1
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Gheonea T, Bogdan M, Meca AD, Rogoveanu I, Oancea C. Recent clinical evidence on nutrition, novel pharmacotherapy, and vaccination in inflammatory bowel diseases. Front Pharmacol 2024; 15:1380878. [PMID: 39308999 PMCID: PMC11413590 DOI: 10.3389/fphar.2024.1380878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 08/20/2024] [Indexed: 09/25/2024] Open
Abstract
Inflammatory bowel diseases (IBD), which enclose Crohn's disease (CD) and ulcerative colitis (UC), are chronic, relapsing inflammatory ailments. Their specific pathogenesis is not completely clarified, the worldwide incidence and prevalence of IBD has been steadily growing, and there is still not a definitive cure. The management of IBD has become more and more targeted, with specific immune mediators identified to be involved in its pathogenesis. Vedolizumab, a humanised monoclonal antibody binding specifically to the α4β7 integrin, is a gut-selective immunosuppressive biologic drug administered for both CD and UC. With the same indications as vedolizumab, ustekinumab is a fully human IgG1κ monoclonal antibody binding with specificity to the shared p40 protein subunit of human cytokines interleukin (IL)-12 and IL-23. Several selective IL-23p19 monoclonal antibodies (risankizumab, mirikizumab, and guselkumab) have also revealed admirable efficacy and safety in IBD patients. Nutrition is a very important environmental factor associated with the onset and progression of IBD, and the Western diet is considered to contribute to the development of IBD. In this narrative review, our aim is to present an overview of the main results from recent clinical studies on IBD regarding diet, new drug treatments, and also vaccination.
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Affiliation(s)
- Theodora Gheonea
- Center for IBD patients, Faculty of Medicine, University of Medicine and Pharmacy from Craiova, Craiova, Romania
| | - Maria Bogdan
- Department of Pharmacology, Faculty of Pharmacy, University of Medicine and Pharmacy from Craiova, Craiova, Romania
| | - Andreea-Daniela Meca
- Department of Pharmacology, Faculty of Pharmacy, University of Medicine and Pharmacy from Craiova, Craiova, Romania
| | - Ion Rogoveanu
- Center for IBD patients, Faculty of Medicine, University of Medicine and Pharmacy from Craiova, Craiova, Romania
| | - Carmen Oancea
- Department of Biochemistry, Faculty of Medicine, University of Medicine and Pharmacy from Craiova, Craiova, Romania
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2
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Atreya R, Redondo I, Streit P, Protic M, Hartz S, Gurses G, Knight H, Barlow S, Harvey N, Hunter Gibble T. Burden of Bowel Urgency in Patients With Ulcerative Colitis and Crohn's Disease: A Real-World Global Study. CROHN'S & COLITIS 360 2024; 6:otae047. [PMID: 39281848 PMCID: PMC11401995 DOI: 10.1093/crocol/otae047] [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: 11/30/2023] [Indexed: 09/18/2024] Open
Abstract
Background Bowel urgency is a highly disruptive and bothersome symptom experienced by patients with inflammatory bowel diseases (IBD), (ulcerative colitis [UC], and Crohn's disease [CD]). However, the burden of bowel urgency among patients with varying experiences in targeted treatment has not been consistently assessed. This real-world study explored the clinical and health-related quality of life burden of bowel urgency among patients with IBD with differing treatment experiences. Methods This cross-sectional survey included gastroenterologists and their patients with IBD across France, Germany, Italy, Spain, the United Kingdom, and the United States treated for over 3 months. Physicians provided patient demographics, clinical characteristics, and treatment history. Patients reported their health-related quality of life and work productivity. Patients with UC and CD were analyzed separately and stratified into 3 groups: Targeted therapy naïve, those receiving their first-line targeted therapy, and targeted therapy experienced. Results This study found that 17%-26% of UC and 13%-17% of CD patients experienced persistent bowel urgency, irrespective of receiving conventional or targeted therapy. Moreover, patients with bowel urgency experienced an increased clinical and health-related quality of life burden compared to patients without bowel urgency, which physicians most commonly regarded as one of the most difficult symptoms to treat, with the burden remaining substantial irrespective of their treatment experience. Conclusions Despite several current treatment options, new therapeutic strategies are necessary to provide relief from bowel urgency, one of the most challenging symptoms for people living with IBD.
