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Suárez Ferrer C, Mesonero Gismero F, Caballol B, Ballester MP, Bastón Rey I, Castaño García A, Miranda Bautista J, Saiz Chumillas R, Benitez JM, Sanchez-Delgado L, López-García A, Rubin de Celix C, Alonso Abreu I, Melcarne L, Plaza Santos R, Marques-Camí M, Caballero Mateos A, Gómez Díez C, Calafat M, Galan HA, Vega Vilaamil P, Castro Senosiain B, Guerro Moya A, Rodriguez Diaz CY, Spicakova K, Manceñido Marcos N, Molina G, de Castro Parga L, Rodriguez Angulo A, Cuevas Del Campo L, Rodriguez Grau MDC, Ramirez F, Gomez Pastrana B, Gonzalez Partida I, Botella Mateu B, Peña Gonzalez E, Iyo E, Elosua Gonzalez A, Sainz Arnau E, Hernandez Villalba L, Perez Galindo P, Torrealba Medina L, Monsalve Alonso S, Olmos Perez JA, Dueñas Sadornil C, Garcia Ramirez L, Martín-Arranz MD, López Sanroman A, Fernández A, Merino Murgui V, Calviño Suárez C, Flórez-Diez P, Lobato Matilla ME, Sicilia B, Soto Escribano P, Maroto Martin C, Mañosa M, Barreiro-De Acosta M. Efficacy and safety of biological treatment for inflammatory bowel disease in elderly patients: Results from a GETECCU cohort. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:S0210-5705(24)00155-9. [PMID: 38710465 DOI: 10.1016/j.gastrohep.2024.502197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/07/2024] [Accepted: 02/27/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Biological therapies used for the treatment of inflammatory bowel disease (IBD) have shown to be effective and safe, although these results were obtained from studies involving mostly a young population, who are generally included in clinical trials. The aim of our study was to determine the efficacy and safety of the different biological treatments in the elderly population. METHODS Multicenter study was carried out in the GETECCU group. Patients diagnosed with IBD and aged over 65 years at the time of initiating biological therapy (infliximab, adalimumab, golimumab, ustekinumab or vedolizumab) were retrospectively included. Among the patients included, clinical response was assessed after drug induction (12 weeks of treatment) and at 52 weeks. Patients' colonoscopy data in week 52 were assessment, where available. Regarding complications, development of oncological events during follow-up and infectious processes occurring during biological treatment were collected (excluding bowel infection by cytomegalovirus). RESULTS A total of 1090 patients were included. After induction, at approximately 12-14 weeks of treatment, 419 patients (39.6%) were in clinical remission, 502 patients (47.4%) had responded without remission and 137 patients (12.9%) had no response. At 52 weeks of treatment 442 patients (57.1%) had achieved clinical remission, 249 patients had responded without remission (32.2%) and 53 patients had no response to the treatment (6.8%). Before 52 weeks, 129 patients (14.8%) had discontinued treatment due to inefficacy, this being significantly higher (p<0.0001) for Golimumab - 9 patients (37.5%) - compared to the other biological treatments analyzed. With respect to tumor development, an oncological event was observed in 74 patients (6.9%): 30 patients (8%) on infliximab, 23 (7.14%) on adalimumab, 3 (11.1%) on golimumab, 10 (6.4%) on ustekinumab, and 8 (3.8%) on vedolizumab. The incidence was significantly lower (p=0.04) for the vedolizumab group compared to other treatments. As regards infections, these occurred in 160 patients during treatment (14.9%), with no differences between the different biologicals used (p=0.61): 61 patients (19.4%) on infliximab, 39 (12.5%) on adalimumab, 5 (17.8%) on golimumab, 22 (14.1%) on ustekinumab, and 34 (16.5%) on vedolizumab. CONCLUSIONS Biological drug therapies have response rates in elderly patients similar to those described in the general population, Golimumab was the drug that was discontinued most frequently due to inefficacy. In our experience, tumor development was more frequent in patients who used anti-TNF therapies compared to other targets, although its incidence was generally low and that this is in line with younger patients based on previous literature.
