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Strande V, Lund C, Hagen M, Bengtson MB, Cetinkaya RB, Detlie TE, Frigstad SO, Høie O, Medhus AW, Henriksen M, Aass Holten KI, Hovde Ø, Huppertz-Hauss G, Johansen I, Olsen BC, Opheim R, Ricanek P, Torp R, Tønnessen T, Vatn S, Aabrekk TB, Høivik ML, Kristensen VA. Clinical course of ulcerative colitis: Frequent use of biologics and low colectomy rate first year after diagnosis-results from the IBSEN III inception cohort. Aliment Pharmacol Ther 2024; 60:357-368. [PMID: 38837289 DOI: 10.1111/apt.18097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/16/2024] [Accepted: 05/18/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The introduction of biologic therapies and the 'treat-to-target' treatment strategy may have changed the disease course of ulcerative colitis (UC). AIMS To describe the early disease course and disease outcome at 1-year follow-up in a population-based inception cohort of adult patients with newly diagnosed UC. METHODS The Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) III study is a population-based inception cohort study with prospective follow-up. Patients newly diagnosed with inflammatory bowel disease during 2017-2019 were included. Patients ≥18 years at diagnosis of UC who attended the 1-year follow-up were investigated. We registered clinical, endoscopic and demographic data at diagnosis and 1-year follow-up. RESULTS We included 877 patients with UC (median age 36 years (range: 18-84), 45.8% female). At diagnosis, 39.2% presented with proctitis, 24.7% left-sided colitis and 36.0% extensive colitis. At the 1-year follow-up, 13.9% experienced disease progression, and 14.5% had received one or more biologic therapies. The colectomy rate was 0.9%. Steroid-free clinical remission was observed in 76.6%, and steroid-free endoscopic remission in 68.7%. Anaemia and initiation of systemic steroid treatment at diagnosis were associated with biologic therapy within the first year after diagnosis. CONCLUSION In this population-based inception cohort, colectomy rate in the first year after diagnosis was low, and a high proportion of patients were in remission at 1-year follow-up. The use of biologic therapy increases, consistent with findings from previous studies.
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Affiliation(s)
- Vibeke Strande
- Unger-Vetlesen Institute, Lovisenberg Diaconal Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Lund
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Public Health, Oslo Metropolitan University, Oslo, Norway
| | - Milada Hagen
- Department of Public Health, Oslo Metropolitan University, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - May-Bente Bengtson
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | | | - Trond Espen Detlie
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Svein Oskar Frigstad
- Department of Internal Medicine, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Ole Høie
- Department of Internal Medicine, Hospital of Southern Norway, Arendal, Norway
| | - Asle W Medhus
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
| | - Magne Henriksen
- Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway
| | - Kristina I Aass Holten
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Østfold Hospital Trust, Sarpsborg, Norway
| | - Øistein Hovde
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Internal Medicine, Innlandet Hospital Trust, Gjøvik, Norway
| | | | - Ingunn Johansen
- Faculty of Health, Welfare and Org., Østfold University College, Fredrikstad, Norway
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bjørn Christian Olsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Telemark Hospital Trust, Skien, Norway
| | - Randi Opheim
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
- Department of Public Health Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Petr Ricanek
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
- Department of Gastroenterology, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Roald Torp
- Department of Internal Medicine, Innlandet Hospital Trust, Hamar, Norway
| | - Tor Tønnessen
- Department of Internal Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway
| | - Simen Vatn
- Department of Gastroenterology, Akershus University Hospital, Lørenskog, Norway
| | - Tone Bergene Aabrekk
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Vestfold Hospital Trust, Tønsberg, Norway
| | - Marte Lie Høivik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Gastroenterology, Oslo University Hospital, Oslo, Norway
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Aratari A, Scribano ML, Pugliese D, Baccolini V, De Biasio F, Verna S, Morretta C, Festa S, Armuzzi A, Papi C. Crohn's disease after surgery: Changes in post-operative management strategies over time and their impact on long-term re-operation rate-A retrospective multicentre real-world study. Aliment Pharmacol Ther 2024; 59:1579-1588. [PMID: 38616417 DOI: 10.1111/apt.18001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/09/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Few data are available addressing the impact of post-operative management of Crohn's disease (CD) on long-term clinical course. AIM To assess the evolution of post-operative management strategies over the last 40 years and their impact on the re-operation rate of CD. METHODS We included 657 patients with CD who had undergone their first radical ileo-caecal resection between 1980 and 2020. Three cohorts were defined according to year of surgery: cohort 1 (1980-1998; n = 198), cohort 2 (1999-2009; n = 218) and cohort 3 (2010-2020; n = 241). We estimated exposure to immunomodulators and anti-TNFα agents after surgery and rates of re-operation using Kaplan-Meier survival analyses. We used Cox proportional hazards regression to assess the association of clinical variables with time to re-operation. RESULTS Immunosuppressants, (IMMs) and anti-TNFα exposure within 5 years after surgery increased significantly from cohort 1 to cohort 2 and cohort 3 (IMMs: 1.6%, 38.2% and 28.0%, respectively, p < 0.001; anti-TNFα: 0.0%, 20.7% and 52.0%, respectively, p < 0.001). There was no significant difference across cohorts regarding the cumulative probability of re-operation within 5 and 10 years. Multivariate analysis identified IMMs/anti-TNFα exposure before the first surgery (HR 9.15; 95% CI 2.77-30.21) and post-operatively (HR: 0.24; 95% CI 0.07-0.74) as variables associated with the risk of re-operation. However, these associations had a time-varying effect and become non-significant after 5 and 2 years after surgery, respectively. CONCLUSION Despite increased post-operative use of IMMs and anti-TNFα agents in the last two decades, the impact of these strategies on the risk of long-term re-operation rate has been modest.
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Affiliation(s)
| | | | - Daniela Pugliese
- IBD Unit, Digestive Disease Center (CEMAD) Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Serena Verna
- Gastroenterology Unit, San Camillo-Forlanini Hospital, Rome, Italy
| | - Chiara Morretta
- IBD Unit, Digestive Disease Center (CEMAD) Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | | | - Alessandro Armuzzi
- IBD Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
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3
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Chapman TP, Ahmad T, Satsangi J. Use of immunomodulators in combination with infliximab in Crohn's disease: time for a reappraisal? Lancet Gastroenterol Hepatol 2024; 9:402-405. [PMID: 38402894 DOI: 10.1016/s2468-1253(23)00406-5] [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] [Received: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 02/27/2024]
Affiliation(s)
- Thomas P Chapman
- Department of Gastroenterology, St Richard's and Worthing Hospitals, University Hospitals Sussex NHS Foundation Trust, West Sussex, UK; Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK.
| | - Tariq Ahmad
- Department of Gastroenterology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK; Exeter Inflammatory Bowel Disease and Pharmacogenetics Research Group, University of Exeter, Exeter, UK
| | - Jack Satsangi
- Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
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Hope E, Kuronen-Stewart C, Wilson DC, Henderson P, Clark C. The Impact of Biologic Therapies on Rate of Colectomy in Paediatric-onset Ulcerative Colitis - A Population-Based Cohort Study. J Pediatr Surg 2024; 59:230-234. [PMID: 37981545 DOI: 10.1016/j.jpedsurg.2023.10.034] [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: 10/07/2023] [Accepted: 10/11/2023] [Indexed: 11/21/2023]
Abstract
AIM Biologic therapies have been associated with reduced rate of colectomy in ulcerative colitis (UC) in adults, but data are limited in paediatric-onset UC. Our aim was to define the rate of colectomy in paediatric-onset UC, including post-transition into adult care, and to evaluate the impact of biologic therapies on rate of colectomy. METHOD All prevalent patients diagnosed with paediatric-onset UC in South-East Scotland were identified from a prospectively accrued database at our regional tertiary centre. Patients exposed to biologics or surgery were identified and further data collected from health records. Kaplan-Meier analysis was used to calculate cumulative risk of colectomy over time. RESULTS 145 prevalent patients were identified between 2000 and 2021. Median follow-up was 7.9 years (IQR 4.1-13.1). 23 patients (16 %) underwent a colectomy. 50/145 (34 %) patients received biologic therapy, and 13/23 (57 %) patients who underwent colectomy received biologics. The cumulative risk of colectomy across the whole cohort at 1, 5, and 10 years was 3 %, 13 % and 16 %, respectively. Patients exposed to biologics had a higher colectomy rate at 5 and 10 years (22 % and 34 %). Patients in the pre-biologic era (2000-2008) had non-significantly reduced time from diagnosis to colectomy (2.4 vs 3.7 years, p = 0.204). CONCLUSION We have defined the 1-, 5-, and 10-year colectomy rate in a population-based cohort of Paediatric-onset UC patients. Patients who received biologic therapy had a significantly increased risk of colectomy. Increased severity of disease in these patients may account for the greater colectomy risk. LEVEL OF EVIDENCE Level 1.
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Affiliation(s)
- Emma Hope
- Department of Paediatric Surgery, Royal Hospital for Children and Young People, Edinburgh, 50 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Cameron Kuronen-Stewart
- Department of Paediatric Surgery, Royal Hospital for Children and Young People, Edinburgh, 50 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - David C Wilson
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, 50 Little France Crescent, Edinburgh, EH16 4TJ, UK; Department of Child Life and Health, University of Edinburgh, 50 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Paul Henderson
- Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, 50 Little France Crescent, Edinburgh, EH16 4TJ, UK; Department of Child Life and Health, University of Edinburgh, 50 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Claire Clark
- Department of Paediatric Surgery, Royal Hospital for Children and Young People, Edinburgh, 50 Little France Crescent, Edinburgh, EH16 4TJ, UK
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Gonczi L, Lakatos L, Golovics PA, Ilias A, Pandur T, David G, Erdelyi Z, Szita I, Al Khoury A, Lakatos PL. Declining Trends of Reoperations and Disease Behaviour Progression in Crohn's Disease over Different Therapeutic Eras-A Prospective, Population-Based Study from Western Hungary between 1977-2020, Data from the Veszprem Cohort. J Crohns Colitis 2023; 17:1980-1987. [PMID: 37422727 PMCID: PMC10798863 DOI: 10.1093/ecco-jcc/jjad117] [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: 04/19/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND AND AIMS Few population-based studies have investigated long-term surgery rates for Crohn's disease [CD]. Our aim was to analyse disease progression and surgery rates in a population-based cohort over different therapeutic eras, based on the time of diagnosis: cohort-A [1977-1995], cohort-B [1996-2008], and cohort-C [2009-2018]. METHODS A total of 946 incident CD patients were analysed (male/female: 496/450; median age at diagnosis: 28 years [y]; interquartile range [IQR]: 22-40]). Patient inclusion lasted between 1977 and 2018. Immunomodulators have become widespread in Hungary since the mid-1990s and biologic therapies since 2008. Patients were followed prospectively, with both in-hospital and outpatient records reviewed regularly. RESULTS The probability of disease behaviour progression from inflammatory [B1] to stenosing or penetrating phenotype [B2/B3] significantly decreased (27.1 ± 5.3%/21.5 ± 2.5%/11.3 ± 2.2% in cohorts A/B/C, respectively, after 5 years; 44.3 ± 5.9%/30.6 ± 2.8%/16.1 ± 2.9% after 10 years, respectively; [pLogRank <0.001]). The probability of first resective surgery between cohorts A/B/C were 33.3 ± 3.8%/26.5 ± 2.1%/28.1 ± 2.4%, respectively, after 5 years; 46.1 ± 4.1%/32.6 ± 2.2%/33.0 ± 2.7% after 10 years, respectively; and 59.1 ± 4.0%/41.4 ± 2.6% [cohorts A/B] after 20 years. There was a significant decrease in first resective surgery risk between cohorts A and B [plog rank = 0.002]; however, no further decrease between cohorts B and C [plog rank = 0.665]. The cumulative probability of re-resection in cohorts A/B/C was decreasing over time (17.3 ± 4.1%/12.6 ± 2.6%/4.7 ± 2.0%, respectively, after 5 years [plog rank = 0.001]). CONCLUSION We report a continuous decline in reoperation rates and disease behaviour progression in CD over time, with the lowest values in the biologic era. In contrast, there was no further decrease in the probability of first major resective surgery after the immunosuppressive era.
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Affiliation(s)
- Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - Akos Ilias
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Tunde Pandur
- Department of Gastroenterology, Grof Eszterhazy Hospital, Papa, Hungary
| | - Gyula David
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | - Istvan Szita
- Department of Gastroenterology, Ferenc Csolnoky Hospital, Veszprem, Hungary
| | | | - Peter L Lakatos
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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Everhov ÅH, Söderling J, Befrits G, Khalili H, Bröms G, Neovius M, Askling J, Halfvarson J, Ludvigsson JF, Olén O. Increasing healthcare costs in inflammatory bowel disease 2007-2020 in Sweden. Aliment Pharmacol Ther 2023; 58:692-703. [PMID: 37594381 DOI: 10.1111/apt.17675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/06/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Inflammatory bowel disease has been linked to increasing healthcare costs, but longitudinal data on other societal costs are scarce. AIM To assess costs, including productivity losses, in patients with prevalent Crohn's disease (CD) or ulcerative colitis (UC) in Sweden between 2007 and 2020. METHODS We linked data from national registers on all patients with CD or UC and a matched (sex, birthyear, healthcare region and education) reference population. We assessed mean costs/year in Euros, inflation-adjusted to 2020, for hospitalisations, out-patient visits, medications, sick leave and disability pension. We defined excess costs as the mean difference between patients and matched comparators. RESULTS Between 2007 and 2020, absolute mean annual societal costs in working-age (18-64 years) individuals decreased by 17% in CD (-24% in the comparators) and by 20% in UC (-27% in comparators), due to decreasing costs from sick leave and disability, a consequence of stricter sick leave regulations. Excess costs in 2007 were dominated by productivity losses. In 2020, excess costs were mostly healthcare costs. Absolute and excess costs increased in paediatric and elderly patients. Overall, costs for TNF inhibitors/targeted therapies increased by 274% in CD and 638% in UC, and the proportion treated increased from 5% to 26% in CD, and from 1% to 10% in UC. CONCLUSION Between 2007 and 2020, excess costs shifted from productivity losses to direct healthcare costs; that is, the patients' compensation for sickness absence decreased, while society increased its spending on medications. Medication costs were driven both by expanding use of TNF inhibitors and by high costs for newer targeted therapies.
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Affiliation(s)
- Åsa H Everhov
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Hamed Khalili
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gabriella Bröms
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Gastroenterology Unit, Danderyd Hospital, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas F Ludvigsson
- Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Ola Olén
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatric Gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden
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Kim ES, Kim SK, Park DI, Kim HJ, Lee YJ, Koo JS, Kim ES, Yoon H, Lee JH, Kim JW, Shin SJ, Kim HW, Kim HS, Park YS, Kim YS, Kim TO, Lee J, Choi CH, Han DS, Chun J, Kim HS. Comparison of the Pharmacokinetics of CT-P13 Between Crohn's Disease and Ulcerative Colitis. J Clin Gastroenterol 2023; 57:601-609. [PMID: 35470308 DOI: 10.1097/mcg.0000000000001715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/20/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND We aimed to compare trough infliximab levels and the development of antidrug antibody (ADA) for 1 year between Crohn's disease (CD) and ulcerative colitis (UC) patients who were biologic-naive, and to evaluate their impact on clinical outcomes. METHODS This was a prospective, multicenter, observational study. Biologic-naive patients with moderate to severe CD or UC who started CT-P13, an infliximab biosimilar, therapy were enrolled. Trough drug and ADA levels were measured periodically for 1 year after CT-P13 initiation. RESULTS A total of 267 patients who received CT-P13 treatment were included (CD 168, UC 99). The rates of clinical remission (72% vs. 32.3%, P <0.001) at week 54 were significantly higher in CD than in UC. The median trough drug level (μg/mL) was significantly higher in CD than in UC up to week 14 (week 2, 18.7 vs. 14.7, P <0.001; week 6, 12.5 vs. 8.6, P <0.001; week 14, 3.4 vs. 2.5, P =0.001). The median ADA level (AU/mL) was significantly lower in CD than in UC at week 2 (6.3 vs. 6.5, P =0.046), week 30 (7.9 vs. 11.8, P =0.007), and week 54 (9.3 vs. 12.3, P =0.032). Development of ADA at week 2 [adjusted odds ratio (aOR)=0.15, P =0.026], initial C-reactive protein level (aOR=0.87, P =0.032), and CD over UC (aOR=1.92, P <0.001) were independent predictors of clinical remission at week 54. CONCLUSION Infliximab shows more favorable pharmacokinetics, including high drug trough and low ADA levels, in CD than in UC, which might result in better clinical outcomes for 1-year infliximab treatment in CD patients.
