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Mantzaris GJ, Zeglinas C, Theodoropoulou A, Koutroubakis I, Orfanoudaki E, Katsanos K, Christodoulou D, Michalopoulos G, Tzouvala M, Moschovis D, Michopoulos S, Zampeli E, Soufleris K, Ilias A, Chatzievangelinou C, Kyriakakis A, Antachopoulou K, Karmiris K. The Effect of Early vs Delayed Initiation of Adalimumab on Remission Rates in Patients With Crohn's Disease With Poor Prognostic Factors: The MODIFY Study. CROHN'S & COLITIS 360 2021; 3:otab064. [PMID: 36777275 PMCID: PMC9802300 DOI: 10.1093/crocol/otab064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Indexed: 12/07/2022] Open
Abstract
Background Data on the effectiveness of anti-tumor necrosis factor medications in patients with Crohn's disease (CD) with poor prognostic factors (PPFs) are scarce. This study aimed to generate real-world evidence on the effect of early (≤24 months after diagnosis) vs delayed (>24 months) initiation of adalimumab (ADL) on the 26-week remission rate (Harvey-Bradshaw Index ≤4) in these patients. Methods This multicentre, retrospective, chart review study performed in 10 Greek hospitals enrolled adult patients with moderate to severe CD (Harvey-Bradshaw Index ≥8) with ≥3 PPFs who were initiated on ADL ≥12 months before enrollment. A sample size of 164 patients (early:delayed cohort allocation ratio, 30:70) was required to address the primary endpoint. Results Eligible patients (n = 171) were consecutively enrolled. In the early vs delayed cohorts, the 26-week remission rates (off-steroids) using the last-observation-carried-forward imputation method were 60.7% (37/61) vs 47.2% (50/106), respectively (Δ = 13.5%, P = .044). The respective remission rates were 61.2% vs 42.4% among anti-tumor necrosis factor-naive patients (P = .023) and 58.3% vs 53.2% among anti-tumor necrosis factor-experienced patients (P = .374). The 52-week remission rates using as-observed data were 78.8% and 60.3%, and the intestinal resection rates were 6.5% and 11.9% in the early vs delayed ADL cohorts, respectively. Conclusions Patients with CD with PPFs who received early vs delayed treatment with ADL achieved higher clinical response and remission rates. This effect was more pronounced in those patients who were bio-naive and steroid-dependent/refractory with concurrent extraintestinal manifestations than those who were not.
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Affiliation(s)
- Gerassimos J Mantzaris
- Department of Gastroenterology, General Hospital of Athens “Evaggelismos”, Athens, Greece,Address correspondence to: Gerassimos J. Mantzaris, MD, PhD, Department of Gastroenterology, General Hospital of Athens “Evaggelismos”, 45-47 Ipsilantou St., 10676, Athens, Attiki, Greece ()
| | | | - Angeliki Theodoropoulou
- Department of Gastroenterology, General Hospital of Heraklion “Venizeleio-Pananeio”, Heraklion, Crete, Greece
| | | | - Eleni Orfanoudaki
- Department of Gastroenterology, University Hospital of Heraklion, Crete, Greece
| | - Konstantinos Katsanos
- Department of Gastroenterology, Pathology Unit, University General Hospital of Ioannina, Ioannina, Greece
| | - Dimitrios Christodoulou
- Department of Gastroenterology, Pathology Unit, University General Hospital of Ioannina, Ioannina, Greece
| | | | - Maria Tzouvala
- Department of Gastroenterology, General Hospital of Nikaia & Piraeus “Agios Panteleimon”-General Hospital Dytikis Attikis “Agia Varvara”, Nikaia, Greece
| | - Dimitrios Moschovis
- Department of Gastroenterology, General Hospital of Nikaia & Piraeus “Agios Panteleimon”-General Hospital Dytikis Attikis “Agia Varvara”, Nikaia, Greece