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Affiliation(s)
- Cristina Suárez Ferrer
- Gastroenterology Department, School of Medicine, Universidad Autónoma de Madrid, Hospital La Paz Institute for Health Research, La Paz Hospital, Madrid, Spain.
| | | | - Berta Caballol
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Iria Bastón Rey
- Gastroenterology Department, Hospital Universitario Clínico de Santiago, Santiago de Compostela, Spain
| | - Andrés Castaño García
- Gastroenterology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Rosa Saiz Chumillas
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - Jose Manuel Benitez
- Gastroenterology Department, Hospital Universitario Reina Sofia, Cordoba, Spain
| | | | - Alicia López-García
- Gastroneterology Department, Hospital del Mar, IMIM (Institut de Recerca Hospital del Mar ó Research Institute Hospital del Mar), Barcelona, Spain
| | - Cristina Rubin de Celix
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IISIP), Madrid, Spain
| | - Inmaculada Alonso Abreu
- Gastroenterology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Luigi Melcarne
- Gastroenterology Department, Hospital Universitari Parc Taulli, Sabadel, Barcelona, Spain
| | - Rocío Plaza Santos
- Gastroenterology Department, Infanta Leonor University Hospital, Madrid, Spain
| | | | | | - César Gómez Díez
- Gastroenterology Department, Hospital Universitario Cabueñes, Gijón, Spain
| | - Margalida Calafat
- Gastroenterology Department, Hospital Germans Trias i Pujol, Badalona, Ciberehd, Spain
| | | | - Pablo Vega Vilaamil
- Gastroenterology Department, Complexo Hospitalario Universitario de Ourense, Spain
| | - Beatriz Castro Senosiain
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Andrea Guerro Moya
- Gastroenterology Department, Complexo Hospitalario Universitario A Coruña, Spain
| | | | - Katerina Spicakova
- Gastroenterology Department, Hospital Universitario de Alava, Vitoria, Spain
| | | | - Gema Molina
- Gastroenterology Department, Hospital Universitario de Ferrol, A Coruña, Spain
| | | | | | | | | | - Fernando Ramirez
- Gastroneterology Department, Ciudad Real University Hospital, Ciudad Real, Spain
| | | | - Irene Gonzalez Partida
- Gastroenterology Department, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Belen Botella Mateu
- Gastroenterology Department, Hospital Univesitario Infanta Cristina, Parla, Madrid, Spain
| | | | - Eduardo Iyo
- Gastroenterology Department, Hospital Comarcal de Inca, Baleares, Spain
| | | | - Empar Sainz Arnau
- Gastroenterology Department, Hospital Xara Assistencial Althaia de Manressa, Spain
| | | | - Pablo Perez Galindo
- Gastroenterology Department, Pontevedra University Hospital Complex, Pontevedra, Spain
| | | | | | | | | | - Laura Garcia Ramirez
- Gastroenterology Department, School of Medicine, Universidad Autónoma de Madrid, Hospital La Paz Institute for Health Research, La Paz Hospital, Madrid, Spain
| | - María Dolores Martín-Arranz
- Gastroenterology Department, School of Medicine, Universidad Autónoma de Madrid, Hospital La Paz Institute for Health Research, La Paz Hospital, Madrid, Spain
| | | | - Agnès Fernández
- Gastroenterology Department, Hospital Clinic of Barcelona, Barcelona, Spain
| | | | - Cristina Calviño Suárez
- Gastroenterology Department, Hospital Universitario Clínico de Santiago, Santiago de Compostela, Spain
| | - Pablo Flórez-Diez
- Gastroenterology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Beatriz Sicilia
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Carlos Maroto Martin
- Gastroenterology Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Míriam Mañosa
- Gastroenterology Department, Hospital Germans Trias i Pujol, Badalona, Ciberehd, Spain
| | - Manuel Barreiro-De Acosta
- Gastroenterology Department, Hospital Universitario Clínico de Santiago, Santiago de Compostela, Spain
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Lin ZH, Li CP, Sun CK, Cho DY, Tsai FJ, Yip HT, Chang R, Hung YM. Increased Risk of Inflammatory Bowel Disease Among Patients With Nontyphoidal Salmonella Infections: A Population-Based Cohort Study. Inflamm Bowel Dis 2024:izae053. [PMID: 38567440 DOI: 10.1093/ibd/izae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Despite the known association between microorganisms and development of inflammatory bowel disease (IBD), the role of nontyphoidal Salmonella (NTS) in IBD is not adequately addressed. We aimed at elucidating the relationship between NTS infection and the risk of IBD. METHODS Based on the National Health Insurance Research Database in Taiwan, this retrospective cohort study enrolled patients with NTS infection (exposure group; n = 4651) and those without NTS infection (comparator group; n = 4651) who were propensity score matched (1:1) by demographic data, medications, comorbidities, and index date. All patients were