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Affiliation(s)
- Eun Soo Kim
- Department of Internal Medicine, Kyungpook National University, School of Medicine
| | - Sung Kook Kim
- Department of Internal Medicine, Kyungpook National University, School of Medicine
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - Hyo Jong Kim
- Center for Crohn's and Colitis, Kyung Hee University Hospital
| | - Yoo Jin Lee
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu
| | - Ja Seol Koo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Ansan Hospital, Korea University College of Medicine, Ansan
| | - Eun Sun Kim
- Department of Internal Medicine, Korea University College of Medicine
| | - Hyuk Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
| | - Ji Hyun Lee
- Digestive Endoscopic Center, Seoul Song Do Colorectal Hospital
| | - Ji Won Kim
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine
| | - Sung Jae Shin
- Department of Internal Medicine, Ajou University School of Medicine, Suwon
| | - Hyung Wook Kim
- Department of Internal Medicine, Pusan National University School of Medicine And Medical Research Institute
| | - Hyun-Soo Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju
| | - Young Sook Park
- Department of Internal Medicine, Eulji University School of Medicine, Eulji Hospital
| | - You Sun Kim
- Department of Internal Medicine, Seoul Paik Hospital, Inje University College of Medicine
| | - Tae Oh Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan
| | - Jun Lee
- Department of Internal Medicine, Chosun University, School of Medicine
| | - Chang Hwan Choi
- Department of Internal Medicine, College of Medicine, Chung-Ang University
| | - Dong Soo Han
- Department of Internal Medicine, Hanyang University College of Medicine, Guri, Korea
| | - Jaeyoung Chun
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul
| | - Hyun Soo Kim
- Department of Internal Medicine, Chonnam University Medical School, Gwangju
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8
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Burisch J. Long-term disease course, cost and prognosis of inflammatory bowel disease: epidemiological studies of a European and a Danish inception cohort. APMIS 2023; 131 Suppl 147:1-46. [PMID: 37336790 DOI: 10.1111/apm.13334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
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9
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Wang DY, Ohnuma S, Suzuki H, Ishida M, Ishii K, Hirosawa T, Hirashima T, Murakami M, Kobayashi M, Kudoh K, Haneda S, Musha H, Naitoh T, Unno M. Infliximab Inhibits Colitis Associated Cancer in Model Mice by Downregulating Genes Associated with Mast Cells and Decreasing Their Accumulation. Curr Issues Mol Biol 2023; 45:2895-2907. [PMID: 37185713 PMCID: PMC10136890 DOI: 10.3390/cimb45040189] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Inflammatory bowel diseases (IBDs), such as Crohn’s disease or ulcerative colitis, can be treated with anti TNF-alpha (TNF-α) antibodies (Abs), but they also put patients with IBDs at risk of cancer. We aimed to determine whether the anti TNF-α Ab induces colon cancer development in vitro and in vivo, and to identify the genes involved in colitis-associated cancer. We found that TNF-α (50 ng/mL) inhibited the proliferation, migration, and invasion of HCT8 and COLO205 colon cancer cell lines and that anti TNF-α Ab neutralized TNF-α inhibition in vitro. The effects of anti TNF-α Ab, infliximab (10 mg/kg) were investigated in mouse models of colitis-associated cancer induced by intraperitoneally injected azoxymethane (AOM: 10 mg/kg)/orally administered dextran sodium sulfate (DSS: 2.5%) (AOM/DSS) in vivo. Infliximab significantly attenuated the development of colon cancer in these mice. Microarray analyses and RT-qPCR revealed that mast cell protease 1, mast cell protease 2, and chymase 1 were up-regulated in cancer tissue of AOM/DSS mice; however, those mast cell related genes were downregulated in cancer tissue of AOM/DSS mice with infliximab. These results suggested that mast cells play a pivotal role in the development of cancer associated with colitis in AOM/DSS mice.
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Affiliation(s)
- Dan-Yang Wang
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Shinobu Ohnuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Hideyuki Suzuki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Kentaro Ishii
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Takashi Hirosawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Tomoaki Hirashima
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Megumi Murakami
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Minoru Kobayashi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Katsuyoshi Kudoh
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Sho Haneda
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Hiroaki Musha
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Takeshi Naitoh
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
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10
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Rich KM, Guardado R, Bigham ZR, Boms O, Long M, Wurcel AG. The Impact of Incarceration on Readmissions Among Patients With Inflammatory Bowel Disease Hospitalized at a Community Hospital. GASTRO HEP ADVANCES 2023; 2:660-665. [PMID: 39129865 PMCID: PMC11308048 DOI: 10.1016/j.gastha.2023.03.016] [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: 11/02/2022] [Accepted: 03/13/2023] [Indexed: 08/13/2024]
Abstract
Background and Aims Individuals who are incarcerated often have limited access to first-line treatment and comprehensive health care. In this study, we aimed to compare the frequency of readmissions among patients with inflammatory bowel disease (IBD) receiving care at a community hospital who were and were not incarcerated at the time of hospitalization. Methods We analyzed records from Lemuel Shattuck Hospital for all patients admitted between January 1, 2011, and December 31, 2019. Patients with IBD were identified using International Classification of Diseases codes. The primary outcome was all-cause readmission at 1 year following an IBD-related admission. Secondary outcomes were (1) all-cause readmission at 30 days, (2) IBD-related readmission at 30 days, and (3) IBD-related readmission at 1 year. Our indicator of interest was incarceration. Multivariable logistic regression models were built to describe predictors of all-cause readmissions at 1 year. Results Among the 6511 individuals hospitalized at Lemuel Shattuck Hospital between 2011 and 2019, 90 individuals (1.4%) had International Classification of Diseases codes for IBD, either ulcerative colitis (n = 44) and/or Crohn's disease (n = 39). Half (n = 46) of patients with IBD were incarcerated during hospital admission. Individuals who were incarcerated had a higher rate of all-cause readmissions at 1 year than those who were not incarcerated at the time of hospitalization (76.0% vs 41.5%, P = .005). Multivariable analysis showed patients who were incarcerated had 3.98 (95% confidence interval: 1.39-12.78) increased odds of all-cause readmission within 1 year. Conclusion Our results suggest individuals with IBD who are incarcerated may experience worse health outcomes than individuals who are not incarcerated, adding to a body of literature documenting the negative impact of incarceration on health.
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Affiliation(s)
| | - Rubeen Guardado
- Tufts Medical Center, Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Boston, Massachusetts
| | - Zahna R. Bigham
- Tufts University School of Medicine, Boston, Massachusetts
- Graduate School of Biomedical Sciences, Tufts University, Boston, Massachusetts
| | - Okechi Boms
- Harvard Medical School, Boston, Massachusetts
- Harvard Kennedy School, Boston, Massachusetts
| | - Michelle Long
- Section of Gastroenterology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
- Medical & Science, Clinical Drug Development, Novo Nordisk, Inc, Cambridge, Massachusetts
| | - Alysse G. Wurcel
- Tufts Medical Center, Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Boston, Massachusetts
- Tufts University School of Medicine, Department of Public Health and Community Medicine, Boston, Massachusetts
- Infectious Diseases Liaison, Massachusetts Sheriffs Association, Boston, Massachusetts
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11
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Higashiyama M, Hokari R. New and Emerging Treatments for Inflammatory Bowel Disease. Digestion 2022; 104:74-81. [PMID: 36366823 DOI: 10.1159/000527422] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 10/05/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The specific etiopathogenesis of inflammatory bowel disease (IBD) is still unknown. Although the conventional anti-inflammatory or immunomodulatory drugs relatively nonspecific to pathogenesis have been quite useful in many cases, elucidating the pathogenesis has gradually facilitated developments of disease-specific therapies for refractory cases in the last 2 decades. SUMMARY With a greater understanding of the multiple overactive signaling pathways of the gut mucosal immune response and enhanced leukocyte trafficking, several biological agents or small molecule drugs following the first novel biologic, anti-tumor necrosis factor α (anti-TNFα), have been developed against several modes of action including adhesion molecules, sphingosine-1-phospate receptors, cytokines (IL-12/23, TL1A, and IL-36), Janus kinase (JAK), and phosphodiesterase. Although preceding biological agents have dramatically changed the IBD treatment strategy, many patients still require alternative therapies due to failure or side effects. Newer treatments are now expected to be provided for better efficacy with an improved adverse event profile. In addition, translational studies have highlighted the new therapeutic concepts' potential, including modulation of host-microbiome interactions, stem therapy for perianal fistula, regulation of fibrosis, regulation of the gut-brain axis, and control of previously less targeted immune cells (B cells and innate lymphoid cells). This paper comprehensively reviewed not only the latest already or shortly available therapies but also emerging promising treatments that will be hopefully established in the future for IBD. KEY MESSAGES Many kinds of new treatments are available, and promising treatments with new perspectives are expected to emerge for refractory IBD in the future.
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Affiliation(s)
- Masaaki Higashiyama
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
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12
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Constant BD, de Zoeten EF, Stahl MG, Vajravelu RK, Lewis JD, Fennimore B, Gerich ME, Scott FI. Delays Related to Prior Authorization in Inflammatory Bowel Disease. Pediatrics 2022; 149:184867. [PMID: 35190811 DOI: 10.1542/peds.2021-052501] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Delays in advancing to biologic therapies are associated with adverse outcomes in inflammatory bowel disease (IBD). Insurer-mandated prior authorizations have been linked to prolonged medication initiation times. We hypothesized that prior authorizations are associated with prolonged biologic initiation time and increased IBD-related healthcare utilization among children with IBD. METHODS We performed a retrospective cohort study of 190 pediatric patients with IBD initiating biologics at a tertiary care hospital to measure the association between prior authorization, biologic initiation time (physician recommendation to first dose), and healthcare utilization (hospitalization, surgery, or emergency department visit). Demographic, insurance, and disease severity-related covariables were collected. Multivariable linear regression was used to measure the association between prior authorization and biologic initiation time. Propensity score methods were used to measure the associations between prior authorization and IBD-related healthcare utilization within 180 days and corticosteroid dependence at 90 days, with adjustment for insurance type, demographics, and disease severity-related characteristics. RESULTS Median biologic initiation time was 21 days. Prior authorization and complicated prior authorizations (requiring appeal, step therapy, or peer-to-peer review) were associated with 10.2-day (95% confidence interval [CI] 8.2 to 12.3) and 24.6-day (95% CI 16.4 to 32.8) increases in biologic initiation time, respectively. Prior authorizations increased the likelihood of IBD-related healthcare utilization within 180 days by 12.9% (95% CI 2.5 to 23.4) and corticosteroid dependence at 90 days by 14.1% (95% CI 3.3 to 24.8). CONCLUSIONS Prior authorizations are associated with prolonged biologic initiation time and increased IBD-related healthcare utilization. Minimizing prior authorization-related delays may expedite biologic delivery and reduce the risk of IBD-related healthcare utilization.
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Affiliation(s)
- Brad D Constant
- Digestive Health Institute, Children's Hospital Colorado, Division of Pediatrics and Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado.,Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Edwin F de Zoeten
- Digestive Health Institute, Children's Hospital Colorado, Division of Pediatrics and Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Marisa G Stahl
- Digestive Health Institute, Children's Hospital Colorado, Division of Pediatrics and Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Ravy K Vajravelu
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Lewis
- Division of Gastroenterology and Hepatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Blair Fennimore
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Mark E Gerich
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Frank I Scott
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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13
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van Linschoten RCA, van Leeuwen N, Nieboer D, Birnie E, Scherpenzeel M, Verweij KE, de Jonge V, Hazelzet JA, van der Woude CJ, West RL, van Noord D. Value-based care pathway for inflammatory bowel disease: a protocol for the multicentre longitudinal non-randomised parallel cluster IBD Value study with baseline period. BMJ Open 2022; 12:e050539. [PMID: 35022169 PMCID: PMC8756277 DOI: 10.1136/bmjopen-2021-050539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Biologics are effective for the treatment of inflammatory bowel disease (IBD). However, unwarranted variation in processes and outcomes has been reported in the treatment of IBD. A care pathway for the treatment of IBD has the potential to reduce practice variation and improve outcomes. This study aims to compare the effect of a uniform care pathway for the treatment of patients with IBD with biologics to the current situation. METHODS AND ANALYSIS IBD Value is a longitudinal multicentre non-randomised parallel cluster trial with a baseline period. The study takes place in eight centres in the Netherlands. The baseline period will run for 12 months, after which the care pathway will be implemented in 6 of the 8 participating hospitals during the implementation phase of 3 months. Hereafter, the effect of the care pathway will be assessed for 12 months. Total study period is 27 months. The primary outcome is the effect of the care pathway on disease control (IBD-Control questionnaire). Secondary outcomes are the effect of the care pathway on the other outcomes of the International Consortium of Health Outcomes Measurement IBD standard set, health-related generic quality of life, patient experiences and degree of variation; cost effectiveness of the care pathway; and the variation between hospitals in the aforementioned outcomes in the baseline period. Outcomes will be measured every 6 months. The study started on 1 December 2020 and a minimum of 200 patients will be included. ETHICS AND DISSEMINATION The study was deemed not to be subject to Dutch law (WMO; Medical Research Involving Human Subjects Act) by the Medical Ethics Committee of the Erasmus MC, the Netherlands (registration number: MEC-2020-075) and a waiver was provided. Results will be disseminated through peer-reviewed journals and presented at (inter)national conferences. TRIAL REGISTRATION NUMBER NL8276.
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Affiliation(s)
- Reinier Cornelis Anthonius van Linschoten
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nikki van Leeuwen
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
- Department of Genetics, University of Groningen, Groningen, The Netherlands
| | | | - Karen Evelyne Verweij
- Department of Gastroenterology and Hepatology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Vincent de Jonge
- Department of Gastroenterology and Hepatology, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | | | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rachel Louise West
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
| | - Desirée van Noord
- Department of Gastroenterology and Hepatology, Franciscus Gasthuis en Vlietland, Rotterdam, The Netherlands
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14
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de Paula-Silva M, da Rocha GHO, Broering MF, Queiroz ML, Sandri S, Loiola RA, Oliani SM, Vieira A, Perretti M, Farsky SHP. Formyl Peptide Receptors and Annexin A1: Complementary Mechanisms to Infliximab in Murine Experimental Colitis and Crohn's Disease. Front Immunol 2021; 12:714138. [PMID: 34603288 PMCID: PMC8484756 DOI: 10.3389/fimmu.2021.714138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/16/2021] [Indexed: 02/02/2023] Open
Abstract
Non-responsiveness to anti-TNF-α therapies presents relevant rates in inflammatory bowel disease patients, presenting the need to find biomarkers involved in therapeutic efficacy. Herein, we demonstrate that higher levels of colonic formyl peptide receptor 1 and annexin A1 correlate with histological recovery in Crohn’s disease patients under remission. Using the dextran sulfate sodium colitis model in mice, we suggest that infliximab induces annexin A1 expression and secretion in activated intestinal leukocytes. Conversely, this mechanism might stimulate epithelial formyl peptide receptors, inducing wound healing and consequent histological remission. Our data indicate that assessing intestinal expressions of formyl peptide receptors and annexin A1 might provide precious information on the disease activity and responsiveness to infliximab in inflammatory bowel disease patients.