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Affiliation(s)
- Raja Atreya
- Medical Department 1, University Hospital Erlangen, Friedrich Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Isabel Redondo
- Medical Affairs, Eli Lilly and Company, Lisbon, Portugal
| | - Petra Streit
- Global New Product Planning, Eli Lilly and Company, Vernier, Switzerland
| | - Marijana Protic
- Medical Affairs, Eli Lilly and Company, Vernier, Switzerland
| | - Susanne Hartz
- Value, Evidence and Outcomes - International, Eli Lilly and Company, Bracknell, UK
| | - Gamze Gurses
- Reimbursement Access, Eli Lilly and Company, Istanbul, Turkey
| | - Hannah Knight
- Autoimmune Franchise, Adelphi Real World, Bollington, UK
| | - Sophie Barlow
- Statistics & Data Analytics, Adelphi Real World, Bollington, UK
| | - Niamh Harvey
- Autoimmune Franchise, Adelphi Real World, Bollington, UK
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3
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Jiang C, Godoy-Brewer G, Rodriguez A, Graff E, Quintero MA, Leavitt J, Lopez J, Goldberg DS, Damas OM, Whelan K, Abreu MT. Food-Related Quality of Life Is Impaired in Latinx and Non-Latinx Patients With Inflammatory Bowel Disease. GASTRO HEP ADVANCES 2024; 3:773-782. [PMID: 39280907 PMCID: PMC11401539 DOI: 10.1016/j.gastha.2024.05.008] [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: 03/12/2024] [Accepted: 05/21/2024] [Indexed: 09/18/2024]
Abstract
Background and Aims Anxiety over food choices and symptoms related to food consumption diminish quality of life (QoL) in inflammatory bowel disease (IBD) patients. However, the specific factors that impact QoL among IBD patients remain unclear. In this study, we analyzed the relationships of demographic and disease factors with food-related QoL (FRQoL) in a large, diverse US cohort of IBD patients. Methods In this cross-sectional analysis of 1108 IBD patients aged ≥18 years, we measured FRQoL with the 29-item Food-Related Quality of Life Questionnaire (FR-QoL-29) and disease activity with the Harvey-Bradshaw index in Crohn's disease (CD) patients or the Simple Clinical Colitis Activity Index in ulcerative colitis (UC) patients. Latinx immigrants completed a Spanish translation of the FR-QoL-29. A subset of patients had colonoscopy and inflammatory marker data available. We used univariate, multivariate, and subgroup analyses to examine the factors that influence FRQoL. Results In our cohort, 55% of IBD patients self-identified as Latinx. Latinx and non-Latinx patients had similar FR-QoL-29 scores. Female patients had significantly lower FRQoL than male patients (P = .001). Increasing age and IBD duration correlated with higher FRQoL (P < .0001). In UC patients, higher Simple Clinical Colitis Activity Index scores (P < .0001), higher Mayo scores (P = .0009), and longer disease duration (P = .03) predicted significantly lower FRQoL. Disease activity and FRQoL were not significantly related in CD patients. Conclusion This is the largest study to date to examine FRQoL in American IBD patients, and the first to include Latinx patients. Disease-related factors had a greater impact on FRQoL than ethnicity. Clinical and endoscopic disease activity had a more detrimental impact on FRQoL in UC than in CD. Diet intervention studies are needed to alleviate symptoms and improve FRQoL in the IBD population.