followed until IBD onset, individual mortality, or December 31, 2018. Cox proportional hazards regression analysis was performed to determine the hazard ratios and 95% confidence intervals (CIs). Sensitivity analyses were used for cross-validation. RESULTS The NTS group demonstrated an increased risk of IBD compared with the non-NTS groups (adjusted hazard ratio [aHR], 2.12; 95% CI, 1.62-2.78) with a higher risk of developing ulcerative colitis in the former (aHR, 2.27; 95% CI, 1.69-3.04). Nevertheless, the small sample size may contribute to lack of significant difference in Crohn's disease. Consistent findings were noted after excluding IBD diagnosed within 6 months of NTS infection (aHR, 2.28; 95% CI, 1.71-3.03), excluding those with enteritis/colitis before index date (aHR, 1.85; 95% CI, 1.28-2.68), excluding those using antibiotics for 1 month in the year before IBD onset (aHR, 1.81; 95% CI, 1.34-2.45), inverse probability of treatment weighting (aHR, 1.64; 95% CI, 1.31-2.04), and inclusion of individuals regardless of age (n = 10 431; aHR, 1.83; 95% CI, 1.53-2.19). CONCLUSIONS Patients with NTS were associated with an increased risk of developing IBD, especially ulcerative colitis.
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Affiliation(s)
- Zong-Han Lin
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chung-Pin Li
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Therapeutic and Research Center of Pancreatic Cancer, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Der-Yang Cho
- Translational Cell Therapy Center, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Neurosurgery, China Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan
| | - Fuu-Jen Tsai
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Division of Medical Genetics, China Medical University Children's Hospital, Taichung, Taiwan
- Department of Biotechnology and Bioinformatics, Asia University, Taichung, Taiwan
| | - Hei-Tung Yip
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Renin Chang
- Division of Medical Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yao-Min Hung
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital Taitung Branch, Taitung, Taiwan
- Master Program in Biomedicine, College of Science and Engineering, National Taitung University, Taitung, Taiwan
- College of Health and Nursing, Meiho University, Pingtung, Taiwan
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Mosli MH, Alghamdi MK, Bokhary OA, Alzahrani MA, Takieddin SZ, Galai TA, Alsahafi MA, Saadah OI. Inflammatory bowel disease in the elderly: A focus on disease characteristics and treatment patterns. Saudi J Gastroenterol 2023; 29:212-218. [PMID: 36722525 PMCID: PMC10445499 DOI: 10.4103/sjg.sjg_503_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/18/2022] [Accepted: 12/18/2022] [Indexed: 02/02/2023] Open
Abstract
Background As the population ages, the number of elderly inflammatory bowel disease (IBD) patients is expected to increase. The clinical features and therapeutic options for young and old patients may differ, as elderly IBD patients are likely to have different comorbidities and disease characteristics. The goal of this study was to examine the clinical aspects and therapeutic choices for elderly Saudi IBD patients. Methods We conducted a retrospective study aimed at describing the demographic, clinical, and management characteristics of IBD in elderly patients (≥60 years) who followed up at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. The data was extracted from the KAUH inflammatory bowel disease information system (IBDIS) registry. The primary outcome was to describe disease characteristics in accordance with the Montréal classification and the secondary outcomes were to describe treatment patterns and identify significant clinical associations. Results Our data were collected from 76 patients who fulfilled the study inclusion criteria. Females outnumbered males (53.9% vs 46.1%) and the mean age was 51.5 ± 9.7 years. Essential hypertension (26.3%) was the most common comorbidity followed by diabetes mellitus (23.6%), and malignant neoplasms (9.21%). More than half of the patients with Crohn's disease (CD) had disease onset after forty years of age. The most common form of disease distribution was ileocolonic disease (64.7%). Less than 17% of patients had a penetrating disease phenotype. About 88 percent of patients with UC presented >40 years of age. Approximately, half of the cohort had left-sided ulcerative colitis (UC) (48%), followed by pancolitis (40%). The most prescribed medication class for IBD was 5-aminosalicylic acid (5-ASA) derivatives (56.58%) followed by corticosteroids and immunosuppressive drugs. Conclusions In Saudi Arabia, age-specific concerns including comorbidities and polypharmacy remain the major challenges in the management of elderly IBD patients.