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Affiliation(s)
- Marina de Paula-Silva
- Department of Clinical and Toxicological Analyses, University of São Paulo (USP), São Paulo, Brazil.,Centre for Biochemical Pharmacology, The William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London (QMUL), London, United Kingdom
| | | | - Milena Fronza Broering
- Department of Clinical and Toxicological Analyses, University of São Paulo (USP), São Paulo, Brazil
| | - Maria Luíza Queiroz
- Gastroenterology Service, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Silvana Sandri
- Department of Clinical and Toxicological Analyses, University of São Paulo (USP), São Paulo, Brazil
| | - Rodrigo Azevedo Loiola
- Department of Clinical and Toxicological Analyses, University of São Paulo (USP), São Paulo, Brazil
| | - Sonia Maria Oliani
- Department of Biology, São Paulo State University (UNESP), São José do Rio Preto, São Paulo, Brazil
| | - Andrea Vieira
- Gastroenterology Service, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Mauro Perretti
- Centre for Biochemical Pharmacology, The William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London (QMUL), London, United Kingdom
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15
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van Linschoten RCA, Visser E, Niehot CD, van der Woude CJ, Hazelzet JA, van Noord D, West RL. Systematic review: societal cost of illness of inflammatory bowel disease is increasing due to biologics and varies between continents. Aliment Pharmacol Ther 2021; 54:234-248. [PMID: 34114667 PMCID: PMC8361769 DOI: 10.1111/apt.16445] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/24/2021] [Accepted: 05/10/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Knowledge of the cost of illness of inflammatory bowel disease (IBD) is essential for health policy makers worldwide. AIM To assess the cost of illness of IBD from the societal perspective taking into account time trends and geographical differences. METHODS A systematic review of all population-based studies on cost of illness of IBD published in Embase, Medline, Web of Science and Google Scholar. Methodology of included studies was assessed and costs were adjusted to 2018 US dollars. RESULTS Study methodologies differed considerably, with large differences in perspective, valuation method and population. For prevalent Crohn's disease (CD) cases in the last ten years annual healthcare costs were in Asia $4417 (range $1230-$31 161); Europe $12 439 ($7694-$15 807) and North America $17 495 ($14 454-$20 535). For ulcerative colitis (UC), these were $1606 ($309-$14 572), $7224 ($3228-$9779) and $13 559 ($13 559-$13 559). The main cost driver was medication, the cost of which increased considerably between 1985 and 2018, while outpatient and inpatient costs remained stable. IBD had a negative impact on work productivity. Annual costs of absenteeism for CD and UC were in Asia (with presenteeism) $5638 ($5638-$5638) and $4828 ($4828-$4828); Europe $2660 ($641-$5277) and $2394 ($651-$5992); North America $752 ($307-$1303) and $1443 ($85-$2350). CONCLUSION IBD societal cost of illness is increasing, driven by growing costs of medication, and varies considerably between continents. While biologic therapy was expected to decrease inpatient costs by reducing hospitalisations and surgery, these costs have not declined.
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Affiliation(s)
- Reinier Cornelis Anthonius van Linschoten
- Department of Gastroenterology & HepatologyFranciscus Gasthuis & VlietlandRotterdamthe Netherlands,Department of Gastroenterology & HepatologyErasmus Medical CenterRotterdamthe Netherlands
| | - Elyke Visser
- Department of Gastroenterology & HepatologyFranciscus Gasthuis & VlietlandRotterdamthe Netherlands
| | | | | | | | - Desirée van Noord
- Department of Gastroenterology & HepatologyFranciscus Gasthuis & VlietlandRotterdamthe Netherlands
| | - Rachel Louise West
- Department of Gastroenterology & HepatologyFranciscus Gasthuis & VlietlandRotterdamthe Netherlands
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16
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Holubar SD, Lightner AL, Poylin V, Vogel JD, Gaertner W, Davis B, Davis KG, Mahadevan U, Shah SA, Kane SV, Steele SR, Paquette IM, Feingold DL. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Surgical Management of Ulcerative Colitis. Dis Colon Rectum 2021; 64:783-804. [PMID: 33853087 DOI: 10.1097/dcr.0000000000002037] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Stefan D Holubar
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Amy L Lightner
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Vitaliy Poylin
- McGaw Medical Center of Northwestern University, Chicago, Illinois
| | - Jon D Vogel
- Colorectal Surgery Section, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Wolfgang Gaertner
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Bradley Davis
- Colon and Rectal Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | | | - Uma Mahadevan
- Department of Medicine, University of California, San Francisco, California
| | - Samir A Shah
- Department of Medicine, Brown University, Providence, Rhode Island
| | - Sunanda V Kane
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Scott R Steele
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ian M Paquette
- Division of Colon and Rectal Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Daniel L Feingold
- Section of Colorectal Surgery, Rutgers University, New Brunswick, New Jersey
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17
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Chaparro M, Garre A, Núñez Ortiz A, Diz-Lois Palomares MT, Rodríguez C, Riestra S, Vela M, Benítez JM, Fernández Salgado E, Sánchez Rodríguez E, Hernández V, Ferreiro-Iglesias R, Ponferrada Díaz Á, Barrio J, Huguet JM, Sicilia B, Martín-Arranz MD, Calvet X, Ginard D, Alonso-Abreu I, Fernández-Salazar L, Varela Trastoy P, Rivero M, Vera-Mendoza I, Vega P, Navarro P, Sierra M, Cabriada JL, Aguas M, Vicente R, Navarro-Llavat M, Echarri A, Gomollón F, Guerra del Río E, Piñero C, Casanova MJ, Spicakova K, Ortiz de Zarate J, Torrella Cortés E, Gutiérrez A, Alonso-Galán H, Hernández-Martínez Á, Marrero JM, Lorente Poyatos R, Calafat M, Martí Romero L, Robledo P, Bosch O, Jiménez N, Esteve Comas M, Duque JM, Fuentes Coronel AM, Josefa Sampedro M, Sesé Abizanda E, Herreros Martínez B, Pozzati L, Fernández Rosáenz H, Crespo Suarez B, López Serrano P, Lucendo AJ, Muñoz Vicente M, Bermejo F, Ramírez Palanca JJ, Menacho M, Carmona A, Camargo R, Torra Alsina S, Maroto N, Nerín de la Puerta J, Castro E, Marín-Jiménez I, Botella B, Sapiña A, Cruz N, Forcelledo JLF, Bouhmidi A, Castaño-Milla C, Opio V, Nicolás I, Kutz M, Abraldes Bechiarelli A, Gordillo J, Ber Y, Torres Domínguez Y, Novella Durán MT, Rodríguez Mondéjar S, Martínez-Cerezo FJ, Kolle L, Sabat M, Ledezma C, Iyo E, Roncero Ó, Irisarri R, Lluis L, Blázquez Gómez I, Zapata EM, José Alcalá M, Martínez Pascual C, Montealegre M, Mata L, Monrobel A, Hernández Camba A, Hernández L, Tejada M, Mir A, Galve ML, Soler M, Hervías D, Gómez-Valero JA, Barreiro-de Acosta M, Rodríguez-Artalejo F, García-Esquinas E, Gisbert JP, GETECCU OBOTESGO. Incidence, Clinical Characteristics and Management of Inflammatory Bowel Disease in Spain: Large-Scale Epidemiological Study. J Clin Med 2021; 10:jcm10132885. [PMID: 34209680 PMCID: PMC8268420 DOI: 10.3390/jcm10132885] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Aims: To assess the incidence of inflammatory bowel disease (IBD) in Spain, to describe the main epidemiological and clinical characteristics at diagnosis and the evolution of the disease, and to explore the use of drug treatments. (2) Methods: Prospective, population-based nationwide registry. Adult patients diagnosed with IBD—Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)—during 2017 in Spain were included and were followed-up for 1 year. (3) Results: We identified 3611 incident cases of IBD diagnosed during 2017 in 108 hospitals covering over 22 million inhabitants. The overall incidence (cases/100,000 person-years) was 16 for IBD, 7.5 for CD, 8 for UC, and 0.5 for IBD-U; 53% of patients were male and median age was 43 years (interquartile range = 31–56 years). During a median 12-month follow-up, 34% of patients were treated with systemic steroids, 25% with immunomodulators, 15% with biologics and 5.6% underwent surgery. The percentage of patients under these treatments was significantly higher in CD than UC and IBD-U. Use of systemic steroids and biologics was significantly higher in hospitals with high resources. In total, 28% of patients were hospitalized (35% CD and 22% UC patients, p < 0.01). (4) Conclusion: The incidence of IBD in Spain is rather high and similar to that reported in Northern Europe. IBD patients require substantial therapeutic resources, which are greater in CD and in hospitals with high resources, and much higher than previously reported. One third of patients are hospitalized in the first year after diagnosis and a relevant proportion undergo surgery.
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Affiliation(s)
- María Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
- Correspondence: ; Tel.: +34-913093911
| | - Ana Garre
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
| | - Andrea Núñez Ortiz
- Department of Gastroenterology, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain;
| | | | - Cristina Rodríguez
- Department of Gastroenterology, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain;
| | - Sabino Riestra
- Department of Gastroenterology, Hospital Universitario Central de Asturias and ISPA, 33011 Oviedo, Spain;
| | - Milagros Vela
- Department of Gastroenterology, Complejo Hospitalario Universitario Ntra. Sra. de Candelaria, 38010 Santa Cruz de Tenerife, Spain;
| | - José Manuel Benítez
- Department of Gastroenterology, Hospital Universitario Reina Sofía and IMIBIC, 14004 Córdoba, Spain;
| | - Estela Fernández Salgado
- Department of Gastroenterology, Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur, 36071 Pontevedra, Spain;
| | | | - Vicent Hernández
- Department of Gastroenterology, Hospital Álvaro Cunqueiro, Estrutura Organizativa de Xestión Integrada de Vigo, 36213 Vigo, Spain;
| | - Rocío Ferreiro-Iglesias
- Department of Gastroenterology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain; (R.F.-I.); (M.B.-d.A.)
| | - Ángel Ponferrada Díaz
- Department of Gastroenterology, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Universitario Rio Hortega, 47012 Valladolid, Spain;
| | - José María Huguet
- Department of Gastroenterology, Consorcio Hospital General Universitario de Valencia, 46014 Valencia, Spain;
| | - Beatriz Sicilia
- Department of Gastroenterology, Hospital Universitario de Burgos, 09006 Burgos, Spain;
| | | | - Xavier Calvet
- Servei de Malalties Digestives, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, CIBEREHD—Instituto de Salud Carlos III, Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain;
| | - Daniel Ginard
- Department of Gastroenterology, Hospital Universitari Son Espases, 07120 Palma de Mallorca, Spain;
| | - Inmaculada Alonso-Abreu
- Department of Gastroenterology, Hospital Universitario de Canarias (H.U.C.), 38320 Santa Cruz de Tenerife, Spain;
| | - Luis Fernández-Salazar
- Department of Gastroenterology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain;
| | | | - Montserrat Rivero
- Department of Gastroenterology, Hospital Universitario Marqués de Valdecilla and IDIVAL, 39008 Santander, Spain;
| | - Isabel Vera-Mendoza
- Department of Gastroenterology, Hospital Universitario Puerta de Hierro Majadahonda, 28222 Madrid, Spain;
| | - Pablo Vega
- Department of Gastroenterology, Complexo Hospitalario Universitario de Ourense, 32005 Ourense, Spain;
| | - Pablo Navarro
- Department of Gastroenterology, Hospital Clínico Universitario de Valencia, Universitat de València, 46010 Valencia, Spain;
| | - Mónica Sierra
- Department of Gastroenterology, Complejo Asistencial Universitario de León, 24001 León, Spain;
| | - José Luis Cabriada
- Department of Gastroenterology, Hospital de Galdakao-Usansolo, Galdakao, 48960 Vizcaya, Spain;
| | - Mariam Aguas
- Department of Gastroenterology, Hospital Universitari i Politecnic La Fe and CIBERehd, 46026 Valencia, Spain;
| | - Raquel Vicente
- Department of Gastroenterology, Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain;
| | - Mercè Navarro-Llavat
- Department of Gastroenterology, Hospital de Sant Joan Despí Moisès Broggi, 08970 Barcelona, Spain;
| | - Ana Echarri
- Department of Gastroenterology, Complejo Hospitalario Universitario de Ferrol, 15405 A Coruña, Spain;
| | - Fernando Gomollón
- Department of Gastroenterology, Hospital Clínico Universitario “Lozano Blesa”, IIS Aragón and CIBERehd, 50009 Zaragoza, Spain;
| | - Elena Guerra del Río
- Department of Gastroenterology, Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas, Spain;
| | - Concepción Piñero
- Department of Gastroenterology, Hospital Universitario de Salamanca, 37007 Salamanca, Spain;
| | - María José Casanova
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
| | - Katerina Spicakova
- Department of Gastroenterology, Hospital Universitario de Araba (sede Txagorritxu y sede Santiago), 01009 Álava, Spain; katerina.spicakova-@osakidetza.eus
| | - Jone Ortiz de Zarate
- Department of Gastroenterology, Hospital Universitario de Basurto, 48013 Bilbao, Spain;
| | - Emilio Torrella Cortés
- Department of Gastroenterology, Hospital General Universitario J.M. Morales Meseguer, 30008 Murcia, Spain;
| | - Ana Gutiérrez
- Department of Gastroenterology, Hospital General Universitario de Alicante and CIBERehd, 03010 Alicante, Spain;
| | - Horacio Alonso-Galán
- Department of Gastroenterology, Hospital Universitario Donostia-Donostia Unibertsitate Ospitalea, Guipuzkoa and Organizacion Sanitaria Integrada Tolosaldea, Clínica Santa María de la Asunción, 20014 Guipúzcoa, Spain;
| | - Álvaro Hernández-Martínez
- Department of Gastroenterology, Complejo Hospitalario de Especialidades Torrecárdenas, 04009 Almería, Spain;
| | - José Miguel Marrero
- Department of Gastroenterology, Hospital Universitario Insular de Gran Canaria, 35016 Las Palmas, Spain;
| | - Rufo Lorente Poyatos
- Department of Gastroenterology, Hospital General Universitario de Ciudad Real, 13005 Ciudad Real, Spain;
| | - Margalida Calafat
- Department of Gastroenterology, Hospital Son Llatzer, 07198 Palma de Mallorca, Spain;
| | - Lidia Martí Romero
- Department of Gastroenterology, Hospital Francesc De Borja de Gandía, 46702 Valencia, Spain;
| | - Pilar Robledo
- Department of Gastroenterology, Hospital Universitario de Cáceres, 10004 Cáceres, Spain;
| | - Orencio Bosch
- Department of Gastroenterology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Nuria Jiménez
- Department of Gastroenterology, Hospital General Universitario de Elche, 03203 Alicante, Spain;
| | - María Esteve Comas
- Department of Gastroenterology, Hospital Universitari Mutua Terrasa, 08221 Terrassa, Spain;
| | - José María Duque
- Department of Gastroenterology, Hospital San Agustín, 33401 Avilés, Spain;
| | - Ana María Fuentes Coronel
- Department of Gastroenterology, Hospital Virgen de La Concha, Complejo Asistencial de Zamora, 49022 Zamora, Spain;
| | | | - Eva Sesé Abizanda
- Department of Gastroenterology, Hospital Universitario Arnau de Vilanova, 25198 Lérida, Spain;
| | | | - Liliana Pozzati
- Department of Gastroenterology, Hospital de Mérida, 06800 Mérida, Spain;
| | | | - Belén Crespo Suarez
- Department of Gastroenterology, Hospital da Costa (EOXI Lugo-Cervo-Monforte), 27880 Lugo, Spain;
| | - Pilar López Serrano
- Department of Gastroenterology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain;
| | - Alfredo J. Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, 13700 Tomelloso, Spain;
- Instituto de Investigación Sanitaria Princesa (IIS-IP), 28006 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain
| | - Margarita Muñoz Vicente
- Department of Gastroenterology, Hospital General Universitario de Castellón, 12004 Castellón, Spain;
| | - Fernando Bermejo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada and Instituto de Investigación Sanitaria Hospital La Paz (IdiPaz), 28942 Madrid, Spain;
| | | | - Margarita Menacho
- Department of Gastroenterology, Hospital Joan XXIII, 43005 Tarragona, Spain;
| | - Amalia Carmona
- Department of Gastroenterology, Hospital Povisa, 36211 Pontevedra, Spain;
| | - Raquel Camargo
- Department of Gastroenterology, Complejo Hospitalario de Especialidades Virgen de la Victoria, 29010 Málaga, Spain;
| | - Sandra Torra Alsina
- Department of Gastroenterology, Parc Sanitari Sant Joan de Déu, 08830 Barcelona, Spain;
| | - Nuria Maroto
- Department of Gastroenterology, Hospital de Manises, 46940 Valencia, Spain;
| | | | - Elena Castro
- Department of Gastroenterology, Complexo Hospitalario Universitario Xeral-Calde de Lugo, 27004 Lugo, Spain;
| | - Ignacio Marín-Jiménez
- Department of Gastroenterology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Biomédica Gregorio Marañón (IiSGM), 28007 Madrid, Spain;
| | - Belén Botella
- Department of Gastroenterology, Hospital Universitario Infanta Cristina, 28981 Madrid, Spain;
| | - Amparo Sapiña
- Department of Gastroenterology, Hospital de Manacor, 07500 Manacor, Spain;
| | - Noelia Cruz
- Department of Gastroenterology, Hospital Doctor José Molina Orosa, 35500 Lanzarote, Spain;
| | | | - Abdel Bouhmidi
- Department of Gastroenterology, Hospital Santa Bárbara, 13500 Puertollano, Spain;
| | | | - Verónica Opio
- Department of Gastroenterology, Hospital Universitario de Getafe, 28905 Madrid, Spain;
| | - Isabel Nicolás
- Department of Gastroenterology, Hospital General Universitario Reina Sofía, 30003 Murcia, Spain;
| | - Marcos Kutz
- Department of Gastroenterology, Hospital Reina Sofía, 31500 Tudela, Spain;
| | | | - Jordi Gordillo
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain;
| | - Yolanda Ber
- Department of Gastroenterology, Hospital San Jorge, 22004 Huesca, Spain;
| | | | | | | | | | - Lilyan Kolle
- Department of Gastroenterology, Hospital General de La Palma, 38713 Santa Cruz de Tenerife, Spain;
| | - Miriam Sabat
- Department of Gastroenterology, Hospital Santa Caterina, 17190 Gerona, Spain;
| | - Cesar Ledezma
- Department of Gastroenterology, Hospital Palamós, 17230 Girona, Spain;
| | - Eduardo Iyo
- Department of Gastroenterology, Hospital Comarcal de Inca, 07300 Inca, Spain;
| | - Óscar Roncero
- Department of Gastroenterology, Hospital General La Mancha Centro, 13600 Ciudad Real, Spain;
| | - Rebeca Irisarri
- Department of Gastroenterology, Hospital García Orcoyen, 31200 Estella, Spain;
| | - Laia Lluis
- Department of Gastroenterology, Hospital Sagrat Cor, 08029 Barcelona, Spain;
| | | | - Eva María Zapata
- Department of Gastroenterology, Hospital de Mendaro, 20850 Guipuzkoa, Spain;
| | - María José Alcalá
- Department of Gastroenterology, Hospital Obispo Polanco, 44002 Teruel, Spain;
| | - Cristina Martínez Pascual
- Department of Gastroenterology, Hospital General Universitario Los Arcos del Mar Menor, San Javier, 30739 Murcia, Spain;
| | - María Montealegre
- Department of Gastroenterology, Hospital General de Villarobledo, 02600 Albacete, Spain;
| | - Laura Mata
- Department of Gastroenterology, Hospital Medina del Campo, 47400 Valladolid, Spain;
| | - Ana Monrobel
- Department of Gastroenterology, Hospital de Montilla, 14550 Córdoba, Spain;
| | | | - Luis Hernández
- Department of Gastroenterology, Hospital Santos Reyes, 09400 Aranda de Duero, Spain;
| | - María Tejada
- Department of Gastroenterology, Clínica Astarté, 11011 Cádiz, Spain;
| | - Alberto Mir
- Department of Gastroenterology, Hospital Ernest Lluch, 50299 Zaragoza, Spain;
| | - María Luisa Galve
- Department of Gastroenterology, Hospital Central de La Cruz Roja San José y Santa Adela, 28003 Madrid, Spain;
| | - Marta Soler
- Department of Gastroenterology, Hospital San Juan De Dios, 38009 Tenerife, Spain;
| | - Daniel Hervías
- Department of Gastroenterology, Hospital Virgen de Altagracia, 13002 Manzanares, Spain;
| | | | - Manuel Barreiro-de Acosta
- Department of Gastroenterology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain; (R.F.-I.); (M.B.-d.A.)