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Affiliation(s)
- Chunsu Jiang
- Division of Digestive Health and Liver Diseases, University of Miami, Miami, Florida
| | - Gala Godoy-Brewer
- Department of Internal Medicine, University of Miami, Miami, Florida
| | - Andres Rodriguez
- Department of Internal Medicine, University of Miami, Miami, Florida
| | - Erica Graff
- Department of Internal Medicine, University of Miami, Miami, Florida
| | | | | | | | - David S Goldberg
- Division of Digestive Health and Liver Diseases, University of Miami, Miami, Florida
| | - Oriana M Damas
- Division of Digestive Health and Liver Diseases, University of Miami, Miami, Florida
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Maria T Abreu
- Division of Digestive Health and Liver Diseases, University of Miami, Miami, Florida
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D'Amico F, Magro F, Siegmund B, Kobayashi T, Kotze PG, Solitano V, Caron B, Al Awadhi S, Hart A, Jairath V, Dignass A, Peyrin-Biroulet L, Danese S. Disease Clearance as a New Outcome in Ulcerative Colitis: a Systematic Review and Expert Consensus. Inflamm Bowel Dis 2024; 30:1009-1017. [PMID: 37549104 DOI: 10.1093/ibd/izad159] [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: 04/26/2023] [Indexed: 08/09/2023]
Abstract
The concept of disease clearance has been proposed as a potential target in ulcerative colitis (UC). We conducted a systematic review to investigate the role of disease clearance, defined as a composite outcome including simultaneous clinical, endoscopic, and histologic remission of disease in the management of patients with UC. Based on the literature data, statements regarding disease clearance were developed and voted on by the members of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) according to a Delphi methodology. A definition of disease clearance was proposed to standardize its use in clinical practice and clinical trials and to provide practical recommendations for its implementation as a therapeutic target in UC.
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Affiliation(s)
- Ferdinando D'Amico
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Fernando Magro
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Britta Siegmund
- Medizinische Klinik m. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Benedicte Caron
- University of Lorraine, CHRU-Nancy, Department of Gastroenterology, F-54000 Nancy, France
- University of Lorraine, Inserm, NGERE, F-54000 Nancy, France
| | - Sameer Al Awadhi
- Digestive Diseases Unit, Rashid Hospital, Dubai 003206, United Arab Emirates
| | - Ailsa Hart
- St Mark's Hospital, Harrow, Middlesex, UK
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Laurent Peyrin-Biroulet
- University of Lorraine, CHRU-Nancy, Department of Gastroenterology, F-54000 Nancy, France
- University of Lorraine, Inserm, NGERE, F-54000 Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
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Jairath V, Gibble TH, Moses R, Klooster B, Litcher-Kelly L, Walker M, Bernstein MC, Rupinski K, McLafferty M, Travis S, Dubinsky M. Patient interpretations of patient-reported outcome measures to assess bowel urgency: qualitative interviews in ulcerative colitis. J Patient Rep Outcomes 2024; 8:54. [PMID: 38819757 PMCID: PMC11143159 DOI: 10.1186/s41687-024-00733-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024] Open
Abstract
OBJECTIVES Bowel urgency is an impactful core symptom of ulcerative colitis (UC). Patient-reported outcome (PRO) questionnaires have been developed and used to assess the patient experience of this important symptom. The objective of this paper is to present evidence from qualitative research conducted to support the use and interpretation of select PRO questionnaires to assess bowel urgency related to the UC patient experience. METHODS Qualitative interviews were conducted with ten adults with a clinician-confirmed diagnosis of moderately to severely active UC. Interviews aimed to document patient interpretation of modified recall periods for the Urgency Numeric Rating Scale (Urgency NRS), two global assessments (i.e., the Patient Global Impression of Severity [PGIS] and Patient Global Impression of Change [PGIC]), and four items (Items 11, 16, 23, and 26) of the Inflammatory Bowel Disease Questionnaire (IBDQ), and explore the patient perspective of meaningful change on these questionnaires. RESULTS Both modified Urgency NRS versions (with 7-day or 3-day recall period) were interpreted as intended by most patients (≥ 88.9%), and slightly more than half of patients (60.0%) reported that the 7-day recall period was more relevant to their bowel urgency experience. Patients reported thinking of bowel urgency (≥ 80.0%) or bowel urgency-related accidents (70.0% of patients) when interpreting the global assessments and IBDQ items. Most patients reported a 1- to 3-point change as the smallest meaningful improvement that would be meaningful on the Urgency NRS (similar to findings on other questionnaires). CONCLUSION Adults with UC can understand and respond to the Urgency NRS with modified recall periods (i.e., 7-day or 3-day), interpret the conceptual content of the PGIS, PGIC, and select IBDQ items to be inclusive of bowel urgency and bowel urgency-related accidents, and select answers representing meaningful improvements on the Urgency NRS, PGIS, PGIC, and IBDQ item response scales. These results further contribute patient-centered data to existing UC and bowel urgency research.