| | - Spyridon Michopoulos
- Department of Gastroenterology, Pathology Unit, General Hospital of Athens “Alexandra”, Athens, Greece
| | - Evanthia Zampeli
- Department of Gastroenterology, Pathology Unit, General Hospital of Athens “Alexandra”, Athens, Greece
| | - Konstantinos Soufleris
- Department of Gastroenterology-Oncology, Pathology Unit, Anticancer Hospital of Thessaloniki “Theageneio”, Thessaloniki, Greece
| | - Anastasios Ilias
- Department of Gastroenterology, Pathology Unit, General Hospital of Thessaloniki “G. Papanikolaou”, Thessaloniki, Greece
| | | | | | | | - Konstantinos Karmiris
- Department of Gastroenterology, General Hospital of Heraklion “Venizeleio-Pananeio”, Heraklion, Crete, Greece
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Ben-Horin S, Zhao Y, Guo J, Mao R, Novack L, Sergienko R, Zhang J, Kobayashi T, Hibi T, Chowers Y, Colombel JF, Peyrin-Biroulet L, Kaplan G, Chen MH. Efficacy of biological drugs in short-duration versus long-duration inflammatory bowel disease: a protocol for a systematic review and an individual-patient level meta-analysis of randomised controlled trials. BMJ Open 2019; 9:e024222. [PMID: 30782731 PMCID: PMC6352773 DOI: 10.1136/bmjopen-2018-024222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 09/15/2018] [Accepted: 12/04/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Crohn's disease (CD) and ulcerative colitis (UC) are remitting-relapsing inflammatory diseases often culminating in disease complications and/or need for surgery. Biologic monoclonal antibody drugs ('Biologics') are efficacious for both diseases, but there are no systematic assessments of their efficacy if administered early after disease onset ('top-down' strategy) vis-à-vis later in the course of disease ('step-up' approach). METHODS AND ANALYSIS Electronic databases (MEDLINE, EMBASE/EMBASE classic Cochrane CENTRAL register of controlled trials, the Cochrane IBD Group Specialised Trials Register and Clinicaltrials.gov registry) will be searched to identify all randomised placebo-controlled clinical trials of food and drug administration (FDA)-approved biologics for CD and UC (by March 2016). Two independent reviewers will screen identified papers, extract data and assess the risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. Individual-patient-level data (IPD) will be extracted from the identified trials through data-sharing platforms for pharmaceutical companies' sponsored trials and by contacting principal investigators of independent investigator-initiated trials. We will analyse induction of remission in patients with early-disease (<18 months since disease onset) versus patients with longer disease duration, using a generalised linear mixed effect model and by a two-stage approach using coefficient for the treatment-by-subgroup interaction within each trial. We will perform receiver operator curve analysis of optimal disease duration for response. Analyses will be separate for CD and UC. This first-of-its-kind meta-analysis at IPD level of interaction of disease duration with the response to biologics in UC and CD may elucidate the impact of early initiation of biologics, which is of paramount importance for clinical practice and management strategies of inflammatory bowel disease. ETHICS AND DISSEMINATION This meta-analysis was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-sen University. Findings will be published in peer-reviewed journal and disseminated via scientific meetings and links with organisations. PROSPERO REGISTRATION NUMBER CRD42018041961.