| | - Fernando Rodríguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, 28029 Madrid, Spain; (F.R.-A.); (E.G.-E.)
| | - Esther García-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPaz and CIBERESP, 28029 Madrid, Spain; (F.R.-A.); (E.G.-E.)
| | - Javier P. Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28006 Madrid, Spain; (A.G.); (M.J.C.); (J.P.G.)
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18
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Iesalnieks I, Agha A, Dederichs F, Schlitt HJ. [Bowel resections for Crohn's disease: developments over the last three decades]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:927-936. [PMID: 34161989 DOI: 10.1055/a-1482-9147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The present observational study demonstrates developments of surgery in Crohn's disease patients undergoing bowel resection at two tertiary referral centers during the recent 3 decades. METHODS Consecutive patients undergoing intestinal resections were included. Exclusion criteria were: resection for malignancy, mere stoma formation and closure, bowel resections for other reasons than Crohn's disease, abdomino-perineal resections for anal fistula. Data collection was retrospective between 1992 and 2004, and prospective thereafter. Six time periods were compared: 1992-1995, 1996-2000, 2001-2005, 2006-2010, 2011-2015, and 2016-2020. RESULTS Between 2000 and 2015 several significant developments could be observed: decline in preoperative steroid intake, increase in preoperative intake of immunomodulators and biologic agents; abandonment of preoperative mechanical bowel preparation, increase in surgery for penetrating disease and more patients with previous bowel resections, increase in laparoscopy use, stoma rate and postoperative morbidity. Since 2016, mechanical bowel preparation and oral antibiotics were (re)introduced, there was significantly more laparoscopic surgery (67%), preoperative steroid and immunomodulator intake diminished, whereas preoperative biological therapy increased; patients were older and less were active smokers; stoma formation rate and morbidity rate decreased significantly. CONCLUSION There were several very strong trends in Crohn's disease surgery during the last 3 decades. However, present results cannot be generalized to broader patient' population.
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Affiliation(s)
- Igors Iesalnieks
- Klinik für Allgemein-, Viszeral-, Endokrine und Minimal-invasive Chirurgie, Klinik München Bogenhausen, München, Germany
| | - Ayman Agha
- Klinik für Allgemein-, Viszeral-, Endokrine und Minimal-invasive Chirurgie, Klinik München Bogenhausen, München, Germany
| | - Frank Dederichs
- Klinik für Innere Medizin, Gastroenterologie, Hepatologie und Diabetologie, Kath. Klinikum Essen, Essen, Germany
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19
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Dheri AK, Kuenzig ME, Mack DR, Murthy SK, Kaplan GG, Donelle J, Smith G, Benchimol EI. Shifting Health Care Use from Hospitalisations and Surgeries to Outpatient Visits in Children with Inflammatory Bowel Disease: A Population-based Cohort Study from Ontario, Canada. J Crohns Colitis 2021; 15:1991-2000. [PMID: 34019625 PMCID: PMC8684492 DOI: 10.1093/ecco-jcc/jjab095] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Modern, specialised care for children with inflammatory bowel disease [IBD] may have resulted in changes in health services use. We report trends over time in health services utilisation and surgery for children with IBD and children without IBD. METHODS Children aged <18 years, diagnosed with IBD between 1994 and 2013 [n = 5518] and followed until 2015 in Ontario, Canada, were identified from health administrative data and matched to children without IBD on age, sex, rural/urban household, and income [n = 26,677]. We report the annual percentage change [APC] with 95% confidence intervals [CI] in the rate of outpatient visits, emergency department [ED] visits, and hospitalisations, using negative binomial regression for events within 5 years from the diagnosis/index date. We used Cox proportional hazards regression models to report APC in hazards of intestinal resection [Crohn's disease; CD] and colectomy [ulcerative colitis; UC]. RESULTS IBD-specific hospitalisation rates decreased by 2.5% [95% CI 1.8-3.2%] annually, and all-cause hospitalisation rates in children without IBD decreased by 4.3% [95% CI 3.5-5.1%] annually. Intestinal resection risk in CD decreased by 6.0% [95% CI 4.6-7.3%] annually and colectomy risk in UC decreased by 3.0% [95% CI 0.7-5.2%] annually. In contrast, IBD-specific outpatient visit rates increased after 2005 by 4.0% [95% CI 3.1-4.9%] annually. Similar trends in outpatient visits were not observed in children without IBD. CONCLUSIONS Hospitalisations and surgeries decreased over time while outpatient visits increased after 2005. Decreasing hospitalisations were mirrored in children without IBD, likely resulting from a combination of changes in disease management and health system factors.
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Affiliation(s)
- Aman K Dheri
- Children’s Hospital of Eastern Ontario [CHEO] Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON,Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON,Canada,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, ON,Canada
| | - David R Mack
- Children’s Hospital of Eastern Ontario [CHEO] Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada,CHEO Research Institute, Ottawa, ON,Canada,Department of Pediatrics, University of Ottawa, Ottawa, ON,Canada
| | - Sanjay K Murthy
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON,Canada,ICES, Toronto, ON,Canada,Department of Medicine, University of Ottawa, Ottawa, ON,Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB,Canada
| | | | | | - Eric I Benchimol
- Children’s Hospital of Eastern Ontario [CHEO] Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON,Canada,SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, ON,Canada,Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, ON,Canada,CHEO Research Institute, Ottawa, ON,Canada,Department of Pediatrics, University of Ottawa, Ottawa, ON,Canada,ICES, Toronto, ON,Canada,Department of Paediatrics and Institute of Health Policy, Management andEvaluation,Corresponding author: Eric Benchimol, Hospital for Sick Children, Division of Gastroenterology, Hepatology and Nutrition, 555 University Avenue, Toronto, ON, M5G 1X8, Canada. Tel.: [416]813–1500; fax: [416]813–4972;
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20
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Palacio FGM, de Souza LMP, Moreira JPDL, Luiz RR, de Souza HSP, Zaltman C. Hospitalization and surgery rates in patients with inflammatory bowel disease in Brazil: a time-trend analysis. BMC Gastroenterol 2021; 21:192. [PMID: 33906627 PMCID: PMC8077865 DOI: 10.1186/s12876-021-01781-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/20/2021] [Indexed: 12/25/2022] Open
Abstract
Background The prevalence of inflammatory bowel disease (IBD) is increasing globally, and the disease is frequently managed surgically. The aim of this study was to investigate the time trends and geographic distribution of IBD hospitalizations, surgeries and surgical-associated lethality.
Methods Data from the Brazilian Health Public System were retrospectively collected regarding hospitalizations, in-hospital deaths, IBD-related surgical procedures and lethality from 2005 to 2015. Results This eleven-year period revealed decreases in the rates of hospitalization (24%), IBD-related surgeries (35%), and IBD-related surgical lethality (46%). Most surgeries were performed in Crohn’s disease patients, and the predominant procedure was small bowel resection, mostly in young adults. A higher prevalence of ulcerative was observed throughout the country. The highest hospitalization and surgical rates were observed in the more industrialized regions of the South and the Southeast and in the municipalities integrated with metropolitan regions (MRs). The highest surgical-related lethality rates were seen in the less-developed regions and in municipalities not integrated with MRs. The length of hospital stay showed a slight increase throughout the period. Conclusions Brazil follows the global trend of decreases in hospitalizations, lethality, surgeries, and surgical lethality associated with IBD. The unequal distribution of hospitalizations and surgeries, concentrated in the industrialized areas, but with a shift towards the Northeast and from urbanized to rural areas, indicates ongoing changes within the country. Reductions in the rates of IBD-related hospitalizations, surgeries and lethality suggest the effectiveness of decentralization and improvements in the quality of public health services and the advances in medical therapy during the study period. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01781-x.
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Affiliation(s)
- Flávia Gonçalves Musauer Palacio
- Departamento de Clínica Médica, Hospital Universitário, Universidade Federal Do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil
| | - Lucila Marieta Perrotta de Souza
- Departamento de Clínica Médica, Hospital Universitário, Universidade Federal Do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil
| | | | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde Coletiva (IESC), Universidade Federal Do Rio de Janeiro, Rio de Janeiro, 21944-970, Brazil
| | - Heitor Siffert Pereira de Souza
- Departamento de Clínica Médica, Hospital Universitário, Universidade Federal Do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil. .,D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro 30, Botafogo, Rio de Janeiro, RJ, 22281-100, Brazil.
| | - Cyrla Zaltman
- Departamento de Clínica Médica, Hospital Universitário, Universidade Federal Do Rio de Janeiro, Rua Prof. Rodolpho Paulo Rocco 255, Ilha Do Fundão, Rio de Janeiro, RJ, 21941-913, Brazil
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21
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Wang Y, Makadia R, Knoll C, Hardin J, Voss EA, Fife D, Davis K, Sloan S. Understanding patient journey in ulcerative colitis prior to biologic initiation: a 5-year exploration. BMC Gastroenterol 2021; 21:121. [PMID: 33731009 PMCID: PMC7967955 DOI: 10.1186/s12876-021-01708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There has been a more pronounced shift toward earlier, more aggressive therapies in Crohn's disease than in ulcerative colitis (UC). The aim of this study was to describe the pre-biologic treatment and health care experience, including co-morbidities and overall health care utilization, for UC patients who initiated biologic therapies, in the 5 years prior to the initiation of the first biologic agent. METHODS UC patients who initiated a biologic agent approved for UC between 9/15/2005 and 1/30/2018 were identified from the IBM® MarketScan® Commercial Database, a large US database. The date of the first recorded UC biologic exposure was defined as the index date, and ≥ 5 years of pre-index records were required to evaluate patients' treatment, disease progression and overall health care utilization prior to initiating biologic agents. RESULTS Among the 1891 eligible patients, treatment with oral corticosteroids, 5-aminosalicylates, and other non-biologic immunomodulators, all increased progressively across the 5 years prior to the index. From within year-five to within year-one prior to the index, the median duration of oral corticosteroid treatment increased from 34 to 88 days per year and the proportion of patients who experienced more extensive/pancolitis disease increased from 16 to 59%. Overall, the frequency of all-cause health care visits also increased. CONCLUSIONS Patients with UC experienced increasing morbidity and treatment burden in the 5 years prior to initiating biologic therapy. To achieve reduced corticosteroids in UC management, better risk stratification is needed to help identify patients for more timely biologic treatment.
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Affiliation(s)
- Yiting Wang
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | - Rupa Makadia
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Christopher Knoll
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Jill Hardin
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Erica A Voss
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Daniel Fife
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Kourtney Davis
- Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Sheldon Sloan
- Janssen Global Services, LLC, Raritan, 08869, NJ, USA
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22
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Postoperative Ratio of C-Reactive Protein to Albumin as a Predictive Marker in Patients with Crohn's Disease Undergoing Bowel Resection. Gastroenterol Res Pract 2021; 2021:6629608. [PMID: 33727917 PMCID: PMC7936899 DOI: 10.1155/2021/6629608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/08/2021] [Accepted: 02/14/2021] [Indexed: 01/08/2023] Open
Abstract
Background The ratio of C-reactive protein (CRP) to albumin (CAR) has a significant correlation with postoperative complications and acts as a predictor in patients with pancreatic cancer and colorectal cancer. However, whether the CAR can be used to predict complications in Crohn's disease (CD) patients after surgery has not yet been reported. Methods A total of 534 CD patients undergoing surgery between 2016 and 2020 were enrolled. The risk factors of postoperative complications were assessed by univariate and multivariate analyses. The cutoff values and the accuracy of diagnosis for the CAR and postoperative CRP levels were examined with receiver operating characteristic (ROC) curves. Results The rate of postoperative complications was 32.2%. The postoperative CAR (OR 13.200; 95% CI 6.501-26.803; P < 0.001) was a significant independent risk factor for complications. Compared with the CRP level on postoperative day 3, the CAR more accurately indicated postoperative complications in CD patients (AUC: 0.699 vs. 0.771; Youden index: 0.361 vs. 0.599). ROC curves showed that the cutoff value for the CAR was 3.25. Patients with a CAR ≥ 3.25 had more complications (P < 0.001), a longer postoperative stay (15.5 ± 0.6 d vs. 9.0 ± 0.2 d, P < 0.001), and more surgical site infections (48.2% vs. 5.7%, P < 0.001) than those with a CAR < 3.25. Conclusions Compared to the CRP level, the CAR can more accurately predict postoperative complications and can act as a predictive marker in CD patients after surgery.
