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Abadir A, Troia A, Said H, Tarugu S, Billingsley BC, Sairam N, Minchenberg SB, Owings AH, Parker AM, Brousse B, Carlyle A, Owens BR, Hosseini-Carroll P, Galeas-Pena M, Frasca J, Glover SC, Papamichael K, Cheifetz AS. Factors Associated with Delays in Initiating Biologic Therapy in Patients with Inflammatory Bowel Disease. Dig Dis Sci 2024:10.1007/s10620-024-08514-6. [PMID: 38963462 DOI: 10.1007/s10620-024-08514-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/29/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Expeditious initiation of biologic therapy is important in patients with inflammatory bowel disease (IBD). However, initiation of biologics in the outpatient setting may be delayed by various clinical, social, and financial variables. AIM To evaluate the delay in initiation of an advanced therapy in IBD and to identify factors that contributed to this delay. METHODS This was a multi-center retrospective study. Outpatients who were initiated on a biologic therapy from 3/1/2019 to 9/30/20 were eligible for the study. Univariate and multivariate linear regression analyses were performed to identify variables associated with a delay in biologic treatment initiation. Delay was defined as the days from decision date (prescription placement) to first infusion or delivery of medication. RESULTS In total 411 patients (Crohn's disease, n = 276; ulcerative colitis, n = 129) were included in the analysis. The median [interquartile range-(IQR)] delay for all drugs was 20 [12-37] days (infliximab, 19 [13-33] days; adalimumab, 10 [5-26] days; vedolizumab, 21 [14-42] days; and ustekinumab, 21 [14-42] days). Multivariate linear regression analysis identified that the most important variables associated with delays in biologic treatment initiation was self-identification as Black, longer distance from treatment site, and lack of initial insurance coverage approval. CONCLUSION There may be a significant delay in biologic treatment initiation in patients with IBD. The most important variables associated with this delay included self-identification as Black, longer distance from site, and lack of initial insurance coverage approval.
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Affiliation(s)
- Alexander Abadir
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Angela Troia
- University of Vermont Medical Center, Burlington, VT, USA
| | - Hyder Said
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Spurthi Tarugu
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Nathan Sairam
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Scott B Minchenberg
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Anna H Owings
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Adam M Parker
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | | | - Bobby R Owens
- University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Michelle Galeas-Pena
- Department of Medicine, Section of Gastroenterology and Hepatology, Tulane University, New Orleans, LA, USA
| | - Joseph Frasca
- University of Vermont Medical Center, Burlington, VT, USA
- Center for Crohn's and Colitis, Division of Digestive Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Sarah C Glover
- University of Mississippi Medical Center, Jackson, MS, USA
- Department of Medicine, Section of Gastroenterology and Hepatology, Tulane University, New Orleans, LA, USA
| | - Konstantinos Papamichael
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA.
| | - Adam S Cheifetz
- Center for Inflammatory Bowel Diseases, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
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Wong C, van Oostrom J, Pittet V, Bossuyt P, Hanzel J, Samaan M, Tripathi M, Czuber-Dochan W, Burisch J, Leone S, Saldaña R, Baert F, Kopylov U, Jaghult S, Adamina M, Gecse K, Arebi N. Baseline Data and Measurement Instruments Reported in Observational Studies in Inflammatory Bowel Disease: Results from a Systematic Review. J Crohns Colitis 2024; 18:875-884. [PMID: 38214470 DOI: 10.1093/ecco-jcc/jjae004] [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: 09/28/2023] [Revised: 12/04/2023] [Accepted: 01/11/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND Heterogeneity in demographic and outcomes data with corresponding measurement instruments [MIs] creates barriers to data pooling and analysis. Several core outcome sets have been developed in inflammatory bowel disease [IBD] to homogenize outcomes data. A parallel Minimum Data Set [MDS] for baseline characteristics is lacking. We conducted a systematic review to develop the first MDS. METHODS A systematic review was made of observational studies from three databases [2000-2021]. Titles and abstracts were screened, full-text articles were reviewed, and data were extracted by two reviewers. Baseline data were grouped into ten domains: demographics, clinical features, disease behaviour/complications, biomarkers, endoscopy, histology, radiology, healthcare utilization and patient-reported data. Frequency of baseline data and MIs within respective domains are reported. RESULTS From 315 included studies [600 552 subjects], most originated from Europe [196; 62%] and North America [59; 19%], and were published between 2011 and 2021 [251; 80%]. The most frequent domains were demographics [311; 98.7%] and clinical [289; 91.7%]; 224 [71.1%] studies reported on the triad of sex [306; 97.1%], age [289; 91.7%], and disease phenotype [231; 73.3%]. Few included baseline data for radiology [19; 6%], healthcare utilization [19; 6%], and histology [17; 5.4%]. Ethnicity [19; 6%], race [17; 5.4%], and alcohol/drug consumption [6; 1.9%] were the least reported demographics. From 25 MIs for clinical disease activity, the Harvey-Bradshaw Index [n = 53] and Mayo score [n = 37] were most frequently used. CONCLUSIONS Substantial variability exists in baseline population data reporting. These findings will inform a future consensus for MDS in IBD to enhance data harmonization and credibility of real-world evidence.
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Affiliation(s)
- Charlotte Wong
- Department of Inflammatory Bowel Disease, St Mark's National Bowel Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Joep van Oostrom
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Valerie Pittet
- Center for Primary Care and Public Health-University of Lausanne, Department of Epidemiology and Health Systems, Lausanne, Switzerland
| | - Peter Bossuyt
- Department of Gastroenterology, Imelda General Hospital and Imelda Clinical Research Centre, Bonheiden, Belgium
| | - Jurij Hanzel
- Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mark Samaan
- Inflammatory Bowel Diseases Unit, Guy's and St Thomas' Hospital, London, UK
| | - Monika Tripathi
- Department of Histopathology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Wladyslawa Czuber-Dochan
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Johan Burisch
- Department of Gastroenterology, Medical Division, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescents and Adults, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Salvatore Leone
- European Federation of Crohn's and Colitis Associations [EFCCA], Brussels, Belgium
| | - Roberto Saldaña
- European Federation of Crohn's and Colitis Associations [EFCCA], Brussels, Belgium
- Confederation of Patients with Crohn's Disease and Ulcerative Colitis, Madrid, Spain
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel, Israel
| | - Susanna Jaghult
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Michel Adamina
- Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Krisztina Gecse
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Naila Arebi
- Department of Inflammatory Bowel Disease, St Mark's National Bowel Hospital, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Swaroop S, Vuyyuru SK, Kante B, Kumar P, Mundhra SK, Arora U, Goyal A, Kandasamy D, Sharma R, Kabilan K, Kedia S, Dash NR, Ahuja V. A phase I/II clinical trial of ex-vivo expanded human bone marrow derived allogeneic mesenchymal stromal cells in adult patients with perianal fistulizing Crohn's Disease. Stem Cell Res Ther 2024; 15:140. [PMID: 38745184 PMCID: PMC11094973 DOI: 10.1186/s13287-024-03746-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Perianal fistulas (PF) affect one-third patients with Crohn's disease (CD) with limited therapeutic options. There is dearth of literature on safety and efficacy of bone marrow-derived mesenchymal stromal cells (BMSCs) in this population. METHODS An open-label, phase I/II, single-arm study was conducted involving local administration of human allogeneic bone marrow-derived mesenchymal stromal cells in perianal fistula of patients with Crohn's disease refractory to standard therapies. Clinical severity and biomarkers were assessed at baseline and periodically until week 104 , and MRI at week 24 and 104. Primary and secondary objectives were to assess safety and efficacy respectively. Fistula remission was complete closure of fistula openings with < 2 cm perianal collection on MRI, and fistula response was decrease in drainage by ≥ 50%. Change in perianal disease activity index, quality-of-life and Van Assche index on MRI over time was assessed using mixed-effect linear regression model. RESULTS Ten patients (male:8, mean age:27.4 ± 12.0years) were recruited. Self-resolving procedure-related adverse events occurred in three patients, with no follow-up adverse events. In intention to treat analysis at week 24, two patients (20%) achieved fistula remission and seven (70%) had fistula response. At week 52, two (20%) patients were in remission and seven (70%) maintained response. At 104 weeks, two (20%) patients maintained response and one (10%) was in remission. Statistically significant decrease in perianal disease activity index (P = 0.008), Van Assche Index (P = 0.008) and improvement in quality-of-life (P = 0.001) were observed over time. CONCLUSIONS Allogeneic BMSCs are safe and effective for the treatment of perianal fistulizing CD with significant improvement in clinical severity and radiological healing. TRIAL REGISTRATION The study was prospectively registered on Clinical trials registry - India (CTRI), CTRI/2020/01/022743 on 14 January 2020, http://ctri.nic.in .
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Affiliation(s)
| | | | - Bhaskar Kante
- Department of Medical Gastroenterology, KIMS Hospitals, Hyderabad, India
| | - Peeyush Kumar
- Department of Gastroenterology, AIIMS, New Delhi, India
| | | | - Umang Arora
- Department of Gastroenterology, AIIMS, New Delhi, India
| | - Ankur Goyal
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | | | - Raju Sharma
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | - Kavirajan Kabilan
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology, AIIMS, New Delhi, India
| | | | - Vineet Ahuja
- Department of Gastroenterology, AIIMS, New Delhi, India.
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Kweon OS, Kang B, Lee YJ, Kim ES, Kim SK, Lee HS, Chung YJ, Kim KO, Jang BI. Self-screening questionnaire for perianal fistulizing disease in patients with Crohn's disease. Korean J Intern Med 2024; 39:430-438. [PMID: 38576234 PMCID: PMC11076884 DOI: 10.3904/kjim.2023.410] [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] [Received: 09/27/2023] [Revised: 11/02/2023] [Accepted: 12/19/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND/AIMS A poor prognostic factor for Crohn's disease (CD) includes perianal fistulizing disease, including perianal fistula and/or perianal abscess. Currently, a tool to assess perianal symptoms in patients with CD remains nonexistent. This study aimed to develop a perianal fistulizing disease self-screening questionnaire for patients with CD. METHODS This prospective pilot study was conducted at three tertiary referral centers between January 2019 and May 2020. We formulated questions on perianal symptoms, including tenesmus, anal discharge, bleeding, pain, and heat. A 4-point Likert scale was used to rate each question. Patients with CD completed a questionnaire and underwent pelvic magnetic resonance imaging (MRI). RESULTS Overall, 93 patients were enrolled, with 51 (54.8%) diagnosed with perianal fistulizing disease, as determined by pelvic MRI. The Spearman correlation findings demonstrated that anal pain (p = 0.450, p < 0.001) and anal discharge (p = 0.556, p < 0.001) were the symptoms that most significantly correlated with perianal disease. For anal pain and discharge, the area under the receiver operating characteristic curve of the scores was significantly higher than that of the combined score for all five symptoms (0.855 vs. 0.794, DeLong's test p = 0.04). For the two symptoms combined, the sensitivity, specificity, and positive predictive and negative predictive values were 88.2, 73.8, 80.4, and 83.8%, respectively, with 81.7% accuracy for detecting perianal fistulizing disease. CONCLUSION This study indicates that simple questions regarding anal pain and discharge can help accurately identify the presence of perianal fistulizing disease in patients with CD.
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Affiliation(s)
- O Seong Kweon
- Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Ben Kang
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Yoo Jin Lee
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
| | - Eun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Sung Kook Kim
- Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Hyun Seok Lee
- Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Yun Jin Chung
- Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea
| | - Kyeong Ok Kim
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Byung Ik Jang
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - on behalf of Crohn’s Colitis Association in Daegu-Gyeongbuk (CCAiD)
- Division of Gastroenterology, Department of Internal Medicine, Kyungpook National University, School of Medicine, Daegu, Korea
- Department of Pediatrics, Kyungpook National University, School of Medicine, Daegu, Korea
- Division of Gastroenterology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- Division of Gastroenterology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
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Simovic I, Hilmi I, Ng RT, Chew KS, Wong SY, Lee WS, Riordan S, Castaño-Rodríguez N. ATG16L1 rs2241880/T300A increases susceptibility to perianal Crohn's disease: An updated meta-analysis on inflammatory bowel disease risk and clinical outcomes. United European Gastroenterol J 2024; 12:103-121. [PMID: 37837511 PMCID: PMC10859713 DOI: 10.1002/ueg2.12477] [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] [Received: 05/16/2023] [Accepted: 08/17/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND ATG16L1 plays a fundamental role in the degradative intracellular pathway known as autophagy, being a mediator of inflammation and microbial homeostasis. The variant rs2241880 can diminish these capabilities, potentially contributing to inflammatory bowel disease (IBD) pathogenesis. OBJECTIVES To perform an updated meta-analysis on the association between ATG16L1 rs2241880 and IBD susceptibility by exploring the impact of age, ethnicity, and geography. Moreover, to investigate the association between rs2241880 and clinical features. METHODS Literature searches up until September 2022 across 7 electronic public databases were performed for all case-control studies on ATG16L1 rs2241880 and IBD. Pooled odds ratios (ORP ) and 95% CI were calculated under the random effects model. RESULTS Our analyses included a total of 30,606 IBD patients, comprising 21,270 Crohn's disease (CD) and 9336 ulcerative colitis (UC) patients, and 33,329 controls. ATG16L1 rs2241880 was significantly associated with CD susceptibility, where the A allele was protective (ORP : 0.74, 95% CI: 0.72-0.77, p-value: <0.001), while the G allele was a risk factor (ORP : 1.23, 95% CI: 1.09-1.39, p-value: 0.001), depending on the minor allele frequencies observed in this multi-ancestry study sample. rs2241880 was predominantly relevant in Caucasians from North America and Europe, and in Latin American populations. Importantly, CD patients harbouring the G allele were significantly more predisposed to perianal disease (ORP : 1.21, 95% CI: 1.07-1.38, p-value: 0.003). CONCLUSIONS ATG16L1 rs2241880 (G allele) is a consistent risk factor for IBD in Caucasian cohorts and influences clinical outcomes. As its role in non-Caucasian populations remains ambiguous, further studies in under-reported populations are necessary.
