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AlHarbi O, Farsakh NA, Al-Awadhi S, Al-Taweel T, Mikhail I, Batwa F, Bedran K, Balkan D, Gunay LM, Cappelleri JC, Boeri M, Leach C, Habjoka S, Mosli M. Patient Preferences for Ulcerative Colitis Treatment in the Middle East Region: A Discrete-Choice Experiment. GASTRO HEP ADVANCES 2023; 3:190-200. [PMID: 39129949 PMCID: PMC11307764 DOI: 10.1016/j.gastha.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 10/03/2023] [Indexed: 08/13/2024]
Abstract
Background and Aims Treatments for ulcerative colitis (UC) differ in safety, efficacy, and route of administration; patient preferences for treatment attributes should be considered in treatment decisions. No study to date has explored patient preferences for moderate-to-severe UC treatment in Middle Eastern countries. Methods A discrete-choice experiment aimed to quantify treatment preferences in patients with moderate-to-severe UC in 5 Middle Eastern countries (Saudi Arabia, Kuwait, Jordan, the United Arab Emirates, and Lebanon). Respondents chose between experimentally designed profiles for hypothetical UC treatments with varying efficacy (time until UC symptoms improve and chance of UC symptom control after 1 year), side effects (annual risk of serious infection, 5-year risk of malignancy), mode and frequency of administration, and need for occasional steroid use. A random-parameters logit model was used to estimate preference weights for these attributes, from which conditional relative importance estimates and maximum acceptable increases in risks of serious infection and malignancy were derived. Results Among 365 adults with moderate-to-severe UC who completed the survey (mean age, 36 years; 50% female), 5-year risk of malignancy and symptom control after 1 year had the greatest conditional relative importance. Respondents were generally willing to accept statistically significant increases in annual risk of serious infection and 5-year risk of malignancy in exchange for better efficacy, changes in mode of administration and dosing schedule, and avoiding occasional steroid use. Conclusion Of the attributes evaluated, individuals with UC in Middle Eastern countries most value avoiding 5-year risk of malignancy and a higher probability of symptom control, on average.
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Affiliation(s)
- Othman AlHarbi
- Department of Medicine, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Niazy Abu Farsakh
- Gastroenterology Unit, King Abdullah University Hospital, Irbed, Jordan
| | | | - Talal Al-Taweel
- Division of Gastroenterology, Department of Internal Medicine, Jaber Al-Ahmad Hospital, Kuwait City, Kuwait
| | - Inas Mikhail
- Sheikh Shakhbout Medical City, Adu Dhabi, United Arab Emirates
| | - Faisal Batwa
- King Saud Bin Abdulaziz University of Health Sciences, Jeddah, Saudi Arabia
| | - Khalil Bedran
- Gastroenterology Division, Saint George Hospital University Medical Center (SGHUMC), Beirut, Lebanon
| | | | | | | | - Marco Boeri
- RTI Health Solutions, Health Preference Assessment, Belfast, UK
- Queen’s University of Belfast, School of Medicine, Belfast, UK
| | - Colton Leach
- RTI Health Solutions, Health Preference Assessment, Research Triangle Park, North Carolina
| | | | - Mahmoud Mosli
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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2
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Banerjee A, Scarpa M, Pathak S, Burra P, Sturniolo GC, Russo FP, Murugesan R, D'Incá R. Inflammatory Bowel Disease Therapies Adversely Affect Fertility in Men- A Systematic Review and Meta-analysis. Endocr Metab Immune Disord Drug Targets 2020; 19:959-974. [PMID: 30864530 DOI: 10.2174/1871530319666190313112110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Sexual functions are sometimes adversely affected by the therapeutic drugs delivered for treating IBD. Much attention has been focused on pregnancy/sexual issues in women. Relatively less attention has been poured in to address this issue in men. This systematic review assesses the drugs having potential detrimental effects on fertility in men. METHODS Three databases were searched by two researchers independently for potentially relevant publications between 1964 to 2015 and 249 papers were retrieved. Studies that dealt with sexual problems after IBD drugs administration were included in the purview of this review. RESULTS Fourteen studies with 327 human patients and 110 animals were analysed. Sulphasalazine treated patients had lower spermatozoa count, lower sperm motility and higher risk of oligospermia compared to mesalazine treated ones. Biologics seem to be safe to use while attempting to conceive however, proper clinical studies reporting male fertility problems in IBD patients are lacking. Azathioprine caused oligospermia but a meta-analytical approach was not possible due to heterogeneity in studies. Some animal studies showed methotrexate affects abnormal testis structure and spermatogenesis. CONCLUSION This study summarises the current literature and safety issues affecting fertility parameters in men and animals treated with IBD therapeutic drugs, which can further assist clinicians in better management of adult male IBD patients.
