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Taneja V, Anand RS, El-Dallal M, Dong J, Desai N, Taneja I, Feuerstein JD. Safety of Biologic and Small Molecule Therapy for Inflammatory Bowel Disease Among Solid Organ Transplant Recipients: Systematic Review and Meta-Analysis. Inflamm Bowel Dis 2024; 30:585-593. [PMID: 37300512 DOI: 10.1093/ibd/izad108] [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: 11/18/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND Patients undergoing organ transplantation are often on immunosuppressing medications to prevent rejection of the transplant. The data on use of concomitant immunosuppression for inflammatory bowel disease (IBD) and organ transplant management are limited. This study sought to evaluate the safety of biologic and small molecule therapy for the treatment of IBD among solid organ transplant recipients. METHODS Medline, Embase, and Web of Science databases were systematically searched for studies reporting on safety outcomes associated with the use of biologic and small molecule therapy (infliximab, adalimumab, certolizumab, golimumab, vedolizumab, ustekinumab, and tofacitinib) in patients with IBD postsolid organ transplant (eg, liver, kidney, heart, lung, pancreas). The primary outcome was infectious complications. Secondary outcomes included serious infections, colectomy, and discontinuation of biologic therapy. RESULTS Seven hundred ninety-seven articles were identified for screening, yielding 16 articles for the meta-analyses with information on 163 patients. Antitumor necrosis factor α (Anti-TNFs; infliximab and adalimumab) were used in 8 studies, vedolizumab in 6 studies, and a combination of ustekinumab or vedolizumab and anti-TNFs in 2 studies. Two studies reported outcomes after kidney and cardiac transplant respectively, whereas the rest of the studies included patients with liver transplants. The rates of all infections and serious infections were 20.09 per 100 person-years (100-PY; 95% CI, 12.23-32.99 per 100-PY, I2 = 54%) and 17.39 per 100-PY (95% CI, 11.73-25.78 per 100-PY, I2 = 21%), respectively. The rates of colectomy and biologic medication discontinuation were 12.62 per 100-PY (95% CI, 6.34-25.11 per 100-PY, I2 = 34%) and 19.68 per 100-PY (95% CI, 9.97-38.84 per 100-PY, I2 = 74%), respectively. No cases of venous thromboembolism or death attributable to biologic use were reported. CONCLUSION Biologic therapy is overall well tolerated in patients with solid organ transplant. Long-term studies are needed to better define the role of specific agents in this patient population.
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Affiliation(s)
- Vikas Taneja
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rajsavi S Anand
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammed El-Dallal
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Cambridge Health Alliance, Harvard Medical School, Boston, MA, USA
| | - Jeffrey Dong
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nisa Desai
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Isha Taneja
- Massachusetts General Hospital for Children, Harvard Medical School, Boston, MA, USA
| | - Joseph D Feuerstein
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Herfarth HH, Afzali A, Fischer M, Hudesman D, Abdalla M, McCabe R, Cohen BL, Ungaro RC, Harlan W, Hanson J, Konijeti GG, Polyak S, Ritter T, Salzberg B, Seminerio J, English E, Zhang X, Long MD. Clinical Long-Term Outcomes of Patient-Reported Outcomes in the Prospective Real-World Tofacitinib Response in Ulcerative Colitis Registry. Clin Transl Gastroenterol 2024; 15:e00669. [PMID: 38131617 PMCID: PMC10962890 DOI: 10.14309/ctg.0000000000000669] [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: 07/11/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION We previously reported the results of tofacitinib induction therapy in the prospective multisite US real-world Tofacitinib Response in Ulcerative Colitis registry. We now assessed patient-reported outcomes (PROs) and predictors of success during tofacitinib maintenance therapy. METHODS Tofacitinib Response in Ulcerative Colitis included 103 patients with refractory ulcerative colitis (UC); 67% had failed ≥ 2 biologics. Patients reported the Simple Clinical Colitis Activity Index (SCCAI), Patient-Reported Outcome Measurement Information System measures for anxiety, depression, social satisfaction, and adverse events between weeks 8 and 52 using a web-based system. Paired t test and P for trend were used to compare changes in PRO measures over time. Bivariate analyses and logistic regression models were used to determine factors associated with response (SCCAI <5) or remission (SCCAI <2) at week 52. RESULTS Of 103 patients, 82.5% entered the maintenance phase and 43.7% remained on tofacitinib at week 52. Tofacitinib de-escalation to 5 mg BID occurred in 15% of patients. At week 52, 42.7% and 31.1% of all patients reported an SCCAI <5 and SCCAI ≤2, respectively. Normalization of bowel frequency, rectal bleeding, and urgency occurred in 79%, 61%, and 48% of patients remaining on maintenance therapy. Social satisfaction improved significantly ( P < 0.001), while anxiety and depression scores only numerically improved. No consistent predictors for tofacitinib long-term treatment efficacy were identified, and safety findings were consistent with the known safety profile of tofacitinib. DISCUSSION Tofacitinib is an effective maintenance therapy in patients with refractory UC. Dose reductions infrequently occurred during maintenance. Unmet needs in UC maintenance include improvement of urgency and psychosocial factors (NCT03772145).