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Affiliation(s)
- Isidora Simovic
- School of Biotechnology and Biomolecular Sciences, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ida Hilmi
- Department of Medicine, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ruey Terng Ng
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Kee Seang Chew
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Shin Yee Wong
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Way Seah Lee
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Stephen Riordan
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Kuala Lumpur, Malaysia
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Spencer DJ. Understanding Health Outcomes in Pediatric Inflammatory Bowel Diseases: Contributing Factors that Aren't so Black and White. J Pediatr 2024; 265:113839. [PMID: 37995932 DOI: 10.1016/j.jpeds.2023.113839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Dennis J Spencer
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts
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Bonovas S, Tsantes AG, Sokou R, Tsantes AE, Nikolopoulos GK, Piovani D. Racial Disparities in Infliximab Efficacy for Ulcerative Colitis: Evidence Synthesis and Effect Modification Assessment. J Clin Med 2024; 13:319. [PMID: 38256453 PMCID: PMC10816873 DOI: 10.3390/jcm13020319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
An increasing amount of research explores the role of race in clinical phenotypes and outcomes in ulcerative colitis (UC). We aimed to investigate racial differences in infliximab (IFX) treatment efficacy in UC. We used aggregate data from IFX trials and evidence synthesis methods to generate race-specific efficacy estimates. Then, we tested the effect modification by race by comparing the race-specific estimates derived from independent evidence syntheses. We computed ratios of relative risks (RRRs) and performed tests of statistical interaction. We analyzed data from five randomized, placebo-controlled trials evaluating IFX as induction and maintenance therapy for adults with moderate-to-severe UC (875 participants; 45% Asians). We found no substantial evidence of racial differences concerning the efficacy of IFX in inducing clinical response (RRR = 0.89, 95% CI: 0.66-1.20; p = 0.44), clinical remission (RRR = 0.58, 95% CI: 0.24-1.44; p = 0.24), and mucosal healing (RRR = 0.99, 95% CI: 0.69-1.41; p = 0.95), or maintaining clinical remission (RRR = 0.81, 95% CI: 0.46-1.42; p = 0.45) and mucosal healing (RRR = 0.84, 95% CI: 0.48-1.46; p = 0.53), between Asian and Caucasian populations. Future clinical studies should expand the participation of racial minorities to comprehensively assess potential racial differences in the effectiveness of advanced therapies, including IFX, in the context of treating UC.
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Affiliation(s)
- Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
| | - Andreas G. Tsantes
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece;
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece;
| | - Argirios E. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | | | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy;
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
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Burstiner LS, Owings AH, Royer A, Hreish Y, Johnson J, Barr M, Laird H, Tarugu S, Edwards K, Bradley L, Brar H, Robinson TO, Hosseini-Carroll P, Liu J, Glover SC. Black Inflammatory Bowel Disease Patients Have Lower Response to Antitumor Necrosis Factor Agents Compared With White Patients. Inflamm Bowel Dis 2023; 29:1847-1853. [PMID: 36808256 DOI: 10.1093/ibd/izad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 02/23/2023]
Abstract
BACKGROUND Most studies on the safety and efficacy of antitumor necrosis factor alpha (anti-TNF) agents in the treatment of inflammatory bowel disease have included few Black patients. AIMS We aimed to evaluate the therapeutic response rate in Black IBD patients compared with White patients. METHODS We conducted a retrospective review of IBD patients who were treated with anti-TNF agents and assessed those with therapeutic drug levels for clinical, endoscopic, and radiologic response to anti-TNF treatment. RESULTS We identified 118 patients who met the inclusion criteria. Black IBD patients had significantly higher prevalence of endoscopic and radiologic active disease compared with White patients (62% and 34%, respectively; P = .023), despite similar proportions reaching therapeutic titers (67% and 55%, respectively; P = .20). Moreover, Black patients had significantly higher rate of IBD-related hospitalizations than White patients (30% vs 13%, respectively; P = .025) while on anti-TNF agents. CONCLUSIONS Black IBD patients on anti-TNF agents had a significantly higher prevalence of active disease and more IBD-related hospitalizations than White patients.
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Affiliation(s)
- Landen Shane Burstiner
- Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Anna H Owings
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Amor Royer
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Yousef Hreish
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jeshanah Johnson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Madelyn Barr
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Hannah Laird
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Spurthi Tarugu
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kane Edwards
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Lauren Bradley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Himmat Brar
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
- Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Tanya O Robinson
- Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Pegah Hosseini-Carroll
- Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Julia Liu
- Division of Gastroenterology, Morehouse School of Medicine, Atlanta, GA, USA
| | - Sarah C Glover
- Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS, USA
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Jeong J, Walters TD, Huynh HQ, Lawrence S, Mack DR, Deslandres C, Otley A, El-Matary W, Sherlock M, Griffiths AM, Wine E, Jacobson K, Church P, Carroll MW, Benchimol EI, Brill H, Critch J, Bax K, Jantchou P, Rashid M, Kaplan GG, Seow CH, Novak K, deBruyn JC. Inflammatory Bowel Disease Among Canadian Children: Comparison Between Children of Non-European Descent and Children of European Descent. Inflamm Bowel Dis 2023; 29:1760-1768. [PMID: 36688453 PMCID: PMC10628923 DOI: 10.1093/ibd/izac276] [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] [Received: 08/31/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) phenotypes may differ between countries and ancestral groups. The study aim was to examine ancestry and subtype variations of children newly diagnosed with IBD. METHODS Children newly diagnosed with IBD enrolled into the Canadian Children Inflammatory Bowel Disease Network inception cohort study were categorized into 8 ancestral groups. Prospectively collected data at diagnosis and follow-up were compared between ancestral groups. RESULTS Among 1447 children (63.2% Crohn's disease, 30.7% ulcerative colitis), 67.8% were European, 9.4% were South Asian, 3.8% were West Central Asian and Middle Eastern, 2.3% were African, 2.2% were East/South East Asian, 2.0% were Caribbean/Latin/Central/South American, 9.9% were mixed, and 2.6% were other. Children of African descent with ulcerative colitis had an older age of diagnosis compared with children of European descent (median 15.6 years vs 13.3 years; P = .02). Children of European descent had a higher proportion of positive family history with IBD (19.3% vs 12.1%; P = .001) compared with children of non-European descent. Children of European descent also had a lower proportion of immigrants and children of immigrants compared with children of non-European descent (9.8% vs 35.9%; P < .0001; and 3.6% vs 27.2%; P < .0001, respectively) . CONCLUSIONS Important differences exist between different ancestral groups in pediatric patients with IBD with regard to age of diagnosis, family history, and immigrant status. Our study adds to the knowledge of the impact of ancestry on IBD pathogenesis.
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Affiliation(s)
- Jocelyn Jeong
- Department of Community Health Services, University of Calgary, Calgary, AB, Canada
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Thomas D Walters
- SickKids Inflammatory Bowel Disease Centre, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Hien Q Huynh
- Edmonton Pediatric IBD Clinic, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sally Lawrence
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | | | - Anthony Otley
- Division of Pediatric Gastroenterology & Nutrition, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Wael El-Matary
- Section of Pediatric Gastroenterology, Winnipeg Children’s Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Mary Sherlock
- Division of Pediatric Gastroenterology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Anne M Griffiths
- SickKids Inflammatory Bowel Disease Centre, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Eytan Wine
- Edmonton Pediatric IBD Clinic, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Kevan Jacobson
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Peter Church
- SickKids Inflammatory Bowel Disease Centre, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Matthew W Carroll
- Edmonton Pediatric IBD Clinic, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Herbert Brill
- Division of Pediatric Gastroenterology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Jeff Critch
- Department of Pediatrics, Janeway Children’s Hospital, St. John’s, NL, Canada
| | - Kevin Bax
- Department of Pediatrics, Schulich School of Medicine, Western University, Children’s Hospital of Western Ontario, London, ON, Canada
| | - Prévost Jantchou
- Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada
| | - Mohsin Rashid
- Division of Pediatric Gastroenterology & Nutrition, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Gilaad G Kaplan
- Department of Community Health Services, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cynthia H Seow
- Department of Community Health Services, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kerri Novak
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jennifer C deBruyn
- Department of Community Health Services, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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10
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Anyane-Yeboa A, Buadu MAE, Khalili H, Cozier YC. Epidemiology of Inflammatory Bowel Disease in a Cohort of US Black Women. Inflamm Bowel Dis 2023; 29:1517-1523. [PMID: 36946376 PMCID: PMC11045662 DOI: 10.1093/ibd/izad049] [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] [Received: 10/19/2022] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease (IBD), including ulcerative colitis and Crohn's disease, are inflammatory diseases of the gastrointestinal tract. The incidence of IBD is increasing in minority populations; however, little is known about the epidemiology and disease characteristics of IBD in Black women. METHODS Our study population included participants in the Black Women's Health Study. Diagnosis of IBD was self-reported through the biennial questionnaires starting at baseline in 1995. We estimated the incidence of IBD according to age and geographic region. A follow-up supplementary questionnaire was also sent to a subset of participants who reported diagnosis of IBD to evaluate the accuracy of self-reported diagnosis and to assess disease characteristics. RESULTS Through December 31, 2021, a total of 609 cases of IBD were reported, of which 142 were prevalent at baseline (prevalence, 0.24%), and 467 were incident (crude incidence rate, 33.2/100 000 person-years). The incidence of IBD was highest in the younger than 30 years age group and similar across geographic region. Among the participants who responded to the supplementary questionnaire, 57.1% had confirmed diagnosis of IBD. CONCLUSIONS In a large prospective cohort of US Black women, we found that the incidence of IBD was similar to previously published estimates in US White women. Future studies should focus on identifying risk factors for IBD in Black individuals in the United States.
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Affiliation(s)
- Adjoa Anyane-Yeboa
- Massachusetts General Hospital, Division of Gastroenterology, Boston, MA, USA
- Clinical Translational Epidemiology Unit, The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Maame Araba E Buadu
- Massachusetts General Hospital, Division of Gastroenterology, Boston, MA, USA
| | - Hamed Khalili
- Massachusetts General Hospital, Division of Gastroenterology, Boston, MA, USA
- Clinical Translational Epidemiology Unit, The Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
| | - Yvette C Cozier
- Slone Epidemiology Center at Boston University, Boston, MA, USA
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11
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Shah S, Shillington AC, Kabagambe EK, Deering KL, Babin S, Capelouto J, Pulliam C, Patel A, LaChappelle B, Liu J. Racial and Ethnic Disparities in Patients With Inflammatory Bowel Disease: An Online Survey. Inflamm Bowel Dis 2023:izad194. [PMID: 37703380 DOI: 10.1093/ibd/izad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Data regarding care access and outcomes in Black/Indigenous/People of Color/Hispanic (BIPOC/H) individuals is limited. This study evaluated care barriers, disease status, and outcomes among a diverse population of White/non-Hispanic (W/NH) and BIPOC/H inflammatory bowel disease (IBD) patients at a large U.S. health system. METHODS An anonymous online survey was administered to adult IBD patients at Ochsner Health treated between Aug 2019 and Dec 2021. Collected data included symptoms, the Consumer Assessment of Healthcare Providers and Systems and Barriers to Care surveys, health-related quality of life (HRQOL) via the Short Inflammatory Bowel Disease Questionnaire, the Medication Adherence Rating Scale-4, and the Beliefs about Medicines Questionnaire. Medical record data examined healthcare resource utilization. Analyses compared W/NH and BIPOC/H via chi-square and t tests. RESULTS Compared with their W/NH counterparts, BIPOC/H patients reported more difficulties accessing IBD specialists (26% vs 11%; P = .03), poor symptom control (35% vs 18%; P = .02), lower mean HRQOL (41 ± 14 vs 49 ± 13; P < .001), more negative impact on employment (50% vs 33%; P = .029), worse financial stability (53% vs 32%; P = .006), and more problems finding social/emotional support for IBD (64% vs 37%; P < .001). BIPOC/H patients utilized emergency department services more often (42% vs 22%; P = .004), reported higher concern scores related to IBD medication (17.1 vs 14.9; P = .001), and worried more about medication harm (19.5% vs 17.7%; P = .002). The survey response rate was 14%. CONCLUSIONS BIPOC/H patients with IBD had worse clinical disease, lower HRQOL scores, had more medication concerns, had less access to specialists, had less social and emotional support, and used emergency department services more often than W/NH patients.
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Affiliation(s)
- Shamita Shah
- Department of Gastroenterology, Ochsner Health, New Orleans, LA, USA
| | | | - Edmond Kato Kabagambe
- Department of Gastroenterology, Ochsner Health, New Orleans, LA, USA
- Research Administration, Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | | | - Sheena Babin
- Department of Gastroenterology, Ochsner Health, New Orleans, LA, USA
| | - Joseph Capelouto
- Department of Gastroenterology, Ochsner Health, New Orleans, LA, USA
| | | | - Aarti Patel
- Population Health, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | | | - Julia Liu
- Department of Gastroenterology, Morehouse School of Medicine, Atlanta, GA, USA
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12
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Smith J, Liu C, Beck A, Fei L, Brokamp C, Meryum S, Whaley KG, Minar P, Hellmann J, Denson LA, Margolis P, Dhaliwal J. Racial Disparities in Pediatric Inflammatory Bowel Disease Care: Differences in Outcomes and Health Service Utilization Between Black and White Children. J Pediatr 2023; 260:113522. [PMID: 37244575 PMCID: PMC10894641 DOI: 10.1016/j.jpeds.2023.113522] [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] [Received: 09/30/2022] [Revised: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To describe racial inequities in pediatric inflammatory bowel disease care and explore potential drivers. METHODS We undertook a single-center, comparative cohort study of newly diagnosed Black and non-Hispanic White patients with inflammatory bowel disease, aged <21 years, from January 2013 through 2020. Primary outcome was corticosteroid-free remission (CSFR) at 1 year. Other longitudinal outcomes included sustained CSFR, time to anti-tumor necrosis factor therapy, and evaluation of health service utilization. RESULTS Among 519 children (89% White, 11% Black), 73% presented with Crohn's disease and 27% with ulcerative colitis. Disease phenotype did not differ by race. More patients from Black families had public insurance (58% vs 30%, P < .001). Black patients were less likely to achieve CSFR 1-year post diagnosis (OR: 0.52, 95% CI:0.3-0.9) and less likely to achieve sustained CSFR (OR: 0.48, 95% CI: 0.25-0.92). When adjusted by insurance type, differences by race to 1-year CSFR were no longer significant (aOR: 0.58; 95% CI: 0.33, 1.04; P = .07). Black patients were more likely to transition from remission to a worsened state, and less likely to transition to remission. We found no differences in biologic therapy utilization or surgical outcomes by race. Black patients had fewer gastroenterology clinic visits and 2-fold increased odds for emergency department visits. CONCLUSIONS We observed no differences by race in phenotypic presentation and medication usage. Black patients had half the odds of achieving clinical remission, but a degree of this was mediated by insurance status. Understanding the cause of such differences will require further exploration of social determinants of health.
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Affiliation(s)
- Julia Smith
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Andrew Beck
- Division of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Lin Fei
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Cole Brokamp
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Syeda Meryum
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kaitlin G Whaley
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Phillip Minar
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Jennifer Hellmann
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Lee A Denson
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Peter Margolis
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Jasbir Dhaliwal
- Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati, Cincinnati, OH.
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13
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Tracy MS, Challa PK, Lopes EW, Khalili H. Prevalence and Treatment Patterns of Inflammatory Bowel Disease in the All of Us Research Program. Inflamm Bowel Dis 2023:izad170. [PMID: 37603847 DOI: 10.1093/ibd/izad170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Indexed: 08/23/2023]
Abstract
Among All of Us participants, the prevalence of inflammatory bowel disease is similar to past estimates (around 1%) and is highest among White, non-Hispanic, college-educated participants. Medication treatment patterns differ significantly based on ethnicity, education, and income status.
