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Musters AH, van Lookeren FL, van der Gang LF, Middelkamp-Hup MA, Bosma AL, Jessurun NT, Lapeere H, Nguyen AL, Ouwerkerk W, de Schepper S, Gerbens LAA, Spuls PI. Real-world reported adverse events related to systemic immunomodulating therapy in patients with atopic dermatitis: Results from the TREAT NL (TREatment of ATopic eczema, the Netherlands) registry. J Eur Acad Dermatol Venereol 2024; 38:530-542. [PMID: 38031478 DOI: 10.1111/jdv.19643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Evidence on the (long-term) safety of systemic immunomodulating therapies in atopic dermatitis (AD) generated by real-world data is sparse. OBJECTIVES To describe real-world reported adverse drug reactions (AEs) related to systemic immunomodulating therapy in patients with AD and to compare the incidence rates of AEs with the Summaries of Product Characteristics (SmPCs). METHODS We conducted an observational prospective multi-centre cohort study, using the TREAT NL registry. All severe AEs, AEs of special interest and serious AEs in adult and paediatric patients on systemic immunomodulating treatment (ciclosporin, methotrexate, azathioprine, mycophenolic acid, dupilumab, tralokinumab, baricitinib and upadacitinib) were assessed. Incidences rates of all (potentially) drug-related AEs were standardized in patient years and compared to the cumulative incidences in the associated SmPCs. RESULTS We collected 422 patient years of safety data from 266 patients, of whom 129 (48.5%) reported a total of 224 (potentially) drug-related AEs. Compared to dupilumab's SmPC, higher incidence rates were found for four AEs (reported ≥5 times): eosinophilia, blepharitis, dry eyes and head and neck erythema (i.e. dupilumab facial redness). A higher incidence rate of fatigue was found in patients on oral methotrexate in our cohort compared to the SmPC. Two new drug-related AEs (reported ≥5 times) were found in patients on dupilumab, including non-infectious conjunctivitis and meibomian gland dysfunction. CONCLUSIONS Real-world reported AEs captured in AD patient registries can add information on the estimated incidence of AEs and benefit clinical decision aids. Future studies using data derived from the TREAT NL registry combined with data from other registries within the TREAT Registry Taskforce will provide more information on (rare) AEs associated with immunomodulating therapy in AD patients.
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Affiliation(s)
- A H Musters
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - F L van Lookeren
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - L F van der Gang
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M A Middelkamp-Hup
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - A L Bosma
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
| | - N T Jessurun
- Netherlands' Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - H Lapeere
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - A L Nguyen
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - W Ouwerkerk
- Department of Dermatology, Amsterdam Infection & Immunity Institute, Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- National Heart Centre Singapore, Singapore, Singapore
| | - S de Schepper
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - L A A Gerbens
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
- Huid Medisch Centrum, Amsterdam, The Netherlands
| | - P I Spuls
- Department of Dermatology, Amsterdam UMC, location Academic Medical Center, Amsterdam Public Health, Infection and Immunity, University of Amsterdam, Amsterdam, The Netherlands
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Losa A, Gomes R, Mourão FR, Cardoso SS, Vieira PM, Correia MR, Silva HM, Silva G, Tavares M, Silva ES, Lima R. Drug-Related Adverse Reactions in Pediatric Inflammatory Bowel Disease. J Clin Pharmacol 2024; 64:103-110. [PMID: 37611322 DOI: 10.1002/jcph.2339] [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] [Received: 04/28/2023] [Accepted: 08/18/2023] [Indexed: 08/25/2023]
Abstract
The therapeutic approach to inflammatory bowel disease (IBD) is complex, often involving multiple pharmacologic classes. We aimed to evaluate the prevalence of drug-related adverse reactions (ARs) associated with therapies used in pediatric IBD. We conducted a retrospective study of pediatric patients with IBD followed in a tertiary hospital from 2010 to 2022. Ninety-nine patients were included (62.6% were male), with a median age at diagnosis of 13 years (interquartile range [IQR] 11-15 years). The majority had Crohn's disease (69.7%), followed by ulcerative colitis (21.2%) and unclassified IBD (9.1%). The most prescribed therapies were: immunomodulators (n = 75, 75.8%), exclusive enteral nutrition (n = 61, 61.6%), and biologics (n = 58, 58.6%). During a median follow-up time of 31 months (IQR 11-51 months), the incidence of ARs was 16.2% (16 ARs occurred in 14 patients). The main drug involved was azathioprine (12/16) and the most frequent AR was hepatitis (5/16). Drug discontinuation was necessary in all but 1 case. Of the ARs recorded, 75% were mild to moderate and 81.3% did not require specific treatment; all patients had clinical and/or analytical normalization. There was a positive association between the cumulative number of prescribed drugs and the occurrence of ARs (P = .044). The incidence of ARs was similar to the rates reported in the few existing previous studies. The majority of ARs were mild, but implied the discontinuation of therapy or dose reduction, with a possible impact on disease control.