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Affiliation(s)
- Shomron Ben-Horin
- Department of Gastroenterology, First affiliated Hospital of the Sun Yatsen University, Guangzhou, China
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yue Zhao
- Department of Gastroenterology, First affiliated Hospital of the Sun Yatsen University, Guangzhou, China
| | - Jing Guo
- Department of Gastroenterology, First affiliated Hospital of the Sun Yatsen University, Guangzhou, China
| | - Ren Mao
- Department of Gastroenterology, First affiliated Hospital of the Sun Yatsen University, Guangzhou, China
| | - Lena Novack
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jian Zhang
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Taku Kobayashi
- Department of Gastroenterology, Kitasato Institute Hospital, Tokyo, Japan
| | - Toshifumi Hibi
- Department of Gastroenterology, Kitasato Institute Hospital, Tokyo, Japan
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam Health Care Campus, Bruce & Ruth Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Jean Frederic Colombel
- Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine, Mount Sinai Hospital, New York City, New York, USA
| | | | - Gilaad Kaplan
- Department of Gastroenterology, University of Calgary, Calgary, Canada
| | - Min-Hu Chen
- Department of Gastroenterology, First affiliated Hospital of the Sun Yatsen University, Guangzhou, China
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Kotze PG, Ludvig JC, Teixeira FV, Malluta EF, Miranda EF, Hardt MR, Olandoski M, da Silva Kotze LM, Kleinubing H. Disease duration did not influence the rates of loss of efficacy of the anti-TNF therapy in Latin American Crohn’s disease patients. Digestion 2015; 91:158-63. [PMID: 25721295 DOI: 10.1159/000371655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/18/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS The efficacy of both Infliximab (IFX) and Adalimumab (ADA) can be reduced over time. The aim of this study was to analyze the incidence of loss of efficacy (LOE) of both IFX and ADA, and outline the influence of disease duration on its occurrence. METHODS Retrospective, multicenter, observational cohort study, with CD patients treated with anti-TNF therapy. LOE was defined as the need for steroids, occurrence of major abdominal surgery during treatment, dose increase, interval shortening or switching of the anti- TNF agent. Patients were allocated in three subgroups based on disease duration (DD): <24 months, between 24 and 60 months and >60 months. RESULTS 175 patients were included in the study (117 under IFX and 58 under ADA therapy). LOE occurred in 32% of patients with DD <24 months, in 33.3% with DD between 24 and 60 months and in 31.3% of subjects with DD over 60 months (p = 0.975). CONCLUSIONS Disease duration (DD) did not influence LOE rates. These results suggest that in real-world observational practice, patients with early CD might have the same rates of LOE than patients with a disease prolonging for a longer duration.
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Hiroz P, Vavricka SR, Fournier N, Safroneeva E, Pittet V, Rogler G, Schoepfer AM. Analysis of TNF-antagonist switch over time and associated risk factors in the Swiss Inflammatory Bowel Disease Cohort. Scand J Gastroenterol 2014; 49:1207-18. [PMID: 25120029 DOI: 10.3109/00365521.2014.946082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Limited data from large cohorts are available on tumor necrosis factor (TNF) antagonists (infliximab, adalimumab, certolizumab pegol) switch over time. We aimed to evaluate the prevalence of switching from one TNF antagonist to another and to identify associated risk factors. METHODS Data from the Swiss Inflammatory Bowel Diseases Cohort Study (SIBDCS) were analyzed. RESULTS Of 1731 patients included into the SIBDCS (956 with Crohn's disease [CD] and 775 with ulcerative colitis [UC]), 347 CD patients (36.3%) and 129 UC patients (16.6%) were treated with at least one TNF antagonist. A total of 53/347 (15.3%) CD patients (median disease duration 9 years) and 20/129 (15.5%) of UC patients (median disease duration 7 years) needed to switch to a second and/or a third TNF antagonist, respectively. Median treatment duration was longest for the first TNF antagonist used (CD 25 months; UC 14 months), followed by the second (CD 13 months; UC 4 months) and third TNF antagonist (CD 11 months; UC 15 months). Primary nonresponse, loss of response and side effects were the major reasons to stop and/or switch TNF antagonist therapy. A low body mass index, a short diagnostic delay and extraintestinal manifestations at inclusion were identified as risk factors for a switch of the first used TNF antagonist within 24 months of its use in CD patients. CONCLUSION Switching of the TNF antagonist over time is a common issue. The median treatment duration with a specific TNF antagonist is diminishing with an increasing number of TNF antagonists being used.