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Affiliation(s)
- Michaela S Tracy
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Prasanna K Challa
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Emily W Lopes
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hamed Khalili
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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14
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Song EM, Na SY, Hong SN, Ng SC, Hisamatsu T, Ye BD. Treatment of inflammatory bowel disease-Asian perspectives: the results of a multinational web-based survey in the 8th Asian Organization for Crohn's and Colitis meeting. Intest Res 2023; 21:339-352. [PMID: 37533265 PMCID: PMC10397553 DOI: 10.5217/ir.2022.00135] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/16/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND/AIMS As the characteristics of inflammatory bowel disease (IBD) differ between Asians and Westerners, it is necessary to determine adequate therapeutic strategy for Asian IBD patients. We evaluated the current treatment of IBD in Asian countries/regions using a web-based survey. METHODS The Korean Association for the Study of Intestinal Diseases conducted a multinational web-based survey for current IBD care in Asia between September 16, 2020, and November 13, 2020. RESULTS A total of 384 doctors treating IBD patients from 24 Asian countries/regions responded to the survey. Anti-tumor necrosis factor (TNF) agents, anti-integrins, and anti-interleukin-12/23 agents were available for use by 93.8%, 72.1%, and 70.1% of respondents in Asian countries/regions. Compared with a previous survey performed in 2014, an increased tendency for treatment with biologics, including anti-TNF agents, was observed. In the treatment of corticosteroid-refractory acute severe ulcerative colitis, 72.1% of respondents chose anti-TNF agents, followed by tacrolimus (11.7%). In the treatment of corticosteroid-refractory Crohn's disease, 90.4% chose anti-TNF agents, followed by thiopurines (53.1%), anti-interleukin-12/23 agents (39.3%), and anti-integrin agents (35.7%). In the treatment of Crohn's disease patients refractory to anti-TNF agents, the most preferred strategy was to measure serum levels of anti-TNF and anti-drug antibodies (40.9%), followed by empiric dose escalation or shortening of dosing intervals (25.3%). CONCLUSIONS Although there were some differences, treatment strategies for patients with IBD were mostly similar among Asian doctors. Based on the therapeutic outcomes, it is necessary to identify the most appropriate therapeutic strategy for Asian IBD patients.
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Affiliation(s)
- Eun Mi Song
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
| | - Soo-Young Na
- Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sung Noh Hong
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Siew Chien Ng
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Inflammatory Bowel Disease Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Weng MT, Lin KL, Huang YL, Karki C, Hong JL, Bennett D, Arnold Chan K, Wei SC. Epidemiology, Disease Course, and Clinical Outcomes of Perianal Fistulas and Fissures Crohn's Disease: A Nationwide Population-Based Study in Taiwan. CROHN'S & COLITIS 360 2023; 5:otad035. [PMID: 37497019 PMCID: PMC10368329 DOI: 10.1093/crocol/otad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Indexed: 07/28/2023] Open
Abstract
Background Population-based data on the course of perianal disease in East Asian populations with Crohn's disease (CD) are limited. This study examined the prevalence, clinical course, and compared the outcomes of CD patients with perianal CD (pCD) versus without pCD in Taiwan. Methods A nationwide population-based study was implemented from 2000 to 2017 by using the Taiwan National Health Insurance Research Database. Results Of 2424 patients with CD, 358 (14.8%) patients with pCD were identified. Most patients with CD and pCD were men (79.3%). The mean age at CD diagnosis was lower in patients with pCD (33.7 years) than in those without pCD (44.9 years). Approximately half the patients with pCD received the pCD diagnosis at least 6 months before receiving a CD diagnosis. Approximately one-third (121/358) of patients with pCD had recurrent fistula; the median recurrence interval was 239 days. Compared with patients without pCD, patients with pCD had higher mean incidences of hospitalization (7.0 vs 3.8, P < .01), outpatient visits (13 vs 2.9, P < .01), and emergency room visits (10.3 vs 4.4, P < .01) over a 15-year period. Although patients with pCD had higher rates of healthcare utilization, their 15-year mortality rate was lower than that of those without pCD (6.1% vs 17.3%, P < .01). Conclusions The period prevalence of pCD in Taiwanese patients with CD was 14.8%. Although patients with pCD required more intensive care and had greater healthcare utilization, they did not have inferior survival outcomes compared with those without pCD.
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Affiliation(s)
- Meng-Tzu Weng
- Department of Medical Research, National Taiwan University Hospital Hsin-Chu Branch, HsinChu, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Kuan-Lin Lin
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Ya-Ling Huang
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Chitra Karki
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | - Jin-Liern Hong
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, MA, USA
| | - Dimitri Bennett
- Global Evidence and Outcomes, Takeda Development Center Americas, Inc., Cambridge, MA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - K Arnold Chan
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Shu-Chen Wei
- Address correspondence to: Shu-Chen Wei, MD, PhD, Division of Hepatology and Gastroenterology, Department of Internal Medicine, No. 7, Zhongshan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan; or, No. 7 Chung-Shan South Road, Taipei, Taiwan ()
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16
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Morales-Cruz M, Ali M, Christou C, Crothers H, McNulty D, Ward ST. Repeat operations in patients with anal fistula, a retrospective study across England and Wales. Int J Colorectal Dis 2023; 38:174. [PMID: 37349532 DOI: 10.1007/s00384-023-04467-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 06/24/2023]
Abstract
AIM This article reports the frequency of repeat operations including waiting times within the National Health Service (NHS) of England and Wales. METHODS Retrospective study on repeat operations for anal fistula (AF) performed between 1st January 2010 and 31st December 2016. Data were extracted from the national registry of data entered into Hospital Episode Statistics (HES). Patient factors (age, sex, self-declared ethnicity) and geographical location were tested for association with repeat operations and time to the second operation. RESULTS We analysed 36,223 patients that had an operation for AF within 148 NHS trusts. The median follow-up time was 28 months. The majority of patients (67.4%) had only one operation. Eighty-five per cent of them remained under the care of a single consultant. Six per cent of the repeat surgeries occurred in at least three different treatment sites. Young age and female sex were associated with higher rates of repeat operations. Non-declared and Black or Black British ethnicity were associated with fewer operations. The median waiting time between the first and second operations was 27.4 weeks (IQR: 14.7-55.3); between the second and third 28.0 weeks (IQR: 14.7-57.0); between the third and fourth 29.0 weeks. CONCLUSION This large real world population-based study shows that the majority of patients with AF undergo only one operation. Patients requiring multiple procedures tend to stay under the care of a small number of consultants but waiting times between operations are long. There is a geographical variation in the number of operations and the time between them.
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Affiliation(s)
- M Morales-Cruz
- University of Birmingham NHS Foundation Trust, Birmingham, UK.
| | - M Ali
- University of Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Christou
- Department of General Surgery, University Hospital of Limoges, 87000, Limoges, France
- Laboratory INSERM U1308, CAPTuR, Faculty of Medicine, University of Limoges, Limoges, France
| | - H Crothers
- University of Birmingham NHS Foundation Trust, Birmingham, UK
| | - D McNulty
- University of Birmingham NHS Foundation Trust, Birmingham, UK
| | - S T Ward
- University of Birmingham NHS Foundation Trust, Birmingham, UK
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Greywoode R, Petralia F, Ullman TA, Frederic Colombel J, Ungaro RC. Racial Difference in Efficacy of Golimumab in Ulcerative Colitis. Inflamm Bowel Dis 2023; 29:843-849. [PMID: 35913121 PMCID: PMC10233400 DOI: 10.1093/ibd/izac161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Observational studies have described racial differences in inflammatory bowel disease (IBD) genetics, clinical manifestations, and outcomes. Whether race impacts response to biologics in IBD is unclear. We conducted a post hoc analysis of phase 2 and 3 randomized clinical trials in ulcerative colitis to evaluate the effect of race on response to golimumab. METHODS We analyzed pooled individual-level data from induction and maintenance trials of golimumab through the Yale Open Data Access Project. The primary outcome was clinical response. Secondary outcomes were clinical remission and endoscopic healing. Multivariable logistic regression was performed comparing White vs racial minority groups (Asian, Black, or other race), adjusting for potential confounders. RESULTS There were 1006 participants in the induction (18% racial minority) and 783 participants in the maintenance (17% racial minority) trials. Compared with White participants, participants from racial minority groups had significantly lower clinical response (adjusted odds ratio [aOR], 0.43; 95% confidence interval [CI], 0.28-0.66), clinical remission (aOR, 0.41; 95% CI, 0.22-0.77), and endoscopic healing (aOR, 0.48; 95% CI, 0.31-0.74) at week 6. Participants from racial minority groups also had significantly lower clinical remission (aOR, 0.46; 95% CI, 0.28-0.74) and endoscopic healing (aOR, 0.63; 95% CI, 0.41-0.96) at week 30. There were no racial differences in placebo response rates. CONCLUSIONS Ulcerative colitis participants from racial minority groups were less likely to achieve clinical response, clinical remission, and endoscopic healing with golimumab compared with White participants in induction and maintenance trials. Further studies are needed to understand the impact of race on therapeutic response in IBD.
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Affiliation(s)
- Ruby Greywoode
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Francesca Petralia
- Department of Genetics and Genomic Sciences, Icahn Institute for Data Science and Genomic Technology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Thomas A Ullman
- Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jean Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ryan C Ungaro
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Borum ML. Racial and Ethnic Disparities in Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2023; 19:281-283. [PMID: 37799459 PMCID: PMC10548245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Marie L Borum
- Professor of Medicine Director, Division of Gastroenterology and Liver Disease George Washington University Washington, DC
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19
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Katsoula A, Axiaris G, Mpitouli A, Palatianou M, Christidou A, Dimitriadis N, Nakos A, Pastras P, Kourkoulis P, Karatzas P, Moutzoukis M, Zlatinoudis C, Philippidis A, Kourikou A, Kokkotis G, Gklavas A, Machaira A, Mantaka A, Talimtzi P, Anagnostopoulou E, Koutroubakis IE, Papaconstantinou I, Bamias G, Manolakopoulos S, Mathou N, Paraskeva K, Protopappas A, Tsironi E, Katsanos KH, Christodoulou DK, Papatheodoridis G, Michalopoulos G, Theocharis G, Triantos C, Pachiadakis I, Soufleris K, Viazis N, Mantzaris GJ, Tribonias G, Tzouvala M, Theodoropoulou A, Karmiris K, Zampeli E, Michopoulos S, Haidich AB, Giouleme O. The Inflammatory Bowel Disease-Disk Tool for Assessing Disability in Inflammatory Bowel Disease Patients: Validation of the Greek Version. J Clin Med 2023; 12:jcm12083023. [PMID: 37109360 PMCID: PMC10143768 DOI: 10.3390/jcm12083023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/05/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The Inflammatory Bowel Disease-Disk (IBD-Disk) is a physician-administered tool that evaluates the functional status of patients with Inflammatory Bowel Disease (IBD). The aim of our study was to validate the content of the IBD-Disk in a Greek cohort of IBD patients. METHODS Two questionnaires [the IBD Disk and the IBD-Disability Index (IBD-DI)] were translated into Greek and administered to IBD patients at baseline visit, after 4 weeks and 6 months. Validation of the IBD Disk included measuring of concurrent validity, reproducibility, and internal consistency. RESULTS A total of 300 patients were included at baseline and 269 at follow-up. There was a good correlation between the total scores of the IBD-Disk and IBD-DI at baseline (Pearson correlation 0.87, p < 0.001). Reproducibility of the total IBD-Disk score was very good [intra-class correlation coefficient (ICC), 95% confidence interval (CI) 0.89 (0.86-0.91)]. Cronbach's coefficient alpha for all items achieved 0.90 (95%CI 0.88-0.92), demonstrating a very good homogeneity of the IBD-Disk items. Female gender and extraintestinal manifestations were significantly associated with a higher IBD-Disk total score. CONCLUSIONS The Greek version of the IBD-Disk proved to be a reliable and valid tool in detecting and assessing IBD-related disability in a Greek cohort of IBD patients.
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Affiliation(s)
- Anastasia Katsoula
- Department of Gastroenterology and Hepatology, 2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University, 54124 Thessaloniki, Greece
| | - Georgios Axiaris
- Department of Gastroenterology, Alexandra General Hospital, 11528 Athens, Greece
| | - Afroditi Mpitouli
- Department of Gastroenterology, Venizeleio General Hospital, 71409 Heraklion, Greece
| | - Maria Palatianou
- Department of Gastroenterology, General Hospital of Nikaia-Piraeus "Agios Panteleimon", General Hospital Ditikis Attikis "Agia Varvara", 12351 Athens, Greece
| | - Angeliki Christidou
- Department of Gastroenterology, GHA 'Evaggelismos-Polykliniki', 10676 Athens, Greece
| | - Nikolaos Dimitriadis
- Department of Gastroenterology, Theagenio Anticancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece
| | - Andreas Nakos
- Department of Gastroenterology and Hepatology, 424 Military General Hospital, 54124 Thessaloniki, Greece
| | - Ploutarchos Pastras
- GI-Unit, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece
| | | | - Pantelis Karatzas
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", 11527 Athina, Greece
| | - Miltiadis Moutzoukis
- Department of Gastroenterology, University Hospital of Ioannina Medical School, 45500 Ioannina, Greece
| | | | - Athanasios Philippidis
- Gastroenterology and Hepatology Division of the First Propedeutic Department of Internal Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Anastasia Kourikou
- Gastroenterology-Liver Unit, Second Department of Internal Medicine, Hippokratio General Hospital, National and Kapodistrian University of Athens, 54643 Athens, Greece
| | - Georgios Kokkotis
- GI-Unit, 3rd Academic Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Antonios Gklavas
- Department of Surgery, Aretaieion University Hospital, 11528 Athens, Greece
| | - Angeliki Machaira
- Department of Gastroenterology, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Aikaterini Mantaka
- Department of Gastroenterology, General Hospital of Chania "Agios Georgios", 73300 Chania, Greece
| | - Persefoni Talimtzi
- Laboratory of Hygiene, Social-Preventive Medicine and Medical Statistics, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | | | - Ioannis E Koutroubakis
- Department of Gastroenterology, University Hospital of Heraklion, 71500 Heraklion, Greece
| | | | - Georgios Bamias
- GI-Unit, 3rd Academic Department of Internal Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Spilios Manolakopoulos
- Gastroenterology-Liver Unit, Second Department of Internal Medicine, Hippokratio General Hospital, National and Kapodistrian University of Athens, 54643 Athens, Greece
| | - Nicoletta Mathou
- Department of Gastroenterology, "Konstantopoulio-Patission" General Hospital, 14233 Nea Ionia, Greece
| | - Konstantina Paraskeva
- Department of Gastroenterology, "Konstantopoulio-Patission" General Hospital, 14233 Nea Ionia, Greece
| | - Andreas Protopappas
- Gastroenterology and Hepatology Division of the First Propedeutic Department of Internal Medicine, AHEPA University Hospital, 54636 Thessaloniki, Greece
| | - Eftychia Tsironi
- Department of Gastroenterology, Metaxa Memorial General Hospital, 18537 Piraeus, Greece
| | - Konstantinos H Katsanos
- Department of Gastroenterology, University Hospital of Ioannina Medical School, 45500 Ioannina, Greece
| | - Dimitrios K Christodoulou
- Department of Gastroenterology, University Hospital of Ioannina Medical School, 45500 Ioannina, Greece
| | - Georgios Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, General Hospital of Athens "Laiko", 11527 Athina, Greece
| | | | - Georgios Theocharis
- GI-Unit, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece
| | - Christos Triantos
- GI-Unit, Department of Internal Medicine, University Hospital of Patras, 26504 Patras, Greece
| | - Ioannis Pachiadakis
- Department of Gastroenterology and Hepatology, 424 Military General Hospital, 54124 Thessaloniki, Greece
| | - Konstantinos Soufleris
- Department of Gastroenterology, Theagenio Anticancer Hospital of Thessaloniki, 54639 Thessaloniki, Greece
| | - Nikolaos Viazis
- Department of Gastroenterology, GHA 'Evaggelismos-Polykliniki', 10676 Athens, Greece
| | | | - Georgios Tribonias
- Department of Gastroenterology, General Hospital of Nikaia-Piraeus "Agios Panteleimon", General Hospital Ditikis Attikis "Agia Varvara", 12351 Athens, Greece
| | - Maria Tzouvala
- Department of Gastroenterology, General Hospital of Nikaia-Piraeus "Agios Panteleimon", General Hospital Ditikis Attikis "Agia Varvara", 12351 Athens, Greece
| | | | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, 71409 Heraklion, Greece
| | - Evanthia Zampeli
- Department of Gastroenterology, Alexandra General Hospital, 11528 Athens, Greece
| | - Spyridon Michopoulos
- Department of Gastroenterology, Alexandra General Hospital, 11528 Athens, Greece
| | - Anna-Bettina Haidich
- Laboratory of Hygiene, Social-Preventive Medicine and Medical Statistics, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Olga Giouleme
- Department of Gastroenterology and Hepatology, 2nd Propedeutic Department of Internal Medicine, Medical School, Aristotle University, 54124 Thessaloniki, Greece
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20
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Hof T, Thimme R, Hasselblatt P. [Diversity in gastroenterology - A focus on inflammatory bowel diseases]. Dtsch Med Wochenschr 2023; 148:519-527. [PMID: 37094587 DOI: 10.1055/a-1892-4878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Factors related to patient diversity may play a major role in the pathogenesis and clinical manifestation of intestinal and liver diseases and should be considered during diagnostic workup and therapeutic decisions. Here we discuss how diversity factors such as gender, ethnicity, age and socioeconomic parameters may affect the manifestation and disease course of inflammatory bowel diseases (IBD, i.e. Crohn's disease and ulcerative colitis). Consideration of such factors may help to pave the path towards personalized medicine approaches in clinical practice.