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Affiliation(s)
- Ana Losa
- Pediatrics Department, Centro Materno Infantil do Norte Albino Aroso, Centro Hospitalar Universitário de Santo António (CMIN-CHUdSA), Porto, Portugal
| | - Rita Gomes
- Pediatrics Department, Centro Materno Infantil do Norte Albino Aroso, Centro Hospitalar Universitário de Santo António (CMIN-CHUdSA), Porto, Portugal
| | | | | | - Paula Manuel Vieira
- Pediatrics Department, Centro Materno Infantil do Norte Albino Aroso, Centro Hospitalar Universitário de Santo António (CMIN-CHUdSA), Porto, Portugal
| | | | | | - Gisela Silva
- Gastroenterology Unit, Pediatrics Department, CMIN-CHUdSA, Porto, Portugal
| | - Marta Tavares
- Gastroenterology Unit, Pediatrics Department, CMIN-CHUdSA, Porto, Portugal
| | | | - Rosa Lima
- Gastroenterology Unit, Pediatrics Department, CMIN-CHUdSA, Porto, Portugal
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Jena A, Neelam PB, Telaprolu H, Mangipudi UK, Dutta U, Sebastian S, Sharma V. Effectiveness and safety of thioguanine as a maintenance therapy of inflammatory bowel disease: Systematic review, meta-analysis and meta-regression. Clin Res Hepatol Gastroenterol 2023; 47:102155. [PMID: 37301255 DOI: 10.1016/j.clinre.2023.102155] [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: 04/10/2023] [Revised: 05/28/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Thiopurines are an important therapy for the maintenance of remission in inflammatory bowel disease (IBD). However, the use of thioguanine has been limited by concerns regarding its toxicity. We performed a systematic review to evaluate its effectiveness and safety in IBD. METHODS Electronic databases were searched to identify studies reporting clinical responses and/or adverse events of thioguanine therapy in IBD. We calculated the pooled clinical response and clinical remission rates of thioguanine in IBD. Subgroup analyses were done for the dosage of thioguanine and the type of studies (prospective or retrospective). Meta-Regression was used to analyze the impact of dose on clinical efficacy and occurrence of nodular regenerative hyperplasia. RESULTS A total of 32 studies were included. The pooled clinical response rate of thioguanine therapy in IBD was 0.66 (95% C.I. 0.62 - 0.70; I2 = 16%). The pooled clinical response rate with low-dose was similar to high-dose thioguanine therapy [0.65 (95% C.I. 0.59 - 0.70; I2 = 24%) and 0.68 (95% C.I. 0.61 - 0.75; I2 = 18%) respectively]. The pooled remission maintenance rate was 0.71 (95% C.I. 0.58 - 0.81; I2 = 86%). The pooled rates of occurrence of nodular regenerative hyperplasia, liver function tests abnormalities and cytopenia were 0.04 (95% C.I. 0.02 - 0.08; I2 = 75%), 0.11 (95% C.I. 0.08 - 0.16; I2 = 72%) and 0.06 (95% C.I. 0.04 - 0.09; I2 = 62%) respectively. Meta-regression suggested that the risk of nodular regenerative hyperplasia is related to the dose of thioguanine. CONCLUSION TG is an efficacious and well-tolerated drug in most patients with IBD. Nodular regenerative hyperplasia, cytopenias, and liver function abnormalities occur in a small subset. Future studies should look into TG as primary therapy in IBD.
