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Zhang H, Zheng H, Wang Q, Ma Z, Liu W, Xu L, Li D, Zhu Y, Xue Y, Mei L, Huang X, Guo Z, Ke X. Sinomenine hydrochloride improves DSS-induced colitis in mice through inhibition of the TLR2/NF-κB signaling pathway. Clin Res Hepatol Gastroenterol 2024; 48:102411. [PMID: 38992426 DOI: 10.1016/j.clinre.2024.102411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 06/20/2024] [Accepted: 06/29/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Sinomenine hydrochloride (SH) has anti-inflammatory and immunosuppressive effects, and its effectiveness in inflammatory diseases, such as rheumatoid arthritis, has been demonstrated. However, whether SH has a therapeutic effect on dextran sodium sulfate (DSS)-induced ulcerative colitis (UC) in mice and its mechanism of action have not been clarified. This study aimed to investigate the therapeutic effects and mechanism of action of SH on UC. METHODS Twenty-four mice were randomly divided into control, model, SH low-dose (SH-L, 20mg/kg), and SH high-dose (SH-H, 60mg/kg) groups with six mice in each group. Disease activity index (DAI), colonic mucosal damage index, and colonic histopathology scores were calculated. The expression levels of related proteins, genes, and downstream inflammatory factors in the Toll-like receptor 2/NF-κB (TLR2/NF-κB) signaling pathway were quantified. RESULTS SH inhibited weight loss, decreased DAI and histopathological scores, decreased the expression levels of TLR2, MyD88, P-P65, P65 proteins, and TLR2 genes, and also suppressed the expression of inflammatory factors TNF-α, IL-1 β, and IL-6 in the peripheral blood of mice. CONCLUSION The therapeutic effect of SH on DSS-induced UC in mice may be related to the inhibition of the TLR2/NF-κB signaling pathway.
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Affiliation(s)
- Huimin Zhang
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Hailun Zheng
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Qizhi Wang
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Zhenzeng Ma
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Wei Liu
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Linxia Xu
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Dapeng Li
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Yu Zhu
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Yongju Xue
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Letian Mei
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Xixiang Huang
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China
| | - Zhiguo Guo
- Department of Gastroenterology, Suzhou Hospital of Anhui Medical University, No. 616, Bianyangsan Road, Suzhou, Anhui 234000, China.
| | - Xiquan Ke
- Department of Gastroenterology, the First Affiliated Hospital of Bengbu Medical University, No. 287, Changhuai Road, Bengbu, Anhui 233000, China.
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Sheridan M, Massich M, Ashourian N. Biosimilars: From Production to Patient. JOURNAL OF INFUSION NURSING 2024; 47:19-29. [PMID: 38211611 PMCID: PMC10786443 DOI: 10.1097/nan.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Biologic drugs are large, complex molecules produced through biotechnology. A biosimilar is a biologic product that is highly similar to an already approved biologic (reference product), with no clinically meaningful differences in purity, safety, or efficacy; as such, a biosimilar does not need to undergo the same level of study in a clinical trial program as the original reference product. Due to the potential impact of biosimilars on patient access and health care systems, the US Food and Drug Administration introduced an abbreviated pathway for approving biosimilars (351[k]) in 2009. There is strong evidence that switching from a reference product to a biosimilar does not reduce treatment effectiveness or increase the risk of adverse events. Biosimilars may reduce costs and increase patient access to biologic therapies. Biosimilar use in the United States has increased, as have the associated biosimilar cost savings, which are expected to reach $104 billion between 2020 and 2024. Yet, a need remains for increased knowledge among health care professionals and patients. Prescriber confidence is key to patient acceptance of biosimilars and minimizing the incidence of the nocebo effect. Infusion nurses are well positioned to help educate patients and to improve clinical outcomes across a range of diseases.