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Affiliation(s)
- Antara Banerjee
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy.,Faculty of Allied Health Science (FAHS), Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai, India
| | - Marco Scarpa
- Oncological Surgery Unit, Veneto Institute of Oncology (IOV-IRCCS), Padova, Italy
| | - Surajit Pathak
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy.,Faculty of Allied Health Science (FAHS), Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai, India
| | - Patrizia Burra
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy
| | - Giacomo C Sturniolo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy
| | - Francesco P Russo
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy
| | - Ram Murugesan
- Chettinad Academy of Research and Education (CARE), Chettinad Hospital and Research Institute (CHRI), Chennai, India
| | - Renata D'Incá
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology/Multivisceral Transplant Unit, University Hospital Padova, Padova, Italy
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Bewtra M, Newcomb CW, Wu Q, Chen L, Xie F, Roy JA, Aarons CB, Osterman MT, Forde KA, Curtis JR, Lewis JD. Mortality associated with medical therapy versus elective colectomy in ulcerative colitis: a cohort study. Ann Intern Med 2015; 163:262-70. [PMID: 26168366 PMCID: PMC4925099 DOI: 10.7326/m14-0960] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Ulcerative colitis (UC) can be treated with surgery or medications. Patients often must choose between long-term immunosuppressant therapy or total colectomy. Whether one of these treatment approaches has a mortality benefit is uncertain. OBJECTIVE To determine whether patients with advanced UC treated with elective colectomy have improved survival compared with those treated with medical therapy. DESIGN Retrospective matched cohort study. SETTING Data from all 50 states for Medicaid beneficiaries (2000 to 2005), Medicare beneficiaries (2006 to 2011), and dual-eligible persons (2000 to 2011). PATIENTS 830 patients with UC pursuing elective colectomy and 7541 matched patients with UC pursuing medical therapy. MEASUREMENTS The primary outcome was time to death. Cox proportional hazards models were used to compare the survival of patients with advanced UC treated with elective colectomy or medical therapy. The models controlled for significant comorbid conditions through matched and adjusted analysis. RESULTS The mortality rates associated with elective surgery and medical therapy were 34 and 54 deaths per 1000 person-years, respectively. Elective colectomy was associated with improved survival compared with long-term medical therapy (adjusted hazard ratio [HR], 0.67 [95% CI, 0.52 to 0.87]), although this result did not remain statistically significant in all sensitivity analyses. Post hoc analysis by age group showed improved survival with surgery in patients aged 50 years or older with advanced UC (HR, 0.60 [CI, 0.45 to 0.79]; P = 0.032 for age-by-treatment interaction). LIMITATIONS Retrospective nonrandomized analysis is subject to residual confounding. The source cohort was derived from different databases throughout the study. Sensitivity and secondary analyses had reduced statistical power. CONCLUSION Elective colectomy seemed to be associated with improved survival relative to medical therapy among patients aged 50 years or older with advanced UC. PRIMARY FUNDING SOURCE National Institutes of Health and Agency for Healthcare Research and Quality.
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Affiliation(s)
- Meenakshi Bewtra
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Craig W. Newcomb
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Qufei Wu
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Lang Chen
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Fenglong Xie
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Jason A. Roy
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Cary B. Aarons
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Mark T. Osterman
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly A. Forde
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey R. Curtis
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
| | - James D. Lewis
- From University of Pennsylvania, Philadelphia, Pennsylvania, and University of Alabama at Birmingham, Birmingham, Alabama
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4
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Olivieri I, Cantini F, Castiglione F, Felice C, Gionchetti P, Orlando A, Salvarani C, Scarpa R, Vecchi M, Armuzzi A. Italian Expert Panel on the management of patients with coexisting spondyloarthritis and inflammatory bowel disease. Autoimmun Rev 2014; 13:822-30. [PMID: 24726868 DOI: 10.1016/j.autrev.2014.04.003] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 03/30/2014] [Indexed: 02/07/2023]
Abstract
Spondyloarthritis (SpA) is a group of diseases with similar clinical, radiologic and serologic features, including SpA associated with inflammatory bowel disease (IBD-associated SpA). Several studies have estimated the occurrence of SpA in IBD patients as ranging from 17% to 39%, confirming that SpA is the most frequent extra-intestinal manifestation in patients with IBD. In this paper, the expert panel presents some red flags to guide clinicians - both rheumatologists and gastroenterologists - to make a correct diagnosis of IBD-associated SpA in clinical practice. IBD-associated SpA classification, clinical presentation and diagnostic work-up are also presented. From the therapeutic point of view, only separate recommendations/guidelines are currently available for the treatment of Crohn's disease, ulcerative colitis and for both axial and peripheral SpA. However, when IBD and SpA coexist, the therapeutic strategy should be modulated to take into account the variable manifestations of IBD in terms of intestinal and extra-intestinal features, and the clinical manifestations of SpA, with particular attention to peripheral enthesitis, dactylitis and anterior uveitis. To our knowledge, this is the first attempt to define therapeutic algorithms for the integrated management of different IBD-associated SpA clinical scenarios.