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Berkovitch G, Cohen S, Lubetzky R, Singer D, Yerushalmy-Feler A. Biologic therapy is associated with a mild decrease in the rate of hospitalizations in pediatric IBD. BMC Pediatr 2021; 21:63. [PMID: 33541320 PMCID: PMC7860024 DOI: 10.1186/s12887-021-02526-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/28/2021] [Indexed: 12/11/2022] Open
Abstract
Background The effect of biologic therapy on the incidence of inflammatory bowel disease (IBD)-related hospitalizations is controversial. The high efficacy of biologic agents is weighted against potential therapy-related adverse events, however, there are no data on the effect of biologic therapy on the indications for hospitalization in IBD. We aimed to evaluate the impact of biologic therapy on the indications and rate of hospitalization in pediatric IBD. Methods This retrospective cohort study included all children (< 18 years of age) with IBD who were hospitalized in our medical center from January 2004 to December 2019. Data on demographics, disease characteristics and course, and therapy were collected, as were the indications for and course of hospitalizations. We evaluated the relationship between therapy with biologic agents, indications and rates of hospitalization. Results Included were 218 hospitalizations of 100 children, of whom 65 (65%) had Crohn’s disease and 35 (35%) had ulcerative colitis. The indications for hospitalization were IBD exacerbations or complications in 194 (89%) and therapy-related adverse events in 24 (11%). The patients of 56 (25.7%) hospitalizations were receiving biologic therapy. In a multivariate analysis, no correlation between therapy and indication for hospitalization was found (p = 0.829). Among children under biologic therapy, a decrease in the rate of hospitalizations from 1.09 (0.11–3.33) to 0.27 (0–0.47) per year was observed for patients that were hospitalized during 2016–2019 (p = 0.043). Conclusion Biologic therapy did not influence the indication for hospitalization, but were associated with a decrease in the rate of hospitalization during 2016–2019 in pediatric IBD.
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Affiliation(s)
- Gil Berkovitch
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.
| | - Ronit Lubetzky
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Singer
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Yerushalmy-Feler
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel
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Rodríguez C, Elosua A, Prieto C, Pérez E, Irisarri R, Campillo A, Rubio S, Nantes Ó, Angós R, Zozaya JM. Colectomy rate in ulcerative colitis 15 years after diagnosis: Results from the 2001-2003 Navarra cohort. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:1-8. [PMID: 33545242 DOI: 10.1016/j.gastrohep.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 11/18/2020] [Accepted: 11/28/2020] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Knowing the natural history of ulcerative colitis (UC) is essential to understand the course of the disease, assess the impact of different treatment strategies and identify poor prognostic factors. One of the most significant matters in this regard is the need for surgery. OBJECTIVES To analyse the Colectomy Incidence Rate (CIR) from diagnosis to end of follow-up (31/12/2017) and identify predictive factors for colectomy. MATERIAL AND METHODS A retrospective study enrolling patients with a definitive diagnosis (DD) of UC or Unclassified Colitis (UnC) in the 2001-03 Navarra cohort. RESULTS We enrolled 174 patients with a DD of UC (E2 42.8%; E3 26.6%) and 5 patients with a DD of UnC: 44.1% women, median age 39.2 years (range 7-88) and median follow-up 15.7 years. A total of 8 patients underwent surgery (CIR 3 colectomies/103 patient-years: 3 at initial diagnosis (<1 month), 2 in the first 2 years, 2 at 5 years from diagnosis and 1 at 12 years from diagnosis. All had previously received steroids; 5 had received immunomodulators and 2 had received biologics. In 7 patients (87%), surgery was performed on an emergency basis. The indication was megacolon in 3 (37.5%), severe flare-up in 3 (37.5%) and medical treatment failure in 2 (25%). In 5 cases (62.5%), an ileoanal pouch was made, and in 3 cases, a definitive ileostomy was performed. In the univariate analysis, patients with loss of more than 5 kg at diagnosis and admission at diagnosis had a lower rate of colectomy-free survival. CONCLUSIONS In our series, colectomy rates are lower than usually reported. Most colectomies were performed in the first 5 years following diagnosis and had an emergency indication.
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Affiliation(s)
- Cristina Rodríguez
- Complejo Hospitalario de Navarra, Servicio de Digestivo, Navarra, España.
| | - Alfonso Elosua
- Universidad Pública de Navarra, Departamento Sociología, Navarra, España
| | - Carlos Prieto
- Complejo Hospitalario de Navarra, Servicio de Digestivo, Navarra, España
| | - Ernesto Pérez
- Hospital García Orcoyen, Servicio Medicina Interna (Digestivo), Navarra, España
| | - Rebeca Irisarri
- Universidad Pública de Navarra, Departamento Sociología, Navarra, España
| | - Ana Campillo
- Hospital Reina Sofía, Sección Digestivo, Navarra, España
| | - Saioa Rubio
- Complejo Hospitalario de Navarra, Servicio de Digestivo, Navarra, España
| | - Óscar Nantes
- Complejo Hospitalario de Navarra, Servicio de Digestivo, Navarra, España
| | - Ramón Angós
- Clínica Universidad de Navarra, Servicio de Digestivo, Navarra, España
| | - José Manuel Zozaya
- Complejo Hospitalario de Navarra, Servicio de Digestivo, Navarra, España
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Effectiveness of Switching from Reference Product Infliximab to Infliximab-Dyyb in Patients with Inflammatory Bowel Disease in an Integrated Healthcare System in the United States: A Retrospective, Propensity Score-Matched, Non-Inferiority Cohort Study. BioDrugs 2021; 34:395-404. [PMID: 32103457 PMCID: PMC7211187 DOI: 10.1007/s40259-020-00409-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim was to compare outcomes in adult patients with inflammatory bowel disease (IBD) who switched to infliximab-dyyb with those who remained on reference product (RP) infliximab in the United States (US) in a retrospective, propensity score-matched, non-inferiority cohort trial. METHODS This study was a retrospective, non-inferiority study conducted within a US integrated healthcare system and included adult patients with a confirmed diagnosis of Crohn's disease or ulcerative colitis. A 1:1 propensity score matching was utilized to match patients who switched to infliximab-dyyb during the period April 2016-March 2018 to patients who remained on RP infliximab. The non-inferiority margin was set at + 10% of the upper limit. The primary outcome was a composite measure of disease worsening requiring acute care after the index date of switching to infliximab-dyyb or continuing RP infliximab. Disease worsening requiring acute care was defined as any IBD-related emergency room visit, hospitalization, or surgery. The secondary outcome was the composite measure of disease worsening requiring acute care or treatment failure. A switch to another biologic or tofacitinib was a proxy for treatment failure. All patients were followed for up to 9 months. RESULTS After propensity score matching, the matched cohort included 1409 patients in the infliximab-dyyb group and 1409 patients in the RP infliximab group. The overall mean age (± standard deviation) was 47.7 ± 17.0 years, 50.9% of patients were of male gender, and 51.8% of patients had Crohn's disease, while the remainder of the cohort had ulcerative colitis. There were 144 patients (10.2%) in the infliximab-dyyb group and 245 patients (17.4%) in the RP infliximab group who experienced disease worsening requiring acute care (P < 0.01 for non-inferiority). There were 347 patients (24.6%) in the infliximab-dyyb group who experienced disease worsening requiring acute care or treatment failure compared to 375 patients (26.6%) who remained on RP infliximab (P < 0.01 for non-inferiority). CONCLUSION There was no increased risk of (1) disease worsening requiring acute care or (2) disease worsening requiring acute care or treatment failure in patients with IBD who switched from RP infliximab to infliximab-dyyb when compared to patients who remained on RP infliximab in this US population. Infliximab-dyyb is an option for patients with IBD who need to use RP infliximab.
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Swanson GR, Kochman N, Amin J, Chouhan V, Yim W, Engen PA, Shaikh M, Naqib A, Tran L, Voigt RM, Forsyth CB, Green SJ, Keshavarzian A. Disrupted Circadian Rest-Activity Cycles in Inflammatory Bowel Disease Are Associated With Aggressive Disease Phenotype, Subclinical Inflammation, and Dysbiosis. Front Med (Lausanne) 2021; 8:770491. [PMID: 35265631 PMCID: PMC8900134 DOI: 10.3389/fmed.2021.770491] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with inflammatory bowel disease (IBD)-Crohn's disease (CD), and ulcerative colitis (UC), have poor sleep quality. Sleep and multiple immunologic and gastrointestinal processes in the body are orchestrated by the circadian clock, and we recently reported that a later category or chronotype of the circadian clock was associated with worse IBD specific outcomes. The goal of this study was to determine if circadian misalignment by rest-activity cycles is associated with markers of aggressive disease, subclinical inflammation, and dysbiosis in IBD. A total of 42 patients with inactive but biopsy-proven CD or UC and 10 healthy controls participated in this prospective cohort study. Subjects were defined as having an aggressive IBD disease history (steroid dependence, use of biologic or immunomodulator, and/or surgery) or non-aggressive history. All participants did two weeks of wrist actigraphy, followed by measurement of intestinal permeability and stool microbiota. Wrist actigraphy was used to calculate circadian markers of rest-activity- interdaily stability (IS), intradaily variability (IV), and relative amplitude (RA). Aggressive IBD history was associated with decrease rest-activity stability (IS) and increased fragmentation compared to non-aggressive IBD and health controls at 0.39 ±.15 vs. 0.51 ± 0.10 vs. 0.55 ± 0.09 (P < 0.05) and 0.83 ± 0.20 vs. 0.72 ± 0.14 (P < 0.05) but not HC at 0.72 ± 0.14 (P = 0.08); respectively. There was not a significant difference in RA by IBD disease history. Increased intestinal permeability and increased TNF-α levels correlated with an increased rest activity fragmentation (IV) at R = 0.35, P < 0.05 and R = 0.37, P < 0.05, respectively; and decreased rest-activity amplitude (RA) was associated with increased stool calprotectin at R = 0.40, P < 0.05. Analysis of intestinal microbiota showed a significant decrease in commensal butyrate producing taxa and increased pro-inflammatory bacteria with disrupted rest-activity cycles. In this study, different components of circadian misalignment by rest-activity cycles were associated with a more aggressive IBD disease history, increased intestinal permeability, stool calprotectin, increased pro-inflammatory cytokines, and dysbiosis. Wrist activity allows for an easy non-invasive assessment of circadian activity which may be an important biomarker of inflammation in IB.
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Affiliation(s)
- Garth R. Swanson
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
- *Correspondence: Garth R. Swanson
| | - Nicole Kochman
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Jaimin Amin
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Vijit Chouhan
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Wesley Yim
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
| | - Phillip A. Engen
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
| | - Maliha Shaikh
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
| | - Ankur Naqib
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
| | - Laura Tran
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
| | - Robin M. Voigt
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
| | - Christopher B. Forsyth
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
| | - Stefan J. Green
- Genomics and Microbiome Core Facility, Rush University, Chicago, IL, United States
| | - Ali Keshavarzian
- Division of Digestive Diseases and Nutrition, Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States
- Rush Medical College, Rush Center for Integrated Microbiome and Chronobiology Research, Rush University Medical Center, Chicago, IL, United States
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Adherence to Adalimumab Was Not Improved by a Reminder-Based Intervention with an Electronic Needle Container. Dig Dis Sci 2021; 66:1477-1487. [PMID: 32556818 PMCID: PMC8053164 DOI: 10.1007/s10620-020-06395-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Adherence to adalimumab in inflammatory bowel disease (IBD) patients is reported to be below par. Non-adherence may result in loss-of-response and increased hospitalization. We analyzed the effect of an electronic needle container (ENC) on adherence to adalimumab. METHODS In this multicenter, 12-months observational study, we included adalimumab treated IBD patients. All patients were invited to receive an ENC. Patients who declined or did not complete the registration for an ENC served as controls. Primary endpoint was whether an ENC increased adherence, calculated from pharmacy refills as proportion of days covered (PDC). Secondary endpoints were clinical outcomes, including loss-of-response, identification of predictors of adherence and correlation between different modalities for measuring adherence. Loss-of-response was defined as a disease flare, dose-escalation or IBD-related hospitalization or surgery. RESULTS The pharmacies' records identified 198 eligible patients, of whom 32 were excluded. The ENC was supplied to 69 patients, the remaining 97 patient formed the control group. Median baseline PDC (98.4% vs. 96.1%, p = 0.047) and the proportion of adherent (PDC ≥ 86%) patients (87.0% vs. 74.2%, p = 0.045) was higher for the ENC group. The ENC did not improve the adherence of patients during follow-up (odds ratio 1.26, 95% CI 0.55-2.86). During follow-up, five (7.2%) patients in the ENC group and 13 (13.4%) in the control group discontinued adalimumab (log-rank p = 0.22). Loss-of-response occurred in 12 (17.4%) and 14 (14.4%) patients, respectively (log-rank p = 0.66). CONCLUSIONS Our results show no beneficial effect of a reminder-based intervention on adherence or treatment outcomes.
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Teich N, Bläker M, Holtkamp-Endemann F, Jörgensen E, Stallmach A, Hohenberger S. Effect of Originator Infliximab Treatment on Disease-Related Hospitalizations, Work Productivity and Activity Impairment, and Health Resource Utilization in Patients with Crohn's Disease in a Real-Life Setting: Results of a Prospective Multicenter Study in Germany. Inflamm Intest Dis 2020; 6:48-60. [PMID: 33850839 DOI: 10.1159/000512159] [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: 06/02/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Infliximab (IFX) therapy is efficacious for inducing and maintaining symptomatic remission in patients with Crohn's disease (CD), but whether this benefit results in reduced hospitalization rates and therefore may improve patients' quality of life in an economically sensible way is conflicting so far. Methods We conducted a noninterventional, multicenter, open-label, prospective study to evaluate the effect of originator IFX treatment on patient-reported outcomes and disease-related hospitalizations in adult CD patients in Germany treated for the first time with IFX according to label. Results Two hundred and ninety-four patients were included in the study. We observed a statistically significant reduction in the number of CD-related hospitalizations from the year before baseline (mean 1.00 per patient, SD ± 0.93) to the mean value of the 1st (0.62, SD ± 0.95) and 2nd year (0.32, SD ± 0.75) of the observation period (p < 0.0001). After 3 months of IFX therapy, work productivity and activity increased by an average of 12.6 and 17.1%, respectively. Patient's clinical outcome was markedly improved as the total CD activity index (CDAI) sum score continuously decreased from baseline to month 24 and the mean score of the total inflammatory bowel disease questionnaire (IBDQ) changed substantially from 141 at baseline to 172 after 24 months of IFX treatment. Additionally, the number of work incapacity days declined. Recently, no new safety issues of IFX have been identified. Conclusion In this large, prospective, multicenter study on disease-related hospitalization rates, work productivity, capacity for daily activities, and HRQoL in patients with CD, IFX significantly reduces their hospitalization rates and improves work productivity, daily activity, and quality of life over 24 months.
