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Sanz Segura P, Gomollón F, Casas D, Iborra M, Vela M, Fernández-Clotet A, Muñoz R, García de la Filia I, García Prada M, Ferrer Rosique JÁ, García MJ, de Francisco R, Arias L, Barrio J, Guerra I, Ponferrada Á, Gisbert JP, Carrillo-Palau M, Calvet X, Márquez-Mosquera L, Gros B, Cañete F, Monfort D, Madrigal Domínguez RE, Roncero Ó, Laredo V, Montoro M, Muñoz C, López-Cauce B, Lorente R, Fuentes Coronel A, Vega P, Martín D, Peña E, Varela P, Olivares S, Pajares R, Lucendo AJ, Sesé E, Botella Mateu B, Nos P, Domènech E, García-López S. Psoriasis induced by antiTNF therapy in inflammatory bowel disease: Therapeutic management and evolution of both diseases in a nationwide cohort study. Dig Liver Dis 2024:S1590-8658(24)00779-5. [PMID: 38876834 DOI: 10.1016/j.dld.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND some patients with inflammatory bowel disease (IBD) treated with antiTNF develop drug-induced psoriasis (antiTNF-IP). Several therapeutic strategies are possible. AIMS to assess the management of antiTNF-IP in IBD, and its impact in both diseases. METHODS patients with antiTNF-IP from ENEIDA registry were included. Therapeutic strategy was classified as continuing the same antiTNF, stopping antiTNF, switch to another antiTNF or swap to a non-antiTNF biologic. IP severity and IBD activity were assessed at baseline and 16, 32 and 54 weeks. RESULTS 234 patients were included. At baseline, antiTNF-IP was moderate-severe in 60 % of them, and IBD was in remission in 80 %. Therapeutic strategy was associated to antiTNF-IP severity (p < 0.001). AntiTNF-IP improved at week 54 with all strategies, but continuing with the same antiTNF showed the worst results (p = 0.042). Among patients with IBD in remission, relapse was higher in those who stopped antiTNF (p = 0.025). In multivariate analysis, stopping antiTNF, trunk and palms and soles location were associated with antiTNF-IP remission; female sex and previous surgery in Crohn´s disease with IBD relapse. CONCLUSION skin lesions severity and IBD activity seem to determine antiTNF-IP management. Continuing antiTNF in mild antiTNF-IP, and swap to ustekinumab or switch to another antiTNF in moderate-severe cases, are suitable strategies.
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Affiliation(s)
| | - Fernando Gomollón
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sanitaria (ISS) Aragón, Zaragoza, Spain
| | - Diego Casas
- Instituto de Investigación Sanitaria (ISS) Aragón, Zaragoza, Spain; Gastroenterology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Marisa Iborra
- Gastroenterology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Milagros Vela
- Gastroenterology Department, Hospital Universitario Ntra. Sra. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Agnès Fernández-Clotet
- Gastroenterology Department, Hospital Clinic de Barcelona. Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd). Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Roser Muñoz
- Gastroenterology Department, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | | | - María García Prada
- Gastroenterology Department, Complejo Asistencial Universitario de León, Spain
| | | | - María José García
- Gastroenterology and Hepatology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Ruth de Francisco
- Gastroenterology Department, Hospital Universitario Central de Asturias, and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lara Arias
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Jesús Barrio
- Gastroenterology Department, Hospital Universitario Río Hortega. Gerencia Regional de Salud de Castilla y León (SACYL). Valladolid, Spain
| | - Iván Guerra
- Gastroenterology Department, Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Ángel Ponferrada
- Gastroenterology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Marta Carrillo-Palau
- Gastroenterology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Xavier Calvet
- Servei d'Aparell Digestiu. Parc Taulí, Hospital Universitari. Institutd'Investigació i Innovació Parc Taulí(I3PT-CERCA). Universitat Autònoma de Barcelona. Sabadell, Spain. Centro de Investigación Biomédica En Red de enfermedades hepáticas y digestivas (CIBERehd). Instituto de Salud Carlos III. Madrid, Spain
| | - Lucía Márquez-Mosquera
- Servei de Digestiu, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Beatriz Gros
- Gastroenterology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Fiorella Cañete
- Gastroenterology Department, Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Barcelona, Spain
| | - David Monfort
- Gastroenterology Department, Consorci Sanitari de Terrassa, Spain
| | | | - Óscar Roncero
- Gastroenterology Department, Hospital General La Mancha Centro, Ciudad Real, Spain
| | - Viviana Laredo
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Miguel Montoro
- Gastroenterology Department, Hospital San Jorge, Huesca, Spain
| | - Carmen Muñoz