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Affiliation(s)
- Hans H. Herfarth
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA
| | | | - Monika Fischer
- Indiana University, Division of Gastroenterology and Hepatology, Indianapolis, Indiana, USA
| | | | - Maisa Abdalla
- University of Rochester, Division of Gastroenterology and Hepatology, Rochester, New York, USA
| | | | - Benjamin L. Cohen
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ryan C. Ungaro
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Will Harlan
- Digestive Health Partners, Ashville, North Carolina, USA
| | - John Hanson
- Atrium Health Gastroenterology and Hepatology, Charlotte, North Carolina, USA
| | - Gauree G. Konijeti
- Scripps Clinic, Division of Gastroenterology & Hepatology, La Jolla, California, USA
| | - Steven Polyak
- University of Iowa, Division of Gastroenterology and Hepatology, Iowa City, Iowa, USA
| | | | - Bruce Salzberg
- Atlanta Gastroenterology Specialists, Atlanta, Georgia, USA
| | - Jennifer Seminerio
- Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Emily English
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA
| | - Xian Zhang
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA
| | - Millie D. Long
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, North Carolina, USA
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Banerjee R, Sharma V, Patel R, Jena A, Pal P, Raghunathan N, Kumar A, Sood A, Puri AS, Goswami B, Desai D, Mekala D, Ramesh GN, Rao GV, Peddi K, Philip M, Tandon M, Bhatia S, Godbole S, Bhatia S, Ghoshal UC, Dutta U, Midha V, Prasad VGM, Reddy DN. Tofacitinib use in ulcerative colitis: An expert consensus for day-to-day clinical practice. Indian J Gastroenterol 2024; 43:22-35. [PMID: 38347433 DOI: 10.1007/s12664-023-01507-9] [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: 10/13/2023] [Accepted: 12/13/2023] [Indexed: 03/10/2024]
Abstract
Rising number of inflammatory bowel disease (IBD) cases in developing countries necessitate clear guidance for clinicians for the appropriate use of advanced therapies. An expert consensus document was generated to guide the usage of tofacitinib, a Janus kinase inhibitor, in ulcerative colitis. Tofacitinib is a useful agent for the induction and maintenance of remission in ulcerative colitis. It can be used in the setting of biological failure or even steroid-dependent and thiopurine refractory disease. Typically, the induction dose is 10 mg BD orally. Usually, clinical response is evident within eight weeks of therapy. In those with clinical response, the dose can be reduced from 10 mg BD to 5 mg BD. Tofacitinib should be avoided or used cautiously in the elderly, patients with cardiovascular co-morbidity, uncontrolled cardiac risk factors, previous thrombotic episodes and those at high risk for venous thrombosis or previous malignancy. Baseline evaluation should include testing for and management of hepatitis B infection and latent tuberculosis. Where feasible, it is prudent to ensure complete adult vaccination, including Herpes zoster, before starting tofacitinib. The use of tofacitinib may be associated with an increased risk of infections such as herpes zoster and tuberculosis reactivation. Maternal exposure to tofacitinib should be avoided during pre-conception, pregnancy, and lactation. There is emerging evidence of tofacitinib in acute severe colitis, although the exact positioning (first-line with steroids or second-line) is uncertain.