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Affiliation(s)
- Vipul Jairath
- Departments of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Canada
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Nardone OM, Calabrese G, La Mantia A, Caso R, Testa A, Castiglione F. Insights into disability and psycho-social care of patients with inflammatory bowel disease. Front Med (Lausanne) 2024; 11:1416054. [PMID: 38863889 PMCID: PMC11165103 DOI: 10.3389/fmed.2024.1416054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024] Open
Abstract
In recent years, the concept of disability has increasingly garnered attention as a crucial long-term target of inflammatory bowel disease (IBD) management. The treatment paradigm has changed dramatically from full control of the disease (clinical and endoscopic remission) toward physical and emotional well-being with the goal of preventing disability and normalizing quality of life. However, in certain cases, despite achieving good disease control, patients may still experience symptoms associated with disability, and reduced emotional wellness. These symptoms can significantly impact various biopsychosocial factors, including interpersonal relationships, educational or work-related activities, body image, and sexual functioning. Nevertheless, they often remain overlooked in the context of IBD care. In this narrative review, we aim to shed light on the burden of certain disability-related symptoms such as bowel urgency, sexual dysfunction, impaired fertility and fatigue, emphasizing the importance of acknowledging and validating them in a clinical setting. There is a demanding need for comprehensive care for IBD patients, with IBD clinicians being mindful of the psychosocial challenges faced by their patients. Providing timely and appropriate management of these challenges alongside IBD treatment is key to achieving holistic remission and enhancing the overall quality of life while reducing disability.
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Affiliation(s)
- Olga Maria Nardone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giulio Calabrese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessia La Mantia
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Rossella Caso
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Testa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Siffledeen J, Singh S, Shulman SM, Igoe J, Heatta-Speicher T, Leitner C, Chung CH, Targownik L. Effect of Suboptimal Disease Control on Patient Quality of Life: Real-World Data from the Observational IBD-PODCAST Canada Trial. Dig Dis Sci 2024; 69:1636-1648. [PMID: 38493273 PMCID: PMC11098930 DOI: 10.1007/s10620-024-08313-z] [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: 12/19/2023] [Accepted: 01/23/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND The real-world application of STRIDE-II treatment targets to identify whether disease control is optimal in Crohn's disease (CD) and ulcerative colitis (UC) is not well known. AIMS This study aimed to estimate proportions of patients with suboptimally controlled CD and UC in real-world Canadian healthcare settings and the impact on quality of life (QoL). METHODS The noninterventional, multicenter, observational IBD-PODCAST Canada study comprised a single study visit involving routine assessments, patient- and clinician-completed questionnaires, and a retrospective chart review. Primary outcomes were proportions of patients with STRIDE-II-based red flags indicative of suboptimal disease control and mean ± standard deviation Short Inflammatory Bowel Disease Questionnaire (SIBDQ) scores. Secondary outcomes included proportions of patients and clinicians subjectively reporting suboptimal control. RESULTS Among 163 enrolled patients from 10 sites, 45/87 patients with CD (51.7%; 95% CI: 40.8%, 62.6%) and 33/76 patients with UC (43.3%; 95% CI: 32.1%, 55.3%) had suboptimal disease control based on STRIDE-II criteria. Suboptimal control was subjectively reported at lower proportions (patients: CD, 15.0%; UC, 18.6%; clinicians: CD, 19.5%; UC, 25.0%). Numerically lower SIBDQ scores were observed with suboptimal control (CD, 43.0 ± 10.8; UC, 42.5 ± 12.0) than with optimal control (CD, 58.2 ± 7.2; UC, 57.8 ± 6.6). CONCLUSIONS Approximately 50% (CD) and 40% (UC) of patients from real-world Canadian practices had suboptimal disease control based on STRIDE-II criteria. Suboptimal control was underestimated by patients and clinicians and accompanied by reduced QoL, suggesting further efforts to implement STRIDE-II treat-to-target strategies are needed.