- Gastroenterology Department, Hospital de Basurto, Bilbao, Spain
| | - Beatriz López-Cauce
- Gastroenterology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rufo Lorente
- Gastroenterology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Ana Fuentes Coronel
- Gastroenterology Department, Hospital Virgen de La Concha, Complejo Asistencial de Zamora, Zamora, Spain
| | - Pablo Vega
- Gastroenterology Department, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Dolores Martín
- Gastroenterology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Elena Peña
- Gastroenterology Department, Hospital Royo Villanova, Zaragoza, Spain
| | - Pilar Varela
- Gastroenterology Department, Hospital Universitario de Cabueñes, Gijón, Spain
| | | | - Ramón Pajares
- Gastroenterology Department, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Alfredo J Lucendo
- Gastroenterology Department, Hospital General de Tomelloso, IIS-IP, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM) and CIBEREHD Ciudad Real, Spain
| | - Eva Sesé
- Gastroenterology Department, Hospital Universitario Arnau de Vilanova de Lleida, Spain
| | - Belén Botella Mateu
- Gastroenterology Department, Hospital Universitario Infanta Cristina, Madrid, Spain
| | - Pilar Nos
- Gastroenterology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Eugeni Domènech
- Gastroenterology Department, Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Barcelona, Spain
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Lee KE, Tu VY, Faye AS. Optimal Management of Refractory Crohn's Disease: Current Landscape and Future Direction. Clin Exp Gastroenterol 2024; 17:75-86. [PMID: 38558912 PMCID: PMC10981422 DOI: 10.2147/ceg.s359376] [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: 01/24/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
Refractory Crohn's disease, defined as ongoing inflammation despite the trial of multiple advanced therapies, impacts a number of individuals with Crohn's disease, and leads to significant burden in quality of life and cost. Interventions such as early implementation of advanced therapies, optimization of current therapies prior to switching to an alternative, as well as understanding the overlapping pathophysiology between immune-mediated disorders, however, can help shift the current landscape and reduce the number of patients with refractory disease. As such, in this review we summarize the key takeaways of the latest research in the management of moderate-to-severe Crohn's disease, focusing on maximization of our currently available medications, while also exploring topics such as combination advanced therapies. We also describe evidence for emerging and alternative therapeutic modalities, including fecal microbiota transplant, exclusive enteral feeding, hyperbaric oxygen, stem cell therapy, bone marrow transplant, and posaconazole, with a focus on both the potential impact and specific indications for each.
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Affiliation(s)
- Kate E Lee
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Violet Y Tu
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Adam S Faye
- Department of Gastroenterology, New York University School of Medicine, New York, NY, USA
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Hydrolyzable Tannins in the Management of Th1, Th2 and Th17 Inflammatory-Related Diseases. Molecules 2022; 27:molecules27217593. [DOI: 10.3390/molecules27217593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Plants rich in hydrolyzable tannins were traditionally used all over the world for a variety of chronic inflammatory disorders, including arthritis, colitis, and dermatitis. However, the knowledge of their immunological targets is still limited though fundamental for their rational use in phytotherapy. The recent advances regarding the pathogenesis of inflammatory-based diseases represent an opportunity to elucidate the pharmacological mechanism of plant-derived metabolites with immunomodulatory activity. This review collects recent articles regarding the role of hydrolyzable tannins and their gut metabolites in Th1, Th2, and Th17 inflammatory responses. In line with the traditional use, rheumatoid arthritis (RA), inflammatory bowel diseases (IBDs), psoriasis, atopic dermatitis (AD), and asthma were the most investigated diseases. A substantial body of in vivo studies suggests that, beside innate response, hydrolyzable tannins may reduce the levels of Th-derived cytokines, including IFN-γ, IL-17, and IL-4, following oral administration. The mode of action is multitarget and may involve the impairment of inflammatory transcription factors (NF-κB, NFAT, STAT), enzymes (MAPKs, COX-2, iNOS), and ion channels. However, their potential impact on pathways with renewed interest for inflammation, such as JAK/STAT, or the modulation of the gut microbiota demands dedicate studies.
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