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Affiliation(s)
- Ignazio Olivieri
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Italy
| | - Fabrizio Cantini
- Division of Rheumatology, Misericordia e Dolce Hospital, Prato, Italy
| | | | - Carla Felice
- IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Paolo Gionchetti
- IBD Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Italy
| | - Ambrogio Orlando
- IBD Unit, Internal Medicine, A.O. Ospedali Riuniti "Villa Sofia-Cervello", Palermo, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Raffaele Scarpa
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University Federico II, Naples, Italy
| | - Maurizio Vecchi
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato, Department of Biomedical Sciences for the Health, University of Milan, Milan, Italy
| | - Alessandro Armuzzi
- IBD Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy.
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5
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Bewtra M, Johnson FR. Assessing patient preferences for treatment options and process of care in inflammatory bowel disease: a critical review of quantitative data. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 6:241-55. [PMID: 24127239 DOI: 10.1007/s40271-013-0031-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Inflammatory bowel disease (IBD), consisting of both Crohn's disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions of the intestinal tract. As there is no cure for either CD or UC, patients with these conditions face numerous treatment decisions regarding their disease. The aim of this review is to evaluate literature regarding quantitative studies of patient preferences in therapy for IBD with a focus on the emerging technique of stated preference and its application in IBD. Numerous simple survey-based studies have been performed evaluating IBD patients' preferences for medication frequency, mode of delivery, potential adverse events, etc., as well as variations in these preferences. These studies are limited, however, as they are purely descriptive in nature with limited quantitative information on the relative value of treatment alternatives. Time trade-off and standard-gamble studies have also been utilized to quantify patient utility for various treatment options or outcomes. However, these types of studies suffer from inaccurate assumptions regarding patient choice behavior. Stated preference is an emerging robust methodology increasingly utilized in health care that can determine the relative utility for a therapy option as well as its specific attributes (such as efficacy or adverse side effects). Stated preference techniques have begun to be applied in IBD and offer an innovative way of examining the numerous therapy options these patients and their providers face.
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Affiliation(s)
- Meenakshi Bewtra
- Department of Gastroenterology, University of Pennsylvania, 423 Guardian Drive, 724 Blockley Hall, Philadelphia, PA, 19104-6021, USA,
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6
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Abstract
BACKGROUND Therapy options for mesalamine-refractory ulcerative colitis (UC) include immunosuppressive medications or surgery. Chronic immunosuppressive therapy increases risks of infection and cancer, whereas surgery produces a permanent change in bowel function. We sought to quantify the willingness of patients with UC to accept the risks of chronic immunosuppression to avoid colectomy. METHODS We conducted a state-of-the-art discrete-choice experiment among 293 patients with UC who were offered a choice of medication or surgical treatments with different features. Random parameters logit was used to estimate patients' willingness to accept trade-offs among treatment features in selecting surgery versus medical treatment. RESULTS A desire to avoid surgery and the surgery type (ostomy versus J-pouch) influenced patients' choices more than a specified range of 10-year mortality risks from lymphoma or infection, or disease activity (mild versus remission). To avoid an ostomy, patients were willing to accept a >5% 10-year risk of dying from lymphoma or infection from medical therapy, regardless of medication efficacy. However, data on patients' stated choice indicated perceived equivalence between J-pouch surgery and incompletely effective medical therapy. Patient characteristics and disease history influenced patients' preferences regarding surgery versus medical therapy. CONCLUSIONS Patients with UC are willing to accept relatively high risks of fatal complications from medical therapy to avoid a permanent ostomy and to achieve durable clinical remission. However, patients view J-pouch surgery, but not permanent ileostomy, as an acceptable therapy for refractory UC in which medical therapy is unable to induce a durable remission.