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Affiliation(s)
- Anuraag Jena
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pardhu B Neelam
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harshavardhan Telaprolu
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Uday Kiran Mangipudi
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shaji Sebastian
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Broekharst DS, Thomas PW, Russel MG, West RL, Jansen JM, Bloem S, Römkens TE. Health State Questionnaires Deployed in Ulcerative Colitis Patients: The Medical, Psychological, and Economic Perspective. GASTRO HEP ADVANCES 2023; 2:770-777. [PMID: 39130121 PMCID: PMC11307943 DOI: 10.1016/j.gastha.2023.03.020] [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: 10/30/2022] [Accepted: 03/15/2023] [Indexed: 08/13/2024]
Abstract
Background and Aims To determine how the health state of ulcerative colitis patients is impacted by their disease, different health state questionnaires are deployed. This study examines to what extent these health state questionnaires determine the same underlying health state concept and to what extent the complementary use of the health state questionnaires has added value for physicians. Methods In total, 307 patients were enrolled in this cross-sectional multicenter cohort study. Medical, psychological, economic, and composite health state questionnaires were administered to determine reliability, convergent validity, and explained variance. Reliability was determined using Cronbach's alpha. Convergent validity was measured using Spearman's correlation coefficients. Explained variance was interpreted using R-squared coefficients. Results All questionnaires can be considered reliable. The medical, psychological, and economic health state questionnaires show weak to moderate convergent validity with each other. The medical, psychological, and economic health state questionnaires also explain limited variance in each other's outcomes. The composite health state questionnaire shows moderate to strong convergent validity with the other health state questionnaires. The composite health state questionnaire further explains considerable variance in the outcomes of the other health state questionnaires. Conclusion Deploying divergent medical, psychological, and economic health state questionnaires may have added value as they provide a multiperspective holistic insight into patients' health states. Deploying the composite health state questionnaire combined with other health state questionnaires may have added value as it provides additional understanding of their outcomes. Deploying an independent psychological health state questionnaire may have added value as it shows particularly limited convergent validity and explained variance regarding other health state questionnaires.
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Affiliation(s)
- Damien S.E. Broekharst
- Center for Marketing & Supply Chain Management, Nyenrode Business University, Breukelen, the Netherlands
| | - Pepijn W.A. Thomas
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maurice G.V.M. Russel
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Rachel L. West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Jeroen M. Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Sjaak Bloem
- Center for Marketing & Supply Chain Management, Nyenrode Business University, Breukelen, the Netherlands
| | - Tessa E.H. Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
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Long-term effectiveness and safety of ustekinumab in Crohn's disease: a prospective cohort study. Eur J Gastroenterol Hepatol 2023; 35:261-269. [PMID: 36708296 PMCID: PMC9935642 DOI: 10.1097/meg.0000000000002506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Real-world data showed that ustekinumab is an effective treatment for Crohn's disease for up to 52 weeks. Yet, long-term effectiveness and safety outcomes beyond 52 weeks are limited. This study aimed to evaluate the corticosteroid-free clinical remission for up to 104 weeks. Secondary aims were focused on biochemical disease, dosing adjustments and safety outcomes. METHODS This multicentre prospective cohort study enrolled Crohn's disease patients who started ustekinumab between May 2016 and September 2019. Participants had scheduled outpatient visits at week 0, 13, 26, 52 and 104. Data on clinical disease [Harvey Bradshaw Index (HBI) = 4 points = remission], biochemical disease (faecal calprotectin = 200 µg/g or C-reactive protein = 10 mg/l = remission), dose adjustments and adverse drug reactions (ADRs) were recorded. RESULTS We included 101 Crohn's disease patients. In all patients, the proportion of patients in corticosteroid-free clinical remission was 35 and 36% at week 52 and 104. Of patients achieving corticosteroid-free remission at week 52, more than half maintained corticosteroid-free remission throughout week 104. Biochemical remission rates were 25 and 30% at week 52 and 104, respectively. In the first year of treatment, 33% required their first dose escalation, and 15% in the second year. Overall, 7% of patients discontinued ustekinumab due to ADRs. Ustekinumab persistency rates were 68% at week 52 and 59% at week 104. CONCLUSION Ustekinumab is an effective and well-tolerated treatment for Crohn's disease. More than half of all patients continued ustekinumab treatment after 104 weeks whereas one-third achieved corticosteroid-free remission.
