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Ghosh CK, Islam S, Tabassum N, Mohiuddin SA, Hossain MM, Sarkar A, Bari A. Quality of Life of Patients With Inflammatory Bowel Disease in Bangladesh. Cureus 2023; 15:e39929. [PMID: 37283595 PMCID: PMC10239544 DOI: 10.7759/cureus.39929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction The importance of maintaining quality of life in managing inflammatory bowel disease (IBD) has increased in recent years. However, there is a lack of studies examining the health-related quality of life (HRQoL) of IBD patients in Bangladesh. Methodology This cross-sectional study was carried out in the IBD clinic, Bangabandhu Sheikh Mujib Medical University (BSMMU) from 2020 to 2022. Data were collected from both ulcerative colitis (UC) and Crohn's disease (CD) patients. HRQoL was recorded on the EuroQol 5 Dimension 5 Level (EQ-5D-5L) questionnaire. Statistical analysis was done by Statistical Analysis Software (SAS, SAS Institute, Cary, NC). Results The mean age was 36.3 years. The majority of the patients were male and had low incomes. People with more monthly income, more frequent relapse, extraintestinal involvement, and moderate to severe disease had lower utility index (p = 0.01, 0.01, 0.0004, and <0.0001, respectively). Among the five individual components, only usual activity was lower in UC patients (p = 0.03); all the other components and consequently the overall utility index did not vary between UC and CD. The visual analog scale (VAS) score seemed to be comparable in UC and CD patients. Conclusion In more severe and frequently relapsing cases of IBD, the utility index representing HRQoL was found to be lower. Comparatively, the HRQoL was mostly similar between patients with UC and CD. Additionally, the mean utility score in IBD patients was higher than that observed in patients with type 2 diabetes mellitus in Bangladesh.
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Affiliation(s)
- Chanchal Kumar Ghosh
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Sumona Islam
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Nowrin Tabassum
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Syed Arafat Mohiuddin
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Md Mosarrof Hossain
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Aditi Sarkar
- Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Amit Bari
- Department of Nephrology, Kidney Foundation Hospital and Research Institute, Dhaka, BGD
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Barreiro-de Acosta M, Molero A, Artime E, Díaz-Cerezo S, Lizán L, de Paz HD, Martín-Arranz MD. Epidemiological, Clinical, Patient-Reported and Economic Burden of Inflammatory Bowel Disease (Ulcerative colitis and Crohn's disease) in Spain: A Systematic Review. Adv Ther 2023; 40:1975-2014. [PMID: 36928496 PMCID: PMC10129998 DOI: 10.1007/s12325-023-02473-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION This study describes the epidemiological, clinical, patient-reported and economic burden of inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), in Spain. METHODS A systematic review was performed of observational studies reporting the epidemiological, clinical, patient-reported and economic burden of IBD in the Spanish population, from 2011 to 2021. Original articles and conference abstracts published in English or Spanish were eligible. RESULTS A total of 45 publications were included in the review. The incidence of IBD in adults ranged from 9.6 to 44.3 per 100,000 inhabitants (4.6 to 18.5 for CD and 3.4 to 26.5 for UC). The incidence increased between 1.5- and twofold from 2000 to 2016 (regionally). Up to 6.0% (CD) and 3.0% (UC) IBD-associated mortality was reported. Disease onset predominantly occurs between 30 and 40 years (more delayed for UC than CD). Most frequently reported gastrointestinal manifestations are rectal bleeding in UC and weight loss in CD. Extraintestinal manifestations (EIM) have been described in up to 47.4% of patients with CD and 48.1% of patients with UC. Psychiatric comorbidities were frequently reported in both CD and UC (depression up to 20% and anxiety up to 11%). Reduced health-related quality of life (HRQoL) compared to the general population was reported. Significant symptomatology was associated with high levels of anxiety, depression, stress and lower HRQoL. Main healthcare resources reported were emergency department visits (24.0%), hospitalization (14.7%), surgery (up to 11%) and use of biologics (up to 60%), especially in CD. Direct and indirect annual costs per patient with UC were €1754.1 and €399.3, respectively. CONCLUSION Patients with CD and UC present a high disease burden which negatively impacts their HRQoL, leading to elevated use of resources.