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21
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Burstiner LS, Owings AH, Tacy C, Perez M, Royer A, Hreish Y, Johnson J, Barr M, Laird H, Tarugu S, Robinson TO, Hosseini-Carroll P, Liu J, Glover SC. A Focused Retrospective Study on Differences in IBD Characteristics between Black and White Patients in the South. Am J Med Sci 2023; 365:488-495. [PMID: 36842466 DOI: 10.1016/j.amjms.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/28/2023] [Accepted: 02/20/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND AND AIMS Most facets of Inflammatory Bowel Disease (IBD) have not been thoroughly compared among minority populations, including Black patients. Our study was designed to characterize the demographics, phenotypes, outcomes, healthcare utilization, and treatment of IBD in a large cohort with 38% Black patients. METHODS Electronic health records of 3272 IBD patients seen in a tertiary academic medical network from 2012 to July 15th, 2019 were analyzed. RESULTS Black patients with Crohn's disease were significantly more likely than White patients to suffer from perianal (p < 0.001), fistulizing (p < 0.001), and fibrostenotic phenotypes (p < 0.001). Black patients with IBD were significantly more likely to undergo IBD-related surgery (p = 0.042) and experience an IBD-related complication (p < 0.001). The proportion of patients with at least one colonoscopy, one visit to the gastroenterology clinic, one visit to the emergency department (ED), and one hospital admission were higher in Black patients (p < 0.001, p = 0.005, p < 0.001, and p < 0.001; respectively). CONCLUSIONS Black IBD patients had more severe disease phenotypes and worse healthcare outcomes than White patients. Black patients also used healthcare facilities and IBD medications to an equal or greater extent, despite being of a lower average socioeconomic class than their White counterparts. Our study suggests that underlying factors that do not pertain to the utilization of healthcare resources may be responsible for these worse outcomes in Black patients.
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Affiliation(s)
- Landen Shane Burstiner
- Department of Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, FL; Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL
| | - Anna H Owings
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Collin Tacy
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL
| | - Melanie Perez
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL
| | - Amor Royer
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Yousef Hreish
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Jeshanah Johnson
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Madelyn Barr
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Hannah Laird
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Spurthi Tarugu
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Tanya O Robinson
- Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS
| | | | - Julia Liu
- Division of Gastroenterology, Morehouse School of Medicine, Atlanta, GA
| | - Sarah C Glover
- Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS.
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22
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Cho S, Stroup BM, Britto SL, Ruan W, Schady D, Hoffman KL, Kellermayer R. Increased number of children in households may protect against inflammatory bowel disease. Pediatr Res 2023; 93:535-540. [PMID: 35701607 DOI: 10.1038/s41390-022-02149-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The increasing incidence of inflammatory bowel disease (IBD: Crohn's disease and ulcerative colitis) around the world has coincided with a wide array of environmental and epidemiologic changes. The relationship between IBD incidence and household or family size decline, however, has not been examined before. Our background epidemiological analyses suggested an inverse association between household size and IBD incidence. We aimed to examine this further in a murine model. METHODS We designed a unique two-generation cohousing model of family size and IBD susceptibility in C57BL/6J mice. Serial fecal microbiomes during cohousing were examined by high-throughput 16S rRNA sequencing. After cohousing for 10 days, mice were exposed to dextran sulfate sodium (DSS) to induce acute colitis. Body weight as a significant correlate of colitis severity was measured. RESULTS Mice in a large household arrangement demonstrated less weight loss than mice in the small household arrangement in the DSS model. Age- and housing-dependent microbiome shifts were found. CONCLUSIONS Larger households may be protective against intestinal inflammation through intergenerational microbiome modulation. Our observations may set the foundation for age-dependent, microbiome-directed future prevention against IBD. IMPACT Epidemiological analyses in this study suggested that IBD incidence may inversely correlate with household size (an indicator of family size/children per family), which has not been examined before. A uniquely designed two-generation cohousing model of family size and IBD susceptibility in mice supported our epidemiologic observations. Microbiome changes in our cohousing model may set the foundation for age-dependent, microbiome-directed prevention against IBD.
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Affiliation(s)
- Stanley Cho
- Section of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Bridget M Stroup
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Savini L Britto
- Section of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Wenly Ruan
- Section of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Deborah Schady
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
| | - Kristi L Hoffman
- Alkek Center for Metagenomics and Microbiome Research, Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Richard Kellermayer
- Section of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA. .,USDA/ARS Children's Nutrition Research Center, Houston, TX, USA.
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23
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Nguyen NH, Luo J, Paul P, Kim J, Syal G, Ha C, Rudrapatna V, Park S, Parekh N, Zheng K, Sauk JS, Limketkai B, Fleshner P, Eisenstein S, Ramamoorthy S, Melmed G, Dulai PS, Boland BS, Mahadevan U, Sandborn WJ, Ohno-Machado L, McGovern D, Singh S. Effectiveness and Safety of Biologic Therapy in Hispanic Vs Non-Hispanic Patients With Inflammatory Bowel Diseases: A CA-IBD Cohort Study. Clin Gastroenterol Hepatol 2023; 21:173-181.e5. [PMID: 35644340 PMCID: PMC9701245 DOI: 10.1016/j.cgh.2022.05.008] [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] [Received: 02/05/2022] [Revised: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There are limited data on outcomes of biologic therapy in Hispanic patients with inflammatory bowel diseases (IBDs). We compared risk of hospitalization, surgery, and serious infections in Hispanic vs non-Hispanic patients with IBD in a multicenter, electronic health record-based cohort of biologic-treated patients. METHODS We identified adult patients with IBD who were new users of biologic agents (tumor necrosis factor α [TNF-α] antagonists, ustekinumab, vedolizumab) from 5 academic institutions in California between 2010 and 2017. We compared the risk of all-cause hospitalization, IBD-related surgery, and serious infections in Hispanic vs non-Hispanic patients using 1:4 propensity score matching and survival analysis. RESULTS We compared 240 Hispanic patients (53% male; 45% with ulcerative colitis; 73% TNF-α antagonist-treated; 20% with prior biologic exposure) with 960 non-Hispanic patients (51% male; 44% with ulcerative colitis; 67% TNF-α antagonist-treated; 27% with prior biologic exposure). After propensity score matching, Hispanic patients were younger (37 ± 15 vs 40 ± 16 y; P = .02) and had a higher burden of comorbidities (Elixhauser index, >0; 37% vs 26%; P < .01), without any differences in patterns of medication use, burden of inflammation, and hospitalizations. Within 1 year of biologic initiation, Hispanic patients had higher rates of hospitalizations (31% vs 23%; adjusted hazard ratio [aHR], 1.32; 95% CI, 1.01-1.74) and IBD-related surgery (7.1% vs 4.6%; aHR, 2.00; 95% CI, 1.07-3.72), with a trend toward higher risk of serious infections (8.8% vs 4.9%; aHR, 1.74; 95% CI, 0.99-3.05). CONCLUSIONS In a multicenter, propensity score-matched cohort of biologic-treated patients with IBD, Hispanic patients experienced higher rates of hospitalization, surgery, and serious infections. Future studies are needed to investigate the biological, social, and environmental drivers of these differences.
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Affiliation(s)
- Nghia H Nguyen
- Division of Gastroenterology, Department of Medicine, UC San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, UC San Diego, La Jolla, California
| | - Jiyu Luo
- Division of Biostatistics and Bioinformatics, Department of Family Medicine and Public Health, UC San Diego, La Jolla, California
| | - Paulina Paul
- Division of Biomedical Informatics, Department of Medicine, UC San Diego, La Jolla, California
| | - Jihoon Kim
- Division of Biomedical Informatics, Department of Medicine, UC San Diego, La Jolla, California
| | - Gaurav Syal
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical System, Los Angeles, California
| | - Christina Ha
- Division of Gastroenterology, Mayo Clinic, Scottsdale, Arizona
| | - Vivek Rudrapatna
- Division of Gastroenterology, Department of Medicine, UC San Francisco, California
| | - Sunhee Park
- Division of Gastroenterology, Department of Medicine, UC Irvine, Orange, California
| | - Nimisha Parekh
- Division of Gastroenterology, Department of Medicine, UC Irvine, Orange, California
| | - Kai Zheng
- Department of Informatics, Donald Bren School of Information and Computer Sciences, UC Irvine, Orange, California
| | - Jenny S Sauk
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, UC Los Angeles, Los Angeles, California
| | - Berkeley Limketkai
- Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, UC Los Angeles, Los Angeles, California
| | - Phillip Fleshner
- Division of Colorectal Surgery, Department of Surgery, Cedars-Sinai Medical System, Los Angeles, California
| | - Samuel Eisenstein
- Division of Colon and Rectal Surgery, Department of Surgery, UC San Diego, La Jolla, California
| | - Sonia Ramamoorthy
- Division of Colon and Rectal Surgery, Department of Surgery, UC San Diego, La Jolla, California
| | - Gil Melmed
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical System, Los Angeles, California
| | - Parambir S Dulai
- Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Brigid S Boland
- Division of Gastroenterology, Department of Medicine, UC San Diego, La Jolla, California
| | - Uma Mahadevan
- Division of Gastroenterology, Department of Medicine, UC San Francisco, California
| | - William J Sandborn
- Division of Gastroenterology, Department of Medicine, UC San Diego, La Jolla, California
| | - Lucila Ohno-Machado
- Division of Biomedical Informatics, Department of Medicine, UC San Diego, La Jolla, California
| | - Dermot McGovern
- Karsh Division of Gastroenterology and Hepatology, Department of Medicine, Cedars-Sinai Medical System, Los Angeles, California
| | - Siddharth Singh
- Division of Gastroenterology, Department of Medicine, UC San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, UC San Diego, La Jolla, California.
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Aniwan S, Santiago P, Loftus EV, Park SH. The epidemiology of inflammatory bowel disease in Asia and Asian immigrants to Western countries. United European Gastroenterol J 2022; 10:1063-1076. [PMID: 36479863 PMCID: PMC9752270 DOI: 10.1002/ueg2.12350] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/24/2022] [Indexed: 12/13/2022] Open
Abstract
Inflammatory bowel disease (IBD), which comprises Crohn's disease and ulcerative colitis, is an idiopathic inflammatory condition of the gastrointestinal tract. The incidence and prevalence of IBD are rapidly increasing worldwide, particularly in newly industrialized regions such as Asia. Although a large medical armamentarium is available for treating this chronic disease, IBD imposes a marked global disease burden. To understand the complex etiopathogenesis of this condition, it is important to consider the rapidly changing trends in its epidemiology in Asia. During the past few decades, the incidence and prevalence of IBD have significantly increased in both Asian countries and Asian immigrants in Western countries. In this review, we aimed to study and update the epidemiology of IBD in diverse Asian regions and among Asian immigrants in North America and Europe. Moreover, we highlighted that this population exhibits a unique disease phenotype, such as male predominance and high frequency of perianal fistula in Crohn's disease. Also, a different disease phenotype including more complicated disease such as perianal complications was noted in Asian Americans and Asian Europeans.
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Affiliation(s)
- Satimai Aniwan
- Division of GastroenterologyChulalongkorn UniversityKing Chulalongkorn Memorial HospitalThai Red Cross SocietyBangkokThailand
| | - Priscila Santiago
- Division of Gastroenterology and HepatologyMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Edward V. Loftus
- Division of Gastroenterology and HepatologyMayo Clinic College of Medicine and ScienceRochesterMinnesotaUSA
| | - Sang Hyoung Park
- Department of GastroenterologyUniversity of Ulsan College of MedicineAsan Medical CenterSeoulKorea
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25
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Misra R, Sarafian M, Pechlivanis A, Ding N, Miguens-Blanco J, McDonald J, Holmes E, Marchesi J, Arebi N. Ethnicity Associated Microbial and Metabonomic Profiling in Newly Diagnosed Ulcerative Colitis. Clin Exp Gastroenterol 2022; 15:199-212. [PMID: 36505887 PMCID: PMC9733448 DOI: 10.2147/ceg.s371965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/07/2022] [Indexed: 12/11/2022] Open
Abstract
Introduction Ulcerative colitis (UC) differs across geography and ethnic groups. Gut microbial diversity plays a pivotal role in disease pathogenesis and differs across ethnic groups. The functional diversity in microbial-driven metabolites may have a pathophysiologic role and offer new therapeutic avenues. Methods Demographics and clinical data were recorded from newly diagnosed UC patients. Blood, urine and faecal samples were collected at three time points over one year. Bacterial content was analysed by 16S rRNA sequencing. Bile acid profiles and polar molecules in three biofluids were measured using liquid-chromatography mass spectrometry (HILIC) and nuclear magnetic resonance spectroscopy. Results We studied 42 patients with a new diagnosis of UC (27 South Asians; 15 Caucasians) with 261 biosamples. There were significant differences in relative abundance of bacteria at the phylum, genus and species level. Relative concentrations of urinary metabolites in South Asians were significantly lower for hippurate (positive correlation for Ruminococcus) and 4-cresol sulfate (Clostridia) (p<0.001) with higher concentrations of lactate (negative correlation for Bifidobacteriaceae). Faecal conjugated and primary conjugated bile acids concentrations were significantly higher in South Asians (p=0.02 and p=0.03 respectively). Results were unaffected by diet, phenotype, disease severity and ongoing therapy. Comparison of time points at diagnosis and at 1 year did not reveal changes in microbial and metabolic profile. Conclusion Ethnic-related microbial metabolite associations were observed in South Asians with UC. This suggests a predisposition to UC may be influenced by environmental factors reflected in a distinct gene-environment interaction. The variations may serve as markers to identify risk factors for UC and modified to enhance therapeutic response.