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Affiliation(s)
- Maria Sheridan
- Fresenius Kabi USA, LLC, Lake Zurich, Illinois
- Maria Sheridan, PharmD, BCNSP, is a pharmacist with inpatient and outpatient clinical experience caring for parenteral nutrition patients with conditions including cancer, autoimmune diseases, intestinal failure, and gastrointestinal and abdominal surgery complications. She spent most of her clinical practice at the Mayo Clinic Florida on a multidisciplinary team prior to transitioning to industry, where she continues to contribute to patient care through her passion for scientific education. Dr Sheridan has presented at local, state, and national professional meetings on biosimilars, pharmacy, and nutrition support topics. She previously led the oncology biosimilars Medical Science Liaison (MSL) team in Medical Affairs at Fresenius Kabi USA, focused on health care practitioner biosimilars education
- Matthew Massich, PhD, is a senior manager of US Biosimilars Medical Affairs at Fresenius Kabi USA. He is responsible for developing and executing the medical affairs strategic plan, educational initiatives, and medical communications to support the launch of biosimilar products. Dr Massich has nearly 10 years of biosimilars experience, working with multiple pharmaceutical companies to bring biologic and biosimilar products to market. He earned his PhD in Biological Sciences at Northwestern University in Evanston, Illinois, and completed postdoctoral training at Argonne National Laboratory's Center for Nanoscale Materials
- Nazanin Ashourian, PhD, was the former head of US Biosimilars Medical Affairs at Fresenius Kabi USA. She led the Medical Affairs team in the identification of data and knowledge gaps, development and execution of medical strategies, data generation, and communication of scientific/clinical information that support health care providers in clinical decision-making and patient care. Dr Ashourian received her PhD in biochemistry and molecular genetics from the Johns Hopkins University and has over 15 years of experience in scientific/clinical research, drug development, and medical strategy and communications
| | - Matthew Massich
- Corresponding Author: Matthew Massich, PhD, Fresenius Kabi USA LLC, 3 Corporate Dr, Lake Zurich, IL 60047 ()
| | - Nazanin Ashourian
- Fresenius Kabi USA, LLC, Lake Zurich, Illinois
- Maria Sheridan, PharmD, BCNSP, is a pharmacist with inpatient and outpatient clinical experience caring for parenteral nutrition patients with conditions including cancer, autoimmune diseases, intestinal failure, and gastrointestinal and abdominal surgery complications. She spent most of her clinical practice at the Mayo Clinic Florida on a multidisciplinary team prior to transitioning to industry, where she continues to contribute to patient care through her passion for scientific education. Dr Sheridan has presented at local, state, and national professional meetings on biosimilars, pharmacy, and nutrition support topics. She previously led the oncology biosimilars Medical Science Liaison (MSL) team in Medical Affairs at Fresenius Kabi USA, focused on health care practitioner biosimilars education
- Matthew Massich, PhD, is a senior manager of US Biosimilars Medical Affairs at Fresenius Kabi USA. He is responsible for developing and executing the medical affairs strategic plan, educational initiatives, and medical communications to support the launch of biosimilar products. Dr Massich has nearly 10 years of biosimilars experience, working with multiple pharmaceutical companies to bring biologic and biosimilar products to market. He earned his PhD in Biological Sciences at Northwestern University in Evanston, Illinois, and completed postdoctoral training at Argonne National Laboratory's Center for Nanoscale Materials
- Nazanin Ashourian, PhD, was the former head of US Biosimilars Medical Affairs at Fresenius Kabi USA. She led the Medical Affairs team in the identification of data and knowledge gaps, development and execution of medical strategies, data generation, and communication of scientific/clinical information that support health care providers in clinical decision-making and patient care. Dr Ashourian received her PhD in biochemistry and molecular genetics from the Johns Hopkins University and has over 15 years of experience in scientific/clinical research, drug development, and medical strategy and communications
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Castle JT, Levy BE, Mangino AA, McDonald HG, McAtee E, Patel JA, Evers BM, Bhakta AS. Impact of the Affordable Care Act on Providing Equitable Healthcare Access for IBD in the Kentucky Appalachian Region. Dis Colon Rectum 2023; 66:1273-1281. [PMID: 37399124 PMCID: PMC10527721 DOI: 10.1097/dcr.0000000000002942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