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Affiliation(s)
- Jesse Siffledeen
- Division of Gastroenterology, Department of Medicine, University of Alberta, 13-103 Clinical Sciences Building, 11350-83 Avenue NW, Edmonton, AB, T6G 2G3, Canada.
| | - Sunny Singh
- Division of Gastroenterology, Department of Medicine, University of British Columbia, Kelowna General Hospital, Kelowna, BC, Canada
| | | | - John Igoe
- Division of Digestive Care and Endoscopy, Department of Medicine, Dalhousie University, Moncton, NB, Canada
| | | | | | | | - Laura Targownik
- Division of Gastroenterology and Hepatology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
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Barnes EL. A Practical Guide to the Use of Mirikizumab. Am J Gastroenterol 2024; 119:400-403. [PMID: 37782274 PMCID: PMC11026297 DOI: 10.14309/ajg.0000000000002531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023]
Affiliation(s)
- Edward L. Barnes
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina, Chapel Hill, NC, USA
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9
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Hu ML, Liao QZ, Liu BT, Sun K, Pan CS, Wang XY, Yan L, Huo XM, Zheng XQ, Wang Y, Zhong LJ, Liu J, He L, Han JY. Xihuang pill ameliorates colitis in mice by improving mucosal barrier injury and inhibiting inflammatory cell filtration through network regulation. JOURNAL OF ETHNOPHARMACOLOGY 2024; 319:117098. [PMID: 37640256 DOI: 10.1016/j.jep.2023.117098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/31/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The prevalence of colitis is on the rise, and effective treatment options are currently lacking. Xihuang pill (XHP) is a traditional Chinese medicine formula mentioned in the "Volume 4 of Surgical Evidence and Treatment of the Whole Life" authored by the renowned doctor Hong-Xu Wang during the Qing Dynasty. It is now part of the "Volume 9 of Chinese medicine formula preparation in Drug Standard." XHP and its primary ingredients have been demonstrated anti-inflammatory properties against colitis. However, the specific effects and underlying mechanisms of XHP in treating colitis remain unknown. AIM OF THE STUDY This study aimed to investigate the potential impact of XHP on colitis and uncover the underlying mechanisms involved. MATERIALS AND METHODS An acute colitis model was developed in C57BL/6N mice, and the effects on weight loss, colon length, the permeability of the colonic mucosa barrier, Claudin-5 and Occludin expression, number of both infiltrating MPO-positive cells and CD68-positive cells, and the content of pro-inflammatory cytokines (IL-6, IL-22, IL-1β, and TNF-α) in the colon tissue were investigated. Low-, medium-, and high-dose XHP (0.45, 0.9, and 1.8 g/kg/day) (batch number: z21021222) were administered to the mice by gavage over the course of two weeks. Additionally, the protein expression levels in colon tissue from the control group, colitis group, and XHP low-dose administration group mice were analyzed by quantitative proteomics techniques. The comprehensive profiling and characterization of absorbed components in mice blood following oral administration of XHP were identified by HPLC/Q-TOF-MS techniques, and the absorbed components in blood were combined with proteomics to reveal the mechanism of enteritis inhibition by XHP. RESULTS Our findings indicated that XHP enhanced weight loss and colonic shortening of colitis mice. Additionally, XHP reduced the increase in permeability of the colonic mucosa barrier and decreased expression of Claudin-5 and Occludin, while significantly reducing the number of infiltrating MPO-positive cells and CD68-positive cells in the colon tissue. We found that XHP reduced the production of pro-inflammatory cytokines, including IL-6, IL-22, IL-1β, and TNF-α in colon tissue. Pharmacokinetic analysis suggested that XHP contained 24 blood-entering prototype ingredients, which improved colitis through the regulation of various proteins (e.g., Ctsb, Sting1, and Abat) linked to mucosal barrier injury and inflammation. CONCLUSION XHP improved intestinal mucosal barrier injury and reduced MPO-positive cells and CD68-positive cell infiltration through multiple targets and pathways, providing support for XHP as a promising therapy for colitis.