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Affiliation(s)
- Ravi Misra
- Gastroenterology, St Mark’s Academic Institute, London, UK,Correspondence: Ravi Misra, St. Mark’s Academic Institute, Imperial College, St. Mark’s Hospital, Watford Road, London, United Kingdom, Tel +44 0208 235 4124, Email
| | - Magali Sarafian
- Division of Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Imperial College, London, UK
| | | | - Nik Ding
- St Vincent’s Hospital, Inflammatory Bowel Disease Unit, Melbourne, Australia
| | - Jesus Miguens-Blanco
- Division of Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Imperial College, London, UK
| | | | - Elaine Holmes
- Division of Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Imperial College, London, UK,Health Futures Institute, Murdoch and Edith Cowan Universities, Murdoch, Australia
| | - Julian Marchesi
- Division of Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Imperial College, London, UK,School of Biosciences, Cardiff University, Cardiff, UK,Centre for Gut Health, Imperial College, London, UK
| | - Naila Arebi
- Gastroenterology, St Mark’s Academic Institute, London, UK
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Predictors of Perianal Fistula Healing in Children With Newly Diagnosed Crohn Disease. J Pediatr Gastroenterol Nutr 2022; 75:709-716. [PMID: 36399175 DOI: 10.1097/mpg.0000000000003595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Perianal fistulas are among the most severe complications of Crohn disease, but limited data regarding their outcomes are available in children. Our objective was to determine predictors of perianal fistula healing among pediatric patients newly diagnosed with Crohn disease. METHODS This single-center retrospective study followed patients with perianal fistulas at Crohn disease diagnosis until fistula healing. Time to healing was analyzed using Cox proportional hazard regression models considering relevant covariates including patient demographics, disease characteristics, medical therapies [no anti-tumor necrosis factor (TNF)α therapy, anti-TNFα therapy ±therapeutic drug monitoring], and perianal surgical procedures including fistulotomy, fistulectomy, removal of perianal lesions, seton placement, and incision and drainage. RESULTS Of 485 patients identified, 107 (22%) had a perianal fistula at Crohn disease diagnosis. Multivariate analysis identified that perianal fistulotomy, fistulectomy, and lesion removal [hazard ratio (HR) 0.46; P = 0.028], non-White race (HR 0.30, P < 0.01), and male sex (HR 0.42; P = 0.02) were associated with delayed fistula healing. Faster fistula healing was associated with treatment with anti-TNFα with therapeutic drug monitoring (HR 1.78, P = 0.009). There were no other differences in healing by treatment. CONCLUSIONS Fistulotomy, fistulectomy, and perianal lesion removal as well as non-White race were associated with delayed fistula healing. Anti-TNFα therapy was associated with faster fistula healing when combined with therapeutic drug monitoring, compared to all other medical treatment groups, including anti-TNFα therapy without therapeutic drug monitoring.
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Shiga H, Kakuta Y, An K, Abe Y, Fujimaki S, Shimoyama Y, Naito T, Moroi R, Kuroha M, Khor S, Kawai Y, Tokunaga K, Kinouchi Y, Masamune A. Response to COVID-19 vaccine is reduced in patients with inflammatory bowel disease, but improved with additional dose. J Gastroenterol Hepatol 2022; 38:44-51. [PMID: 36066279 PMCID: PMC9537921 DOI: 10.1111/jgh.16001] [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] [Received: 07/25/2022] [Revised: 08/28/2022] [Accepted: 09/04/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) vaccination is recommended for patients with inflammatory bowel disease (IBD); however, suppressed immune responses have been reported for fully vaccinated patients under immunosuppressive therapy, mainly from Western countries. We prospectively analyzed antibody titers of IBD patients in Asia induced by two-dose and additional dose of messengerRNA COVID-19 vaccine. METHODS After measuring high-affinity antibody titers, factors associated with antibody titers were identified by multiple regression analyses using the following covariates: sex, age (≥60 or <60 years), disease type (Crohn's disease or ulcerative colitis), vaccine type (BNT162b2 or mRNA-1273), time from second/third vaccination, molecular-targeted agent (anti-tumor necrosis factor [TNF] agents, ustekinumab, vedolizumab, tofacitinib, or no molecular-targeted agents), thiopurine, steroid, and 5-aminosalicylic acid. RESULTS Among 409 patients analyzed, mean titer was 1316.7 U/mL (SD, 1799.3); 403 (98.5%) were judged to be seropositive (≥0.8 U/mL), and 389 (95.1%) had neutralizing antibodies (≥15 U/mL). After the third vaccination, mean titer raised up to 21 123.8 U/mL (SD, 23 474.5); all 179 were seropositive, and 178 (99.4%) had neutralizing antibodies. In 248 patients with genetic data, there was no difference in mean titer after two/third doses between carriers and non-carriers of HLA-A24 associated with severe disease during COVID-19 infection. A multiple regression analyses using covariates revealed that older age, vaccine type (BNT162b2), time from second/third dose, anti-TNF agent, tofacitinib, and thiopurine were independently associated with lower antibody titers. CONCLUSIONS Our findings further support the recommendation for COVID-19 vaccination in patients under immunosuppressive therapy, especially additional third dose for patients receiving anti-TNF agents and/or thiopurine or tofacitinib.
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Affiliation(s)
- Hisashi Shiga
- Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
| | - Yoichi Kakuta
- Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
| | - Kumiko An
- Laboratory DiagnosticsTohoku University HospitalSendaiJapan
| | - Yuko Abe
- Laboratory DiagnosticsTohoku University HospitalSendaiJapan
| | | | - Yusuke Shimoyama
- Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
| | - Takeo Naito
- Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
| | - Rintaro Moroi
- Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
| | - Masatake Kuroha
- Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
| | - Seik‐Soon Khor
- Genome Medical Science ProjectNational Center for Global Health and MedicineTokyoJapan
| | - Yosuke Kawai
- Genome Medical Science ProjectNational Center for Global Health and MedicineTokyoJapan
| | - Katsushi Tokunaga
- Genome Medical Science ProjectNational Center for Global Health and MedicineTokyoJapan
| | - Yoshitaka Kinouchi
- Student Health Care Center, Institute for Excellence in Higher EducationTohoku UniversitySendaiJapan
| | - Atsushi Masamune
- Division of GastroenterologyTohoku University Graduate School of MedicineSendaiJapan
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Wong ECL, Moayyedi P, Narula N. Beyond the White pill: Advocating for racial diversity in IBD trials. J Crohns Colitis 2022; 17:459-461. [PMID: 36087074 DOI: 10.1093/ecco-jcc/jjac134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Indexed: 02/08/2023]
Abstract
Abstract
Although inflammatory bowel disease [IBD] affects an increasingly diverse patient population, most patients in IBD clinical trials are White. Acknowledging current barriers and taking meaningful action is required at multiple levels to improve racial diversity across clinical trials in IBD. Ultimately, improving racial diversity in trials can in turn improve the care received by the diverse patients seen in clinical practice.
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Affiliation(s)
- Emily C L Wong
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton ON, Canada
| | - Paul Moayyedi
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton ON, Canada
| | - Neeraj Narula
- Department of Medicine (Division of Gastroenterology) and Farncombe Family Digestive Health Research Institute; McMaster University, Hamilton ON, Canada
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Pérez-Jeldres T, Pizarro B, Ascui G, Orellana M, Cerda-Villablanca M, Alvares D, de la Vega A, Cannistra M, Cornejo B, Baéz P, Silva V, Arriagada E, Rivera-Nieves J, Estela R, Hernández-Rocha C, Álvarez-Lobos M, Tobar F. Ethnicity influences phenotype and clinical outcomes: Comparing a South American with a North American inflammatory bowel disease cohort. Medicine (Baltimore) 2022; 101:e30216. [PMID: 36086782 PMCID: PMC10980497 DOI: 10.1097/md.0000000000030216] [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: 04/14/2022] [Accepted: 07/12/2022] [Indexed: 11/27/2022] Open
Abstract
Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn disease (CD), has emerged as a global disease with an increasing incidence in developing and newly industrialized regions such as South America. This global rise offers the opportunity to explore the differences and similarities in disease presentation and outcomes across different genetic backgrounds and geographic locations. Our study includes 265 IBD patients. We performed an exploratory analysis of the databases of Chilean and North American IBD patients to compare the clinical phenotypes between the cohorts. We employed an unsupervised machine-learning approach using principal component analysis, uniform manifold approximation, and projection, among others, for each disease. Finally, we predicted the cohort (North American vs Chilean) using a random forest. Several unsupervised machine learning methods have separated the 2 main groups, supporting the differences between North American and Chilean patients with each disease. The variables that explained the loadings of the clinical metadata on the principal components were related to the therapies and disease extension/location at diagnosis. Our random forest models were trained for cohort classification based on clinical characteristics, obtaining high accuracy (0.86 = UC; 0.79 = CD). Similarly, variables related to therapy and disease extension/location had a high Gini index. Similarly, univariate analysis showed a later CD age at diagnosis in Chilean IBD patients (37 vs 24; P = .005). Our study suggests a clinical difference between North American and Chilean IBD patients: later CD age at diagnosis with a predominantly less aggressive phenotype (39% vs 54% B1) and more limited disease, despite fewer biological therapies being used in Chile for both diseases.
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Affiliation(s)
- Tamara Pérez-Jeldres
- Department of Gastroenterology, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
- Instituto Chileno-Japonés, University of Chile, Santiago, Chile
| | - Benjamín Pizarro
- Radiology Department, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Gabriel Ascui
- La Jolla Institute for Allergy and Immunology, San Diego, CA
| | - Matías Orellana
- Department of Computer Science, Faculty of Physical Sciences and Mathematics of the University of Chile, Santiago, Chile
| | - Mauricio Cerda-Villablanca
- Integrative Biology Program, Institute of Biomedical Sciences, Center for Medical Informatics and Telemedicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Danilo Alvares
- Department of Statistics, Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Macarena Cannistra
- Department of Gastroenterology, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Bárbara Cornejo
- Department of Gastroenterology, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Pablo Baéz
- Integrative Biology Program, Institute of Biomedical Sciences, Center for Medical Informatics and Telemedicine, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Verónica Silva
- Instituto Chileno-Japonés, University of Chile, Santiago, Chile
| | | | - Jesús Rivera-Nieves
- Inflammatory Bowel Disease Center, Division of Gastroenterology, University of California, San Diego, La Jolla, CA
| | - Ricardo Estela
- Instituto Chileno-Japonés, University of Chile, Santiago, Chile
| | - Cristián Hernández-Rocha
- Department of Gastroenterology, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Manuel Álvarez-Lobos
- Department of Gastroenterology, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile
| | - Felipe Tobar
- Initiative for Data & Artificial Intelligence, University of Chile
- Center for Mathematical Modeling, University of Chile, Santiago, Chile
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Booth A, Ford W, Brennan E, Magwood G, Forster E, Curran T. Towards Equitable Surgical Management of Inflammatory Bowel Disease: A Systematic Review of Disparities in Surgery for Inflammatory Bowel Disease. Inflamm Bowel Dis 2022; 28:1405-1419. [PMID: 34553754 DOI: 10.1093/ibd/izab237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Existing evidence for disparities in inflammatory bowel disease is fragmented and heterogenous. Underlying mechanisms for differences in outcomes based on race and socioeconomic status remain undefined. We performed a systematic review of the literature to examine disparities in surgery for inflammatory bowel disease in the United States. METHODS Electronic databases were searched from 2000 through June 11, 2021, to identify studies addressing disparities in surgical treatment for adults with inflammatory bowel disease. Eligible English-language publications comparing the use or outcomes of surgery by racial/ethnic, socioeconomic, geographic, and/or institutional factors were included. Studies were grouped according to whether outcomes of surgery were reported or surgery itself was the relevant end point (utilization). Quality was assessed using the Newcastle-Ottawa Scale for observational studies. RESULTS Forty-five studies were included. Twenty-four reported surgical outcomes and 21addressed utilization. Race/ethnicity was considered in 96% of studies, socioeconomic status in 44%, geographic factors in 27%, and hospital/surgeon factors in 22%. Although study populations and end points were heterogeneous, Black and Hispanic patients were less likely to undergo abdominal surgery when hospitalized; they were more likely to have a complication when they did have surgery. Differences based on race were correlated with socioeconomic factors but frequently remained significant after adjustments for insurance and baseline health. CONCLUSIONS Surgical disparities based on sociologic and structural factors reflect unidentified differences in multidisciplinary disease management. A broad, multidimensional approach to disparities research with more granular and diverse data sources is needed to improve health care quality and equity for inflammatory bowel disease.
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Affiliation(s)
- Alexander Booth
- Division of Colon and Rectal Surgery, Medical University of South Carolina, Charleston, SC, USA.,Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Wilson Ford
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Emily Brennan
- Colbert Education Center and Library, Medical University of South Carolina, Charleston, SC, USA
| | - Gayenell Magwood
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Erin Forster
- Division of Gastroenterology, Hepatology and Nutrition, Medical University of South Carolina, Charleston, SC, USA
| | - Thomas Curran
- Division of Colon and Rectal Surgery, Medical University of South Carolina, Charleston, SC, USA
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Florence-Damilola O, Aboubakr A, Anyane-Yeboa A. Inflammatory bowel disease in underserved populations: lessons for practice. Curr Opin Gastroenterol 2022; 38:321-327. [PMID: 35762691 PMCID: PMC10332404 DOI: 10.1097/mog.0000000000000855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW The incidence of inflammatory bowel disease (IBD) is increasing in minority groups across the USA. There are racial and ethnic disparities in IBD care and outcomes that are rooted in historical injustice and inequities in the social determinants of health. RECENT FINDINGS Current literature has identified racial, ethnic and sociodemographic disparities in therapeutics and outcomes for IBD, including disease severity, morbidity and mortality. SUMMARY Strategies to achieve equity in IBD include tackling structural racism as a driver of health disparities and making actionable changes against multilevel barriers to care.