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Affiliation(s)
- Manuel Barreiro-de Acosta
- Gastroenterology Department, Hospital Clínico Universitario de Santiago de Compostela, Santiago, Spain
| | | | | | | | - Luis Lizán
- Health Outcomes Research Department, Outcomes'10, S.L., Castellón de la Plana, Spain
- Department of Medicine, Jaume I University, Castellón de la Plana, Spain
| | - Héctor David de Paz
- Health Outcomes Research Department, Outcomes'10, S.L., Castellón de la Plana, Spain
| | - María Dolores Martín-Arranz
- Department of Gastroenterology of La Paz University Hospital, School of Medicine, Hospital La Paz Institute for Health Research, La Paz Hospital, Universidad Autónoma de Madrid, Madrid, Spain
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Rosa I, Conti C, Zito L, Efthymakis K, Neri M, Porcelli P. Has the COVID-19 Pandemic Worsened Health-Related Quality of Life of Patients with Inflammatory Bowel Disease? A Longitudinal Disease Activity-Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1103. [PMID: 36673856 PMCID: PMC9859077 DOI: 10.3390/ijerph20021103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 12/31/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
The present longitudinal study aimed to investigate the burden of disease activity change on health-related quality of life (HRQoL) of patients with inflammatory bowel disease (IBD) during the two different pandemic waves in 2020 and 2021. A sample of 221 IBD patients (recruited during March-May 2020 for T0 and March-May 2021 for T1) was included. The psychological impact of the COVID-19 pandemic (Impact of Event Scale-Revised (IES-R)) and HRQoL (Inflammatory Bowel Disease Questionnaire (IBDQ)) were assessed. Post-traumatic COVID-19-related symptoms (IES-R) were not significantly different across the disease activity-related groups. Conversely, IBDQ was consistently higher in patients with persistent, quiescent disease activity compared to the other groups, as expected. Even after controlling for baseline IES-R, repeated-measures ANCOVA showed a non-significant main effect of time (p = 0.60) but a significant time-per-group interaction effect with a moderate effect size (η2 = 0.08). During the two different phases of pandemic restrictions, IBD-specific HRQoL was modified by disease-related factors such as disease activity, rather than by the post-traumatic symptoms of COVID-19. This lends further weight to the need for developing an evidence-based, integrated, biopsychosocial model of care for patients with IBD to identify subjective and objective factors that affect the burden of disease.
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Affiliation(s)
- Ilenia Rosa
- Department of Dynamic and Clinical Psychology, and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Chiara Conti
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
| | - Luigia Zito
- Department of Dynamic and Clinical Psychology, and Health Studies, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Konstantinos Efthymakis
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
| | - Matteo Neri
- Department of Medicine and Aging Sciences, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
| | - Piero Porcelli
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, 66100 Chieti, Italy
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Bessissow T, Nguyen GC, Tarabain O, Peyrin-Biroulet L, Foucault N, McHugh K, Ruel J. Impact of adalimumab on disease burden in moderate-to-severe ulcerative colitis patients: The one-year, real-world UCanADA study. World J Gastroenterol 2022; 28:5058-5075. [PMID: 36160646 PMCID: PMC9494926 DOI: 10.3748/wjg.v28.i34.5058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/27/2022] [Accepted: 08/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A gap remains in documenting the impact of anti-tumor necrosis factor therapy on disease burden in ulcerative colitis (UC) patients treated in a real-world setting. The use of patient-reported outcomes (PROs) has been discussed as a primary endpoint in the context of the FDA PRO Guidance, for labelling purposes. Specifically, the efficacy and safety of adalimumab have been demonstrated in pivotal trials; however, data are needed to understand how clinical results translate into improvements in key aspects of the daily lives of UC patients, such as symptoms, health-related quality of life (HRQoL), and disability.
AIM To assess real-world effectiveness of adalimumab on PRO measures in patients with moderate-to-severe UC.
METHODS UCanADA was a single arm, prospective, 1-year multicenter Canadian post-marketing observational study in which multiple PRO questionnaires were completed—with psychologic distress/depression symptoms as the primary endpoint—by patients with moderate-to-severe UC. Assessments were performed during patients’ routine care visit schedule, which was at the initiation of adalimumab (baseline), after induction (approximately 8 wk), and 52 wk after baseline. Additional optional assessments between weeks 8 and 52 were collected at least once but no more than two times during this period. Serious safety events and per-protocol adverse events were collected.
RESULTS From 23 Canadian centres, 100 patients were enrolled and 48 completed the study. Measured with the Patient Health Questionnaire–9 items at week 52, 61.5% (40/65) [95% confidence interval (CI): 49.7%-73.4%] of the patients improved in psychologic distress/depression symptoms, which was slightly higher in completers [65.9% (29/44); 95%CI: 51.9%-79.9%)]. At week 52, clinical response and clinical remission were achieved respectively by 65.7% (44/73) and 47.8% (32/73) of the patients. The odds of improving depressive symptoms for those achieving a clinical remission at week 52 was 7.94 higher compared with those not achieving a clinical remission (CI: 1.42, 44.41; P = 0.018). Significant changes from baseline to weeks 8 and 52 were observed in disability, HRQoL, and fatigue. Meaningful improvement was reported in work impairment.
CONCLUSION At week 52, over 60% of the UCanADA patients had depressive symptoms significantly reduced, as well as HRQoL, fatigue symptoms, and work impairment improved. No new safety signals were detected.