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Affiliation(s)
- Meng-Lei Hu
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China; Tasly Microcirculation Research Center, Peking University Health Science Center, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China
| | - Qian-Zan Liao
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China; Tasly Microcirculation Research Center, Peking University Health Science Center, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China
| | - Bo-Tong Liu
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China; Tasly Microcirculation Research Center, Peking University Health Science Center, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China
| | - Kai Sun
- Tasly Microcirculation Research Center, Peking University Health Science Center, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China
| | - Chun-Shui Pan
- Tasly Microcirculation Research Center, Peking University Health Science Center, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China
| | - Xiao-Yi Wang
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China; Tasly Microcirculation Research Center, Peking University Health Science Center, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China
| | - Li Yan
- Tasly Microcirculation Research Center, Peking University Health Science Center, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China
| | - Xin-Mei Huo
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China; Tasly Microcirculation Research Center, Peking University Health Science Center, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China
| | - Xian-Qun Zheng
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China; Tasly Microcirculation Research Center, Peking University Health Science Center, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China
| | - Yuan Wang
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Li-Jun Zhong
- Medical and Health Analytical Center, Peking University Health Science Center, Beijing, China
| | - Jian Liu
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China
| | - Lin He
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China.
| | - Jing-Yan Han
- Department of Integration of Chinese and Western Medicine, School of Basic Medical Sciences, Peking University, Beijing, China; Tasly Microcirculation Research Center, Peking University Health Science Center, Beijing, China; Key Laboratory of Microcirculation, State Administration of Traditional Chinese Medicine of the People's Republic of China, Beijing, China; State Key Laboratory of Core Technology in Innovative Chinese Medicine, Tianjin, China; Beijing Microvascular Institute of Integration of Chinese and Western Medicine, Beijing, China; State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University Health Science Center, Beijing, China.