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Affiliation(s)
- Rupa Banerjee
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India.
| | - Vishal Sharma
- Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160 012, India
| | - Rajendra Patel
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Anuraag Jena
- IMS and SUM Hospital, K8, Kalinga Nagar, Bhubaneswar, 751 003, India
| | - Partha Pal
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Nalini Raghunathan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Ajay Kumar
- BLK Institute of Digestive Science, BLK-Max Super Speciality Hospital, Pusa Road, New Delhi, 110 005, India
| | - Ajit Sood
- Dayanand Medical College and Hospital, Civil Lines, Tagore Nagar, Ludhiana, 141 001, India
| | - Amarender S Puri
- Medanta Hospital, CH Baktawar Singh Road, Medicity, Islampur Colony, Sector 38, Gurugram, 122 001, India
| | | | - Devendra Desai
- Hinduja Hospital, 8-12, Swatantryaveer Savarkar Road, Mahim West, Mahim, Mumbai, 400 016, India
| | - Dhanush Mekala
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - G N Ramesh
- Aster Hospital, Kuttisahib Road Cheranelloor, South Chittoor, Kochi, 682 027, India
| | - G V Rao
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Kiran Peddi
- Yashoda Hospitals, 6-3-905, Raj Bhavan Road, Matha Nagar, Somajiguda, Hyderabad, 500 082, India
| | - Mathew Philip
- Lisie Institute of Gastroenterology, Cochin, Lisie Hospital Road, North Kaloor, Kaloor, Ernakulam, 682 018, India
| | - Manu Tandon
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Shobna Bhatia
- National Institute of Medical Sciences, Kalwad Kalan and Khurd, Jaipur, 303 121, India
| | - Shubhankar Godbole
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
| | - Sumit Bhatia
- Paras Hospitals, Sec-43, Sushant Lok, Gurugram, 122 002, India
| | - Uday C Ghoshal
- Apollo Institute of Gastrosciences and Liver, Apollo Multispecialty Hospitals, 58, Canal Circular Road, Kadapara, Phool Bagan, Kankurgachi, Kolkata, 700 054, India
| | - Usha Dutta
- Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160 012, India
| | - Vandana Midha
- Dayanand Medical College and Hospital, Civil Lines, Tagore Nagar, Ludhiana, 141 001, India
| | | | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Mindspace Road, Gachibowli, Hyderabad, 500 032, India
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Macaluso FS, D'Antonio E, Fries W, Viola A, Ksissa O, Cappello M, Muscarella S, Belluardo N, Giangreco E, Mocciaro F, Di Mitri R, Ferracane C, Vitello A, Grova M, Renna S, Casà A, De Vivo S, Ventimiglia M, Orlando A. Safety and effectiveness of tofacitinib in ulcerative colitis: Data from TOFA-UC, a SN-IBD study. Dig Liver Dis 2024; 56:15-20. [PMID: 37741749 DOI: 10.1016/j.dld.2023.08.061] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/03/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Real-world evidence is needed to determine the value of tofacitinib (TOFA) for the treatment of ulcerative colitis (UC). AIM To assess the safety and effectiveness of TOFA in clinical practice. METHODS TOFA-UC is a multicenter, observational study performed among the Sicilian Network for Inflammatory Bowel Disease (SN-IBD). All consecutive patients with UC starting TOFA from its introduction in Sicily (July 2021) to July 2022 were included. RESULTS 111 patients were included (mean follow-up: 31.7 ± 14.9 weeks; biologic-experienced: 92.8%). Nineteen adverse events were reported (17.1%; incidence rate: 28.2 per 100 patient years), including 11 cases of hypercholesterolemia and 3 infections (no cases of herpes zoster reactivation. At week 8, the rates of clinical response, steroid free clinical remission, and CRP normalization were 74.8%, 45.0%, and 56.9%, respectively, and 68.5%, 51.4%, and 65.2%, respectively, at the end of follow-up. Eighteen patients experienced a loss of response after successful induction (21.7%; incidence rate: 33.2 per 100 patient years). Twenty-six patients (23.4%) discontinued TOFA over time, of whom 3 due to AEs, and 23 to non response or loss of response. CONCLUSIONS TOFA is safe and effective in patients with UC, including those with history of multiple failures to biological therapies.