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Affiliation(s)
- Talat Bessissow
- Department of Medicine, McGill University Health Center, Montreal H3G 1A4, Quebec, Canada
| | - Geoffrey C Nguyen
- Mount Sinai Hospital Inflammatory Bowel Disease Centre, Toronto M5T 3L9, Ontario, Canada
| | - Osman Tarabain
- Dr. O. Tarabain Clinic, Windsor N8W 1E6, Ontario, Canada
| | | | | | - Kevin McHugh
- AbbVie Corporation, Saint-Laurent H4S 1Z1, Quebec, Canada
| | - Joannie Ruel
- Department of Medicine, Sherbrooke University Hospital Center, Sherbrooke J1H 5N4, Quebec, Canada
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Sood A, Singh A, Mahajan R, Midha V, Bernstein CN, Rubin DT. (Re)Appraising Remission in Ulcerative Colitis. Inflamm Bowel Dis 2022:6653351. [PMID: 35917172 DOI: 10.1093/ibd/izac170] [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: 02/14/2022] [Indexed: 12/09/2022]
Abstract
As the therapeutic targets in ulcerative colitis (UC) shift from control of symptoms to mucosal healing and prevention of disease complications like disability, colectomy, and cancer, the definition of remission has evolved. The current definition of clinical remission is variable and is determined by the clinical context in which it is being used. This results in skepticism and uncertainty about the true meaning of the term "clinical remission." In this review, the authors reexamine the definition of clinical remission and propose a novel approach to define remission in UC.
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Affiliation(s)
- Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Charles N Bernstein
- IBD Clinical and Research Centre and Section of Gastroenterology, Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
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Effect of golimumab on health-related quality of life, other patient-reported outcomes and healthcare resource utilization in patients with moderate-to-severe ulcerative colitis: a real-world multicenter, noninterventional, observational study in Greece. Eur J Gastroenterol Hepatol 2021; 33:e615-e624. [PMID: 34034278 DOI: 10.1097/meg.0000000000002182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS This real-world study assessed the impact of golimumab on health-related quality of life (HRQoL) and other patient-reported outcomes (PROs) in patients with ulcerative colitis over 12 months in Greece. METHODS GO-LIFE was a noninterventional, prospective, multicenter, 12-month study. Patients who had moderately-to-severely active ulcerative colitis were naïve to antitumor necrosis factor (anti-TNFα) therapy and had failed previous conventional therapy. Patients received golimumab as per label. The primary endpoint was patients achieving inflammatory bowel disease questionnaire 32-item (IBDQ-32) remission at 12 months. Secondary endpoints, at 6 and 12 months, included patients achieving IBDQ-32 response; the mean change in the treatment satisfaction questionnaire for medication (TSQM) and the work productivity and activity impairment in ulcerative colitis (WPAI:UC) questionnaires; changes in healthcare utilization; patients achieving clinical response and remission; adherence rates and the percentage of patients who discontinued golimumab. RESULTS IBDQ-32 remission was achieved by 76.9% of patients at 12 months. Mean changes in all TSQM and WPAI:UC domain scores at 12 months were statistically significant. Clinical remission was achieved by 49.4 and 50.6% of patients at 6 and 12 months, and clinical response by 59.3 and 56.8%, respectively. All patients but one (80/81) had high adherence (≥80%) to golimumab treatment over 12 months. Ulcerative colitis-related health care resource utilization was reduced during the follow-up period. CONCLUSIONS In real-world settings, treatment with golimumab resulted in meaningful improvements in HRQoL and other PROs, and in disease activity at 6 and 12 months in patients with moderately-to-severely active ulcerative colitis who were naïve to anti-TNFa therapy.