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Affiliation(s)
- Mahmoud H. Mosli
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maha K. Alghamdi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar A. Bokhary
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Siba Z. Takieddin
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Tala A. Galai
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majid A. Alsahafi
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Omar I. Saadah
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Swerdel JN, Schuemie M, Murray G, Ryan PB. PheValuator 2.0: Methodological improvements for the PheValuator approach to semi-automated phenotype algorithm evaluation. J Biomed Inform 2022; 135:104177. [PMID: 35995107 DOI: 10.1016/j.jbi.2022.104177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Phenotype algorithms are central to performing analyses using observational data. These algorithms translate the clinical idea of a health condition into an executable set of rules allowing for queries of data elements from a database. PheValuator, a software package in the Observational Health Data Sciences and Informatics (OHDSI) tool stack, provides a method to assess the performance characteristics of these algorithms, namely, sensitivity, specificity, and positive and negative predictive value. It uses machine learning to develop predictive models for determining a probabilistic gold standard of subjects for assessment of cases and non-cases of health conditions. PheValuator was developed to complement or even replace the traditional approach of algorithm validation, i.e., by expert assessment of subject records through chart review. Results in our first PheValuator paper suggest a systematic underestimation of the PPV compared to previous results using chart review. In this paper we evaluate modifications made to the method designed to improve its performance. METHODS The major changes to PheValuator included allowing all diagnostic conditions, clinical observations, drug prescriptions, and laboratory measurements to be included as predictors within the modeling process whereas in the prior version there were significant restrictions on the included predictors. We also have allowed for the inclusion of the temporal relationships of the predictors in the model. To evaluate the performance of the new method, we compared the results from the new and original methods against results found from the literature using traditional validation of algorithms for 19 phenotypes. We performed these tests using data from five commercial databases. RESULTS In the assessment aggregating all phenotype algorithms, the median difference between the PheValuator estimate and the gold standard estimate for PPV was reduced from -21 (IQR -34, -3) in Version 1.0 to 4 (IQR -3, 15) using Version 2.0. We found a median difference in specificity of 3 (IQR 1, 4.25) for Version 1.0 and 3 (IQR 1, 4) for Version 2.0. The median difference between the two versions of PheValuator and the gold standard for estimates of sensitivity was reduced from -39 (-51, -20) to -16 (-34, -6). CONCLUSION PheValuator 2.0 produces estimates for the performance characteristics for phenotype algorithms that are significantly closer to estimates from traditional validation through chart review compared to version 1.0. With this tool in researcher's toolkits, methods, such as quantitative bias analysis, may now be used to improve the reliability and reproducibility of research studies using observational data.
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Affiliation(s)
- Joel N Swerdel
- Janssen Research and Development, Titusville, NJ, USA; Observational Health Data Sciences and Informatics (OHDSI), New York, NY.