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Affiliation(s)
- Philippe Hiroz
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois , Lausanne , Switzerland
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Exploring the use of adalimumab for patients with moderate Crohn's disease: subanalyses from induction and maintenance trials. J Crohns Colitis 2013; 7:958-67. [PMID: 23517933 DOI: 10.1016/j.crohns.2013.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 12/01/2012] [Accepted: 02/14/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Anti-TNF agents are often reserved for patients with severe Crohn's disease (CD). AIMS We explored the predictive value of baseline disease activity and C-reactive protein (CRP) for disease course, adalimumab efficacy for remission (induction and maintenance) in patients with moderate and severe CD, and adalimumab efficacy in moderate CD by CRP category. METHODS Post hoc analyses of remission data were performed for all randomized patients from induction (CLASSIC I) and maintenance (CHARM, EXTEND) adalimumab trials in patients with moderate (CDAI≤300) or severe (CDAI>300) CD, and in high (≥10 mg/L) or low (<10 mg/L) CRP moderate CD subgroups. Placebo-treated CHARM patients were evaluated for disease activity over time and time to CD-related hospitalization, by baseline disease severity and CRP. RESULTS Moderate CD patients had the highest clinical remission rate and largest treatment effect size compared with placebo at week 4 after 160/80 mg induction (46.3% adalimumab, 17.4% placebo; versus 22.9%, 3.6% for severe patients). Moderate-CD/high-CRP patients had the most pronounced efficacy (57.1% adalimumab, 6.7% placebo; versus 40.7%, 20.0% for lower CRP group). Adalimumab maintenance treatment (40 mg every-other-week) achieved superior remission versus placebo at one year in moderate (32.9% versus 13.7%) and severe (27.2% versus 7.5%) cohorts. Among moderate patients, efficacy was similar by CRP category. Moderate-CD/high-CRP placebo-treated patients experienced disease activity and hospitalization rates at week 56 of CHARM approaching those of severe CD patients. CONCLUSIONS This analysis suggests that moderate CD patients can be treated effectively with adalimumab, and supports using CRP to identify moderate CD patients at greatest risk of disease progression.
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Sjöberg M, Magnuson A, Björk J, Benoni C, Almer S, Friis-Liby I, Hertervig E, Olsson M, Karlén P, Eriksson A, Midhagen G, Carlson M, Lapidus A, Halfvarson J, Tysk C. Infliximab as rescue therapy in hospitalised patients with steroid-refractory acute ulcerative colitis: a long-term follow-up of 211 Swedish patients. Aliment Pharmacol Ther 2013; 38:377-87. [PMID: 23799948 DOI: 10.1111/apt.12387] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 05/15/2013] [Accepted: 06/05/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Rescue therapy with infliximab (IFX) has been proven effective in a steroid-refractory attack of ulcerative colitis (UC). The long-term efficacy is not well described. AIM To present a retrospective study of IFX as rescue therapy in UC. Primary end points were colectomy-free survival at 3 and 12 months. METHODS In this multicentre study, 211 adult patients hospitalised between 1999 and 2010 received IFX 5 mg/kg as rescue therapy due to a steroid-refractory, moderate-to-severe attack of UC. Exclusion criteria were duration of current flare for >12 weeks, corticosteroid treatment for >8 weeks before hospitalisation, previous IFX therapy or Crohn's disease. RESULTS Probability of colectomy-free survival at 3 months was 0.71 (95% CI, 0.64-0.77), at 12 months 0.64 (95% CI, 0.57-0.70), at 3 years 0.59 (95% CI, 0.52-0.66) and at 5 years 0.53 (95% CI, 0.44-0.61). Steroid-free, clinical remission was achieved in 105/211 (50%) and 112/209 (54%) patients at 3 and 12 months respectively. Of 75 colectomies during the first year, 48 (64%) were carried out during the first 14 days, 13 (17%) on days 15-90 and 14 (19%) between 3 and 12 months. There were three (1.4%) deaths during the first 3 months. CONCLUSIONS Infliximab is an effective rescue treatment, both short- and long-term, in a steroid-refractory attack of UC. Most IFX failures underwent surgery during the first 14 days, which calls for studies on how to optimise induction treatment with IFX. Serious complications, including mortality, were rare.