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Ghosh S, Sanchez Gonzalez Y, Zhou W, Clark R, Xie W, Louis E, Loftus EV, Panes J, Danese S. Upadacitinib Treatment Improves Symptoms of Bowel Urgency and Abdominal Pain, and Correlates With Quality of Life Improvements in Patients With Moderate to Severe Ulcerative Colitis. J Crohns Colitis 2021; 15:2022-2030. [PMID: 34107013 PMCID: PMC8684481 DOI: 10.1093/ecco-jcc/jjab099] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Bowel urgency and abdominal pain are impactful, yet under-appreciated ulcerative colitis symptoms and not commonly assessed in clinical trials. We evaluated how these symptoms may improve with upadacitinib treatment and correlate with clinical and health-related quality of life [HRQOL] outcomes in the phase 2b U-ACHIEVE study. METHODS Patients aged 18-75 years, with moderately to severely active ulcerative colitis, were randomised to receive placebo or upadacitinib (7.5, 15, 30, or 45 mg once daily [QD]). Bowel urgency and abdominal pain were evaluated at baseline and Weeks 2, 4, 6, and 8. Week 8 correlations were evaluated between bowel urgency/abdominal pain with clinical [Mayo subscores and high-sensitivity C-reactive protein and faecal calprotectin measurements] and HRQOL outcomes [Inflammatory Bowel Disease Questionnaire and 36-Item Short Form Health Survey scores]. RESULTS A greater proportion of patients [n = 250] reported no bowel urgency and less abdominal pain with upadacitinib treatment compared with placebo, with improvements observed as early as 2 weeks. At Week 8, patients receiving the 45-mg QD dose had the greatest improvements versus placebo, with 46% reporting no bowel urgency [vs 9%; p ≤ 0.001] and 38% reporting no abdominal pain [vs 13%; p = 0.015]. At Week 8, moderate correlations were found between bowel urgency or abdominal pain and most clinical and HRQOL outcomes. CONCLUSIONS Induction treatment with upadacitinib demonstrated significant reductions in bowel urgency and abdominal pain compared with placebo. These symptoms also correlate to clinical and HRQOL outcomes, supporting their use to monitor disease severity and other treatment outcomes.
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Affiliation(s)
- Subrata Ghosh
- College of Medicine and Health, University College Cork, Cork, Ireland,Corresponding author: Subrata Ghosh, MD, FRCP, FRCPE, FRCPC, College of Medicine and Health, University College Cork, Cork, Ireland T12 K8AF. Tel.: +44 7391 619 920;
| | - Yuri Sanchez Gonzalez
- Department of Health Economics and Outcomes Research, AbbVie Inc., North Chicago, IL, USA
| | - Wen Zhou
- Department of Clinical Development, AbbVie Inc., North Chicago, IL, USA
| | - Ryan Clark
- Department of Health Economics and Outcomes Research, AbbVie Inc., North Chicago, IL, USA
| | - Wangang Xie
- Department of Data and Statistical Sciences, AbbVie Inc., North Chicago, IL, USA
| | - Edouard Louis
- Department of Gastroenterology, University Hospital CHU of Liège, Liège, Belgium
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Julian Panes
- Department of Gastroenterology, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Silvio Danese
- Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
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Teich N, Grümmer H, Jörgensen E, Liceni T, Holtkamp-Endemann F, Fischer T, Hohenberger S. Golimumab improves work productivity in patients suffering from moderate to severe ulcerative colitis: results of a prospective study over 24 months. BMC Gastroenterol 2021; 21:161. [PMID: 33845784 PMCID: PMC8042988 DOI: 10.1186/s12876-021-01747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ulcerative colitis (UC) is a chronic inflammatory bowel disease with recurrent episodes of debilitating symptoms negatively affecting work productivity and health-related quality of life (HRQoL). The use of biologics in UC treatment improves work and HRQoL but prospective long-term data concerning the treatment with TNFα inhibitor golimumab in UC patients are still rare. Therefore, our study aimed to evaluate the change in work productivity, capacity for daily activities and HRQoL in UC patients treated with golimumab in Germany. METHODS Using the Work Productivity and Activity Impairment questionnaire, the change in work productivity and in capacity for daily activities after 3 months and over the whole observational period of 24 months were assessed (both primary endpoints). Disease-specific and health-related quality of life (QoL) were analyzed with the Inflammatory Bowel Disease Questionnaire (IBDQ), the Short-Form 12 Health Survey Questionnaire (SF-12), and the Partial Mayo Score (secondary endpoints). Further, disease-related hospitalization rates were assessed. RESULTS This prospective non-interventional study included 286 patients. Thereof, 212 patients were employed at baseline (modified intention to treat analysis set employed at baseline, mITTe). 61.3% of the mITTe patients had moderate and 17.0% had severe UC. Three months after initiation of golimumab therapy, total work productivity impairment (TWPI) score and activity impairment score improved significantly from baseline with a mean change of - 17.3% (p < 0.0001) and - 14.4% (p < 0.0001), respectively. Results persisted over 24 months (mean change TWPI score: - 24.5%, mean change activity impairment score: - 30.0%). Disease- and health-related QoL also improved significantly under golimumab treatment as indicated by increased IBDQ [mean change: 28.0 (SD: ± 36.1, month 3), 42.1 (SD: ± 39.5, month 24)] and SF-12 scores [PCS-12: 45.9 (SD: ± 8.5), MCS-12: 4.9 (SD: ± 10.6, month 3), PCS-12: 5.9 (SD: ± 9.0), MCS-12: 6.4 (SD: ± 11.1, month 24)]. Disease-related hospitalization rate decreased from 16.0% (BL) to 4.3% at month 24 and the mean number of missed working days due to UC decreased from 8.2 (SD: 17.6, BL) to 0.7 (SD: 2.1) after golimumab induction. CONCLUSIONS Golimumab leads to notable long-term improvements in work productivity, daily activity, HRQoL, and disease-related hospitalization rates in patients with moderate to severe UC. TRIAL REGISTRATION PEI (Paul-Ehrlich-Institute, Langen, Germany) Registration Nr: NIS#255 ( https://www.pei.de/SharedDocs/awb/nis-0201-0300/0255.html ).