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Affiliation(s)
- Niels Teich
- Internistische Gemeinschaftspraxis für Verdauungs- und Stoffwechselkrankheiten Leipzig und Schkeuditz, Leipzig, Germany
| | - Michael Bläker
- Gastroenterologie/Gastropraxis Eppendorfer Baum, Hamburg, Germany
| | | | | | - Andreas Stallmach
- Klinik für Innere Medizin IV, Gastroenterologie, Hepatologie, Infektiologie, Interdisziplinäre Endoskopie, Universitätsklinikum Jena, Jena, Germany
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Pierre N, Baiwir D, Huynh-Thu VA, Mazzucchelli G, Smargiasso N, De Pauw E, Bouhnik Y, Laharie D, Colombel JF, Meuwis MA, Louis E. Discovery of biomarker candidates associated with the risk of short-term and mid/long-term relapse after infliximab withdrawal in Crohn's patients: a proteomics-based study. Gut 2020; 70:gutjnl-2020-322100. [PMID: 33106355 DOI: 10.1136/gutjnl-2020-322100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE A subset of Crohn's disease (CD) patients experiences mid/long-term remission after infliximab withdrawal. Biomarkers are needed to identify those patients. DESIGN New biomarkers of relapse were searched in the baseline serum of CD patients stopping infliximab when they were under combined therapy (antimetabolite and infliximab) and stable clinical remission (diSconTinuation in CrOhn's disease patients in stable Remission on combined therapy with Immunosuppressors cohort, n=102). From shotgun proteomics experiment (discovery step), biomarker candidates were identified and further targeted by selected reaction monitoring (verification step). The dataset was stratified to search for markers of short-term (<6 months) or mid/long-term relapse (>6 months). The risk of relapse and the predicting capacity associated with biomarker candidates were evaluated using univariate Cox model and log-rank statistic, respectively. To test their complementary predicting capacity, biomarker candidates were systematically combined in pairs. RESULTS Distinct biomarker candidates were associated with the risk (HR) of short-term (15 proteins, 2.9
CONCLUSION We identified for the first time circulating biomarker candidates associated with the risk of mid/long-term relapse in CD patients stopping infliximab. We also highlight a sequence of pathophysiological processes leading to relapse, this could help to better understand the disease progression. Our findings may pave the way for a better non-invasive evaluation of the risk of relapse when contemplating antitumour necrosis factor α withdrawal in CD patients.
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Affiliation(s)
- Nicolas Pierre
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liege University, Liege, Belgium
| | | | - Vân Anh Huynh-Thu
- Department of Electrical Engineering and Computer Science, Liege University, Liege, Belgium
| | - Gabriel Mazzucchelli
- Laboratory of Mass Spectrometry, MolSys Research Unit, Liege University, Liege, Belgium
| | - Nicolas Smargiasso
- Laboratory of Mass Spectrometry, MolSys Research Unit, Liege University, Liege, Belgium
| | - Edwin De Pauw
- Laboratory of Mass Spectrometry, MolSys Research Unit, Liege University, Liege, Belgium
| | - Yoram Bouhnik
- Service de Gastroentérologie et Assistance Nutritive, Hôpital Beaujon, Clichy, France
| | - David Laharie
- Service d'Hépato-Gastroentérologie, CHU de Bordeaux, Bordeaux, France
| | - Jean-Frédéric Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sina, New York, New York, USA
| | - Marie-Alice Meuwis
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liege University, Liege, Belgium
- Hepato-Gastroenterology and Digestive Oncology Department, Liege University, Liege, Belgium
| | - Edouard Louis
- Laboratory of Translational Gastroenterology, GIGA-Institute, Liege University, Liege, Belgium
- Hepato-Gastroenterology and Digestive Oncology Department, Liege University, Liege, Belgium
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Abstract
Despite the recent emergence of expensive biologic therapies, hospitalization and surgery remain important contributors for the overall costs of inflammatory bowel disease (IBD). In this study, we aimed to describe the burden of reoperations in patients with IBD by evaluating reoperation rates, charges, and risk factors over 16 years.
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Kumar A, Kim ES, Kozan P, Jacob V, Longman RS, Scherl EJ, Battat RJ, Lukin DJ. Patient-Preferences Favoring Treatment Discontinuation Are Reduced With Vedolizumab and Ustekinumab Compared With TNF Antagonists in Inflammatory Bowel Disease. CROHN'S & COLITIS 360 2020; 2:otaa074. [PMID: 36777752 PMCID: PMC9802380 DOI: 10.1093/crocol/otaa074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 11/14/2022] Open
Abstract
Background Nonadherence to biologic therapy in inflammatory bowel disease (IBD) is associated with risk of relapse, immunogenicity, and disease complications. Significant nonadherence prevalence is reported with tumor necrosis factor (TNF) antagonists but the risk of nonadherence with newer biologics with better safety profiles is unknown. This study aimed to investigate if IBD patient-preferences favoring biologic discontinuation vary by biologic class and analyze factors associated with such preferences. Methods A convenience sample of 200 adults with IBD on biologic therapy treated at an academic outpatient center was surveyed using a 22-point questionnaire. Patient-preference favoring treatment discontinuation between TNF-antagonist and non-TNF-antagonist biologics [vedolizumab (VDZ)/ustekinumab (UST)] was compared using χ 2 test. Risk factors associated with a preference to discontinue biologic therapy were evaluated using univariable and multivariable logistic regression, and Spearman rank correlation analyses. Results A total of 190 questionnaires were analyzed that contained data on preferences regarding biologic discontinuation (median age 36 years, 62% were females; 63% had Crohn disease; 56% were receiving a TNF antagonist, 31% VDZ, and 14% UST). Overall, 32% patients reported a preference to discontinue biologic treatment with a higher proportion among those receiving a TNF antagonist compared with VDZ/UST (39.6% vs 21.4%; P < 0.01). Current VDZ/UST use was independently associated with a reduced odds of patient-preference favoring biologic discontinuation [adjusted odds ratio: 2.67 (1.42-5.01); P < 0.01]. The most concerning factor to patients was the perceived risk of side effects. Patients on VDZ/UST perceived their therapy to be safer than those receiving a TNF antagonist (r = 0.2, P = 0.04). Conclusions Patient-preference favoring treatment discontinuation is improved with VDZ/UST compared with TNF-antagonist biologic therapy.
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Affiliation(s)
- Anand Kumar
- Division of Gastroenterology, Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, New York, New York, USA
| | - Emilie S Kim
- Division of Gastroenterology, Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, New York, New York, USA,New Jersey Medical School—Rutgers University, New Brunswick, New Jersey, USA
| | - Philip Kozan
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Vinita Jacob
- Division of Gastroenterology, Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, New York, New York, USA
| | - Randy S Longman
- Division of Gastroenterology, Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, New York, New York, USA
| | - Ellen J Scherl
- Division of Gastroenterology, Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, New York, New York, USA
| | - Robert J Battat
- Division of Gastroenterology, Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, New York, New York, USA
| | - Dana J Lukin
- Division of Gastroenterology, Jill Roberts Center for Inflammatory Bowel Disease, Weill Cornell Medical College, New York, New York, USA,Address correspondence to: Dana J. Lukin, MD, PhD, 1315 York Avenue, Mezzanine SM1A15, New York, NY 10021 ()
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Ihekweazu FD, Fofanova T, Palacios R, Ajjarapu A, Karam L, Vogel AM, Rodriguez JR, Kellermayer R. Progression to colectomy in the era of biologics: A single center experience with pediatric ulcerative colitis. J Pediatr Surg 2020; 55:1815-1823. [PMID: 32087936 PMCID: PMC7396289 DOI: 10.1016/j.jpedsurg.2020.01.054] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 01/13/2020] [Accepted: 01/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE Clinical outcomes in pediatric ulcerative colitis (UC) in the era of biologic agents are poorly defined. We aimed to describe risk factors for colectomy in pediatric UC in the era of infliximab therapy. METHODS We reviewed 217 pediatric patients at Texas Children's Hospital with newly diagnosed UC between 2003 and 2015; 117 had a minimum of 5 years of follow-up. Extent of disease at diagnosis, medication exposure, the presence of extraintestinal manifestations (EIMs), and need for surgery were noted. RESULTS Average length of follow up was 5.02 ± 2.27 years. Forty-two percent presented with pancolitis. Infliximab was used in 39%, immunomodulators in 65%, and steroids in 89% of patients. EIMs occurred in 24.9% of patients. The cumulative rate of colectomy was 12.9% at 5 years. Children presenting as E2 (Paris Classification) and children prescribed oral steroid monotherapy at diagnosis progressed to surgery faster than any other group. Of the children who received infliximab, females and children less than 5 years old were less likely to respond to therapy. CONCLUSIONS The natural course of pediatric UC remains aggressive despite the addition of infliximab to the standard of care and suggests a need for early aggressive clinical intervention. LEVEL-OF-EVIDENCE RATING Level IV.
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Affiliation(s)
- Faith D. Ihekweazu
- Department of Pediatric Gastroenterology, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin St, MW1010, Houston, TX, 77030,Corresponding author at: Section of Pediatric Gastroenterology, Hepatology & Nutrition, Baylor College of Medicine, 1102 Bates St, FT 860.28, Houston, TX 77030-2399. Tel.: +1 832 824 3754 (Voice); fax: +1 832 825 3633, (F.D. Ihekweazu)
| | - Tatiana Fofanova
- Alkek Center for Metagenomics and Microbiome Research, Baylor College of Medicine, One Baylor Plaza, MS BCM385, Houston, TX 77030,Program in Translational Biology and Molecular Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030
| | - Ryan Palacios
- Department of Pediatric Gastroenterology, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin St, MW1010, Houston, TX, 77030
| | - Avanthi Ajjarapu
- Department of Pediatric Gastroenterology, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin St, MW1010, Houston, TX, 77030
| | - Lina Karam
- Department of Pediatric Gastroenterology, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin St, MW1010, Houston, TX, 77030
| | - Adam M. Vogel
- Department of Pediatric Surgery, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin St, Houston, TX 77030
| | - J R Rodriguez
- Department of Pediatric Surgery, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin St, Houston, TX 77030
| | - Richard Kellermayer
- Department of Pediatric Gastroenterology, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin St, MW1010, Houston, TX, 77030,USDA/ARS Children’s Nutrition Research Center, 1100 Bates Ave, Houston, TX, 77030
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Chuah KH, Raja Ali RA, Hilmi IN. Decreasing major surgical rates for Crohn's disease in an emerging economy over two decades: Is it due to biologic therapy? Indian J Gastroenterol 2020; 39:261-267. [PMID: 32613522 DOI: 10.1007/s12664-020-01044-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/17/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Alteration in the natural history of Crohn's disease (CD) since the advent of biologic therapy remains to be proven. Our aim was to look at the intestinal surgical rates and the association with biologic therapy over the last two decades. METHODS This was a retrospective study in which all CD patients seen in two tertiary referral hospitals in Malaysia were recruited. Patients were stratified into two cohorts; cohort 1 was patients diagnosed from year 1991 to 2000 and cohort 2 was patients diagnosed from year 2001 to 2010. These time cohorts were selected based on initial availability of biologic agents in Malaysia in year 2000. Details of demography, disease location, medications and cumulative surgical rates over 7 years were recorded. RESULTS A total of 207 patients were recruited: 70 from cohort 1 and 137 from cohort 2. Differences seen in terms of disease location, phenotype, and use of immunomodulatory therapy between the two cohorts were not significant. Patients who were ever exposed to biologics were significantly different between the two cohorts, approximately two times higher at 35.8% (n = 49) in cohort 2, and 18.6% (n = 13) in cohort 1, p = 0.011. There was a significant reduction in the 7-year cumulative intestinal surgical rates between cohort 1 and cohort 2, from 21.4% (n = 15) to 10.2% (n = 14), p = 0.028. However, there was no statistically significant difference in biologic exposure between those who underwent surgery and those who did not. CONCLUSIONS There has been a significant reduction in intestinal surgical rates for Crohn's disease over the last two decades but does not appear to be associated with the increased use of biologics.
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Affiliation(s)
- Kee Huat Chuah
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
| | - Raja Affendi Raja Ali
- Gastroenterology and Hepatology Unit, Department of Medicine, The National University of Malaysia, Bangi, Malaysia
| | - Ida Normiha Hilmi
- Gastroenterology and Hepatology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Surgery for Inflammatory Bowel Disease in the Era of Biologics. J Gastrointest Surg 2020; 24:1430-1435. [PMID: 32253646 DOI: 10.1007/s11605-020-04563-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/29/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The advent of monoclonal antibody therapy for the treatment of inflammatory bowel disease has greatly changed the multidisciplinary management of these patients, including surgical approaches. As an increasing number of inflammatory bowel disease patients are being medically managed with monoclonal antibody therapy or combination therapy with immunomodulators, more patients are coming to the operating room having been exposed to these medical therapies. METHODS A search of the relevant literature regarding monoclonal antibody therapy and postoperative outcomes was performed. RESULTS Significant controversy remains regarding the association between monoclonal antibodies and postoperative outcomes. Different classes of monoclonal antibodies may have different impacts on infectious complications. Operations for Crohn's disease and ulcerative colitis alter how we think about a change in care in the era of monoclonal antibodies. CONCLUSION In Crohn's disease, intestinal diversion may be considered in patient and disease specific scenarios and in ulcerative colitis, the use of a 3-stage approach to an ileal pouch is now more often used.
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Santiago M, Magro F, Correia L, Portela F, Ministro P, Lago P, Trindade E, Dias CC. Rehospitalization rates, costs, and risk factors for inflammatory bowel disease: a 16-year nationwide study. Therap Adv Gastroenterol 2020; 13:1756284820923836. [PMID: 35154386 PMCID: PMC8832310 DOI: 10.1177/1756284820923836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/09/2020] [Indexed: 02/04/2023] Open
Abstract
AIMS We aimed to describe the burden of rehospitalization in patients with inflammatory bowel disease (IBD), by evaluating rehospitalization rates, charges, and risk factors over 16 years. METHODS We performed a retrospective analysis of all hospital discharges with a primary diagnosis of IBD in public hospitals between 2000 and 2015 in mainland Portugal from the Central Administration of the Health System (ACSS)'s national registry. We collected data on patient, clinical, and healthcare charges. We used survival analysis to estimate the rate and risk factors of IBD-related rehospitalization. RESULTS We found that 33% (n = 15,931) of the IBD-related hospitalizations corresponded to rehospitalizations, which increased by 12% over 16 years. However, IBD rehospitalization rate per 100,000 IBD patients decreased 2.5-fold between 2003 and 2015. Mean IBD-related rehospitalization charges were €14,589/hospitalization-year in 2000 and €17,548 /hospitalization-year in 2015, with total rehospitalization charges reaching €3.1 million/year by 2015. Overall, the 30-day rate of rehospitalization was 24% for Crohn's disease (CD) and 22.4% for ulcerative colitis (UC). Novel risk factors for rehospitalization include penetrating disease in CD patients {hazard ratio (HR) 1.34 [95% confidence interval (CI) 1.20-1.51], p < 0.001} and colostomy in UC patients [HR 2.84 (95% CI 1.06-7.58)]. CONCLUSION IBD-related rehospitalization should be closely monitored, and efforts to reduce its risk factors should be made to improve the quality of care and, consequently, to reduce the burden of IBD.
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Affiliation(s)
| | | | - Luís Correia
- Portuguese Inflammatory Bowel Disease (IBD)
Study Group (GEDII), Porto, Portugal,Department of Gastroenterology, Hospital Santa
Maria, University Hospital Center of Lisbon North, Lisbon, Portugal
| | - Francisco Portela
- Portuguese Inflammatory Bowel Disease (IBD)
Study Group (GEDII), Porto, Portugal,Department of Gastroenterology, University
Hospital Center of Coimbra, Coimbra, Portugal
| | - Paula Ministro
- Portuguese Inflammatory Bowel Disease (IBD)
Study Group (GEDII), Porto, Portugal,Department of Gastroenterology, Tondela-Viseu
Hospital Center, Viseu, Portugal
| | - Paula Lago
- Portuguese Inflammatory Bowel Disease (IBD)
Study Group (GEDII), Porto, Portugal,Department of Gastroenterology, Hospital Santo
António, University Hospital Center of Porto, Porto, Portugal
| | - Eunice Trindade
- Portuguese Inflammatory Bowel Disease (IBD)
Study Group (GEDII), Porto, Portugal,Department of Pediatrics, São João Hospital
Center, Porto, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services
Research (CINTESIS), Porto, Portugal,Department of Community Medicine, Information
and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of
Porto, Portugal
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Strictureplasty for Crohn’s disease of the small bowel in the biologic era: long-term outcomes and risk factors for recurrence. Tech Coloproctol 2020; 24:711-720. [DOI: 10.1007/s10151-020-02208-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 04/01/2020] [Indexed: 02/08/2023]
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Lasa JS, Zubiaurre I, Rausch A, Olivera P. PLACEBO USE IN THE CONTEXT OF INFLAMMATORY BOWEL DISEASE CLINICAL TRIALS. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:87-90. [PMID: 32294741 DOI: 10.1590/s0004-2803.202000000-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/22/2019] [Indexed: 11/21/2022]
Abstract
Inflammatory bowel disease comprises two distinct conditions - Crohn's disease and ulcerative colitis - which can be treated with immunomodulators. A non-neglectable proportion of these patients will need biologic therapy, and many patients under biologic treatment will experience either primary or secondary failure. As a consequence, clinical trials evaluating new therapeutic alternatives are being developed. These trials share common features, such as being controlled with placebo. Placebo use in clinical trials is a matter of intense debate. Those who support placebo use highlight the methodologic advantages placebo-controlled trials have. Those against placebo use argue that it would be against ethical principles in clinical research to expose a patient to placebo when a valid therapeutic alternative exists. In this review, we summarize the existing arguments for and against the use of placebo in the context of inflammatory bowel disease research. We finally suggest that it is very likely that in the near future inflammatory bowel disease trials will no longer be controlled with a placebo arm, but instead they will be non-inferiority trials with an active comparator.