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Affiliation(s)
- Odufalu Florence-Damilola
- Division of GI & Liver Disease, Department of Medicine, Keck School of Medicine of USC; Los Angeles, California
| | - Aiya Aboubakr
- Department of Medicine, New York Presbyterian/Weill Cornell Medical Center; New York, NY
| | - Adjoa Anyane-Yeboa
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School; Boston, MA
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Rabie EA, Sayed ISM, Amr K, Ahmed HA, Mostafa MI, Hassib NF, El-Sayed H, Zada SK, El-Kamah G. Confirmation of a Phenotypic Entity for TSPEAR Variants in Egyptian Ectodermal Dysplasia Patients and Role of Ethnicity. Genes (Basel) 2022; 13:genes13061056. [PMID: 35741818 PMCID: PMC9222913 DOI: 10.3390/genes13061056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 02/01/2023] Open
Abstract
Ectodermal dysplasia (ED) are hereditary disorders characterized by the disturbance of the ectodermal development of at least two of four ectodermal tissues: teeth, hair, nails and sweat glands. Clinical classification of ED is challenged by overlapping features, variable expressivity, and low number of patients, hindering full phenotypic spectrum identification. Disease-causing variants in elements of major developmental pathways, e.g., Ectodysplasin/NFκB, Wnt, and Tp63 pathways, have been identified in fewer than half of ED phenotypes. Whole-exome sequencing (WES) was performed for ten Egyptian ED patients presenting with tooth agenesis, normal sweating, scalp hypotrichosis, and sharing characteristic facial features. WES was followed by in silico analysis of the effects of novel detected genetic variants on mRNA and protein structure. The study identified four novel rare pathogenic and likely pathogenic TSPEAR variants, a gene which was recently found to be involved in ectodermal organogenesis. A novel in-frame deletion recurred in eight patients from six unrelated families. Comparing our cohort to previously reported TSPEAR cohorts highlighted the influence of ethnicity on TSPEAR phenotypic affection. Our study expands the clinical and mutational spectrum of the growing TSPEAR associated phenotypes, and pinpoints the influence of WES and in silico tools on identification of rare disease-causing variants.
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Affiliation(s)
- Eman A. Rabie
- Medical Molecular Genetics Department, Human Genetics & Genome Research Division (HGGR), National Research Centre (NRC), Cairo 12622, Egypt;
- Biology Department, School of Sciences and Engineering, The American University in Cairo (AUC), Cairo 11835, Egypt;
- Correspondence: (E.A.R.); (K.A.); (G.E.-K.)
| | - Inas S. M. Sayed
- Orodental Genetics Department, Human Genetics & Genome Research Division (HGGR), National Research Centre (NRC), Cairo 12622, Egypt; (I.S.M.S.); (M.I.M.); (N.F.H.)
| | - Khalda Amr
- Medical Molecular Genetics Department, Human Genetics & Genome Research Division (HGGR), National Research Centre (NRC), Cairo 12622, Egypt;
- Correspondence: (E.A.R.); (K.A.); (G.E.-K.)
| | - Hoda A. Ahmed
- Medical Molecular Genetics Department, Human Genetics & Genome Research Division (HGGR), National Research Centre (NRC), Cairo 12622, Egypt;
| | - Mostafa I. Mostafa
- Orodental Genetics Department, Human Genetics & Genome Research Division (HGGR), National Research Centre (NRC), Cairo 12622, Egypt; (I.S.M.S.); (M.I.M.); (N.F.H.)
| | - Nehal F. Hassib
- Orodental Genetics Department, Human Genetics & Genome Research Division (HGGR), National Research Centre (NRC), Cairo 12622, Egypt; (I.S.M.S.); (M.I.M.); (N.F.H.)
| | - Heba El-Sayed
- Clinical Genetics Department, Human Genetics & Genome Research Division (HGGR), National Research Centre (NRC), Cairo 12622, Egypt;
| | - Suher K. Zada
- Biology Department, School of Sciences and Engineering, The American University in Cairo (AUC), Cairo 11835, Egypt;
| | - Ghada El-Kamah
- Clinical Genetics Department, Human Genetics & Genome Research Division (HGGR), National Research Centre (NRC), Cairo 12622, Egypt;
- Correspondence: (E.A.R.); (K.A.); (G.E.-K.)
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The first association study of Protein Tyrosine Phosphatase, Non-Receptor Type 2 (PTPN2) gene polymorphisms in Malaysian patients with Crohn's disease. Gene 2022; 836:146661. [PMID: 35680018 DOI: 10.1016/j.gene.2022.146661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 04/21/2022] [Accepted: 06/03/2022] [Indexed: 11/20/2022]
Abstract
Crohn's disease (CD) is one of the sub-entities of Inflammatory Bowel Disease which causes chronic inflammation in the gastrointestinal tract. The development of CD has shown to have a strong genetic association. Therefore, the present study aimed to investigate the association between genetic polymorphisms in a susceptible locus of CD, the protein tyrosine phosphatase, non-receptor type 2 (PTPN2) gene and the development of CD in Malaysian patients. A total of 137 CD patients and 274 matched healthy controls were recruited in the present study. Genomic DNA was extracted from the venous blood of participants and five targeted single nucleotide polymorphisms (SNPs) in the PTPN2 gene were genotyped using polymerase chain reaction. Associations between the SNPs and CD were determined using Fisher's exact test and odds ratio. Findings showed that all five selected SNPs were not significantly associated with the development of CD in Malaysian patients, which was in contrast to studies among the European populations. Malaysian Chinese with rs487273 heterozygous G/T genotype was found to have a lower occurrence of CD (P-value = 0.0253; OR = 0.4396). Patients with rs2542152 homozygous T genotype were associated with stricturing behaviour (P-value = 0.0302, OR = 2.9944). The rs16939895 A/G genotype was associated with inflammation at the ileum site (P-value = 0.0387, OR = 2.2105)while homozygous G genotype was associated with colonic CD (P-value = 0.0164, OR = 2.3917). Functional studies of these SNPs are needed to evaluate their potential use as a biomarker for disease phenotypes among Asian patients.
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Peña-Sánchez JN, Osei JA, Marques Santos JD, Jennings D, Andkhoie M, Brass C, Bukassa-Kazadi G, Lu X, Johnson-Jennings M, Porter L, Porter R, Quintin CL, Sanderson R, Teucher U, Fowler S. Increasing Prevalence and Stable Incidence Rates of Inflammatory Bowel Disease Among First Nations: Population-Based Evidence From a Western Canadian Province. Inflamm Bowel Dis 2022; 28:514-522. [PMID: 34037223 PMCID: PMC8972279 DOI: 10.1093/ibd/izab096] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is limited to no evidence of the prevalence and incidence rates of inflammatory bowel disease (IBD) among Indigenous peoples. In partnership with Indigenous patients and family advocates, we aimed to estimate the prevalence, incidence, and trends over time of IBD among First Nations (FNs) since 1999 in the Western Canadian province of Saskatchewan. METHODS We conducted a retrospective population-based study linking provincial administrative health data from the 1999-2000 to 2016-2017 fiscal years. An IBD case definition requiring multiple health care contacts was used. The prevalence and incidence data were modeled using generalized linear models and a negative binomial distribution. Models considered the effect of age groups, sex, diagnosis type (ulcerative colitis [UC], Crohn disease [CD]), and fiscal years to estimate prevalence and incidence rates and trends over time. RESULTS The prevalence of IBD among FNs increased from 64/100,000 (95% confidence interval [CI], 62-66) in 1999-2000 to 142/100,000 (95% CI, 140-144) people in 2016-2017, with an annual average increase of 4.2% (95% CI, 3.2%-5.2%). Similarly, the prevalence of UC and CD, respectively, increased by 3.4% (95% CI, 2.3%-4.6%) and 4.1% (95% CI, 3.3%-4.9%) per year. In contrast, the incidence rates of IBD, UC, and CD among FNs depicted stable trends over time; no statistically significant changes were observed in the annual change trend tests. The ratio of UC to CD was 1.71. CONCLUSIONS We provided population-based evidence of the increasing prevalence and stable incidence rates of IBD among FNs. Further studies are needed in other regions to continue understanding the patterns of IBD among Indigenous peoples.
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Affiliation(s)
- Juan Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jessica Amankwah Osei
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jose Diego Marques Santos
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Derek Jennings
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Mustafa Andkhoie
- School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Germain Bukassa-Kazadi
- Health Surveillance and Assessment Unit Service, Department of Indigenous Services Canada, Regina, Saskatchewan, Canada
| | - Xinya Lu
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | - Michelle Johnson-Jennings
- Department of Indigenous Studies, College of Arts and Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Rob Porter
- York Factory First Nation, Manitoba, Canada
| | - Carol-Lynne Quintin
- Crohn’s and Colitis Canada, Saskatchewan Chapter, Saskatoon, Saskatchewan, Canada
| | | | - Ulrich Teucher
- Department of Psychology, College of Arts and Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sharyle Fowler
- Division of Gastroenterology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Piestansky J, Olesova D, Matuskova M, Cizmarova I, Chalova P, Galba J, Majerova P, Mikus P, Kovac A. Amino acids in inflammatory bowel diseases: Modern diagnostic tools and methodologies. Adv Clin Chem 2022; 107:139-213. [PMID: 35337602 DOI: 10.1016/bs.acc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Amino acids are crucial building blocks of living organisms. Together with their derivatives, they participate in many intracellular processes to act as hormones, neuromodulators, and neurotransmitters. For several decades amino acids have been studied for their potential as markers of various diseases, including inflammatory bowel diseases. Subsequent improvements in sample pretreatment, separation, and detection methods have enabled the specific and very sensitive determination of these molecules in multicomponent matrices-biological fluids and tissues. The information obtained from targeted amino acid analysis (biomarker-based analytical strategy) can be further used for early diagnostics, to monitor the course of the disease or compliance of the patients. This review will provide an insight into current knowledge about inflammatory bowel diseases, the role of proteinogenic amino acids in intestinal inflammation and modern analytical techniques used in its diagnosis and disease activity monitoring. Current advances in the analysis of amino acids focused on sample pretreatment, separation strategy, or detection methods are highlighted, and their potential in clinical laboratories is discussed. In addition, the latest clinical data obtained from the metabolomic profiling of patients suffering from inflammatory bowel diseases are summarized with a focus on proteinogenic amino acids.
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Affiliation(s)
- Juraj Piestansky
- Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia; Toxicological and Antidoping Center, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Dominika Olesova
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Michaela Matuskova
- Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Ivana Cizmarova
- Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Petra Chalova
- Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Jaroslav Galba
- Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Petra Majerova
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Peter Mikus
- Department of Pharmaceutical Analysis and Nuclear Pharmacy, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia; Toxicological and Antidoping Center, Faculty of Pharmacy, Comenius University in Bratislava, Bratislava, Slovakia
| | - Andrej Kovac
- Institute of Neuroimmunology, Slovak Academy of Sciences, Bratislava, Slovakia.
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Damas OM, Kuftinec G, Khakoo NS, Morillo D, Quintero MA, Levitt J, Lopez J, Kerman DH, Abreu MT, Deshpande AR, Schwartz SJ, Palacio A. Social barriers influence inflammatory bowel disease (IBD) outcomes and disproportionally affect Hispanics and non-Hispanic Blacks with IBD. Therap Adv Gastroenterol 2022; 15:17562848221079162. [PMID: 35356362 PMCID: PMC8958706 DOI: 10.1177/17562848221079162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The impact of social determinants of health in inflammatory bowel disease (IBD) remains understudied. We evaluated the impact of social barriers on IBD outcomes within a diverse cohort of patients. METHODS We performed a cross-sectional study on adult IBD patients and assessed known social determinants of health. We calculated the total prevalence of these barriers in the sample as a whole and within each ethnic group. We summed the number of barriers present for each individual to create a cumulative social barrier score (SBS), and we evaluated the relationship of each barrier and of the cumulative SBS with IBD outcomes, including disease activity and depressive symptoms. RESULTS A total of 316 patients were included in the study. Disparities in the prevalence of social barriers emerged by ethnicity: non-Hispanic Blacks reported the greatest number of social barriers, followed by Hispanic patients. Prevalent social barriers included financial strains (38.4%), such as food insecurity, medical care delays (~30%), and low educational attainment (26.8%). Social barriers associated with poor IBD outcomes included low educational attainment, poor health literacy, and financial insecurity. High SBS was associated with greater depressive symptoms [odds ratio (OR) 1.94, 95% confidence interval (CI) 1.21-2.9, p = 0.001] and lower reported use of medications. Greater ulcerative colitis (UC) disease activity was observed in patients with greater SBS. No associations were identified between SBS and IBD surgeries, hospitalizations, or disease location. CONCLUSION Our study identifies social barriers that may impact IBD care and are disproportionately higher in non-Hispanic Blacks and Hispanics in the United States. Future studies should focus on implementing interventions to reduce these barriers and improve delivery of care.
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Affiliation(s)
| | - Gabriela Kuftinec
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nidah S. Khakoo
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Diana Morillo
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria A. Quintero
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - David H. Kerman
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Maria T. Abreu
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Amar R. Deshpande
- Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seth J. Schwartz
- Departments of Kinesiology, Health Education, and Educational Psychology, College of Education, The University of Texas at Austin, Austin, TX, USADepartment of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ana Palacio
- Department of Public Health Sciences, University of Miami Miller School of Medicine and Miami VA Geriatric Research Education and Clinical Center, Miami, FL, USA
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Park SH, Im JP, Park H, Jeong SK, Lee JH, Rhee KH, Kim YH, Hong SN, Kim KH, Seo SI, Cha JM, Park SY, Kim JS, Yoon H, Kim SH, Jang J, Kim JH, Suh SO, Kim YK, Ye BD, Yang SK. Clinical Features and Long-Term Outcomes of Paediatric-Onset Inflammatory Bowel Disease in a Population-Based Cohort in the Songpa-Kangdong District of Seoul, Korea. J Crohns Colitis 2022; 16:207-215. [PMID: 34309652 DOI: 10.1093/ecco-jcc/jjab132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS The long-term outcomes of paediatric-onset inflammatory bowel disease [pIBD] in non-Caucasian populations are unknown. We therefore evaluated and compared the clinical features and long-term outcomes of pIBD with those of adult-onset IBD [aIBD] using a population-based cohort in the Songpa-Kangdong district of Seoul, Korea. METHODS Clinical characteristics and prognoses were compared between the two groups: pIBD [defined as <18 years of age at diagnosis] and aIBD [18-59 years of age at diagnosis]. RESULTS We identified 131 patients with pIBD (48 ulcerative colitis [UC], 83 Crohn's disease [CD]) and 1192 patients with aIBD [866 UC, 326 CD] during 1986-2015. Extensive colitis at diagnosis was more prevalent in pUC than in aUC [45.8% vs 22.3%, p < 0.001], and the overall exposure to corticosteroids, thiopurines and anti-tumour necrosis factor agents was higher in pUC than in aUC [p < 0.001]. The cumulative risk of colectomy was higher in pUC than in aUC during a median follow-up of 125.0 and 112.1 months, respectively [8.9% vs 1.8% at 10 years after diagnosis, p = 0.030]. Ileocolonic location and inflammatory behaviour at diagnosis were more common in pCD than in aCD; however, patients with pCD and aCD did not differ regarding treatment or disease course during a median follow-up of 137.2 and 120.9 months, respectively. CONCLUSION Our study showed clear differences between pIBD and aIBD, especially in UC. pUC presents with more extensive diseases and may have a more severe disease course, as suggested by an earlier time to administering medications and performing colectomy.