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Affiliation(s)
- Niels Teich
- Internistische Gemeinschaftspraxis Für Verdauungs- Und Stoffwechselkrankheiten Leipzig Und Schkeuditz, Nordstraße 21, 04105, Leipzig, Sachsen, Germany.
| | - Harald Grümmer
- Praxis Für Innere Medizin/Gastroenterologie, Allee Nach Sanssouci 7, 14471, Potsdam, Germany
| | - Eric Jörgensen
- Magen-Darm-Zentrum Remscheid, Rosenhügelerstraße 2, 42859, Remscheid, Germany
| | - Thomas Liceni
- MVZ Für Gastroenterologie Am Bayerischen Platz, Innsbrucker Straße 58, 10825, Berlin, Germany
| | - Frank Holtkamp-Endemann
- Gastroenterologische Gemeinschaftspraxis Am Germania-Campus, An der Germania Brauerei 6, 48159, Münster, Germany
| | - Tim Fischer
- Medical Affairs, MSD Sharp & Dohme GmbH, Lindenplatz 1, 85540, Haar, Germany
| | - Susanne Hohenberger
- Medical Affairs, MSD Sharp & Dohme GmbH, Lindenplatz 1, 85540, Haar, Germany
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Trigo-Vicente C, Gimeno-Ballester V, López-Del Val A. Cost-effectiveness analysis of infliximab, adalimumab, golimumab, vedolizumab and tofacitinib for moderate to severe ulcerative colitis in Spain. Eur J Hosp Pharm 2020; 27:355-360. [PMID: 33097619 PMCID: PMC7856137 DOI: 10.1136/ejhpharm-2018-001833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/13/2019] [Accepted: 03/20/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Despite the biological drugs, the treatment of moderate to severe ulcerative colitis is still a challenge, particularly in resource-limited settings. The aim of this study was to assess the efficiency of biological drugs and tofacitinib for moderate to severe ulcerative colitis in the Spanish context. METHODS A Markov model was built to simulate the progression of moderate to severe ulcerative colitis in a cohort of patients. The model used a time horizon of 10 years. The perspective chosen was the National Health Service, with a discount rate of 3%, and a threshold of €30,000/quality adjusted life-year (QALY). It carried out a one-way sensitivity analysis and probabilistic sensitivity analysis. RESULTS The comparison of infliximab with adalimumab and golimumab estimated an incremental cost-effectiveness ratio (ICER) of €43,928.07/QALY and €31,340.69/QALY, with a difference of - 0.43 and - 0.82 QALY, respectively. Vedolizumab vs infliximab achieved an ICER of €122,890.19/QALY with a gain of 0.46 QALY. The comparison of infliximab with tofacitinib yielded an estimated ICER of €270,503.19/QALY, with a slight gain in QALY (0.16). The one-way sensitivity analysis showed a robust study. CONCLUSION For a threshold of €30,000/QALY, adalimumab was the most cost-effective treatment versus infliximab for moderate to severe ulcerative colitis in Spain.
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Rasmussen B, Haastrup P, Wehberg S, Kjeldsen J, Waldorff FB. Predictors of health-related quality of life in patients with moderate to severely active ulcerative colitis receiving biological therapy. Scand J Gastroenterol 2020; 55:656-663. [PMID: 32442051 DOI: 10.1080/00365521.2020.1768282] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and aims: Patients with ulcerative colitis have reduced health-related quality of life compared to the general population. Current treatment strategy aims to reduce patients' symptoms and increase health-related quality of life. We investigated which symptoms of ulcerative colitis correlate to decreased health-related quality of life.Methods: Among 743 patients with moderate to severely active ulcerative colitis receiving biological therapy in a cross-sectional national study, we determined which disease-related symptoms, as measured by the Simple Clinical Colitis Activity Index, worsened health-related quality of life scores across the Short Health Scale dimensions, while adjusting for treatment, age, and clinical manifestation, and stratifying for sex, by means of multiple linear regression.Results: Patients with active disease had decreased health-related quality of life compared to those with inactive disease (median 5.8 (range 4.5-7.5) vs. 2 (0.8-3.3)). Both sexes had decreased health-related quality of life in all dimensions for the symptoms: bowel frequency during daytime (0.37-0.86 and 0.46-0.84), urgency of defecation (0.54-0.79 and 0.49-0.65) and blood in stool (0.50-0.75 and 0.36-0.54) for men and women respectively. Women were more often negatively affected by bowel frequency during night-time (4 domains vs. 1) and arthritis (5 domains vs. 3). In non-stratified analysis female sex is an independent predictor of lower health-related quality of life for 3 domains (0.38-0.53).Conclusions: Health-related quality of life was most prominently associated with bowel frequency during daytime, urgency of defecation, and blood in stool. Other symptoms associated for some health-related quality of life dimensions, and appear to vary between the sexes.