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Affiliation(s)
| | - Elvira D'Antonio
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Walter Fries
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Anna Viola
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Omar Ksissa
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Maria Cappello
- Gastroenterology & Hepatology Section, PROMISE, University of Palermo, Italy
| | - Stefano Muscarella
- Gastroenterology & Hepatology Section, PROMISE, University of Palermo, Italy
| | | | | | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | | | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Mauro Grova
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Sara Renna
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Simona De Vivo
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service, Italian Ministry of Health, Rome, Italy
| | - Ambrogio Orlando
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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5
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Huang J, Deng S, Li J, Tang Y, Liu F, Liu Y, Rao S, Shi W. Drug Survival and Long-term Outcome of Tofacitinib in Patients with Alopecia Areata: A Retrospective Study. Acta Derm Venereol 2023; 103:adv13475. [PMID: 37955531 PMCID: PMC10655123 DOI: 10.2340/actadv.v103.13475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/10/2023] [Indexed: 11/14/2023] Open
Abstract
Several non-randomized clinical trials and retrospective studies have demonstrated encouraging efficacy and well-tolerated safety of tofacitinib in the treatment of alopecia areata. However, there are scarce data on a large cohort of patients with alopecia areata in long-term real-world practice. This single-centre, retrospective, observational cohort study included 126 patients with alopecia areata treated with tofacitinib between February 2021 and December 2022. The aims of this study are to evaluate drug survival, effectiveness and safety of tofacitinib for treatment of alopecia areata, and to identify potential factors influencing long-term outcomes. Median duration of treatment was 23.00 (interquartile range (IQR) 15.00, 47.25) weeks. Median all-cause survival time of 126 patients treated with tofacitinib was 44 weeks (95% confidence interval (95% CI) 36.3, 51.7), and the all-cause drug retention rate at 12 weeks, 24 weeks and 48 weeks were 90.0%, 66.4% and 42.3%, respectively. The most common reason for discontinuation was complete remission/satisfaction. A total of 80 patients treated with tofacitinib for over 6 months were included in the efficacy analysis, the overall complete response rate at 24 weeks was 33.8% (27/80). No life-threatening serious adverse events occurred. Sex is an independent risk factor in predicting patient outcomes. This real-world study confirmed the high effectiveness and acceptable safety profile of tofacitinib in alopecia areata, with a satisfactory drug survival rate, and provides supporting data for the clinical application of tofacitinib in Chinese patients with alopecia areata.
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Affiliation(s)
- Jundong Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Sihan Deng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China; Hunan key laboratory of aging biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan Tang
- DDepartment of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fangfen Liu
- DDepartment of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China; Hunan key laboratory of aging biology, Xiangya Hospital, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shijia Rao
- Department of Dermatology, The Second Xiangya Hospital, Central South University, Hunan Key Laboratory of Medical Epigenomics, Changsha, Hunan, PR China.
| | - Wei Shi
- DDepartment of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Cozzi G, Scagnellato L, Lorenzin M, Savarino E, Zingone F, Ometto F, Favero M, Doria A, Vavricka SR, Ramonda R. Spondyloarthritis with inflammatory bowel disease: the latest on biologic and targeted therapies. Nat Rev Rheumatol 2023:10.1038/s41584-023-00984-8. [PMID: 37386288 DOI: 10.1038/s41584-023-00984-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 07/01/2023]
Abstract
Spondyloarthritis (SpA) encompasses a heterogeneous group of chronic inflammatory diseases that can affect both axial and peripheral joints, tendons and entheses. Among the extra-articular manifestations, inflammatory bowel disease (IBD) is associated with considerable morbidity and effects on quality of life. In everyday clinical practice, treatment of these conditions requires a close collaboration between gastroenterologists and rheumatologists to enable early detection of joint and intestinal manifestations during follow-up and to choose the most effective therapeutic regimen, implementing precision medicine for each patient's subtype of SpA and IBD. The biggest issue in this field is the dearth of drugs that are approved for both diseases, as only TNF inhibitors are currently approved for the treatment of full-spectrum SpA-IBD. Janus tyrosine kinase inhibitors are among the most promising drugs for the treatment of peripheral and axial SpA, as well as for intestinal manifestations. Other therapies such as inhibitors of IL-23 and IL-17, phosphodiesterase 4 inhibitor, α4β7 integrin blockers and faecal microbiota transplantation seem to only be able to control some disease domains, or require further studies. Given the growing interest in the development of novel drugs to treat both conditions, it is important to understand the current state of the art and the unmet needs in the management of SpA-IBD.