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Messner EM, Sturm N, Terhorst Y, Sander LB, Schultchen D, Portenhauser A, Schmidbaur S, Stach M, Klaus J, Baumeister H, Walter BM. Mobile Apps for the Management of Gastrointestinal Diseases: Systematic Search and Evaluation Within App Stores. J Med Internet Res 2022; 24:e37497. [PMID: 36197717 PMCID: PMC9582913 DOI: 10.2196/37497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/30/2022] [Accepted: 07/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Gastrointestinal diseases are associated with substantial cost in health care. In times of the COVID-19 pandemic and further digitalization of gastrointestinal tract health care, mobile health apps could complement routine health care. Many gastrointestinal health care apps are already available in the app stores, but the quality, data protection, and reliability often remain unclear. Objective This systematic review aimed to evaluate the quality characteristics as well as the privacy and security measures of mobile health apps for the management of gastrointestinal diseases. Methods A web crawler systematically searched for mobile health apps with a focus on gastrointestinal diseases. The identified mobile health apps were evaluated using the Mobile Application Rating Scale (MARS). Furthermore, app characteristics, data protection, and security measures were collected. Classic user star rating was correlated with overall mobile health app quality. Results The overall quality of the mobile health apps (N=109) was moderate (mean 2.90, SD 0.52; on a scale ranging from 1 to 5). The quality of the subscales ranged from low (mean 1.89, SD 0.66) to good (mean 4.08, SD 0.57). The security of data transfer was ensured only by 11 (10.1%) mobile health apps. None of the mobile health apps had an evidence base. The user star rating did not correlate with the MARS overall score or with the individual subdimensions of the MARS (all P>.05). Conclusions Mobile health apps might have a positive impact on diagnosis, therapy, and patient guidance in gastroenterology in the future. We conclude that, to date, data security and proof of efficacy are not yet given in currently available mobile health apps.
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Affiliation(s)
- Eva-Maria Messner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Niklas Sturm
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Yannik Terhorst
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany.,Department of Research Methods, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Lasse B Sander
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, Albert-Ludwigs-University Freiburg, Freiburg at Breisgau, Germany
| | - Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Alexandra Portenhauser
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Simone Schmidbaur
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Michael Stach
- Institute of Databases and Information Systems, University of Ulm, Ulm, Germany
| | - Jochen Klaus
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, University of Ulm, Ulm, Germany
| | - Benjamin M Walter
- Department of Internal Medicine I, University Hospital Ulm, Ulm, Germany
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Abstract
PURPOSE OF REVIEW Sarcoidosis is a chronic multisystemic inflammatory disease of unknown aetiology with a wide range of highly variable clinical manifestations and unpredictable disease course. Sarcoidosis patients may present with specific organ-related symptoms involving functional impairments, and less specific symptoms. The decision whether and when to treat a sarcoidosis patient with pharmacotherapy depends on two major factors: risk of organ failure and/or death and impairment of quality of life. This decision is complex and not standardized. RECENT FINDINGS Glucocorticoids (GCs) are recommended as initial treatment, when needed. Subsequent GC-sparing alternatives frequently follow. Comorbidities or adverse drug reactions (ADRs) from drugs used in sarcoidosis treatment are sometimes very hard to differentiate from symptoms associated with the disease itself, which may cause diagnostic dilemmas. An ideal approach to minimalize ADRs would involve genetic screening prior to prescribing certain 'high-risk drugs' and therapeutic drug monitoring during treatment. Pharmacogenomic testing aims to guide appropriate selection of medicines, with the potential of reducing unnecessary polypharmacy while improving clinical outcomes. SUMMARY A multidisciplinary approach to the management of sarcoidosis may avoid unnecessary ADRs. It is important to consider the possibility of drug-induced damage in sarcoidosis, especially if the clinical situation deteriorates after the introduction of a particular drug.