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Affiliation(s)
- Bjørn Rasmussen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Peter Haastrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital and Institute of Clinical Research, University of Southern, Odense C, Denmark
| | - Frans Boch Waldorff
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Hagelund LM, Elkjær Stallknecht S, Jensen HH. Quality of life and patient preferences among Danish patients with ulcerative colitis - results from a survey study. Curr Med Res Opin 2020; 36:771-779. [PMID: 31944145 DOI: 10.1080/03007995.2020.1716704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objective: To explore health-related quality of life (HRQoL) and assess preferences for medical treatment attributes to obtain information of the relative importance of the different attributes in a Danish population with ulcerative colitis (UC).Methods: We used data from an online survey collected in March 2018 among people with self-reported UC. A total of 302 eligible respondents answered the HRQoL questionnaires (EuroQol-5 Dimensions (EQ-5D-5L) and the Short Inflammatory Bowel Disease Questionnaire (SIBDQ)), and 212 also completed the discrete choice experiment (DCE). The probability of choosing an alternative from a number of choices in the DCE was estimated using a conditional logit model.Results: The respondents had an average SIBDQ score of 4.5 and an HRQoL score of 0.77, applying the EQ-5D-5L questionnaire. HRQoL correlated with disease severity, and the respondents had lower HRQoL than did a gender- and age-matched subset of the Danish population. The most important medical treatment attribute was efficacy within eight weeks. Additionally, respondents stated a preference for avoiding taking steroids, for fast onset of effect and for oral formulations.Conclusions: HRQoL correlates with disease severity, and patients with UC have lower HRQoL than the general population. The most important treatment attribute was efficacy, but patients also would like to avoid steroids, value fast onset of effect and prefer oral formulations.
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Armuzzi A, Tarallo M, Lucas J, Bluff D, Hoskin B, Bargo D, Cappelleri JC, Salese L, daCosta DiBonaventura M. The association between disease activity and patient-reported outcomes in patients with moderate-to-severe ulcerative colitis in the United States and Europe. BMC Gastroenterol 2020; 20:18. [PMID: 31964359 PMCID: PMC6975026 DOI: 10.1186/s12876-020-1164-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/06/2020] [Indexed: 02/08/2023] Open
Abstract
Background Patients with ulcerative colitis (UC) experience periods of recurring and episodic clinical signs and symptoms. This study sought to establish the association between disease activity and health-related quality of life (HRQoL) and other patient-reported outcomes. Methods United States (US) and European Union 5 ([EU5]; i.e., France, Germany, Italy, Spain, and the United Kingdom) data from the 2015 and 2017 Adelphi Inflammatory Bowel Disease-Specific Programme (IBD-DSP) were used. The IBD-DSP is a database of retrospective patient chart information integrated with patient survey data (EuroQoL-5 Dimensions [EQ-5D], Short Quality of Life in Inflammatory Bowel Disease Questionnaire [SIBDQ], and Work Productivity and Activity Impairment-Ulcerative Colitis [WPAI-UC] questionnaire). Using available chart information, physicians classified their moderate-to-severe patients into one of the following categories: remission with a Mayo endoscopic score = 0 (“deep remission”), remission without a Mayo endoscopic score = 0 (“remission”), or active disease. Differences among disease activity categories with respect to patient-reported outcomes were analyzed using generalized linear models, controlling for confounding variables. Results N = 289 and N = 1037 patient charts with linked surveys were included from the US and EU5, respectively. The disease activity distribution was as follows: active disease = 40.1% (US) and 33.6% (EU5); remission = 48.0 and 53.0%; deep remission = 11.9 and 13.3%. Patients with active disease reported significantly lower levels of EQ-5D health state utilities (adjusted mean [AdjM] = 0.87 [US] and 0.78 [EU5]) compared with remission (AdjM = 0.92 and 0.91) and deep remission (AdjM = 0.93 and 0.91) (all P < 0.05 compared with active disease within each region). Similar findings were observed with the scores from the SIBDQ and the WPAI-UC. No significant differences were observed between remission categories. Conclusions Among patients with moderate-to-severe UC in the US and EU5, active disease was associated with significant impairments in HRQoL, work and leisure activities. These results reinforce the importance, to both the patient and society, of achieving some level of remission to restore generic and disease-related HRQoL and one’s ability to work productively.