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Affiliation(s)
- Giacomo Cozzi
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Laura Scagnellato
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
| | - Fabiana Zingone
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University Hospital of Padova, Padova, Italy
| | - Francesca Ometto
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Stephan R Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zürich and Center for Gastroenterology and Hepatology, Zürich, Switzerland
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy.
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7
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Wang W, Jia S, Miao G, Sun Z, Yu F, Gao Z, Li Y. Bioactive glass in the treatment of ulcerative colitis to regulate the TLR4 / MyD88 / NF-κB pathway. BIOMATERIALS ADVANCES 2023; 152:213520. [PMID: 37336008 DOI: 10.1016/j.bioadv.2023.213520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 06/21/2023]
Abstract
Ulcerative colitis (UC) is a chronic and recurrent intestinal disease of unknown aetiology, and the few treatments approved for UC have serious side effects. In this study, a new type of uniformly monodispersed calcium-enhanced radial mesoporous micro-nano bioactive glass (HCa-MBG) was prepared for UC treatment. We established cellular and rat UC models to explore the effects and mechanism of HCa-MBG and traditional BGs (45S5, 58S) on UC. The results showed that BGs significantly reduced the cellular expression of several inflammatory factors, such as IL-1β, IL-6, TNF-α and NO. In the animal experiments, BGs were shown to repair the DSS-damaged colonic mucosa. Moreover, BGs downregulated the mRNA levels of the inflammatory factors IL-1β, IL-6, TNF-α and iNOS, which were stimulated by DSS. BGs were also found to manage the expression of key proteins in NF-kB signal pathway. However, HCa-MBG was more effective than traditional BGs in terms of improving UC clinical manifestations and reducing the expression of inflammatory factors in rats. This study confirmed for the first time that BGs can be used as an adjuvant drug in UC treatment, thereby preventing UC progression.
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Affiliation(s)
- Wenhao Wang
- Qingdao Hospital, University of Health and Rehabilitation Sciences, Qingdao Municipal Hospital, Qingdao 266071, China; Weifang Medical University, Weifang 261042, China
| | | | - Guohou Miao
- Department of laboratory, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangdong Engineering Research Center of Oral Restoration and Reconstruction, Guangzhou 510182, China
| | - Zhenmin Sun
- Weifang Medical University, Weifang 261042, China
| | - Feng Yu
- State Key Laboratory of Marine Resource Utilization in South China Sea, Hainan Provincial Key Laboratory of Research on Utilization of Si-Zr-Ti Resources, College of Materials Science and Engineering, Hainan University, Haikou 570228, China
| | - Zhixing Gao
- Weifang Medical University, Weifang 261042, China
| | - Yuli Li
- Qingdao Hospital, University of Health and Rehabilitation Sciences, Qingdao Municipal Hospital, Qingdao 266071, China; School of Rehabilitation Sciences and Engineering, University of Health and Rehabilitation Sciences, Qingdao 266071, China; Weifang Medical University, Weifang 261042, China.