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Affiliation(s)
- Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Pil Im
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunju Park
- Department of Gastroenterology, Daehang Hospital, Seoul, Korea
| | | | - Ji Hyun Lee
- Digestive Endoscopic Center, Seoul Song Do Colorectal Hospital, Seoul, Korea
| | | | - Young-Ho Kim
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Noh Hong
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Ho Kim
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seung In Seo
- Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University College of Medicine, Seoul, Korea
| | | | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Sung Hoon Kim
- Department of Internal Medicine, VHS Medical Center, Seoul, Korea
| | - Jisun Jang
- Department of Internal Medicine, VHS Medical Center, Seoul, Korea
| | - Jeong Hwan Kim
- Department of Internal Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Seong O Suh
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | | | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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38
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Park SB, Yoon JY, Cha JM. What Are the Different Phenotypes of Inflammatory Bowel Disease in Asia? Gut Liver 2022; 16:676-685. [PMID: 35145045 PMCID: PMC9474490 DOI: 10.5009/gnl210385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/16/2021] [Accepted: 11/23/2021] [Indexed: 12/04/2022] Open
Abstract
The burden of inflammatory bowel disease (IBD) in Asia has been increasing over the past decades. Although patients with IBD show heterogenous phenotypes depending on the individual characteristics, no significant differences have been established in the IBD phenotypes of Western and Asian populations. However, despite the much lower incidence of IBD in Asia than in Western countries, the incidence has been rapidly increasing in Asia while remaining stable in Western countries. The incidence of ulcerative colitis (UC) showed an earlier and a more marked increase than the incidence of Crohn disease (CD), but the UC-to-CD ratio has recently decreased because of a relative increase in the incidence of CD in Asia. While CD shows a significant male predominance, UC only shows a slight male predominance. A recent study reported that the incidence of IBD in Asia showed a bimodal age distribution with increasing IBD prevalence, similar to the findings of Western studies. CD in Asian patients, especially those in East Asia, is characterized by ileocolonic involvement and perianal fistula. The frequency of extraintestinal manifestations, including primary sclerosing cholangitis, appears to be lower in Asia, but this finding should be interpreted with caution due to the transient and nonspecific nature of these manifestations. Although familial aggregation is lower in East Asia, it may also be explained by the low prevalence of IBD in Asia. Thus, more studies should focus on the differences in phenotypes in Asian IBD patients versus Western patients.
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Affiliation(s)
- Su Bee Park
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jin Young Yoon
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae Myung Cha
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Korea
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Avalos DJ, Satiya J, Contreras A, Trivedi S, Alvarado L, Dodoo C, Dwivedi AK, Zuckerman MJ. Latin Americans and US Hispanics show differences in IBD phenotype: a systematic review with meta-analysis. J Investig Med 2021; 70:919-933. [PMID: 34933995 DOI: 10.1136/jim-2021-001846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2021] [Indexed: 11/03/2022]
Abstract
Latin America has experienced a rise in the prevalence and incidence of inflammatory bowel disease (IBD). Differences in IBD phenotype between Hispanics in Latin America and those in the USA have not been described. We conducted a systematic review with meta-analysis of population-based and cohort studies comparing the phenotype of ulcerative colitis (UC) and Crohn's disease (CD) in Latin Americans and US Hispanics. A systematic search was conducted up to March 2019 using MEDLINE, EMBASE and Google Scholar. Inclusion criterion includes studies describing IBD phenotype in Latin Americans or in US Hispanics. Exclusion criterion includes prevalence or incidence studies not describing phenotype. A random effects model was chosen "a priori" for analysis of pooled proportions. A total of 46 studies were included from Latin America and 7 studies from the USA. The predominant IBD subtype in Latin America was UC with a more balanced UC:CD ratio noted in Puerto Rico (0.53) and Brazil (0.56). UC-related extensive colitis was more common in US Hispanics (0.64) than in Latin Americans (0.38), p<0.001. CD phenotype was similar between US Hispanics and Latin Americans. UC is the predominant IBD subtype in Latin America, with the exception of Puerto Rico and Brazil which demonstrate a more balanced UC:CD ratio. In UC, extensive colitis was more frequently seen in US Hispanics than in Latin Americans. CD phenotype was similar in both US Hispanics and Latin Americans.
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Affiliation(s)
| | - Jinendra Satiya
- Division of Gastroenterology & Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alberto Contreras
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Shivani Trivedi
- Department of Internal Medicine, Largo Medical Center, Largo, Florida, USA
| | - Luis Alvarado
- Biostatistics and Epidemiology Consulting lab, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Christopher Dodoo
- Biostatistics and Epidemiology Consulting lab, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Alok Kumar Dwivedi
- Department of Molecular and Translational Medicine, Division of Biostatistics & Epidemiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Marc J Zuckerman
- Division of Gastroenterology, Texas Tech University Health Sciences Center, El Paso, Texas, USA
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40
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Chin YH, Ng CH, Lin SY, Jain SR, Kong G, Koh JWH, Tan DJH, Ong DEH, Muthiah MD, Chong CS, Foo FJ, Leong R, Chan WPW. Systematic review with meta-analysis: The prevalence, risk factors and outcomes of upper gastrointestinal tract Crohn's disease. Dig Liver Dis 2021; 53:1548-1558. [PMID: 34412995 DOI: 10.1016/j.dld.2021.07.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/28/2021] [Accepted: 07/21/2021] [Indexed: 12/11/2022]
Abstract
AIMS Upper gastrointestinal Crohn's disease (UGI-CD) is an important subclassification of Crohn's Disease (CD). We performed a systematic review and meta-analysis to evaluate the prevalence, risk factors, and clinical outcomes associated with UGI-CD. METHODS We searched Embase and Medline for articles reporting the clinical information of UGI-CD in CD patients, through 27 October 2020. Disease location and phenotype were coded according to the Montreal classification, and results were pooled with random effects by DerSimonian and Laird model. RESULTS 26 articles were included. The prevalence of UGI-CD was 13%. UGI-CD was most commonly found in the stomach (56%) and was associated with concurrent ileocolonic involvement (54%). Non-stricturing, non-penetrating UGI-CD was the most common behavioral phenotype (61%). L4-jejunal disease was associated with the highest rates of surgery. Region of origin did not significantly influence the location and phenotype of UGI-CD. Young, male patients presenting with erythema nodosum, aphthous ulcers and stricturing-phenotype are more likely to have UGI-CD, which in turn is linked to increased risk of hospitalization and surgery. CONCLUSION UGI-CD is present in 13% of patients with CD, and patients with L4-jejunal disease are more likely to require surgery. Further studies examining the effect of ethnicity and region on UGI-CD are needed.
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Affiliation(s)
- Yip Han Chin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore.
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Snow Yunni Lin
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Sneha Rajiv Jain
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - Gwyneth Kong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | | | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
| | - David Eng Hui Ong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital
| | - Mark Dhinesh Muthiah
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital
| | - Choon Seng Chong
- Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore; Division of Colorectal Surgery, Department of Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | | | - Rupert Leong
- The University of Sydney, Sydney, New South Wales, Australia; Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Webber Pak Wo Chan
- Department of Gastroenterology, Singapore General Hospital, Singapore, 20 College Road, Academia level 3, Singapore 169856.
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41
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Asowata OE, Singh A, Ngoepe A, Herbert N, Fardoos R, Reddy K, Zungu Y, Nene F, Mthabela N, Ramjit D, Karim F, Govender K, Ndung'u T, Porterfield JZ, Adamson JH, Madela FG, Manzini VT, Anderson F, Leslie A, Kløverpris HN. Irreversible depletion of intestinal CD4+ T cells is associated with T cell activation during chronic HIV infection. JCI Insight 2021; 6:146162. [PMID: 34618690 PMCID: PMC8663780 DOI: 10.1172/jci.insight.146162] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 10/06/2021] [Indexed: 01/04/2023] Open
Abstract
HIV infection in the human gastrointestinal (GI) tract is thought to be central to HIV progression, but knowledge of this interaction is primarily limited to cohorts within Westernized countries. Here, we present a large cohort recruited from high HIV endemic areas in South Africa and found that people living with HIV (PLWH) presented at a younger age for investigation in the GI clinic. We identified severe CD4+ T cell depletion in the GI tract, which was greater in the small intestine than in the large intestine and not correlated with years on antiretroviral treatment (ART) or plasma viremia. HIV-p24 staining showed persistent viral expression, particularly in the colon, despite full suppression of plasma viremia. Quantification of mucosal antiretroviral (ARV) drugs revealed no differences in drug penetration between the duodenum and colon. Plasma markers of gut barrier breakdown and immune activation were elevated irrespective of HIV, but peripheral T cell activation was inversely correlated with loss of gut CD4+ T cells in PLWH alone. T cell activation is a strong predictor of HIV progression and independent of plasma viral load, implying that the irreversible loss of GI CD4+ T cells is a key event in the HIV pathogenesis of PLWH in South Africa, yet the underlying mechanisms remain unknown.
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Affiliation(s)
- Osaretin E Asowata
- Africa Health Research Institute (AHRI), Durban, South Africa.,School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Alveera Singh
- Africa Health Research Institute (AHRI), Durban, South Africa
| | - Abigail Ngoepe
- Africa Health Research Institute (AHRI), Durban, South Africa
| | | | - Rabiah Fardoos
- Africa Health Research Institute (AHRI), Durban, South Africa.,Department of Immunology and Microbiology, University of Copenhagen, Denmark
| | - Kavidha Reddy
- Africa Health Research Institute (AHRI), Durban, South Africa
| | - Yenzekile Zungu
- Africa Health Research Institute (AHRI), Durban, South Africa
| | - Faith Nene
- Africa Health Research Institute (AHRI), Durban, South Africa
| | | | - Dirhona Ramjit
- Africa Health Research Institute (AHRI), Durban, South Africa
| | - Farina Karim
- Africa Health Research Institute (AHRI), Durban, South Africa
| | - Katya Govender
- Africa Health Research Institute (AHRI), Durban, South Africa
| | - Thumbi Ndung'u
- Africa Health Research Institute (AHRI), Durban, South Africa.,School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,University College London, Division of Infection and Immunity, London, United Kingdom.,Max Planck Institute for Infection Biology, Berlin, Germany
| | - J Zachary Porterfield
- Africa Health Research Institute (AHRI), Durban, South Africa.,Department of Microbiology, Immunology, and Molecular Genetics, University of Kentucky, Lexington, Kentucky, USA
| | - John H Adamson
- Africa Health Research Institute (AHRI), Durban, South Africa
| | - Fusi G Madela
- Division Upper Gastrointestinal Tract and Colorectal Surgery, Inkosi Albert Luthuli Central Hospital (IALCH), University of KwaZulu-Natal, Durban, South Africa
| | - Vukani T Manzini
- Division Upper Gastrointestinal Tract and Colorectal Surgery, Inkosi Albert Luthuli Central Hospital (IALCH), University of KwaZulu-Natal, Durban, South Africa
| | - Frank Anderson
- Division Upper Gastrointestinal Tract and Colorectal Surgery, Inkosi Albert Luthuli Central Hospital (IALCH), University of KwaZulu-Natal, Durban, South Africa
| | - Alasdair Leslie
- Africa Health Research Institute (AHRI), Durban, South Africa.,School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,University College London, Division of Infection and Immunity, London, United Kingdom
| | - Henrik N Kløverpris
- Africa Health Research Institute (AHRI), Durban, South Africa.,School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Immunology and Microbiology, University of Copenhagen, Denmark.,University College London, Division of Infection and Immunity, London, United Kingdom
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A Systematic Review and Meta-Analysis on the Association between Inflammatory Bowel Disease Family History and Colorectal Cancer. Gastroenterol Res Pract 2021; 2021:4874459. [PMID: 34725546 PMCID: PMC8557079 DOI: 10.1155/2021/4874459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/08/2021] [Indexed: 12/30/2022] Open
Abstract
Background Colorectal cancer (CRC) and inflammatory bowel disease (IBD) are closely interrelated. However, the effect of having a family history of one disease on the risk of another remains undetermined. Aim The purpose of this meta-analysis was to estimate the prevalence of a family history of CRC among patients with IBD, as well as the prevalence of a family history of IBD among patients with CRC. Methods PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched to identify studies reporting the prevalence of family history of IBD among patients with CRC, in addition to the prevalence of family history of CRC among IBD patients. Criteria for study inclusion consisted of the following: (1) studies that evaluated either IBD or CRC and dysplasia, (2) included all age groups, and (3) evaluated the family history effects for IBD or CRC. The total number of IBD patients and IBD patients with a family history of CRC and the total number of CRC patients and CRC patients with a family history of IBD were reviewed. The pooled prevalence of diseases was also estimated according to degree of relatives and geographical area. Random-effects models were used for estimating pooled prevalence. Results A total of 27 studies were included with 26,576 IBD and 9,181 CRC or dysplasia patients. Eligible studies included 13 case-control, 10 cohort, and 4 cross-sectional types. The pooled prevalence of a family history of CRC among patients with IBD was 6% (95% CI: 4-9%). The pooled prevalence for first- and second-degree relatives (11%, 95% CI: 0-37%) was more than that for the other relative subgroups of relatedness degree. The prevalence in the American regions (8% (95% CI: 5-13%)) was higher than that in the others. The pooled prevalence for a family history of IBD among CRC or dysplasia patients was 11% (95% CI: 6-16%). The pooled prevalence for first-degree relatives (13% (95% CI: 3-28%) was higher than that for the other relative subgroups of relatedness degree; it was also greater in American countries (15%, 95% CI: 8-23%). Conclusion This study emphasizes the relationship between a family history of IBD and CRC development. Additionally, there was notable prevalence for a family history of CRC among IBD patients. American countries and first-degree relatives were identified to have a higher prevalence for both disease processes.
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43
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Um SH, Lee SW, Song KH, Lee SM, Choe BH, Lee YM, Kang B. Incidentally Detected Asymptomatic Perianal Abscess in an Adolescent during Crohn's Disease Diagnosis: Is Routine Pelvic Imaging Required in Korean Pediatric Patients at Diagnosis? Pediatr Gastroenterol Hepatol Nutr 2021; 24:564-570. [PMID: 34796101 PMCID: PMC8593359 DOI: 10.5223/pghn.2021.24.6.564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/16/2021] [Accepted: 08/29/2021] [Indexed: 12/20/2022] Open
Abstract
Perianal fistulizing diseases, namely perianal fistulas and/or abscesses, are well-known complications of Crohn's disease (CD). These are known to develop more frequently in Asian children with CD, especially in the early stages of the disease course. Approximately half of the pediatric CD cases in Korea present with perianal fistulizing diseases at diagnosis. We report a rare case of a 12-year-old boy with CD with an incidental discovery of a perianal abscess on pelvic magnetic resonance imaging during CD diagnosis. No symptoms or signs of perianal fistulizing disease were identified. The early diagnosis of the perianal abscess enabled timely and effective treatment. Considering the high incidence of concomitant perianal CD in Korean children at diagnosis, perianal imaging may be useful and should be considered during diagnostic evaluation, even in patients with no subjective or objective findings indicating perianal CD.