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Affiliation(s)
- Alessandro Armuzzi
- Fondazione Policlinico A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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Fu H, Kaminga AC, Peng Y, Feng T, Wang T, Wu X, Yang T. Associations between disease activity, social support and health-related quality of life in patients with inflammatory bowel diseases: the mediating role of psychological symptoms. BMC Gastroenterol 2020; 20:11. [PMID: 31937264 PMCID: PMC6961247 DOI: 10.1186/s12876-020-1166-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 01/07/2020] [Indexed: 02/06/2023] Open
Abstract
Background Previous studies have indicated that disease activity, psychological symptoms and social support were associated with health-related quality of life (HRQoL) in patients with inflammatory bowel diseases(IBD). However, it is unclear how disease activity, psychological symptoms and social support interact to affect HRQoL. The main purpose of this study was to examine the mediation effect of psychological symptoms in the relationship between disease activity, social support and HRQoL. Methods This was a cross-sectional study, which collected data using convenience sampling, between December 2016 and March 2018, from the Third XiangyaHospital of Central South University in Changsha, China. An online self-administered questionnaire (including demographic and clinical information), Inflammatory Bowel Disease Questionnaire, Disease Activity Indices scale, Hospital Anxiety and Depression Scale and Social Support Rating Scale, were administered to each participant. Descriptive statistics and Pearson’s correlations were used to summarize data, whereas PROCESS analysis was performed to examine the pre-specified mediation effect. Results A total of 199 patients with IBD were included. Disease activity indices (DAI) and hospital anxiety and depression (HAD) were negatively correlated with HRQoL (β = − 3.37, − 2.54 respectively, P < 0.001), while social support was positively correlated with HRQoL (β = 1.38, P < 0.01). HAD partially mediated the negative relationship between DAI and HRQoL (β = − 0.83, P < 0.001) with the mediation effect ratio of 24.6%, and completely mediated the positive relationship between social support and HRQoL (β = 1.20, P < 0.001). Conclusions Psychological symptoms acted as a mediator in the relationship between disease activity, social support and HRQoL. Interventions to improve HRQoL in patients with IBD should take into account the mediation effect of psychological symptoms.
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Affiliation(s)
- Hanlin Fu
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, NO. 238 Shangmayuanling Road, Kaifu District, Changsha, 410078, Hunan Province, China.,Department of Dermatology and Venereal Disease, Shenzhen Center for Chronic Disease Control, Province518020, Shenzhen, Guangdong, China
| | - Atipatsa Chiwanda Kaminga
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, NO. 238 Shangmayuanling Road, Kaifu District, Changsha, 410078, Hunan Province, China.,Department of Mathematics and Statistics, Mzuzu University, Private Bag 201, Luwinga, Mzuzu 2, Malawi
| | - Yan Peng
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, Changsha, 410013, Hunan Province, China
| | - Tiejian Feng
- Department of Dermatology and Venereal Disease, Shenzhen Center for Chronic Disease Control, Province518020, Shenzhen, Guangdong, China
| | - Tingting Wang
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, NO. 238 Shangmayuanling Road, Kaifu District, Changsha, 410078, Hunan Province, China
| | - Xiaobing Wu
- Department of Dermatology and Venereal Disease, Shenzhen Center for Chronic Disease Control, Province518020, Shenzhen, Guangdong, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, XiangYa School of Public Health, Central South University, NO. 238 Shangmayuanling Road, Kaifu District, Changsha, 410078, Hunan Province, China.
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Unmet Medical Needs in the Management of Ulcerative Colitis: Results of an Italian Delphi Consensus. Gastroenterol Res Pract 2019; 2019:3108025. [PMID: 31565051 PMCID: PMC6745180 DOI: 10.1155/2019/3108025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background The lifelong and remitting nature of ulcerative colitis results in considerable disability and a substantial negative impact on quality of life. The major goal of the therapy of ulcerative colitis is considered to be the modification of the course of the disease, so that the patient's quality of life can be improved while minimising disease-related disability. Although considerable progress in understanding the molecular pathways involved in ulcerative colitis has led to improved treatment options, there is currently no definitive cure for ulcerative colitis, there remain considerable unmet needs in terms of long-term efficacy and safety, and there are many patients who continue to be burdened by physical and psychological symptoms. Defining unmet needs can help to increase the awareness of the shortcomings of current therapeutic management and highlight the need to achieve not only a control of clinical symptoms but also control of mucosal healing, in order to attain the best possible long-term outcomes. Methods With the aim of providing a better understanding of the unmet needs of patients towards improving overall care, a Delphi process was used to obtain consensus among a group of Italian ulcerative colitis experts. The consensus group met with a major focus of delineating the unmet needs of current treatment strategies and overall management of ulcerative colitis, while also focusing on quality of life and patient care. Results Three main areas were identified: (i) treatment, (ii) monitoring and risk management, and (iii) patient-related issues. A high level of consensus was reached on all but one of the statements identified. Conclusions The findings arising from the Delphi process provide valuable insights into the unmet needs in the management of moderate-to-severe ulcerative colitis from the clinician's perspective, while emphasising the benefits of therapeutic individualization and suggesting areas that need additional study with the aim of optimising the treatment of patients with ulcerative colitis.