BACKGROUND Medicaid expansion improved insurance coverage for patients with chronic conditions and low income. The effect of Medicaid expansion on patients with IBD from high-poverty communities is unknown. OBJECTIVE This study aimed to evaluate the impact of Medicaid expansion in Kentucky on care for patients with IBD from the Eastern Kentucky Appalachian community, a historically impoverished area. DESIGN This study was a retrospective, descriptive, and ecological study. SETTINGS This study was conducted in Kentucky using the Hospital Inpatient Discharge and Outpatient Services Database. PATIENTS All encounters for IBD care for 2009-2020 for patients from the Eastern Kentucky Appalachian region were included. MAIN OUTCOME MEASURES The primary outcomes measured were proportions of inpatient and emergency encounters, total hospital charge, and hospital length of stay. RESULTS Eight hundred twenty-five preexpansion and 5726 postexpansion encounters were identified. Postexpansion demonstrated decreases in the uninsured (9.2%-1.0%; p < 0.001), inpatient encounters (42.7%-8.1%; p < 0.001), emergency admissions (36.7%-12.3%; p < 0.001), admissions from the emergency department (8.0%-0.2%; p < 0.001), median total hospital charge ($7080-$3260; p < 0.001), and median total hospital length of stay (4-3 days; p < 0.001). Similarly, postexpansion demonstrated increases in Medicaid coverage (18.8%-27.7%; p < 0.001), outpatient encounters (57.3%-91.9%; p < 0.001), elective admissions (46.9%-76.2%; p < 0.001), admissions from the clinic (78.4%-90.2%; p < 0.001), and discharges to home (43.8%-88.2%; p < 0.001). LIMITATIONS This study is subject to the limitations inherent in being retrospective and using a partially de-identified database. CONCLUSION This study is the first to demonstrate the changes in trends in care after Medicaid expansion for patients with IBD in the Commonwealth of Kentucky, especially Appalachian Kentucky, showing significantly increased outpatient care utilization, reduced emergency department encounters, and decreased length of stays. IMPACTO DE LA LEY DEL CUIDADO DE SALUD A BAJO PRECIO EN LA PROVISIN DE ACCESO EQUITATIVO A LA ATENCIN MDICA PARA LA ENFERMEDAD INFLAMATORIA INTESTINAL EN LA REGIN DE LOS APALACHES DE KENTUCKY ANTECEDENTES: La expansión de Medicaid mejoró la cobertura de seguro para pacientes con enfermedades crónicas y bajos ingresos. Se desconoce el efecto de la expansión de Medicaid en pacientes con enfermedad inflamatoria intestinal de comunidades de alta pobreza.OBJETIVO: Este estudio tuvo como objetivo evaluar el impacto de la expansión de Medicaid en Kentucky en la atención de pacientes con enfermedad inflamatoria intestinal de la comunidad de los Apalaches del este de Kentucky, un área históricamente empobrecida.DISEÑO: Este estudio fue un estudio retrospectivo, descriptivo, ecológico.ESCENARIO: Este estudio se realizó en Kentucky utilizando la base de datos de servicios ambulatorios y de alta hospitalaria en pacientes hospitalizados.PACIENTES: Se incluyeron todos los encuentros para la atención de la enfermedad inflamatoria intestinal de 2009-2020 para pacientes de la región de los Apalaches del este de Kentucky.MEDIDAS DE RESULTADO PRINCIPALES: Los resultados primarios medidos fueron proporciones de encuentros de pacientes hospitalizados y de emergencia, cargo hospitalario total y duración de la estancia hospitalaria.RESULTADOS: Se identificaron 825 encuentros previos a la expansión y 5726 posteriores a la expansión. La posexpansión demostró disminuciones en los no asegurados (9.2% a 1.0%, p < 0.001), encuentros de pacientes hospitalizados (42.7% a 8.1%, p < 0.001), admisiones de emergencia (36.7% a 12.3%, p < 0,001), admisiones desde el servicio de urgencias (8.0% a 0.2%, p < 0.001), la mediana de los gastos hospitalarios totales ($7080 a $3260, p < 0.001) y la mediana de la estancia hospitalaria total (4 a 3 días, p < 0.001). De manera similar, la cobertura de Medicaid (18.8% a 27.7%, p < 0.001), consultas ambulatorias (57.3% a 91.9%, p < 0.001), admisiones electivas (46.9% a 76.2%, p < 0.001), admisiones desde la clínica (78.4% al 90.2%, p < 0.001), y las altas domiciliarias (43.8% al 88.2%, p < 0.001) aumentaron después de la expansión.LIMITACIONES: Este estudio está sujeto a las limitaciones inherentes de ser retrospectivo y utilizar una base de datos parcialmente desidentificada.CONCLUSIONES: Este estudio es el primero en demostrar los cambios en las tendencias en la atención después de la expansión de Medicaid para pacientes con enfermedad inflamatoria intestinal en el Estado de Kentucky, especialmente en los Apalaches de Kentucky, mostrando un aumento significativo en la utilización de la atención ambulatoria, visitas reducidas al departamento de emergencias y menor duración de la estancia hospitalaria. (Traducción-Dr. Jorge Silva Velazco ).