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8
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Tiwari A, Ashraf A, Bharali P. Tofacitinib in Ulcerative Colitis-evolving Efficacy and Safety. J Clin Gastroenterol 2023; 57:429. [PMID: 36728526 DOI: 10.1097/mcg.0000000000001823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Avinash Tiwari
- Department of Gastroenterology Sher-i-Kashmir Institute of Medical Sciences Soura, Srinagar, Jammu, and Kashmir
| | - Aadil Ashraf
- Asian Institute of Gastroenterology Hyderabad, Telangana
| | - Pankaj Bharali
- Department of Gastroenterology, SCB Medical College & Hospital, Manglabag Cuttack, India
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9
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Rašková M, Lacina L, Kejík Z, Venhauerová A, Skaličková M, Kolář M, Jakubek M, Rosel D, Smetana K, Brábek J. The Role of IL-6 in Cancer Cell Invasiveness and Metastasis-Overview and Therapeutic Opportunities. Cells 2022; 11:3698. [PMID: 36429126 PMCID: PMC9688109 DOI: 10.3390/cells11223698] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
Interleukin 6 (IL-6) belongs to a broad class of cytokines involved in the regulation of various homeostatic and pathological processes. These activities range from regulating embryonic development, wound healing and ageing, inflammation, and immunity, including COVID-19. In this review, we summarise the role of IL-6 signalling pathways in cancer biology, with particular emphasis on cancer cell invasiveness and metastasis formation. Targeting principal components of IL-6 signalling (e.g., IL-6Rs, gp130, STAT3, NF-κB) is an intensively studied approach in preclinical cancer research. It is of significant translational potential; numerous studies strongly imply the remarkable potential of IL-6 signalling inhibitors, especially in metastasis suppression.
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Affiliation(s)
- Magdalena Rašková
- Department of Cell Biology, Faculty of Science, Charles University, 120 00 Prague, Czech Republic
- BIOCEV, Faculty of Science, Charles University, 252 50 Vestec, Czech Republic
| | - Lukáš Lacina
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
- Department of Dermatovenereology, First Faculty of Medicine, Charles University and General University Hospital, 120 00 Prague, Czech Republic
| | - Zdeněk Kejík
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital, 120 00 Prague, Czech Republic
| | - Anna Venhauerová
- BIOCEV, Faculty of Science, Charles University, 252 50 Vestec, Czech Republic
| | - Markéta Skaličková
- BIOCEV, Faculty of Science, Charles University, 252 50 Vestec, Czech Republic
| | - Michal Kolář
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
- Laboratory of Genomics and Bioinformatics, Institute of Molecular Genetics, Czech Academy of Sciences, 140 00 Prague, Czech Republic
| | - Milan Jakubek
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Department of Paediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital, 120 00 Prague, Czech Republic
| | - Daniel Rosel
- Department of Cell Biology, Faculty of Science, Charles University, 120 00 Prague, Czech Republic
- BIOCEV, Faculty of Science, Charles University, 252 50 Vestec, Czech Republic
| | - Karel Smetana
- Centre for Tumour Ecology, First Faculty of Medicine, Charles University, 120 00 Prague, Czech Republic
- BIOCEV, First Faculty of Medicine, Charles University, 252 50 Vestec, Czech Republic
- Department of Dermatovenereology, First Faculty of Medicine, Charles University and General University Hospital, 120 00 Prague, Czech Republic
| | - Jan Brábek
- Department of Cell Biology, Faculty of Science, Charles University, 120 00 Prague, Czech Republic
- BIOCEV, Faculty of Science, Charles University, 252 50 Vestec, Czech Republic
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10
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Irving PM, Leung Y, Dubinsky MC. Review article: guide to tofacitinib dosing in patients with ulcerative colitis. Aliment Pharmacol Ther 2022; 56:1131-1145. [PMID: 35993338 PMCID: PMC9544682 DOI: 10.1111/apt.17185] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/27/2022] [Accepted: 07/31/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND Tofacitinib is an oral small molecule Janus kinase inhibitor for the treatment of ulcerative colitis (UC). The induction dose is 10 mg twice daily (b.d.), whilst for maintenance therapy, the lowest effective dose should be used. AIM To examine published evidence on the two tofacitinib dosing strategies used in UC treatment, including expert interpretation of the data and how they could inform clinical practice. METHODS The use of tofacitinib 5 or 10 mg b.d. was assessed using data from the tofacitinib UC clinical programme in the context of different clinical scenarios. We include experts' opinions on the clinical implications of dose adjustment to inform the benefit/risk of using tofacitinib 5 or 10 mg b.d., based on clinical scenarios and real-world data. RESULTS Factors to consider when adjusting the tofacitinib dose include disease severity, comorbidities and previous biological exposure. The endoscopic subscore can determine whether a patient is a good candidate for dose reduction. Following disease relapse, the response can be recaptured in a substantial number of patients with a dose increase. Furthermore, data are now published showing real-world use of tofacitinib and, so far, these are consistent with data from the clinical trials. CONCLUSION Clinicians must consider the benefit/risk balance of tofacitinib 10 versus 5 mg b.d. in terms of dose-related side effects, as well as the safety implications of undertreating active disease. All patients should be closely monitored for disease relapse following dose reduction or interruption for early recapture of response.