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10
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Long MD, Schreiber S, Hibi T, Gibble TH, Fisher DA, Park G, Moses RE, Higgins PDR, Lindsay JO, Lee SD, Escobar R, Jairath V. Association of Bowel Urgency With Quality-of-Life Measures in Patients With Moderately-to-Severely Active Ulcerative Colitis: Results From Phase 3 LUCENT-1 (Induction) and LUCENT-2 (Maintenance) Studies. CROHN'S & COLITIS 360 2024; 6:otae001. [PMID: 38313767 PMCID: PMC10838132 DOI: 10.1093/crocol/otae001] [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: 06/30/2023] [Indexed: 02/06/2024] Open
Abstract
Background Improvement in bowel urgency (BU) was associated with better clinical outcomes in phase 3 LUCENT-1 (induction) and LUCENT-2 (maintenance) studies in moderately-to-severely active ulcerative colitis (UC). We assessed association of BU with quality-of-life (QoL) outcomes. Methods LUCENT-1: 1162 patients randomized 3:1 to intravenous mirikizumab 300 mg or placebo every 4 weeks (Q4W) for 12 weeks. LUCENT-2: 544 mirikizumab induction responders re-randomized 2:1 to subcutaneous mirikizumab 200 mg or placebo Q4W through Week (W) 40 (W52 of continuous treatment). Patients reported BU severity in the past 24 hours using a validated Urgency Numeric Rating Scale (NRS). In patients with baseline Urgency NRS ≥3, the association between BU Clinically Meaningful Improvement (CMI; ≥3-point decrease) and remission (score 0 or 1) with patient-reported outcomes was assessed at W12 and W52. Results A significantly greater proportion of patients with versus without BU Remission achieved IBDQ remission (W12: 87.3% vs 42.7%, P < .0001; W52: 91.4% vs 45.5%, p < .0001). Similarly, BU Remission was associated with more patients achieving CMI in SF-36 Physical Component Summary (W12: 69.0% vs 44.4%, P < .0001; W52: 77.5% vs 42.1%, P < .0001) and Mental Component Summary (W12: 53.5% vs 41.0%, P = .0019; W52: 62.0% vs 38.3%, P < .0001) scores. At W12 and W52, patients with BU CMI or Remission showed significant improvements in EQ-5D-5L and Work Productivity and Activity Impairment:UC scores. Significant improvements were also seen in fatigue, abdominal pain, and nocturnal stool. Conclusions In patients with moderately-to-severely active UC, improvement in BU was associated with improved QoL in phase 3 LUCENT-1 and LUCENT-2 studies. Clinical Studies LUCENT-1: NCT03518086; LUCENT-2: NCT03524092.
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Affiliation(s)
- Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC, USA
| | - Stefan Schreiber
- Department Internal Medicine I, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Toshifumi Hibi
- Kitasato Institute Hospital, Minato-ku, Center for Advanced IBD Research and Treatment, Tokyo, Japan
| | | | | | - Gina Park
- Techdata Services Company LLC, King of Prussia, PA, USA
| | | | - Peter D R Higgins
- Department of Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA
| | | | - Scott D Lee
- Division of Gastroenterology, University of Washington Medical Center, Seattle, WA, USA
| | | | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
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11
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Moon M, Chowdhury R, Charabaty A. Editorial: Rectal Urgency Among Patients with Ulcerative Colitis or Crohn's Disease: Analyses from a Global Survey. CROHN'S & COLITIS 360 2023; 5:otad054. [PMID: 37928614 PMCID: PMC10622169 DOI: 10.1093/crocol/otad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Affiliation(s)
- Mackenzie Moon
- Department of Medicine, Internal Medicine Johns Hopkins University, Baltimore, MD, Maryland, USA
| | - Reezwana Chowdhury
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aline Charabaty
- Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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12
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Matsumoto T, Imai K, Goda Y, Fujimitsu Y, Kajioka T, Kihara H, Funaki Y, Imaki S, Ueno M. Questionnaire Survey for Inflammatory Bowel Disease Patients in Japan; A Web-Based Japan, Crohn's Disease, Ulcerative Colitis, Patients Survey. CROHN'S & COLITIS 360 2023; 5:otad069. [PMID: 38028953 PMCID: PMC10676197 DOI: 10.1093/crocol/otad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background/Aims The prevalence of inflammatory bowel disease (IBD) in Japan has been increasing. We aimed to clarify the symptoms of patients with IBD in Japan using an internet-based questionnaire survey. Methods Overall, 805 patients with IBD were asked to complete an internet-based questionnaire addressing their history of disturbances in daily activities, prevalence of fecal urgency, incontinence, and treatment preferences. Results Responses were obtained from 447 patients with IBD (mean age: 54 years; 70% were men), comprising 363 patients with ulcerative colitis (UC), and 84 with Crohn's disease (CD). Notably, 16% of patients with UC and 35% with CD took over 1 year until the diagnosis of IBD, and 5% of patients with CD visited more than 5 medical institutions. Patients with CD were more likely to experience disturbances in their diet, work, travel, and outings than those with UC. Fecal urgency and incontinence were significantly more frequent in patients with CD than in those with UC (72% vs. 44%, and 50% vs. 26%, respectively). In contrast, 26% of the men and 37% of women with IBD had constipation. Acid reflux, sleep disorders, and depressive symptoms were present in approximately 30% of the patients. Oral administration was preferred. Conclusions Patients with IBD in Japan experience more severe disturbances in their daily activities, and these are more severe in those with CD than those with UC. In addition to fecal urgency and incontinence, care is required for constipation, acid reflux, sleep disorders, and depressive symptoms.