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Affiliation(s)
- Marjolein Drent
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht
- ILD Center of Excellence, Department of Respiratory Medicine, St. Antonius Hospital, Nieuwegein
- ILD Care Foundation Research Team, Ede
| | - Naomi T. Jessurun
- ILD Care Foundation Research Team, Ede
- Netherlands Pharmacovigilance Centre Lareb, ‘s-Hertogenbosch
| | - Petal A. Wijnen
- ILD Care Foundation Research Team, Ede
- Central Diagnostic Laboratory, Department of Clinical Chemistry, MUMC, Maastricht, The Netherlands
| | - Otto Bekers
- Central Diagnostic Laboratory, Department of Clinical Chemistry, MUMC, Maastricht, The Netherlands
| | - Aalt Bast
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht
- ILD Care Foundation Research Team, Ede
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De-escalation of biological therapy in inflammatory bowel disease patients following prior dose escalation. Eur J Gastroenterol Hepatol 2022; 34:488-495. [PMID: 34974465 PMCID: PMC8983943 DOI: 10.1097/meg.0000000000002336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Limited data are available on biological therapy de-escalation after prior escalation in inflammatory bowel disease (IBD) patients. This study aimed to assess the frequency and success rate of de-escalation of biological therapy in IBD patients after prior dose escalation and to evaluate which measures are used to guide de-escalation. METHODS This multicentre retrospective cohort study enrolled IBD patients treated with infliximab (IFX), adalimumab (ADA) or vedolizumab (VEDO) in whom therapy was de-escalated after prior biological escalation. De-escalations were considered pharmacokinetic-driven if based on clinical symptoms combined with therapeutic or supratherapeutic trough levels, and disease activity-driven if based on faecal calprotectin less than or equal to 200 µg/g or resolution of perianal fistula drainage or closure or endoscopic remission. Successful de-escalation was defined as remaining on the same or lower biological dose for greater than or equal to 6 months after de-escalation without the need for corticosteroids. RESULTS In total, 206 IFX users, 85 ADA users and 55 VEDO users underwent therapy escalation. Of these patients, 34 (17%) on IFX, 18 (21%) on ADA and 8 (15%) on VEDO underwent therapy de-escalation. De-escalation was successful in 88% of IFX patients, 89% of ADA and 100% of VEDO. The probability of remaining on the de-escalated regimen or further de-escalation after 1 year was 85% for IFX, 62% for ADA and 100% for VEDO. Disease activity-driven de-escalations were more often successful (97%) than pharmacokinetic- and no marker-driven de-escalations (76%); P = 0.017. CONCLUSION De-escalation after biological dose escalation was successful in the majority of carefully selected IBD patients. Objective assessment of remission increased the likelihood of successful de-escalation.
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Thomas PWA, den Broeder N, Derikx M, Kievit W, West RL, Russel MGVM, Jansen JM, Römkens TEH, Hoentjen F. Impact of Biological Therapies and Tofacitinib on Real-world Work Impairment in Inflammatory Bowel Disease Patients: A Prospective Study. Inflamm Bowel Dis 2022; 28:1813-1820. [PMID: 35134917 PMCID: PMC9713499 DOI: 10.1093/ibd/izac002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND There are limited real-world data on the change in total work impairment (TWI) in biological-treated patients with inflammatory bowel disease (IBD). This study aimed to evaluate the real-world effects of initiating biological therapy or tofacitinib on change in TWI in IBD patients. METHODS This multicenter prospective cohort study enrolled IBD patients who started treatment with biological therapy or tofacitinib. Subjects completed the work productivity and activity impairment (WPAI) questionnaire and short inflammatory bowel disease questionnaire at therapy initiation and at week 26. Total work impairment comprises working hours missed due to sick leave and impact of disease during working hours (range 0%-100%). Clinical disease activity was assessed using the Harvey-Bradshaw Index and Simple Clinical Colitis Activity Index (SCCAI). RESULTS We included 137 IBD patients for analyses (median age 38 years, 58% Crohn's disease [CD]). The median baseline TWI was 50% and decreased by a median of 10%-points of points after 26 weeks. Patients with continued biological therapy or tofacitinib use, clinical disease activity at baseline, and clinical response or remission at week 26 showed a greater median TWI reduction (22%-points) than the remaining study patients (7%-points; P = .014). Ulcerative colitis (UC) and IBD-unclassified (IBD-U) patients showed a greater median TWI reduction (26%-points) than CD patients (6%-points); P = .041. Correlations were observed between decrease in TWI and decrease in SCCAI, decrease in fatigue and increase in quality of life. CONCLUSIONS Work impairment in IBD patients decreased following biological therapy or tofacitinib initiation. Patients achieving clinical remission or response showed the greatest improvement, especially UC and IBD-U patients.