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Affiliation(s)
- Jennifer T. Castle
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Brittany E. Levy
- Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Anthony A. Mangino
- Department of Biostatistics, University of Kentucky, Lexington, Kentucky
| | - Hannah G. McDonald
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Erin McAtee
- Department of Surgery, University of Kentucky, Lexington, Kentucky
| | - Jitesh A. Patel
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Division of Colorectal Surgery, University of Kentucky, Lexington, Kentucky
| | - B. Mark Evers
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky
| | - Avinash S. Bhakta
- Department of Surgery, University of Kentucky, Lexington, Kentucky
- Division of Colorectal Surgery, University of Kentucky, Lexington, Kentucky
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Rich KM, Guardado R, Bigham ZR, Boms O, Long M, Wurcel AG. The Impact of Incarceration on Readmissions Among Patients With Inflammatory Bowel Disease Hospitalized at a Community Hospital. GASTRO HEP ADVANCES 2023; 2:660-665. [PMID: 39129865 PMCID: PMC11308048 DOI: 10.1016/j.gastha.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/13/2023] [Indexed: 08/13/2024]
Abstract
Background and Aims Individuals who are incarcerated often have limited access to first-line treatment and comprehensive health care. In this study, we aimed to compare the frequency of readmissions among patients with inflammatory bowel disease (IBD) receiving care at a community hospital who were and were not incarcerated at the time of hospitalization. Methods We analyzed records from Lemuel Shattuck Hospital for all patients admitted between January 1, 2011, and December 31, 2019. Patients with IBD were identified using International Classification of Diseases codes. The primary outcome was all-cause readmission at 1 year following an IBD-related admission. Secondary outcomes were (1) all-cause readmission at 30 days, (2) IBD-related readmission at 30 days, and (3) IBD-related readmission at 1 year. Our indicator of interest was incarceration. Multivariable logistic regression models were built to describe predictors of all-cause readmissions at 1 year. Results Among the 6511 individuals hospitalized at Lemuel Shattuck Hospital between 2011 and 2019, 90 individuals (1.4%) had International Classification of Diseases codes for IBD, either ulcerative colitis (n = 44) and/or Crohn's disease (n = 39). Half (n = 46) of patients with IBD were incarcerated during hospital admission. Individuals who were incarcerated had a higher rate of all-cause readmissions at 1 year than those who were not incarcerated at the time of hospitalization (76.0% vs 41.5%, P = .005). Multivariable analysis showed patients who were incarcerated had 3.98 (95% confidence interval: 1.39-12.78) increased odds of all-cause readmission within 1 year. Conclusion Our results suggest individuals with IBD who are incarcerated may experience worse health outcomes than individuals who are not incarcerated, adding to a body of literature documenting the negative impact of incarceration on health.