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Affiliation(s)
| | - Yvette Leung
- Department of MedicineUniversity of British ColumbiaVancouverCanada
| | - Marla C. Dubinsky
- Susan and Leonard Feinstein IBD Clinical CenterIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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11
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Effectiveness and safety of tofacitinib in ulcerative colitis: Done is better than perfect. Dig Liver Dis 2022; 54:151-153. [PMID: 34953762 DOI: 10.1016/j.dld.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 12/11/2022]
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12
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Tamarit-Sebastian S, Ferrer-Soler FM, Lucendo AJ. Current options and investigational drugs for the treatment of eosinophilic esophagitis. Expert Opin Investig Drugs 2022; 31:193-210. [DOI: 10.1080/13543784.2022.2033207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Sonsoles Tamarit-Sebastian
- Department of Gastroenterology, Hospital General de Tomelloso
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM)
| | - Francisco Miguel Ferrer-Soler
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM)
- Hospital Pharmacy, Hospital General de Tomelloso
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso
- Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM)
- Hospital Pharmacy, Hospital General de Tomelloso
- Instituto de Investigación Sanitaria Princesa (IIS-IP)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD)
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13
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Ramouz A, Shafiei S, Ali-Hasan-Al-Saegh S, Khajeh E, Rio-Tinto R, Fakour S, Brandl A, Goncalves G, Berchtold C, Büchler MW, Mehrabi A. Systematic review and meta-analysis of endoscopic ultrasound drainage for the management of fluid collections after pancreas surgery. Surg Endosc 2022; 36:3708-3720. [PMID: 35246738 PMCID: PMC9085703 DOI: 10.1007/s00464-022-09137-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/13/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The outcomes of endoscopic ultrasonography-guided drainage (EUSD) in treatment of pancreas fluid collection (PFC) after pancreas surgeries have not been evaluated systematically. The current systematic review and meta-analysis aim to evaluate the outcomes of EUSD in patients with PFC after pancreas surgery and compare it with percutaneous drainage (PCD). METHODS PubMed and Web of Science databases were searched for studies reporting outcomes EUSD in treatment of PFC after pancreas surgeries, from their inception until January 2022. Two meta-analyses were performed: (A) a systematic review and single-arm meta-analysis of EUSD (meta-analysis A) and (B) two-arm meta-analysis comparing the outcomes of EUSD and PCD (meta-analysis B). Pooled proportion of the outcomes in meta-analysis A as well as odds ratio (OR) and mean difference (MD) in meta-analysis B was calculated to determine the technical and clinical success rates, complications rate, hospital stay, and recurrence rate. ROBINS-I tool was used to assess the risk of bias. RESULTS The literature search retrieved 610 articles, 25 of which were eligible for inclusion. Included clinical studies comprised reports on 695 patients. Twenty-five studies (477 patients) were included in meta-analysis A and eight studies (356 patients) were included in meta-analysis B. In meta-analysis A, the technical and clinical success rates of EUSD were 94% and 87%, respectively, with post-procedural complications of 14% and recurrence rates of 9%. Meta-analysis B showed comparable technical and clinical success rates as well as complications rates between EUSD and PCD. EUSD showed significantly shorter duration of hospital stay compared to that of patients treated with PCD. CONCLUSION EUSD seems to be associated with high technical and clinical success rates, with low rates of procedure-related complications. Although EUSD leads to shorter hospital stay compared to PCD, the certainty of evidence was low in this regard.
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Affiliation(s)
- Ali Ramouz
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Saeed Shafiei
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Sadeq Ali-Hasan-Al-Saegh
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Ricardo Rio-Tinto
- Department of Gastroenterology, Digestive Oncology Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Sanam Fakour
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Andreas Brandl
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Gil Goncalves
- Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Champalimaud Foundation, Lisbon, Portugal
| | - Christoph Berchtold
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Markus W. Büchler
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 420, 69120 Heidelberg, Germany
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