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Affiliation(s)
- Juan Sebastian Lasa
- Hospital Británico de Buenos Aires, Gastroenterology Department, Argentina.,CEMIC, Gastroenterology Department, Buenos Aires, Argentina
| | - Ignacio Zubiaurre
- Hospital Británico de Buenos Aires, Gastroenterology Department, Argentina
| | - Astrid Rausch
- Hospital Británico de Buenos Aires, Gastroenterology Department, Argentina
| | - Pablo Olivera
- CEMIC, Gastroenterology Department, Buenos Aires, Argentina
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Rate of Reoperation Decreased Significantly After Year 2002 in Patients With Crohn's Disease. Clin Gastroenterol Hepatol 2020; 18:898-907.e5. [PMID: 31336198 DOI: 10.1016/j.cgh.2019.07.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 06/14/2019] [Accepted: 07/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with Crohn's disease (CD) can require multiple intestinal surgeries. We examined time trends and risk factors for reoperation in patients with CD who underwent intestinal surgery, focusing on the effects of postoperative medical treatments. METHODS We performed a retrospective analysis of 1871 patients with CD who underwent initial intestinal resection at 10 tertiary care institutions in Japan, with an initial surgical date after May 1982. We collected data on the background characteristics of all patients, including Montreal Classification, smoking status, and medical therapy after surgery (tumor necrosis factor antagonists [anti-TNF] agents or immunomodulators). The primary outcome was requirement for first reoperation. Rate of reoperation was estimated using the Kaplan-Meier method, and risk factors for reoperation were identified using the Cox regression model. RESULTS The overall cumulative 5- and 10-year reoperation rates were 23.4% and 48.0%, respectively. Multivariable analysis showed that patients who underwent the initial surgery after May 2002 had a significantly lower rate of reoperation than patients who underwent surgery before April 2002 (hazard ratio [HR], 0.72; 95% CI, 0.61-0.86). Preoperative smoking (HR, 1.40; 95% CI, 1.18-1.68), perianal disease (HR, 1.50; 95% CI, 1.27-1.77), and ileocolic type of CD (HR, 1.42; 95% CI, 1.20-1.69) were significant risk factors for reoperation. Postoperative use of immunomodulators (HR, 0.60; 95% CI, 0.44-0.81) and anti-TNF therapy (HR, 0.71; 95% CI, 0.57-0.88) significantly reduced the risk. Anti-TNF was effective in the bionaive subgroup. CONCLUSIONS The rate of reoperation in patients with CD significantly decreased after May 2002. Postoperative use of anti-TNF agents might reduce the reoperation rate for bionaive patients with CD.
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Burisch J, Vardi H, Schwartz D, Friger M, Kiudelis G, Kupčinskas J, Fumery M, Gower-Rousseau C, Lakatos L, Lakatos PL, D'Incà R, Sartini A, Valpiani D, Giannotta M, Arebi N, Duricova D, Bortlik M, Chetcuti Zammit S, Ellul P, Pedersen N, Kjeldsen J, Midjord JMM, Nielsen KR, Winther Andersen K, Andersen V, Katsanos KH, Christodoulou DK, Domislovic V, Krznaric Z, Sebastian S, Oksanen P, Collin P, Barros L, Magro F, Salupere R, Kievit HAL, Goldis A, Kaimakliotis IP, Dahlerup JF, Eriksson C, Halfvarson J, Fernandez A, Hernandez V, Turcan S, Belousova E, Langholz E, Munkholm P, Odes S. Health-care costs of inflammatory bowel disease in a pan-European, community-based, inception cohort during 5 years of follow-up: a population-based study. Lancet Gastroenterol Hepatol 2020; 5:454-464. [PMID: 32061322 DOI: 10.1016/s2468-1253(20)30012-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) places a significant burden on health-care systems because of its chronicity and need for expensive therapies and surgery. With increasing use of biological therapies, contemporary data on IBD health-care costs are important for those responsible for allocating resources in Europe. To our knowledge, no prospective long-term analysis of the health-care costs of patients with IBD in the era of biologicals has been done in Europe. We aimed to investigate cost profiles of a pan-European, community-based inception cohort during 5 years of follow-up. METHODS The Epi-IBD cohort is a community-based, prospective inception cohort of unselected patients with IBD diagnosed in 2010 at centres in 20 European countries plus Israel. Incident patients who were diagnosed with IBD according to the Copenhagen Diagnostic Criteria between Jan 1, and Dec 31, 2010, and were aged 15 years or older the time of diagnosis were prospectively included. Data on clinical characteristics and direct costs (investigations and outpatient visits, blood tests, treatments, hospitalisations, and surgeries) were collected prospectively using electronic case-report forms. Patient-level costs incorporated procedures leading to the initial diagnosis of IBD and costs of IBD management during the 5-year follow-up period. Costs incurred by comorbidities and unrelated to IBD were excluded. We grouped direct costs into the following five categories: investigations (including outpatient visits and blood tests), conventional medical treatment, biological therapy, hospitalisation, and surgery. FINDINGS The study population consisted of 1289 patients with IBD, with 1073 (83%) patients from western Europe and 216 (17%) from eastern Europe. 488 (38%) patients had Crohn's disease, 717 (56%) had ulcerative colitis, and 84 (6%) had IBD unclassified. The mean cost per patient-year during follow-up for patients with IBD was €2609 (SD 7389; median €446 [IQR 164-1849]). The mean cost per patient-year during follow-up was €3542 (8058; median €717 [214-3512]) for patients with Crohn's disease, €2088 (7058; median €408 [133-1161]) for patients with ulcerative colitis, and €1609 (5010; median €415 [92-1228]) for patients with IBD unclassified (p<0·0001). Costs were highest in the first year and then decreased significantly during follow-up. Hospitalisations and diagnostic procedures accounted for more than 50% of costs during the first year. However, in subsequent years there was a steady increase in expenditure on biologicals, which accounted for 73% of costs in Crohn's disease and 48% in ulcerative colitis, in year 5. The mean annual cost per patient-year for biologicals was €866 (SD 3056). The mean yearly costs of biological therapy were higher in patients with Crohn's disease (€1782 [SD 4370]) than in patients with ulcerative colitis (€286 [1427]) or IBD unclassified (€521 [2807]; p<0·0001). INTERPRETATION Overall direct expenditure on health care decreased over a 5-year follow-up period. This period was characterised by increasing expenditure on biologicals and decreasing expenditure on conventional medical treatments, hospitalisations, and surgeries. In light of the expenditures associated with biological therapy, cost-effective treatment strategies are needed to reduce the economic burden of inflammatory bowel disease. FUNDING Kirsten og Freddy Johansens Fond and Nordsjællands Hospital Forskningsråd.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark.
| | - Hillel Vardi
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Schwartz
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; Department of Gastroenterology and Liver Diseases, Soroka Medical Centre, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gediminas Kiudelis
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Juozas Kupčinskas
- Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University, Lille, France; Lille Inflammation Research International Center LIRIC, Lille University, Lille, France
| | - Laszlo Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprem, Hungary
| | - Peter L Lakatos
- First Department of Medicine, Semmelweis University, Budapest, Hungary; Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - Renata D'Incà
- Department of Surgical, Oncological, and Gastroenterological Sciences, Azienda, University of Padua, Padua, Italy
| | - Alessandro Sartini
- Gastroenterology Unit, Bufalini Hospital Cesena, AUSL della Romagna, Rimini, Italy
| | - Daniela Valpiani
- UO Gastroenterologia ed Endoscopia Digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | | | - Naila Arebi
- Inflammatory Bowel Disease Department, Imperial College London, London, UK
| | - Dana Duricova
- Inflammatory Bowel Disease Clinical and Research Centre, ISCARE, Prague, Czech Republic
| | - Martin Bortlik
- Inflammatory Bowel Disease Clinical and Research Centre, ISCARE, Prague, Czech Republic; Institute of Pharmacology, First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | | | - Kári Rubek Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Torshavn, Faroe Islands
| | | | - Vibeke Andersen
- IRS-Center Soenderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark; Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Konstantinos H Katsanos
- Division of Gastroenterology, School of Health Sciences, University Hospital and University of Ioannina, Ioannina, Greece
| | - Dimitrios K Christodoulou
- Division of Gastroenterology, School of Health Sciences, University Hospital and University of Ioannina, Ioannina, Greece
| | - Viktor Domislovic
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Shaji Sebastian
- Hull University Teaching Hospitals NHS Trust, Hull, UK; Hull York Medical School, Hull, UK
| | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Pekka Collin
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Luisa Barros
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Fernando Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal; Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine, Porto University, Porto, Portugal
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | | | - Adrian Goldis
- Clinic of Gastroenterology, Victor Babeş University of Medicine, Timisoara, Romania
| | | | - Jens F Dahlerup
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Vicent Hernandez
- Department of Gastroenterology, Instituto de Investigación Sanitaria Galicia Sur, Hospital Alvaro Cunqueiro, Xerencia Xestion Integrada de Vigo, Vigo, Spain
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Moldova
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russia
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
| | - Selwyn Odes
- Department of Internal Medicine, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Murthy SK, Begum J, Benchimol EI, Bernstein CN, Kaplan GG, McCurdy JD, Singh H, Targownik L, Taljaard M. Introduction of anti-TNF therapy has not yielded expected declines in hospitalisation and intestinal resection rates in inflammatory bowel diseases: a population-based interrupted time series study. Gut 2020; 69:274-282. [PMID: 31196874 PMCID: PMC6984056 DOI: 10.1136/gutjnl-2019-318440] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To better understand the real-world impact of biologic therapy in persons with Crohn's disease (CD) and ulcerative colitis (UC), we evaluated the effect of marketplace introduction of infliximab on the population rates of hospitalisations and surgeries and public payer drug costs. DESIGN We used health administrative data to study adult persons with CD and UC living in Ontario, Canada between 1995 and 2012. We used an interrupted time series design with segmented regression analysis to evaluate the impact of infliximab introduction on the rates of IBD-related hospitalisations, intestinal resections and public payer drug costs over 10 years among patients with CD and 5 years among patients with UC, allowing for a 1-year transition. RESULTS Relative to what would have been expected in the absence of infliximab, marketplace introduction of infliximab did not produce significant declines in the rates of CD-related hospitalisations (OR at the last observation quarter 1.06, 95% CI 0.811 to 1.39) or intestinal resections (OR 1.10, 95% CI 0.810 to 1.50), or in the rates of UC-related hospitalisations (OR 1.22, 95% CI 1.07 to 1.39) or colectomies (OR 0.933, 95% CI 0.54 to 1.61). The findings were similar among infliximab users, except that hospitalisation rates declined substantially among UC patients following marketplace introduction of infliximab (OR 0.515, 95% CI 0.342 to 0.777). There was a threefold rise over expected trends in public payer drug cost among patients with CD following infliximab introduction (OR 2.98,95% CI 2.29 to 3.86), suggesting robust market penetration in this group, but no significant change among patients with UC (OR 1.06, 95% CI 0.955 to 1.18). CONCLUSIONS Marketplace introduction of infliximab has not yielded anticipated reductions in the population rates of IBD-related hospitalisations or intestinal resections, despite robust market penetration among patients with CD. Misguided use of infliximab in CD patients and underuse of infliximab in UC patients may largely explain our study findings.
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Affiliation(s)
- Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada,Clinical Epidemiology Program, OttawaHospital Research Institute, Ottawa, Ontario, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Eric I Benchimol
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada,ICES uOttawa, Ottawa, Ontario, Canada,Children’sHospital of Eastern Ontario (CHEO) Inflammatory Bowel Disease Centre, Divisionof Gastroenterology, Hepatology and Nutrition, Ottawa, Ontario, Canada,Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada,CHEOResearch Institute, Ottawa, Ontario, Canada
| | - Charles N Bernstein
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Health Sciences Centre Winnipeg, Winnipeg, Manitoba, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada,Foothills Medical Centre, Division of Gastroenterology and Hepatology, Calgary, Alberta, Canada
| | - Jeffrey D McCurdy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada,Clinical Epidemiology Program, OttawaHospital Research Institute, Ottawa, Ontario, Canada
| | - Harminder Singh
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Health Sciences Centre Winnipeg, Winnipeg, Manitoba, Canada
| | - Laura Targownik
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Health Sciences Centre Winnipeg, Winnipeg, Manitoba, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, OttawaHospital Research Institute, Ottawa, Ontario, Canada,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Longitudinal Trends in the Direct Costs and Health Care Utilization Ascribable to Inflammatory Bowel Disease in the Biologic Era: Results From a Canadian Population-Based Analysis. Am J Gastroenterol 2020; 115:128-137. [PMID: 31895723 DOI: 10.14309/ajg.0000000000000503] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The prevalence of inflammatory bowel disease (IBD) is increasing. The total direct costs of IBD have not been assessed on a population-wide level in the era of biologic therapy. DESIGN We identified all persons with IBD in Manitoba between 2005 and 2015, with each matched to 10 controls on age, sex, and area of residence. We enumerated all hospitalizations, outpatient visits and prescription medications including biologics, and their associated direct costs. Total and per capita annual IBD-attributable costs and health care utilization (HCU) were determined by taking the difference between the costs/HCU accrued by an IBD case and their controls. Generalized linear modeling was used to evaluate trends in direct costs and Poisson regression for trends in HCU. RESULTS The number of people with IBD in Manitoba increased from 6,323 to 7,603 between 2005 and 2015. The total per capita annual costs attributable to IBD rose from $3,354 in 2005 to $7,801 in 2015, primarily driven by an increase in per capita annual anti-tumor necrosis factor costs, which rose from $181 in 2005 to $5,270 in 2015. There was a significant decline in inpatient costs for CD ($99 ± 25/yr. P < 0.0001), but not for ulcerative colitis ($8 increase ±$18/yr, P = 0.63). DISCUSSION The direct health care costs attributable to IBD have more than doubled over the 10 years between 2005 and 2015, driven mostly by increasing expenditures on biological medications. IBD-attributable hospitalization costs have declined modestly over time for persons with CD, although no change was seen for patients with ulcerative colitis.
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Efficiency and safety of one-year anti-TNF-α treatment in Crohn's disease: a Polish single-centre experience. GASTROENTEROLOGY REVIEW 2019; 15:156-160. [PMID: 32550949 PMCID: PMC7294981 DOI: 10.5114/pg.2019.90079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/08/2019] [Indexed: 12/11/2022]
Abstract
Introduction Anti-TNF-α therapy of Crohn’s disease (CD) represents considerable progress in inflammatory bowel disease (IBD) treatment; however, many patients still require surgical intervention. The Polish National Insurance Fund currently only covers up to 2 years of infliximab (IFX) therapy in CD patients and 1 year of adalimumab (ADA). Aim To estimate the effectiveness and side effects of the anti-TNF-α Polish therapeutic program in CD patients. Material and methods In this retrospective study, medical documentation of 80 CD patients treated with anti-TNF-α (IFX or ADA) was analysed. Fifty-two patients finished 1 year of therapy, and 28 individuals did not complete it due to lack of response to treatment or severe side effects. Results After treatment, 27 (67.50%) patients achieved a semi-annual remission and 14 (35%) achieved yearly remission. Twenty percent of patients experienced severe side effects such as anaphylactic shock, pneumonia, shingles, or upper respiratory tract infections. A strong negative correlation between the number of patients in remission and the period since therapy termination (r = –0.996, p < 0.001) was found. During the 1-year follow-up, 20 patients were re-enrolled in the biological therapy program (the median time to next therapy was 231 days IQR: 126.5–300.5) Conclusions Anti-TNF-α treatment in CD is relatively safe. The restricted time period of the therapy affects the clinical course of the disease and entails the need to resume biological therapy.