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7
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Bautzová T, Rabišková M, Lamprecht A. Multiparticulate systems containing 5-aminosalicylic acid for the treatment of inflammatory bowel disease. Drug Dev Ind Pharm 2011; 37:1100-9. [DOI: 10.3109/03639045.2011.560156] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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8
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Parray FQ, Wani ML, Bijli AH, Thakur N, Irshad I, Nayeem-ul-Hassan. Crohn's disease: a surgeon's perspective. Saudi J Gastroenterol 2011; 17:6-15. [PMID: 21196646 PMCID: PMC3099084 DOI: 10.4103/1319-3767.74430] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Crohn's disease (CD) is known for wide anatomic distribution, different presentations, life-threatening complications, and multiple modalities of management. Its multiple implications are still unaddressed. Since all the patients do not show a good response to medical modalities of treatment, a significant percentage of these patients are referred to the surgeon for the palliation of complications or for the ultimate curative treatment. Since most surgeons come across such patients only rarely, it is sometimes difficult for them to choose the appropriate procedure at the time of need. Moreover, the various surgical modalities available for the different presentations and complications of the disease have not been adequately discussed. The aim of this review is to offer insight and a detailed account of the management of CD from a surgical perspective. This review offers an overview of the various surgical options available, their utility in context, and an approach to various scenarios of complicated CD.
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Affiliation(s)
- Fazl Q. Parray
- Department of General Surgery and Allied Specialities, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Mohd Lateef Wani
- Department of General Surgery and Allied Specialities, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India,Address for correspondence: Dr. Mohd Lateef Wani, Senior Resident (General Surgery), F-12, B Block, Married Doctors Hostel, Skims Soura Srinager, Srinager, India. E-mail:
| | - Akram H. Bijli
- Department of General Surgery and Allied Specialities, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Natasha Thakur
- Department of General Surgery and Allied Specialities, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Ifat Irshad
- Department of General Surgery and Allied Specialities, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
| | - Nayeem-ul-Hassan
- Department of General Surgery and Allied Specialities, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, India
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9
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Abstract
Crohn's disease (CD) is not rare in recent years, but it is sometimes difficult to make a definite diagnosis particularly if it is in the small intestine. We report a patient with fever for 8 months whose disease was mistaken to be Adult onset Still's disease. The patient was diagnosed small intestine Crohn's disease at last by pathology. We want to emphasize that doctors should not forget small intestine Crohn's disease when encountering an unidentified feverish patient, they should not diagnose a feverish patient of Adult onset Still's disease at once. It is important to note that corticosteroids can conceal many diseases and they should not be considered lightly even if the patient is diagnosed with Adult onset Still's disease.
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Affiliation(s)
- Zhang Shuo
- The First Affiliated Hospital of Zhejiang Chinese Medical University, China
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10
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Sung JJY, Kamm MA, Marteau P. Asian perspectives in the management of inflammatory bowel disease: findings from a recent survey. J Gastroenterol Hepatol 2010; 25:183-93. [PMID: 19929931 DOI: 10.1111/j.1440-1746.2009.06024.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIM The prevalence and incidence of inflammatory bowel disease (IBD) differs worldwide. While the prevalence of IBD has stabilized in Europe, the USA and Japan, an increasing trend has been observed in Asia. However, there are no data on the current clinical practice for the management of IBD in the region. The present study aims to investigate the number of existing and new cases of IBD and to understand the current practice of diagnosis and treatment of IBD in different Asian countries. METHODS A self-administered questionnaire, designed according to European and US guidelines, was distributed to IBD specialists throughout Asia. The questionnaire estimated the annual incidence of existing and new IBD cases in physicians' clinical practices and evaluated their procedures of diagnosis and preference for therapeutic treatment and maintenance treatment. RESULTS Eighty-seven questionnaires were received out of the 107 distributed. In the clinical practices of these 87 respondents, there were 502 existing and 73 new cases per year for ulcerative colitis (UC) and 202 existing and 32 new cases per year for Crohn's disease (CD). Colonoscopy and histology were the most commonly used methods for the diagnosis of UC and CD, but clinical practice regarding the diagnosis of IBD varied. The treatment of choice for mild-to-moderate UC and CD was 5-aminosalicylic acid (5-ASA), which is also the preferred choice for the maintenance treatment of UC and CD. CONCLUSION Clinical practice with regards to IBD diagnosis and management varies within Asia.5-ASA is the preferred treatment and maintenance therapy for mild-to-moderate IBD.