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Affiliation(s)
- Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Iwate, Japan
| | - Keita Imai
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuki Goda
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuki Fujimitsu
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | | | - Hideaki Kihara
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
| | - Yuji Funaki
- Department of Integrated Marketing, EA Pharma Co., Ltd., Tokyo, Japan
| | - Shigeru Imaki
- Department of Corporate Communication, EA Pharma Co., Ltd., Tokyo, Japan
| | - Masato Ueno
- Department of IBD Strategy, EA Pharma Co., Ltd., Tokyo, Japan
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13
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Abstract
Importance Ulcerative colitis (UC) is a chronic inflammatory condition of the colon, with a prevalence exceeding 400 per 100 000 in North America. Individuals with UC have a lower life expectancy and are at increased risk for colectomy and colorectal cancer. Observations UC impairs quality of life secondary to inflammation of the colon causing chronic diarrhea and rectal bleeding. Extraintestinal manifestations, such as primary sclerosing cholangitis, occur in approximately 27% of patients with UC. People with UC require monitoring of symptoms and biomarkers of inflammation (eg, fecal calprotectin), and require colonoscopy at 8 years from diagnosis for surveillance of dysplasia. Risk stratification by disease location (eg, Montreal Classification) and disease activity (eg, Mayo Score) can guide management of UC. First-line therapy for induction and maintenance of remission of mild to moderate UC is 5-aminosalicylic acid. Moderate to severe UC may require oral corticosteroids for induction of remission as a bridge to medications that sustain remission (biologic monoclonal antibodies against tumor necrosis factor [eg, infliximab], α4β7 integrins [vedolizumab], and interleukin [IL] 12 and IL-23 [ustekinumab]) and oral small molecules that inhibit janus kinase (eg, tofacitinib) or modulate sphingosine-1-phosphate (ozanimod). Despite advances in medical therapies, the highest response to these treatments ranges from 30% to 60% in clinical trials. Within 5 years of diagnosis, approximately 20% of patients with UC are hospitalized and approximately 7% undergo colectomy. The risk of colorectal cancer after 20 years of disease duration is 4.5%, and people with UC have a 1.7-fold higher risk for colorectal cancer compared with the general population. Life expectancy in people with UC is approximately 80.5 years for females and 76.7 years for males, which is approximately 5 years shorter than people without UC. Conclusions and Relevance UC affects approximately 400 of every 100 000 people in North America. An effective treatment for mild to moderate UC is 5-aminosalicylic acid, whereas moderate to severe UC can be treated with advanced therapies that target specific inflammation pathways, including monoclonal antibodies to tumor necrosis factor, α4β7 integrins, and IL-12 and IL-23 cytokines, as well as oral small molecule therapies targeting janus kinase or sphingosine-1-phosphate.
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Affiliation(s)
- Beatriz Gros
- IBD Edinburgh Unit, Western General Hospital, Edinburgh, Scotland
- Department of Gastroenterology and Hepatology, Reina Sofía University Hospital, Córdoba, Spain
| | - Gilaad G Kaplan
- Division of Gastroenterology and Hepatology, Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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