| | - Martijn Schuemie
- Janssen Research and Development, Titusville, NJ, USA; Observational Health Data Sciences and Informatics (OHDSI), New York, NY
| | - Gayle Murray
- Janssen Research and Development, Titusville, NJ, USA
| | - Patrick B Ryan
- Janssen Research and Development, Titusville, NJ, USA; Columbia University, New York, NY, USA; Observational Health Data Sciences and Informatics (OHDSI), New York, NY
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Shah KK, Caffrey AR, Szczotka A, Belazi D, Kogut SJ. Real-world utilization of top-down and step-up therapy and initial costs in Crohn disease. J Manag Care Spec Pharm 2022; 28:849-861. [PMID: 35876295 PMCID: PMC10373018 DOI: 10.18553/jmcp.2022.28.8.849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND: Medication treatment strategies for Crohn disease (CD) include step-up (SU) therapy, beginning with oral anti-inflammatory agents, and top-down (TD) therapy, beginning with biologics or immunomodulators. The real-world utilization and short-term medical costs associated with these treatment strategies are not well described. OBJECTIVE: To examine the prevalence of TD therapy use over time and compare the first-year direct medical expenditures among patients initiating CD medication treatment with SU and TD therapy in a real-world setting. METHODS: We conducted a retrospective cohort study of Optum Clinformatics Data Mart examining adult patients with CD newly initiated on medication therapy from 2010 to 2018. Included patients had a CD-indicated medication dispensed within 60 days after their initial CD diagnosis, were continuously enrolled in the health plan throughout the study period, and did not have comorbidities treated with a biologic also indicated for CD. A generalized linear model was used to quantify the differences in adjusted mean first-year CD-specific, direct nonpharmacy medical costs between users of TD and SU therapy. RESULTS: We identified 3,157 patients newly initiating medication therapy for CD (2,392 [75.8%] patients treated with SU therapy and 765 [24.2%] treated with TD therapy). The use of TD therapy over the study period increased from 17% in 2011 to 31% in 2017. TD therapy was also associated with a 149.8% ($1,230) higher adjusted average per-patient first-year CD-direct nonpharmacy medical cost compared with SU therapy (adjusted ratio of cost for TD compared with SU [2.498, 95% CI = 2.12-2.95]). CONCLUSIONS: In patients newly initiating medication therapy for CD, TD therapy use increased between 2010 and 2017 and was associated with higher first-year nonpharmacy medical expenditure. These findings align with the strategy of initiating TD therapy in patients with a higher disease burden. Further research is needed to determine long-term overall health care costs and clinical outcomes associated with SU and TD strategies in a real-world setting. DISCLOSURES: Dr Caffrey received research funding from Gilead, Merck, Pfizer, and Shionogi and is a speaker for Merck. The views expressed are those of the author and do not necessarily reflect the position or policy of the US Department of Veterans Affairs. Material is based on work supported, in part, by the Office of Research and Development.
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Affiliation(s)
- Kanya K Shah
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston
| | - Aisling R Caffrey
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston
| | | | | | - Stephen J Kogut
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston
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Hutfless S, Jasper RA, Tilak A, Ghosh T, Kedia S, Liu S, Urrunaga NH, Josephson M, Narang A, Miller S, Chen PH, Joseph S, Brant SR. A Systematic Review of Crohn's Disease Case Definitions in Administrative or Claims Databases. Inflamm Bowel Dis 2022; 29:705-715. [PMID: 35857336 PMCID: PMC10152279 DOI: 10.1093/ibd/izac131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND We sought to review Crohn's disease (CD) case definitions that use diagnosis, procedure, and medication claims. METHODS We searched PubMed and Embase from inception through January 31, 2022, using terms related to CD, inflammatory bowel disease, administrative claims, or validity. Each article was scrutinized by 2 authors independently screening and abstracting data. Collected data included participant characteristics, case definition characteristics, and case definition validity. When diagnostic accuracy was provided for multiple case definitions, we extracted the case definition selected by the authors. All diagnostic accuracy characteristics were captured. RESULTS We identified 30 studies that evaluated a case definition using claims data to identify CD patients. The most common case definition included counts of diagnosis codes (57%) followed by a combination of diagnosis codes and medications (20%). All but 1 study validated the case definition with a medical chart review. In 2 studies, the patient's primary care provider completed a survey to confirm disease status. The positive predictive value of the case definitions ranged from 18% (≥1 code at a single U.S. health plan) to 100% (≥1 code plus a relevant prescription at a U.S. hospital). More complex case definitions (eg, ≥1 code + prescription or ≥2 codes) had lower variability in positive predictive value (≥80%) and specificity (≥85%) than the ≥1 code requirement. CONCLUSIONS Health services researchers should validate case definitions in their research cohorts. When such validation cannot be performed, we recommend using a more complex case definition. Studies without a validated CD case definition should use sensitivity analyses to confirm the robustness of their results.