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Yu ZL, Lin DZ, Hu JC, Chen YF, Cai ZR, Zou YF, Ke J, Guo XF, Lan P, Wu XJ. Laparoscopic Surgery for Complex Crohn's Disease: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2019; 29:1397-1404. [PMID: 31414963 DOI: 10.1089/lap.2019.0398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Zhao-liang Yu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - De-zheng Lin
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Ambulatory Surgery Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jian-cong Hu
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Ambulatory Surgery Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu-feng Chen
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ze-rong Cai
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yi-feng Zou
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jia Ke
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xue-feng Guo
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Ambulatory Surgery Center, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ping Lan
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-jian Wu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Abstract
Inflammatory bowel disease has become a growing concern worldwide. The chronic and progressive nature of inflammatory bowel disease poses significant challenges to the treatment and management of affected patients, straining health care resources. Therapeutic options and optimal management strategies have evolved dramatically. The treat-to-target strategy has shifted focus toward identifiable and attainable treatment targets and with the ability to optimize tight control. Advancements in our understanding of the pathophysiology led to therapeutic mechanisms that have a more narrowed focus toward gut-specific targets, improving safety profiles.
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Affiliation(s)
- Derrick D Eichele
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE 68198-2000, USA.
| | - Renee Young
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE 68198-2000, USA
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45
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Candido FD, Fiorino G, Spadaccini M, Danese S, Spinelli A. Are Surgical Rates Decreasing in the Biological Era In IBD? Curr Drug Targets 2019; 20:1356-1362. [PMID: 31465283 DOI: 10.2174/1389450120666190426165325] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 02/12/2019] [Accepted: 03/15/2019] [Indexed: 02/08/2023]
Abstract
Crohn's Disease (CD) and Ulcerative Colitis (UC), known as Inflammatory Bowel Diseases (IBD), are multifactorial, potentially debilitating diseases with probable genetic heterogeneity and unknown etiology. During the disease course of IBD, periods of inflammatory activity alternate with periods of remission. Severe complications in IBD often result in surgery. In the last two decades, major advances in medical treatment have changed the management of IBD. The advent of monoclonal antibodies targeting cytokines and adhesion molecules has brought a revolution in the treatment of IBD refractory to conventional therapy. However, it is not well established if these treatments could influence the long-term course of the diseases and the need for surgical treatment, though they have no severe adverse effects and improve quality of life. It has been shown that in the era of biologic agents, there has been a relative reduction in surgery rate for mild disease presentation, while the incidence of emergency or urgent surgery both for CD and UC remains unmodified. We summarized key data about current surgical rates in IBD after the advent of biologic agents.
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Affiliation(s)
- Francesca Di Candido
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Marco Spadaccini
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
| | - Antonino Spinelli
- Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Science, Humanitas University, Rozzano, Milan, Italy
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46
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Schütz L, Radke M, Menzel S, Däbritz J. Long-term implications of structured transition of adolescents with inflammatory bowel disease into adult health care: a retrospective study. BMC Gastroenterol 2019; 19:128. [PMID: 31324228 PMCID: PMC6642593 DOI: 10.1186/s12876-019-1046-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022] Open
Abstract
Background We aimed to evaluate the long-term clinical and socioeconomic outcome of structured transition care in adolescents with inflammatory bowel disease (IBD). Methods We compared the clinical long-term course of 24 patients with and 11 patients without structured transition care within 24 months before and 24 months after transfer from paediatric to adult health care. Socio-economic parameters and quality of life were assessed by IBD Questionnaire (IBDQ-32) and additional items. Treatment costs were calculated for medication, surgery and hospitalisation. Results The percentage of transfer group patients with an IBD-related intestinal complication was higher compared to the transition group (64% vs. 21%, p = 0.022). We also found a tendency towards a higher number of IBD-related surgery in the transfer group compared to the transition group (46% vs. 13%, p = 0.077). Transfer group patients received higher mean cumulated doses of radiation compared with the transition group (4.2 ± 5.3 mSv vs. 0.01 ± 0.01 mSv, p = 0.036). Delayed puberty was only noted in the transfer group (27%, p = 0.025). Mean expenditures for surgeries and hospitalisation tended to be lower in the transition group compared to transfer group patients (744 ± 630€ vs. 2,691 ± 4,150€, p = 0.050). Sexual life satisfaction was significantly higher (p = 0.023) and rates of loose bowel movements tended to be lower (p = 0.053) in the transition group. Conclusions Structured transition of adolescents with IBD from paediatric into adult health care can lead to important clinical and economic benefits. Electronic supplementary material The online version of this article (10.1186/s12876-019-1046-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lukas Schütz
- Department of Paediatrics, University Hospital Rostock, Ernst-Heydemann-Str. 8, D-18057, Rostock, Germany
| | - Michael Radke
- Department of Paediatrics, University Hospital Rostock, Ernst-Heydemann-Str. 8, D-18057, Rostock, Germany.,Department of Paediatrics, Klinikum Westbrandenburg, Potsdam, Germany
| | - Stephan Menzel
- Ernst-von-Bergmann Outpatient Clinic, Gastroenterology & Hepatology, Potsdam, Germany
| | - Jan Däbritz
- Department of Paediatrics, University Hospital Rostock, Ernst-Heydemann-Str. 8, D-18057, Rostock, Germany.
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47
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FAN Y, LYU B. [Research frontier of inflammatory bowel disease]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2019; 48:334-341. [PMID: 31496167 PMCID: PMC8800741 DOI: 10.3785/j.issn.1008-9292.2019.06.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
| | - Bin LYU
- 吕宾(1963-), 男, 硕士, 主任医师, 教授, 博士生导师, 主要从事食管疾病和消化道早期癌症临床研究及肠易激综合征基础研究; E-mail:
,
https://orcid.org/0000-0002-6247-571X
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48
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Kolehmainen S, Lepistö A, Färkkilä M. Impact of anti-TNF-alpha therapy on colectomy rate and indications for colectomy in ulcerative colitis: comparison of two patient cohorts from 2005 to 2007 and from 2014 to 2016 . Scand J Gastroenterol 2019; 54:707-711. [PMID: 31136207 DOI: 10.1080/00365521.2019.1620326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: The aim of this study is to assess the impact of biological therapy on the colectomy rate and indications for colectomy in ulcerative colitis (UC) at Helsinki University Hospital (HUH) catchment area in Finland. Methods: This study was conducted retrospectively by comparing two cohorts of UC and indeterminate colitis patients that underwent colectomy in a single centre in HUH during the years 2005-2007 and 2014-2016. All patient data were collected from hospital patient records. Results: In 2005-2007 and 2014-2016, respectively, 2.3 and 18.8% of patients had received biological therapy and more specifically 2.3 and 10.5% infliximab within 3 months prior to colectomy. Colectomy rates were 8.6 (7.2-10.2) and 5.1 (4.3-6.1)/1.000 patient-years (p < .001). During 2005-2007 and 2014-2016, the indications for colectomy were: refractory disease 79.1 and 79.7%, dysplasia 16.3 and 12.8%, cancer 2.3 and 3.0% and other reasons 2.3 and 4.5%, respectively. Emergency colectomy covered 8.5 and 9.8% of the operations. Conclusions: In addition to the markedly increased use of biological therapy during the time preceding colectomy, we noticed a significantly decreased rate of surgery but no changes in the indications for colectomy. Biological therapy seems to have had a favourable effect on the colectomy rate. Even so, the main indication for surgery is still a refractory disease, suggesting urgent need for better treatment options.
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Affiliation(s)
- Sara Kolehmainen
- University of Helsinki , Helsinki , Finland.,Department of Gastroenterology, Helsinki University Hospital , Helsinki , Finland
| | - Anna Lepistö
- Department of Colorectal Surgery, Helsinki University Hospital , Helsinki , Finland
| | - Martti Färkkilä
- University of Helsinki , Helsinki , Finland.,Department of Gastroenterology, Helsinki University Hospital , Helsinki , Finland
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49
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Wong DJ, Roth EM, Feuerstein JD, Poylin VY. Surgery in the age of biologics. Gastroenterol Rep (Oxf) 2019; 7:77-90. [PMID: 30976420 PMCID: PMC6454839 DOI: 10.1093/gastro/goz004] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 02/07/2023] Open
Abstract
Since the introduction of the first anti-tumor necrosis factor antibodies in the late 1990s, biologic therapy has revolutionized the medical treatment of patients with inflammatory bowel disease (IBD). Nevertheless, surgery continues to play a significant role in treating IBD patients. Rates of intestinal resection in patients with Crohn's disease or colectomy in ulcerative colitis are reducing but not substantially over the long term. An increasing variety of biologic medications are now available to treat IBD patients in various clinical situations. Consequently, a number of questions persist about how biologic medications affect the need for surgery and overall course in IBD patients. Given the trend for earlier and more frequent use of biologic medications in IBD patients, a working knowledge of the effects of these medications on surgical decision-making and outcomes is essential for the practicing colorectal surgeon and gastroenterologist. This review seeks to summarize the relevant literature surrounding biologic use and IBD surgery with a focus on the effect of biologics on the frequency, type and complications of surgery in this 'age of biologics'.
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Affiliation(s)
- Daniel J Wong
- Department of Surgery, Division of Colon & Rectum Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Eve M Roth
- Department of Surgery, Division of Colon & Rectum Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph D Feuerstein
- Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Vitaliy Y Poylin
- Department of Surgery, Division of Colon & Rectum Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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50
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Burisch J, Kiudelis G, Kupcinskas L, Kievit HAL, Andersen KW, Andersen V, Salupere R, Pedersen N, Kjeldsen J, D'Incà R, Valpiani D, Schwartz D, Odes S, Olsen J, Nielsen KR, Vegh Z, Lakatos PL, Toca A, Turcan S, Katsanos KH, Christodoulou DK, Fumery M, Gower-Rousseau C, Zammit SC, Ellul P, Eriksson C, Halfvarson J, Magro FJ, Duricova D, Bortlik M, Fernandez A, Hernández V, Myers S, Sebastian S, Oksanen P, Collin P, Goldis A, Misra R, Arebi N, Kaimakliotis IP, Nikuina I, Belousova E, Brinar M, Cukovic-Cavka S, Langholz E, Munkholm P. Natural disease course of Crohn's disease during the first 5 years after diagnosis in a European population-based inception cohort: an Epi-IBD study. Gut 2019; 68:423-433. [PMID: 29363534 DOI: 10.1136/gutjnl-2017-315568] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 12/19/2017] [Accepted: 01/02/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The Epi-IBD cohort is a prospective population-based inception cohort of unselected patients with inflammatory bowel disease from 29 European centres covering a background population of almost 10 million people. The aim of this study was to assess the 5-year outcome and disease course of patients with Crohn's disease (CD). DESIGN Patients were followed up prospectively from the time of diagnosis, including collection of their clinical data, demographics, disease activity, medical therapy, surgery, cancers and deaths. Associations between outcomes and multiple covariates were analysed by Cox regression analysis. RESULTS In total, 488 patients were included in the study. During follow-up, 107 (22%) patients received surgery, while 176 (36%) patients were hospitalised because of CD. A total of 49 (14%) patients diagnosed with non-stricturing, non-penetrating disease progressed to either stricturing and/or penetrating disease. These rates did not differ between patients from Western and Eastern Europe. However, significant geographic differences were noted regarding treatment: more patients in Western Europe received biological therapy (33%) and immunomodulators (66%) than did those in Eastern Europe (14% and 54%, respectively, P<0.01), while more Eastern European patients received 5-aminosalicylates (90% vs 56%, P<0.05). Treatment with immunomodulators reduced the risk of surgery (HR: 0.4, 95% CI 0.2 to 0.6) and hospitalisation (HR: 0.3, 95% CI 0.2 to 0.5). CONCLUSION Despite patients being treated early and frequently with immunomodulators and biological therapy in Western Europe, 5-year outcomes including surgery and phenotype progression in this cohort were comparable across Western and Eastern Europe. Differences in treatment strategies between Western and Eastern European centres did not affect the disease course. Treatment with immunomodulators reduced the risk of surgery and hospitalisation.
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Affiliation(s)
- Johan Burisch
- Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark
| | - Gediminas Kiudelis
- Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Limas Kupcinskas
- Institute for Digestive Research, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | | | - Vibeke Andersen
- Medical Department, Regional Hospital of Viborg, Viborg, Midtjylland, Denmark.,Focused research unit for Molecular Diagnostic and Clinical Research (MOK), IRS-Center Sonderjylland, Hospital of Southern Jutland, Aabenraa, Denmark
| | - Riina Salupere
- Division of Gastroenterology, Tartu University Hospital, University of Tarty, Tartu, Estonia
| | - Natalia Pedersen
- Gastroenterology Department, Slagelse Hospital, Slagelse, Sjaelland, Denmark
| | - Jens Kjeldsen
- Gastroenterology Department, Odense University Hospital, Odense, Denmark
| | - Renata D'Incà
- Department of Surgical, Oncological and Gastroenterological Sciences, Azienda, University of Padua, Padova, Italy
| | - Daniela Valpiani
- U.O. Gastroenterologia ed Endoscopia digestiva, Hospital Morgagni Pierantoni, Forlì, Italy
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Selwyn Odes
- Department of Gastroenterology and Hepatology, Soroka Medical Center and Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jóngerð Olsen
- Medical Department, The National Hospital of the Faroe Islands, Thorshavn, Faroe Islands
| | - Kári Rubek Nielsen
- Medical Department, The National Hospital of the Faroe Islands, Thorshavn, Faroe Islands
| | - Zsuzsanna Vegh
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Peter Laszlo Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.,Division of Gastroenterology, McGill University Health Center, Montreal, Canada
| | - Alina Toca
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | - Svetlana Turcan
- Department of Gastroenterology, State University of Medicine and Pharmacy of the Republic of Moldova, Chisinau, Republic of Moldova
| | | | | | - Mathurin Fumery
- Gastroenterology Unit, Epimad Registry, CHU Amiens Sud, Avenue Laennec-Salouel, Amiens University Hospital, Amiens, France
| | - Corinne Gower-Rousseau
- Public Health, Epidemiology and Economic Health, Registre Epimad, Lille University and Hospital, Lille, France.,Lille Inflammation Research International Center LIRIC, Lille University, Lille, France
| | | | - Pierre Ellul
- Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Fernando Jose Magro
- Department of Gastroenterology, Centro Hospitalar de São João EPE, Porto, Portugal.,Department of Biomedicine, Institute of Pharmacology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Dana Duricova
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, ISCARE, Prague, Czech Republic.,Institute of Pharmacology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | | | - Vicent Hernández
- Department of Gastroenterology, Hospital Alvaro Cunqueiro. Instituto Investigación Sanitaria Galicia Sur. EOXI de Vigo, Vigo, Spain
| | - Sally Myers
- IBD Unit, Hull and East Yorkshire NHS Trust, Hull, UK
| | | | - Pia Oksanen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland.,University of Tampere, Tampere, Finland
| | | | - Adrian Goldis
- Clinic of Gastroenterology, University of Medicine 'Victor Babes', Timisoara, Romania
| | - Ravi Misra
- IBD Department, Imperial College London, London, UK
| | - Naila Arebi
- IBD Department, Imperial College London, London, UK
| | | | - Inna Nikuina
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Elena Belousova
- Department of Gastroenterology, Moscow Regional Research Clinical Institute, Moscow, Russian Federation
| | - Marko Brinar
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Silvija Cukovic-Cavka
- Division of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb, Croatia
| | - Ebbe Langholz
- Department of Gastroenterology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Pia Munkholm
- Department of Gastroenterology, Nordsjællands Hospital, University of Copenhagen, Frederikssund, Denmark
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