmö , Malmö , Sweden
| | - Henrik Hjortswang
- g Department of Gastroenterology , Linköping University , Linköping , Sweden
| | - Hans Strid
- h Department of Internal Medicine , Södra Älvsborgs Sjukhus , Borås , Sweden
| | - Per Karlén
- b Department of Internal Medicine , Danderyd Hospital , Stockholm , Sweden
| | - Scott Montgomery
- i Clinical Epidemiology and Biostatistics, School of Medical Sciences , Örebro University , Örebro , Sweden
- j Clinical Epidemiology Unit, Department of Medicine , Karolinska Institutet , Stockholm , Sweden
- k Department of Epidemiology and Public Health , University College London , London , UK
| | - Jonas Halfvarson
- a Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
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Hoseyni H, Xu Y, Zhou H. Therapeutic Drug Monitoring of Biologics for Inflammatory Bowel Disease: An Answer to Optimized Treatment? J Clin Pharmacol 2018; 58:864-876. [DOI: 10.1002/jcph.1084] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/03/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Hannah Hoseyni
- University of Pittsburgh School of Pharmacy; Pittsburgh PA USA
| | - Yan Xu
- Janssen Research & Development, LLC; Spring House PA USA
| | - Honghui Zhou
- Janssen Research & Development, LLC; Spring House PA USA
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