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Affiliation(s)
- Joseph J Y Sung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
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11
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Pastorelli L, Pizarro TT, Cominelli F, Vecchi M. Emerging drugs for the treatment of ulcerative colitis. Expert Opin Emerg Drugs 2009; 14:505-21. [PMID: 19656075 DOI: 10.1517/14728210903146882] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ulcerative colitis (UC) is a chronic, relapsing inflammatory disorder of the colon for which the etiology is currently unknown. At present, strategies to treat UC are primarily targeted to control inflammation during active phases of disease as well as maintain remission during quiescence. As such, several unmet needs in the treatment of UC still remain. In recent years, basic research has led to the recognition of several key factors in the pathogenesis of UC, translating into the development of several novel therapeutic agents. OBJECTIVE The aim of this study is to review emerging therapies that may advance the treatment and improve the overall care of UC patients. METHODS An extensive literature search on published manuscripts and meeting proceedings has been performed to provide a comprehensive review of future drug therapies to treat UC. RESULTS/CONCLUSION The translational application of new discoveries in the basic understanding of UC pathogenesis is continuing and critical for the development of novel treatment strategies. Design of novel biologic therapies to treat UC has the challenge of addressing potential safety issues, while more traditional drugs should be further developed to facilitate patient compliance to treat this chronic, debilitating disease.
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Affiliation(s)
- Luca Pastorelli
- Case Western Reserve University School of Medicine, Department of Pathology, 2103 Cornell Road, Room 5501, Cleveland, OH, 44106, USA
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12
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Prevention of relapse by mesalazine (Pentasa) in pediatric Crohn's disease: a multicenter, double-blind, randomized, placebo-controlled trial. ACTA ACUST UNITED AC 2008; 33:31-40. [PMID: 19118966 DOI: 10.1016/j.gcb.2008.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 07/14/2008] [Indexed: 12/13/2022]
Abstract
AIM This study aimed to test the efficacy of mesalazine in maintaining remission in pediatric Crohn's disease (CD) following successful flare-up treatment. METHODS In this double-blind, randomized, placebo-controlled trial, 122 patients received either mesalazine 50mg/kg per day (n=60) or placebo (n=62) for one year. Treatment allocation was stratified according to flare-up treatment (nutrition or medication alone). Recruitment was carried out over two periods, as the first period's results showed a trend favoring mesalazine. Relapse was defined as a Harvey-Bradshaw score more than or equal to 5. Time to relapse was analyzed using the Cox model. RESULTS The one-year relapse rate was 57% (n=29) and 63% (n=35) in the mesalazine and placebo groups, respectively. We demonstrated a twofold lower relapse risk (P<0.02) in patients taking mesalazine in the medication stratum (first recruitment period), and a twofold higher risk in patients taking mesalazine in the nutrition stratum (second recruitment period), compared with the other groups. None of the children's characteristics, which differed across the two recruitment periods, accounted for the between-period variation in mesalazine efficacy. One serious adverse event was reported in each treatment group. CONCLUSION Overall, mesalazine does not appear to be an effective maintenance treatment in pediatric CD.
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13
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Kozuch PL, Hanauer SB. Treatment of inflammatory bowel disease: a review of medical therapy. World J Gastroenterol 2008; 14:354-77. [PMID: 18200659 PMCID: PMC2679125 DOI: 10.3748/wjg.14.354] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 07/04/2007] [Indexed: 02/06/2023] Open
Abstract
Crohn's disease (CD) and ulcerative colitis (UC) are chronic inflammatory diseases of the gastrointestinal tract. While a cure remains elusive, both can be treated with medications that induce and maintain remission. With the recent advent of therapies that inhibit tumor necrosis factor (TNF) alpha the overlap in medical therapies for UC and CD has become greater. Although 5-ASA agents have been a mainstay in the treatment of both CD and UC, the data for their efficacy in patients with CD, particularly as maintenance therapy, are equivocal. Antibiotics may have a limited role in the treatment of colonic CD. Steroids continue to be the first choice to treat active disease not responsive to other more conservative therapy; non-systemic steroids such as oral and rectal budesonide for ileal and right-sided CD and distal UC respectively are also effective in mild-moderate disease. 6-mercaptopurine (6-MP) and its prodrug azathioprine are steroid-sparing immunomodulators effective in the maintenance of remission of both CD and UC, while methotrexate may be used in both induction and maintenance of CD. Infliximab and adalimumab are anti-TNF agents approved in the US and Europe for the treatment of Crohn's disease, and infliximab is also approved for the treatment of UC.