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Affiliation(s)
| | - Rubeen Guardado
- Tufts Medical Center, Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Boston, Massachusetts
| | - Zahna R. Bigham
- Tufts University School of Medicine, Boston, Massachusetts
- Graduate School of Biomedical Sciences, Tufts University, Boston, Massachusetts
| | - Okechi Boms
- Harvard Medical School, Boston, Massachusetts
- Harvard Kennedy School, Boston, Massachusetts
| | - Michelle Long
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
- Medical & Science, Clinical Drug Development, Novo Nordisk, Inc, Cambridge, Massachusetts
| | - Alysse G. Wurcel
- Tufts Medical Center, Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Boston, Massachusetts
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Boston, Massachusetts
- Infectious Diseases Liaison, Massachusetts Sheriffs Association, Boston, Massachusetts
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Sariahmed K, Kurian J, Singh AK, Leyton C, Minuti A, Jerschow E, Arora S, Jariwala SP. Social, political, and economic determinants of access to biologics: A scoping review of structural determinants in the clinical disparities literature. Res Social Adm Pharm 2022; 18:4038-4047. [DOI: 10.1016/j.sapharm.2022.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 05/05/2022] [Accepted: 07/28/2022] [Indexed: 02/07/2023]
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Lukin D, Faleck D, Xu R, Zhang Y, Weiss A, Aniwan S, Kadire S, Tran G, Rahal M, Winters A, Chablaney S, Koliani-Pace JL, Meserve J, Campbell JP, Kochhar G, Bohm M, Varma S, Fischer M, Boland B, Singh S, Hirten R, Ungaro R, Lasch K, Shmidt E, Jairath V, Hudesman D, Chang S, Swaminath A, Shen B, Kane S, Loftus EV, Sands BE, Colombel JF, Siegel CA, Sandborn WJ, Dulai PS. Comparative Safety and Effectiveness of Vedolizumab to Tumor Necrosis Factor Antagonist Therapy for Ulcerative Colitis. Clin Gastroenterol Hepatol 2022; 20:126-135. [PMID: 33039584 PMCID: PMC8026779 DOI: 10.1016/j.cgh.2020.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/04/2020] [Accepted: 10/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS We aimed to compare safety and effectiveness of vedolizumab to tumor necrosis factor (TNF)-antagonist therapy in ulcerative colitis in routine practice. METHODS A multicenter, retrospective, observational cohort study (May 2014 to December 2017) of ulcerative colitis patients treated with vedolizumab or TNF-antagonist therapy. Propensity score weighted comparisons for development of serious adverse events and achievement of clinical remission, steroid-free clinical remission, and steroid-free deep remission. A priori determined subgroup comparisons in TNF-antagonist-naïve and -exposed patients, and for vedolizumab against infliximab and subcutaneous TNF-antagonists separately. RESULTS A total of 722 (454 vedolizumab, 268 TNF antagonist) patients were included. Vedolizumab-treated patients were more likely to achieve clinical remission (hazard ratio [HR], 1.651; 95% confidence interval [CI], 1.229-2.217), steroid-free clinical remission (HR, 1.828; 95% CI, 1.135-2.944), and steroid-free deep remission (HR, 2.819; 95% CI, 1.496-5.310) than those treated with TNF antagonists. Results were consistent across subgroup analyses in TNF-antagonist-naïve and -exposed patients, and for vedolizumab vs infliximab and vs subcutaneous TNF-antagonist agents separately. Overall, there were no statistically significant differences in the risk of serious adverse events (HR, 0.899; 95% CI, 0.502-1.612) or serious infections (HR, 1.235; 95% CI, 0.608-2.511) between vedolizumab-treated and TNF-antagonist-treated patients. However, in TNF-antagonist-naïve patients, vedolizumab was less likely to be associated with serious adverse events than TNF antagonists (HR, 0.192; 95% CI, 0.049-0.754). CONCLUSIONS Treatment of ulcerative colitis with vedolizumab is associated with higher rates of remission than treatment with TNF-antagonist therapy in routine practice, and lower rates of serious adverse events in TNF-antagonist-naïve patients.