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Affiliation(s)
- Soo Hyun Um
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sang Woo Lee
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki Hwan Song
- Department of Surgery, Goo Hospital, Daegu, Korea
| | - So Mi Lee
- Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Byung-Ho Choe
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yoo Min Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Ben Kang
- Department of Pediatrics, School of Medicine, Kyungpook National University, Daegu, Korea
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44
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Siregar GA, Darmadi D, Ruslie RH. The Role of Ethnicity in Inflammatory Bowel Disease. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammation of the digestive tract which consists of ulcerative colitis and Crohn’s disease. The disease is previously recognized as a disease of Western countries but later it spreads all over the world across every ethnicity. The disease manifestations vary from intestinal to extra-intestinal manifestations. There are two risk factors related to the incidence of IBD: Internal and environmental factors. The internal factor is related to genetic susceptibility and genetic susceptibility is associated with ethnicity. Subject from Black ethnic has higher risk for suffering from IBD. Caucasians even have the lowest incidence compared to other ethnics. The disease course is also worse in Black and Hispanic ethnics. Asians have milder disease course. Immigrants tend to have higher risk for IBD compared to native subjects. Further investigations showed that ethnicity carries variable genetic characteristics which affect immune activity, intestinal barrier integrity, and autophagy. All the above mentioned will elicit inflammation if being unbalanced. Chronic inflammation particularly in digestive tract leads to IBD. Knowledge regarding the tendency of IBD in several ethnics raises awareness and will initiate earlier preventive measure against IBD.
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45
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Liu JJ. Disparity in the Care of Black Inflammatory Bowel Disease Patients. Inflamm Bowel Dis 2021; 27:1548-1549. [PMID: 34037231 DOI: 10.1093/ibd/izab100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Indexed: 12/09/2022]
Affiliation(s)
- Julia J Liu
- Division of Gastroenterology, Morehouse School of Medicine, Atlanta, GA 30310, USA
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46
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Dhaliwal J, Carroll MW, deBruyn JC, Ricciuto A, Benchimol EI, Lawrence S, Sherlock M, El-Matary W, Brill H, Church P, Wine E, Carman N, Muise A, Huynh H, Mack DR, Walters TD, Griffiths AM, Jacobson K. The Phenotypic Spectrum of New-onset IBD in Canadian Children of South Asian Ethnicity: A Prospective Multi-Centre Comparative Study. J Crohns Colitis 2021; 16:216-223. [PMID: 34379117 PMCID: PMC8864632 DOI: 10.1093/ecco-jcc/jjab143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Canadian-born children of South Asian [SA] ethnicity develop inflammatory bowel disease [IBD] at similar rates to those among Caucasian children. We evaluated the variation in phenotypic spectrum of IBD in SA and Caucasian children in a national paediatric inception cohort of new-onset IBD. METHODS Patients aged <17 years, enrolled in a Canadian nationwide inception cohort study, were included. Baseline demographic and IBD phenotypic features were compared between SA and Caucasian children. Longitudinal outcomes through 18 months of follow-up were compared matched by propensity scores. RESULTS Of 1156 children enrolled over 2014 to 2019, 623 were Caucasian [98% and 88% parents Canadian born] and 114 SA [79% Canadian born, 87% parents SA born]. Fewer SAs have a first-degree relative with IBD, 6% vs 19% in Caucasians, p = 0.002. SAs present at a younger age, median age 11.4 years (interquartile range [IQR] 9.2-14.3) vs 13 years [IQR 10.9-15 years], p = 0.03 and more commonly with a UC/IBD-U [ulcerative colitis/IBD-unclassified] subtype [ratio of UC/IBD-U to CD 1.2:1 vs 1:1.8 for Caucasians, p <0.001]. Additionally, a greater proportion of SA CD patients present with colonic-only disease [colonic-only CD/UC/IBD-U in SAs 67% vs 57% for Caucasians, p = 0.001], and among those with CD, colonic CD in SAs 31% vs 23% in Caucasians, p = 0.20]. Perianal fistulising disease was also numerically more common in SAs (14 [27%] vs 64 [18%], p = 0.06]. Adjusting for differences in phenotypic presentation, anti-tumour necrosis factor [TNF] exposure, and time to initiation was similar, and two-thirds of children, whether anti-TNF exposed or naïve, were in corticosteroid-free clinical remission at 18 months irrespective of ethnicity. CONCLUSIONS The phenotypic spectrum of new-onset IBD in SA children differs from that of Caucasian children, but treatment and clinical course are similar within phenotypic subgroups.
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Affiliation(s)
- J Dhaliwal
- SickKids Hospital, University of Toronto, Toronto, ON, Canada,Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - M W Carroll
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - J C deBruyn
- Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - A Ricciuto
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - E I Benchimol
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - S Lawrence
- British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - M Sherlock
- McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada
| | - W El-Matary
- Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - H Brill
- McMaster Children’s Hospital, McMaster University, Hamilton, ON, Canada,William Osler Health System, University of Toronto, Toronto, ON, Canada
| | - P Church
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - E Wine
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - N Carman
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - A Muise
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - H Huynh
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - D R Mack
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - T D Walters
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - A M Griffiths
- SickKids Hospital, University of Toronto, Toronto, ON, Canada
| | - K Jacobson
- British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada,Corresponding author: Dr Kevan Jacobson, MBBCh, FRCPC, FCP, AGAF, CAGF, British Columbia’s Children’s Hospital and Child and Family Research Institute, University of British Columbia, 4480 Oak Street, Room K4-184, Vancouver, BC V6H 3V4, Canada. Tel.: 604-875-2332 ext 1;
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Mousavi T, Nikfar S, Abdollahi M. Comprehensive study on the administrative, economic, regional, and regulatory prospects of complementary and alternative medicine (CAM) in inflammatory bowel disease (IBD). Expert Rev Clin Pharmacol 2021; 14:865-888. [PMID: 33993811 DOI: 10.1080/17512433.2021.1925108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Introduction: Due to the high cost, low effectiveness, and adverse effects plus the life-long nature of inflammatory bowel disease (IBD), and misconception on safety, efficacy, and cost-effectiveness of complementary and alternative medicine (CAM), the market demand for CAM has risen over the past decades. A critical review of patients' and physicians' attitudes, market drivers, economic aspects, regulatory roles, and regional distribution is lacking.Areas covered: Through relevant databases, the existing English language literature concerning the association of CAM use with IBD was collected over the past two decades. Data was then analyzed, comprehensively summarized in tables/figures, and justified concerning administrative, organizational, regional, economic, and regulatory perspectives.Expert opinion: Although CAM utilization is more prevalent among younger, female, and high-educated IBD patients, issues concerning weak study designs, limited-time period/regional distribution of recent surveys, and lack of economic evaluations on CAM make it entirely unfeasible to draw a firm conclusion. Regulators are lagging in meeting the dire need of IBD patients, especially the elderly. Lack of legislation regarding registration, sales monitoring, licensing, insurance coverage, efficacy/safety assessments, post-marketing surveillance, quality assurance, and reference pricing alongside the limited support for CAM research are the main matters that should be urgently addressed.
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Affiliation(s)
- Taraneh Mousavi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), the Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.,Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Personalized Medicine Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Evidence-Based Evaluation of Cost-Effectiveness and Clinical Outcomes Group, Pharmaceutical Sciences Research Center (PSRC), and the Pharmaceutical Management and Economics Research Center (PMERC), the Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.,Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Toxicology and Diseases Group (TDG), Pharmaceutical Sciences Research Center (PSRC), the Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran.,Department of Toxicology and Pharmacology, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.,Personalized Medicine Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Microaggression is an unconscious statement or action regarded as discrimination against a marginalized community. Microaggression coupled with implicit bias (unconscious prejudice in favor or against one person or group) can be psychologically damaging to the targeted community. The difficulty with microaggressions and implicit biases is that they are subjective and unconscious, and the offender may not view them as damaging. Microaggressions and implicit biases can affect both the patient and the physician. Whether it is the patient that is the victim of these phenomena or the physician, the goal of quality patient care is adversely affected. When patients are victims, bias can also lead to systematic dismissal of symptoms, inferior medical services, and less aggressive preventive care. Physicians who are victims of such phenomena may deal with the repeated trauma of receiving microaggressions and biases from patients and/or colleagues which may cause mental distress and ultimately functional impairment affecting work performance. In either case, repeated direct and indirect exposure of microaggressions and biases through encounters within and outside the workforce are cumulative leading to lasting internalized damage. Awareness that implicit biases and microaggressions exist and recognition that these phenomena are problematic are the first steps toward fostering a more equitable and inclusive culture. As a society and especially as health care workers, we must become increasingly culturally aware and sensitive of all communities for the ultimate good of patient care.
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Affiliation(s)
- Jacquelyn Turner
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
| | - Robert Higgins
- Department of Surgery. 1500Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ed Childs
- Department of Surgery, 1374Morehouse School of Medicine, Atlanta, GA, USA
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Dahiya DS, Kichloo A, Wani F, Singh J, Solanki D, Shaka H. A nationwide analysis on the influence of obesity in inflammatory bowel disease hospitalizations. Intest Res 2021; 20:342-349. [PMID: 34011019 PMCID: PMC9344244 DOI: 10.5217/ir.2021.00046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background/Aims Proinflammatory cytokines released from adipocytes can influence the development, progression, and treatment of inflammatory bowel disease (IBD), and may be associated with worse clinical outcomes. Methods For 2016–2018, we analyzed data from the Nationwide Inpatient Sample to identify adult (≥18 years) hospitalizations with a primary discharge diagnosis of IBD. The study sample was divided based on the presence or absence of obesity. The primary outcomes included inpatient mortality, while the secondary outcomes consisted of system-based complications and disease implications on the United States healthcare system. Results We identified 282,005 hospitalizations of IBD from 2016 to 2018. Of these hospitalizations, 26,465 (9.4%) had a secondary diagnosis of obesity while 255,540 (90.6%) served as controls. IBD hospitalizations with obesity had a higher mean age (47.9 years vs. 45.2 years, P<0.001), middle age (range, 40–65 years) predominance (37.7% vs. 28.9%, P<0.001), female predominance (64.1% vs. 52.5%, P<0.001) and higher proportion of patients with comorbidities compared to the non-obese cohort. White predominance was observed in both subgroups. No difference in the odds of inpatient mortality was noted between the 2 subgroups; however, IBD hospitalizations with obesity had higher mean total hospital charge ($50,126 vs. $45,001, P<0.001), longer length of stay (5.5 days vs. 4.9 days, P<0.001) and higher proportion of complications compared to the non-obese cohort. Conclusions Obese IBD hospitalizations had higher length of stay, total hospital charge, and complications compared to the non-obese cohort.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA.,Department of Internal Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Farah Wani
- Department of Family Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Jagmeet Singh
- Department of Internal Medicine, Geisinger School of Medicine, Scranton, PA, USA
| | - Dhanshree Solanki
- Department of Internal Medicine, Rutgers University, New Brunswick, NJ, USA
| | - Hafeez Shaka
- Department of Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
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Khan N, Patel D, Pernes T, Patel M, Trivedi C, Medvedeva E, Xie D, Yang YX. The Efficacy and Safety of Switching From Originator Infliximab to Single or Double Switch Biosimilar Among a Nationwide Cohort of Inflammatory Bowel Disease Patients. CROHN'S & COLITIS 360 2021; 3:otab022. [PMID: 36778941 PMCID: PMC9802034 DOI: 10.1093/crocol/otab022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Indexed: 12/31/2022] Open
Abstract
Background Data on safety and efficacy of switching to Renflexis (SB2) from originator Infliximab (IFX) (single switch) or from originator IFX to Inflectra (CT-P13) to Renflexis (double switch) are limited. Methods We conducted a retrospective cohort study in a nationwide cohort of patient with inflammatory bowel disease (IBD) in remission who were switched to SB2. The main exposure was the treatment course of SB2. There are 2 levels in this variable: single switch (IFX to SB2) and double switch (IFX to CT-P13 to SB2). The outcome is SB2 drug discontinuation rate and/or not being in remission after 1 year. Logistic regression was used to estimate the adjusted and unadjusted odds ratios with 95% confidence intervals to study the efficacy difference between single switch and double switch. Results A total of 271 IBD patients were started on SB2. Among them 52 (19.2%) patients did not achieve remission at 1 year and 14 (5.1%) patients had to discontinue SB2 due to adverse events). In logistic regression analysis after controlling for covariates, there was no statistically significant difference observed in regard to efficacy or safety of the single switch versus double switch to SB2 (adjusted odds ratio for double switch compared to single switch = 1.33 (95% confidence interval 0.74-2.41, P = 0.3432). Conclusions Among IBD patients in remission, double switch was equally effective as compared to a single switch. This will help reassure the gastroenterologists who have concerns regarding the safety and efficacy of switching between multiple biosimilars for treating IBD.
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Affiliation(s)
- Nabeel Khan
- Corporal Michael J Crescenz VA Medical Center, Department of Gastroenterology, Philadelphia, Pennsylvania, USA,University of Pennsylvania, Perelman School of Medicine, Department of Medicine, Philadelphia, Pennsylvania, USA,Address correspondence to: Nabeel Khan, MD, Department of Gastroenterology, Corporal Michael J Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA-19104, USA (; )
| | - Dhruvan Patel
- University of Pennsylvania, Perelman School of Medicine, Department of Gastroenterology, Philadelphia, Pennsylvania, USA
| | - Tyler Pernes
- Corporal Michael J Crescenz VA Medical Center, Department of Gastroenterology, Philadelphia, Pennsylvania, USA
| | - Manthankumar Patel
- Corporal Michael J Crescenz VA Medical Center, Department of Gastroenterology, Philadelphia, Pennsylvania, USA
| | - Chinmay Trivedi
- Corporal Michael J Crescenz VA Medical Center, Department of Gastroenterology, Philadelphia, Pennsylvania, USA
| | - Elina Medvedeva
- Corporal Michael J Crescenz VA Medical Center, Department of Gastroenterology, Philadelphia, Pennsylvania, USA
| | - Dawei Xie
- Department of Epidemiology and Biostatistics, Center of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Yu-Xiao Yang
- Corporal Michael J Crescenz VA Medical Center, Department of Gastroenterology, Philadelphia, Pennsylvania, USA,University of Pennsylvania, Perelman School of Medicine, Department of Medicine, Philadelphia, Pennsylvania, USA,Department of Epidemiology and Biostatistics, Center of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Department of Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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