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Robertson N, Gunn S, Piper R. Psychological and Social Factors Associated with Pain in Inflammatory Bowel Disease: A Systematic Literature Review of the Evidence in Adult and Pediatric Studies. CROHN'S & COLITIS 360 2019. [DOI: 10.1093/crocol/otz003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Pain is commonly experienced in both active and dormant inflammatory bowel disease (IBD). Psychological and social factors, which can be key to pain experience, have been relatively neglected; the only prior comprehensive review focused solely on studies of adults. The present review, therefore, sought to systematically examine relationships between pediatric and adult experience of pain and psychosocial variables.
Method
Systematic searches of 5 databases were conducted to identify studies including measures of pain and psychosocial variables, in pediatric or adult IBD populations. Quality appraisal of studies was undertaken using a qualified assessment tool.
Results
Twenty-three articles met the inclusion criteria. Ten examined relationships between pain and psychosocial variables in adults, and 13 examined in pediatric populations. Inverse relationships were identified between pain and quality of life (QOL) in both populations, with potential differences in pain localization between the two populations. Psychological distress, notably depression, was also important in both populations, with inconsistent evidence for a role for anxiety in pediatric samples. Specific coping styles, and familial responses to communications, also appeared relevant, but with weaker evidence. There was substantial heterogeneity in measures, statistical analyses and sample characteristics, and quality appraisal revealed methodological weaknesses.
Conclusions
Significant relationships were found between pain and various psychological indices, notably QOL and depression. However, most studies were underpowered, did not sufficiently control for key confounds, and almost exclusively reported on Western participants. Adequately powered, statistically sound studies encompassing diverse populations are required to further clarify relationships between pain and psychosocial variables in IBD.
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Affiliation(s)
- Noelle Robertson
- Neuroscience, Psychology and Behaviour, College of Life Sciences, University of Leicester, Leicester, UK
| | | | - Rebecca Piper
- Neuroscience, Psychology and Behaviour, College of Life Sciences, University of Leicester, Leicester, UK
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Wu B, Wang Z, Zhang Q. Cost-Effectiveness of Different Strategies for the Treatment of Moderate-to-Severe Ulcerative Colitis. Inflamm Bowel Dis 2018; 24:2291-2302. [PMID: 29718241 DOI: 10.1093/ibd/izy114] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Knowledge regarding the economic outcomes of anti-tumour necrosis factor-α (anti-TNFα) and oral Janus kinase inhibitor (JAKi) therapies for the treatment of ulcerative colitis (UC) is limited. We conducted this analysis to assess the economic outcomes of anti-TNFα, antiadhesion molecule inhibitors (anti-AMi), and oral JAKi therapies for the treatment of UC from the perspectives of the United Kingdom (UK) and China, which are the representatives of high-income and middle-income regions, respectively. METHODS A Markov model-based economic analysis was performed by incorporating effectiveness and utility data obtained from the literature and costs based on publicly available reports. The UK and Chinese health care perspectives were adopted to evaluate different intervention treatment sequences, including 14 treatment sequences consisting of conventional therapy, tofacitinib, adalimumab, vedolizumab, golimumab, and infliximab. The participants were the patients with moderate-to-severe UC eligible for anti-TNFα, anti-Ami, and JAKi treatment. Cost, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio (ICER) were reported. RESULTS Compared to other alternatives comprising adalimumab, golimumab, and infliximab, the use of a treatment sequence comprising tofacitinib and vedolizumab always had better health outcomes. The most cost-effective options in the UK included the sequences comprising tofacitinib and vedolizumab, and the most cost-effective treatment option in China was tofacitinib. There were uncertainties surrounding the results, the key drivers of which being the utility values, effectiveness of conventional therapy, and relative efficacy of the active treatments. CONCLUSIONS The treatment with tofacitinib and vedolizumab for moderate-to-severe UC is likely to be the most favorable cost-effective option in the high-income UK, and tofacitinib is the most cost-effective option in the middle-income China.
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Affiliation(s)
- Bin Wu
- Medical Decision and Economic Group, Department of Pharmacy, Ren Ji Hospital, South Campus, School of Medicine, Shanghai Jiaotong University
| | - Zhenhua Wang
- Department of Gastroenterology, Ren Ji Hospital, School of Medicine, Shanghai Jiaotong University
| | - Qiang Zhang
- Department of Oncology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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