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Affiliation(s)
- Dana Lukin
- Montefiore Medical Center, New York, New York
| | - David Faleck
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ronghui Xu
- University of California, San Diego, La Jolla, California
| | - Yiran Zhang
- University of California, San Diego, La Jolla, California
| | - Aaron Weiss
- Montefiore Medical Center, New York, New York
| | | | | | | | | | - Adam Winters
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Joseph Meserve
- University of California, San Diego, La Jolla, California
| | | | | | | | | | | | - Brigid Boland
- University of California, San Diego, La Jolla, California
| | | | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ryan Ungaro
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen Lasch
- Takeda Pharmaceuticals, Lexington, Massachusetts
| | | | - Vipul Jairath
- University of Western Ontario, London, Ontario, Canada
| | | | | | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Bruce E. Sands
- Icahn School of Medicine at Mount Sinai, New York, New York
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Treatment Pathways Leading to Biologic Therapies for Ulcerative Colitis and Crohn's Disease in the United States. Clin Transl Gastroenterol 2021; 11:e00128. [PMID: 32463619 PMCID: PMC7145024 DOI: 10.14309/ctg.0000000000000128] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Biologic therapies have been available for inflammatory bowel disease for >20 years, but patient outcomes have not changed appreciably over this time period. To better understand medication utilization for this disease, we evaluated a novel technique for visualizing treatment pathways, including initial treatment, switching, and combination therapies.
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Bohm M, Xu R, Zhang Y, Varma S, Fischer M, Kochhar G, Boland B, Singh S, Hirten R, Ungaro R, Shmidt E, Lasch K, Jairaith V, Hudesman D, Chang S, Lukin D, Swaminath A, Sands BE, Colombel J, Kane S, Loftus EV, Shen B, Siegel CA, Sandborn WJ, Dulai PS. Comparative safety and effectiveness of vedolizumab to tumour necrosis factor antagonist therapy for Crohn's disease. Aliment Pharmacol Ther 2020; 52:669-681. [PMID: 32656800 PMCID: PMC7496810 DOI: 10.1111/apt.15921] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 01/15/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Direct comparisons are lacking between vedolizumab and tumour necrosis factor (TNF)-antagonist therapy in Crohn's disease (CD). AIM To compare safety and effectiveness of vedolizumab and TNF-antagonist therapy in adult CD patients. METHODS Retrospective observational cohort (May 2014-December 2017) propensity score-weighted comparison of vedolizumab vs TNF-antagonist therapy (infliximab, adalimumab, certolizumab) in CD. Propensity scores were weighted for age, prior treatments, disease complications, extent and severity, steroid dependence, and concomitant immunosuppressive drug use. The primary outcome was comparative risk for infections or non-infectious serious adverse events (requiring antibiotics, antivirals, antifungals, hospitalisation, or treatment discontinuation, or resulting in death). Secondary comparative effectiveness outcomes were clinical remission (resolution of CD-related symptoms), steroid-free clinical remission and endoscopic remission (absence of ulcers/erosions). RESULTS We included 1266 patients (n = 659 vedolizumab). Rates of non-infectious serious adverse events (odds ratio [OR] 0.072, 95% confidence interval [CI] 0.012-0.242), but not serious infections (OR 1.183, 95% CI 0.786-1.795), were significantly lower with vedolizumab vs TNF-antagonist therapy. Safety comparisons for non-infectious serious adverse events remained significant after adjusting for differences in duration of exposure. No significant difference was observed between vedolizumab and TNF-antagonist therapy for clinical remission (hazard ratio [HR] 0.932, 95% CI 0.707-1.228), steroid-free clinical remission (HR 1.250, 95% CI 0.677-2.310) or endoscopic remission (HR 0.827, 95% CI 0.595-1.151). TNF-antagonist therapy was associated with higher treatment persistence compared with vedolizumab. CONCLUSIONS There was a lower risk of non-infectious serious adverse events, but not serious infections, with vedolizumab vs TNF-antagonist therapy, with no significant difference for achieving disease remission.