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Affiliation(s)
- Susan Hutfless
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ryan A Jasper
- Department of Applied Mathematics and Statistics, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Aman Tilak
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tamoghna Ghosh
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Simon Liu
- Medical Genomics Unit, National Human Genome Research Institute, Bethesda, MD, USA
| | - Nathalie H Urrunaga
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matthew Josephson
- Division of Gastroenterology and Hepatology, Albany Medical College, Albany, NY, USA
| | - Arshit Narang
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Steve Miller
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Po-Hung Chen
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Shelly Joseph
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Steven R Brant
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, USA.,Division of Gastroenterology and Hepatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
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Yu K, Faye AS, Wen T, Guglielminotti JR, Huang Y, Wright JD, D'Alton ME, Friedman AM. Outcomes during delivery hospitalisations with inflammatory bowel disease. BJOG 2022; 129:1073-1083. [PMID: 35152548 DOI: 10.1111/1471-0528.17039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/22/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To characterise inflammatory bowel disease (IBD) trends and associated risk during delivery hospitalisations. DESIGN Cross-sectional. SETTING US delivery hospitalisations. POPULATION Delivery hospitalisations in the 2000-2018 National Inpatient Sample. METHODS This study analysed a nationally representative hospital discharge database based on the presence of IBD. Temporal trends in IBD were analysed using joinpoint regression to estimate the average annual percent change (AAPC). IBD severity was characterised by the presence of diagnoses such as penetrating and stricturing disease and history of bowel resection. Risks for adverse outcomes were analysed based on presence of IBD. Poisson regression models were performed with unadjusted and adjusted risk ratios (aRR) as measures of effect. MAIN OUTCOME MEASURE Prevalence of IBD and associated adverse outcomes. RESULTS Of 73 109 790 delivery hospitalisations, 89 965 had a diagnosis of IBD. IBD rose from 0.06% in 2000 to 0.21% in 2018 (AAPC 7.3%, 95% CI 6.7-7.9%). Among deliveries with IBD, IBD severity diagnoses increased from 4.1% to 8.1% from 2000 to 2018. In adjusted analysis, IBD was associated with increased risk for preterm delivery (aRR 1.50, 95% CI 1.47-1.53), severe maternal morbidity (aRR 1.93, 95% CI 1.83-2.04), venous thrombo-embolism (aRR 2.76, 95% CI 2.39-3.18) and surgical injury during caesarean delivery hospitalisation (aRR 5.03, 95% CI 4.76-5.31). In the presence of a severe IBD diagnosis, risk was further increased for all adverse outcomes. CONCLUSION IBD is increasing in the obstetric population and is associated with adverse outcomes. Risk is increased in the presence of a severe IBD diagnosis. TWEETABLE ABSTRACT Deliveries among women with inflammatory bowel disease are increasing. Disease severity is associated with adverse outcomes.
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Affiliation(s)
- K Yu
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - A S Faye
- Department of Medicine, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Gastroenterology, Department of Medicine, NYU Grossman School of Medicine, Inflammatory Bowel Disease Center, NYU Langone Health, New York, NY, USA
| | - T Wen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, CA, USA
| | | | - Y Huang
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - J D Wright
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - M E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - A M Friedman
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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Saggi S, Lekoubou A, Ovbiagele B. Prevalence and Predictors of Stroke in Patients with Crohn's Disease: A Nationwide Study. J Stroke Cerebrovasc Dis 2021; 31:106258. [PMID: 34923435 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/02/2021] [Accepted: 11/28/2021] [Indexed: 12/08/2022] Open
Abstract
OBJECTIVES Mounting evidence points to the microbiome as a susceptibility factor for neurological disorders. Patients with Crohn's disease (CD) are at higher ischemic stroke (IS) risk, but no large scale epidemiologic studies have identified risk factors for stroke in this population. MATERIALS AND METHODS We analyzed the 2017 Nationwide Inpatient Sample (NIS) dataset to identify patients with a discharge diagnosis of Crohn's disease using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) code K50.X. We identified patients with a primary/secondary discharge diagnosis of IS using ICD-10-CM code I63.X. We compared sociodemographic and clinical variables between stroke and non-stroke patients with CD. Logistic regression analysis was applied to identify factors associated with IS. RESULTS Of 30,212 patients with CD, 369 (1.2 %) had a discharge diagnosis of IS. Older age (odds ratio [OR], 1.03 [95% CI, 1.02-1.04], top quartile income (OR, 1.58 [95% CI, 1.10-2.30]), and hospitalization in a South Atlantic (OR, 1.82 [95% CI, 1.11-3.14]), East South Central (OR, 2.30 [95% CI, 1.28-4.25]), or West South Central hospital (OR, 2.40 [95% CI, 1.39-4.28]) were independently associated with IS. Clinical variables independently associated with IS in patients with CD included: atrial fibrillation (OR, 1.66 [95% CI, 1.15-2.33]), atherosclerosis (OR, 2.41 [95% CI, 1.32-4.10]), hyperlipidemia (OR, 1.69 [95% CI, 1.33-2.15]), hypertension (OR, 1.53 [95% CI, 1.18-1.98]) and valvular disease (OR, 1.62 [95% CI, 1.01-2.48). CONCLUSION A subset of traditional stroke risk factors are associated with IS in patients with CD. CD patients with these conditions could be targeted for vascular risk reduction and surveillance.