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Affiliation(s)
- Pepijn W A Thomas
- Address correspondence to: Pepijn W.A. Thomas, MD, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, PO Box 9101, code 455, 6500 HB Nijmegen, The Netherlands ()
| | - Nathan den Broeder
- Department of Gastroenterology and Hepatology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Monique Derikx
- Occupational Medicine, Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Centre, The Netherlands
| | - Rachel L West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis and Vlietland, Rotterdam, The Netherlands
| | - Maurice G V M Russel
- Department of Gastroenterology and Hepatology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Tessa E H Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Hospital, ’s-Hertogenbosch, The Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, The Netherlands and Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
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Bakulin IG, Skalinskaya MI, Maev IV, Skazyvaeva EV, Zhuravleva MS, Gaikovaya LB, Bakulina NV, Ermakov AI, Alekseenko ES, Ivanova KN, Solovev MV. Pharmacotherapy of inflammatory bowel diseases: efficacy performance and safety management. TERAPEVT ARKH 2021; 93:841-852. [DOI: 10.26442/00403660.2021.08.200982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 12/30/2022]
Abstract
Treatment of inflammatory bowel diseases IBD (Crohns disease, ulcerative colitis) is aimed at achieving clinical, endoscopic and histological remission, minimizing surgical complications, and ensuring a normal quality of life. However, the use of medical treatment is potentially associated with various adverse events, among which infectious complications, malignant neoplasms, as well as myelotoxicity, hepatotoxicity, skin lesions and others. The risk of side effects depends on the type of drug therapy (5-aminosalicylates, thiopurines, biologicals, etc.), the duration of treatment, the presence of extra-intestinal manifestations, etc. The article provides an overview of data on both the effectiveness and frequency of various side effects of the main classes of drugs in IBD, presents methods of investigation which can predict the effectiveness and development of side effects, the implementation of which can be considered as a variant of personalized therapy in IBD.
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van Hunsel F, de Jong E, Gross-Martirosyan L, Hoekman J. Signals from the Dutch national spontaneous reporting system: Characteristics and regulatory actions. Pharmacoepidemiol Drug Saf 2021; 30:1115-1122. [PMID: 33840136 DOI: 10.1002/pds.5246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/12/2021] [Accepted: 04/07/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of the study is to characterise safety signals based on the Dutch spontaneous reporting system (SRS) and to investigate the association between signal characteristics and Product Information (PI) update stratified by approval type: centrally authorised products (CAPs) versus nationally and decentralised authorised products (NAPs). METHODS This study evaluates the full cohort of signals disseminated from the Dutch SRS in the period from 2008 to 2017. Each retrieved signal was characterised on a number of aspects. The signal management process from signal generation to a potential PI update was analysed in four steps: (1) signal characterisation; (2) proposed actions by the Dutch national competent authority (NCA) for the signals; (3) presence of PI update (yes/no) and association with signal characteristics; (4) timing from the moment the signal was issued to PI update. For step 1-3 we stratified products in CAPs and NAPs. RESULTS Of all signals, 88.7% led to a proposed regulatory action by the NCA. Signals from the Dutch SRS for CAPs versus NAPs more often concerned biologicals, important medical events, class effects and shorter periods since marketing authorization. We detected PI updates for 26.2% of CAP signals and 61.3% of NAP signals. CONCLUSIONS The Dutch SRSs remains an important source of signals. There are some notable differences in the characteristics of signals for CAPs versus NAPs. Signals for NAPs more frequently led to PI updates.
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Affiliation(s)
- Florence van Hunsel
- Netherlands Pharmacovigilance Centre Lareb, 's Hertogenbosch, The Netherlands
| | - Emma de Jong
- Netherlands Pharmacovigilance Centre Lareb, 's Hertogenbosch, The Netherlands.,Utrecht University, Utrecht, The Netherlands
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