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Scott FI, Luo M, Shah Y, Lasch K, Vajravelu RK, Mamtani R, Fennimore B, Gerich ME, Lewis JD. Identification of the Most Cost-effective Position of Vedolizumab Among the Available Biologic Drugs for the Treatment of Ulcerative Colitis. J Crohns Colitis 2020; 14:575-587. [PMID: 31901085 PMCID: PMC7303595 DOI: 10.1093/ecco-jcc/jjz212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS There are limited data on the most cost-effective sequencing of biologics for ulcerative colitis [UC]. METHODS We used Markov modelling to identify the most cost-effective position for vedolizumab among biologics for steroid-dependent UC, with a base-case of a 35-year-old male. We assessed three treatment algorithms, with vedolizumab use: prior to an initial anti-tumour necrosis factor alpha [anti-TNFα] and azathioprine [Algorithm 1]; prior to a second anti-TNF and azathioprine [Algorithm 2]; and prior to colectomy [Algorithm 3]. The initial anti-TNF could be either infliximab or adalimumab. Transition probabilities, costs, and quality-adjusted life-year estimates were derived from published estimates, Medicare, and the Nationwide Inpatient Sample. Primary analyses included 100 trials of 100 000 individuals over 1 year, with a willingness-to-pay threshold of US$100,000. Multiple sensitivity analyses were conducted to assess our findings. RESULTS From a population perspective, when both infliximab and adalimumab are available, vedolizumab was preferred as the first biologic if ≥14% of initial anti-TNF use was adalimumab. If infliximab is the primary biologic, vedolizumab use after infliximab [Algorithm 2] and prior to adalimumab was the most cost-effective strategy. All models were sensitive to biologic pricing. CONCLUSIONS This simulation demonstrated that the most cost-effective strategy in UC depends on the proportion of patients using adalimumab as the initial anti-TNF. If adalimumab was ≥14%, vedolizumab was preferred as the first biologic. When only infliximab was available for first-line therapy, the most cost-effective position of vedolizumab was prior to cycling to adalimumab.
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Affiliation(s)
- Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO,USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Corresponding author: Frank I. Scott, MD, MSCE, Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA. Tel.: 720-848-2777; fax: 720-848-2778;
| | - Michelle Luo
- University of Pennsylvania School of Arts and Sciences, Philadelphia PA, USA
| | - Yash Shah
- Global Evidence & Out, Takeda Pharmaceuticals, Deerfield, IL, USA
| | - Karen Lasch
- US Medical Department, Takeda Pharmaceuticals, Deerfield, IL, USA
| | - Ravy K Vajravelu
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ronac Mamtani
- Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Blair Fennimore
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO,USA
| | - Mark E Gerich
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO,USA
| | - James D Lewis
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA,US Medical Department, Takeda Pharmaceuticals, Deerfield, IL, USA
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10
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Varyani F, Argyriou K, Phillips F, Tsakiridou E, Moran GW. Profile of Tofacitinib in the Treatment of Ulcerative Colitis: An Evidence-Based Review of Recent Data. Drug Des Devel Ther 2019; 13:4091-4105. [PMID: 31819376 PMCID: PMC6897052 DOI: 10.2147/dddt.s182891] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/20/2019] [Indexed: 12/30/2022] Open
Abstract
Recent advances in the understanding of the pathophysiology of ulcerative colitis (UC) have led to the expansion of our therapeutic arsenal. Conventional treatment options, including aminosalicylates, corticosteroids, thiopurines, and calcineurin inhibitors, fail to control the disease in a significant proportion of patients. Approximately 25-50% of the patients treated with tumor necrosis factor antibodies (anti-TNFα) are primary and secondary non-responders to therapy. Tofacitinib is a novel orally administered small synthetic molecule that inhibits a homologous family of enzymes, termed Janus kinases that modulate multiple key cytokines involved in the pathogenesis of UC. Phase II and III trials showed promising results in UC, leading the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) to approve its administration for the induction and maintenance of remission in moderate-to-severe UC. Herein, we review tofacitinib for the management of UC, its mechanism of action pharmacokinetic properties, efficacy, and safety.
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Affiliation(s)
- Fumi Varyani
- Queen’s Medical Center, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Konstantinos Argyriou
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Frank Phillips
- Queen’s Medical Center, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Gordon William Moran
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute of Health Research, Nottingham Biomedical Research Centre at Nottingham University Hospitals National Health Service Trust and the University of Nottingham, Nottingham, UK
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