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14
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Kale-Pradhan PB, Pradhan RS, Wilhelm SM. Multi-Matrix System Mesalamine: To Use or Not To Use. Ann Pharmacother 2008; 42:265-9. [DOI: 10.1345/aph.1k469] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: To evaluate the role of Multi-Matrix System (MMX) mesalamine in the treatment of ulcerative colitis (UC). Data Sources: Literature was obtained through searches of MEDLINE (1966–October 2007) and a bibliographic review of published articles. Key terms used in the searches included ulcerative colitis, mesalamine, MMX, SPD476, and Lialda. Study Selection and Data Extraction: All English-language articles that were identified through the search were evaluated. All primary literature was included in the review. Data Synthesis: The standard treatment for the induction and maintenance of remission in patients with mi Id-to-moderate UC is aminosalicylate products (mesalamine, sulfasalazine, batasalazide, olsalazine). Current mesalamine formulations are not idea) for long-term treatment due to issues with patient adherence secondary to complex dosing regimens and high pill burden. Clinical studies show that MMX mesalamine achieves clinical and endoscopic remission more frequently compared with placebo or mesalamine enema. Patients receiving MMX mesalamine achieved statistically significant clinical and endoscopic remission when compared with those taking placebo (34.1% vs 12.9%; p < 0.001 with 2.4 g/day vs placebo, and 29.2% vs 12.9%; p = 0.009 with 4.8 g/day vs placebo). Similarly, in another study, significantly more patients achieved remission in the MMX mesalamine groups compared with patients in the placebo group (40.5% vs 22.1% with 2.4 g/day vs placebo; p = 0.01, and 41.2% vs 22.1% with 4.8 g/day vs placebo; p = 0.007). MMX mesalamine is well tolerated, with headache, flatulence, and abdominal pain being the most frequently reported adverse events. Conclusions: Current evidence supports the use of MMX mesalamine for treatment of mi Id-to-moderate UC by demonstrating that MMX mesalamine 2.4–4.8 g daily induces remission. It has the advantage of once-daily dosing regimens with lower pill burden than comparable products and, as an oral agent, may have better patient acceptability compared with topical mesalamine formulations. Therefore, MMX mesalamine is an option in patients with UC. The cost of MMX mesalamine is comparable to that of oral and rectal formulations of mesalamine. Further pharmacoeconomic studies are warranted to examine the cost impact of MMX mesalamine.
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15
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Abstract
Most physicians believe that the drugs they prescribe will work in their patients and thus have made little preparation for alternative strategies in the event of failure. In the treatment of inflammatory bowel disease (IBD), achieving a remission rate of 20% to 30% or a response rate of 50% to 60% is highly acceptable. This review focuses primarily on placebo-controlled trials that evaluated "usual" treatments for IBD in terms of induction and maintenance of remission, and identifies the "gaps" (ie, the percentage of patients lacking any benefit) in currently available treatments for IBD. Approximately, 40% to 60% of patients will not benefit from the available treatments, indicating a considerable unmet need for new, more effective therapies.
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Affiliation(s)
- Seymour Katz
- Department of Medicine, New York University School of Medicine, New York, USA.
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Abstract
There is no medical or surgical treatment that provides a permanent cure for Crohn's disease (CD). However, an evolving understanding of the pathogenesis of CD has provided clinicians with a diversity of medical treatment options for the disease. The goal of therapy is to induce and maintain clinical remission. The efficacy of immune-modifying agents such as azathioprine/6-mercaptopurine and infliximab have supported a paradigm shift in CD treatment in which maintenance agents are introduced earlier in the disease course. At the same time, it is imperative to balance the efficacy, safety, and tolerability of medical therapy. Given the variable and relapsing clinical course of CD, the physician and patient should ideally develop an ongoing relationship that allows for individualization of treatment regimens, monitoring of response and side effects, and modification of the therapeutic strategy in the absence of improvement.
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Affiliation(s)
- Shamina Dhillon
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN 55905, USA.
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