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Affiliation(s)
- M Sjöberg
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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Peyrin-Biroulet L, Billioud V, D'Haens G, Panaccione R, Feagan B, Panés J, Danese S, Schreiber S, Ogata H, Hibi T, Higgins PDR, Beaugerie L, Chowers Y, Louis E, Steinwurz F, Reinisch W, Rutgeerts P, Colombel JF, Travis S, Sandborn WJ. Development of the Paris definition of early Crohn's disease for disease-modification trials: results of an international expert opinion process. Am J Gastroenterol 2012; 107:1770-6. [PMID: 23211844 DOI: 10.1038/ajg.2012.117] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We report the findings and outputs of an international expert opinion process to develop a definition of early Crohn's disease (CD) that could be used in future disease-modification trials. Nineteen experts on inflammatory bowel diseases held an international expert opinion meeting to discuss and agree on a definition for early CD to be used in disease-modification trials. The process included literature searches for the relevant basic-science and clinical evidence. A published preliminary definition of early CD was used as the basis for development of a proposed definition that was discussed at the expert opinion meeting. The participants then derived a final definition, based on best current knowledge, that it is hoped will be of practical use in disease-modification trials in CD.
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Affiliation(s)
- Laurent Peyrin-Biroulet
- INSERM U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy, Université Henri Poincaré 1, Vandoeuvre-lès-Nancy, France.
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Thomson ABR, Gupta M, Freeman HJ. Use of the tumor necrosis factor-blockers for Crohn's disease. World J Gastroenterol 2012; 18:4823-54. [PMID: 23002356 PMCID: PMC3447266 DOI: 10.3748/wjg.v18.i35.4823] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 06/13/2012] [Accepted: 08/14/2012] [Indexed: 02/06/2023] Open
Abstract
The use of anti-tumor necrosis factor-α therapy for inflammatory bowel disease represents the most important advance in the care of these patients since the publication of the National Co-operative Crohn's disease study thirty years ago. The recommendations of numerous consensus groups worldwide are now supported by a wealth of clinical trials and several meta-analyses. In general, it is suggested that tumor necrosis factor-α blockers (TNFBs) are indicated (1) for persons with moderately-severe Crohn's disease or ulcerative colitis (UC) who have failed two or more causes of glucocorticosteroids and an acceptably long cause (8 wk to 12 wk) of an immune modulator such as azathioprine or methotrexate; (2) non-responsive perianal disease; and (3) severe UC not responding to a 3-d to 5-d course of steroids. Once TNFBs have been introduced and the patient is responsive, therapy given by the IV and SC rate must be continued. It remains open to definitive evidence if concomitant immune modulators are required with TNFB maintenance therapy, and when or if TNFB may be weaned and discontinued. The supportive evidence from a single study on the role of early versus later introduction of TNFB in the course of a patient's illness needs to be confirmed. The risk/benefit profile of TNFB appears to be acceptable as long as the patient is immunized and tested for tuberculosis and viral hepatitis before the initiation of TNFB, and as long as the long-term adverse effects on the development of lymphoma and other tumors do not prone to be problematic. Because the rates of benefits to TNFB are modest from a population perspective and the cost of therapy is very high, the ultimate application of use of TNFBs will likely be established by cost/benefit studies.
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Gomollón F. [The future of inflammatory bowel disease from the perspective of Digestive Disease Week 2012]. GASTROENTEROLOGIA Y HEPATOLOGIA 2012; 35 Suppl 1:43-50. [PMID: 23018007 DOI: 10.1016/s0210-5705(12)70033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The new information presented in Digestive Disease Week has allowed us to speculate on the future of inflammatory bowel disease. Manipulation of diet and the microbioma will probably play an increasingly important role in the treatment of this disease and, in the long term, in its prevention. Biological agents will probably be used earlier and more widely; new information on levels of biological agents, mucosal healing and new comparative studies will also allow these agents to be used in a more precise and personalized way. In addition to infliximab, adalimumab, natalizumab and certolizumab, other biological agents will be employed; among the first of these to be used will be ustekinumab, golimumab and vedolizumab. In the near future, biological agents will be used as frequently in ulcerative colitis as in Crohn's disease. New healthcare models will be developed that will progressively include greater participation among patients and nurses. The ability to predict new diagnostic and prognostic models will allow decisions to be more individualized.
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Affiliation(s)
- Fernando Gomollón
- Servicio de Aparato Digestivo, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria de Aragón (IIS), Facultad de Medicina de Zaragoza y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Zaragoza, Spain.
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