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Affiliation(s)
- Satvir Saggi
- University of California, San Francisco School of Medicine
| | - Alain Lekoubou
- Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco
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Weissman S, Patel K, Kolli S, Lipcsey M, Qureshi N, Elias S, Walfish A, Swaminath A, Feuerstein JD. Obesity in Inflammatory Bowel Disease Is Associated with Early Readmissions Characterised by an Increased Systems and Patient-level Burden. J Crohns Colitis 2021; 15:1807-1815. [PMID: 33999137 DOI: 10.1093/ecco-jcc/jjab088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Rates of obesity are rising in patients with inflammatory bowel disease [IBD]. We conducted a US population-based study to determine the effects of obesity on outcomes in hospitalised patients with IBD. METHODS We searched the Nationwide Readmissions Database 2016-2017 to identify all adult patients hospitalised for IBD, using ICD-10 codes. We compared obese (body mass index [BMI] ≥ 30) vs non-obese [BMI < 30] patients with IBD to evaluate the independent effects of obesity on readmission, mortality, and other hospital outcomes. Multivariate regression and propensity matching were performed. RESULTS We identified 143 190 patients with IBD, of whom 9.1% were obese. Obesity was independently associated with higher all-cause readmission at 30 days {18% vs 13% (adjusted odds ratio [aOR] 1.16, p = 0.005)} and 90 days (29% vs 21% [aOR 1.27, p < 0.0001]), as compared with non-obese patients, with similar findings upon a propensity-matched sensitivity analysis. Obese and non-obese patients had similar risks of mortality on index admission [0.24% vs 0.31%, p = 0.18] and readmission [1.5% vs 1.8% p = 0.3]. Obese patients had longer [5.3 vs 4.9 days] and more expensive [USD12,195 vs USD11,154] hospitalisations on index admission. Obesity did not affect the risk of intestinal surgery or bowel obstruction. Compared with index admissions, readmissions were characterised by increased mortality [6-fold], health care use, and bowel obstruction [3-fold] [all p < 0.0001]. CONCLUSIONS Obesity in IBD appears to be associated with increased early readmission, characterised by a higher burden, despite the introduction of weight-based therapeutics. Prevention of obesity should be a focus in the treatment of IBD to decrease readmission and health care burden.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Kirtenkumar Patel
- Department of Medicine, North Shore University Hospital, Conway, SC, USA
| | - Sindhura Kolli
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Megan Lipcsey
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nabeel Qureshi
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Sameh Elias
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, NJ, USA
| | - Aaron Walfish
- Department of Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, Elmhurst, NY, USA
| | - Arun Swaminath
- Division of Gastroenterology, Inflammatory Bowel Disease Program, Lenox Hill Hospital, New York, NY, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Hepatology, and Nutrition, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Jo IH, Lee KM, Kim DB, Kim JW, Lee J, Jeen YT, Kim TO, Kim JS, Park JJ, Hong SN, Park DI, Kim HS, Lee YJ, Kim Y. Quality of Life in Newly Diagnosed Moderate-to-Severe Ulcerative Colitis: Changes in the MOSAIK Cohort Over 1 Year. Gut Liver 2021; 16:384-395. [PMID: 34373363 PMCID: PMC9099394 DOI: 10.5009/gnl210141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 12/07/2022] Open
Abstract
Background/Aims Improving quality of life has been gaining importance in ulcerative colitis (UC) management. The aim of this study was to investigate changes in health-related quality of life (HRQL) and related factors in patients with moderate-to-severe UC. Methods A multicenter, hospital-based, prospective study was performed using a Moderate-to-Severe Ulcerative Colitis Cohort in Korea (the MOSAIK). Changes in HRQL, evaluated using the 12-Item Short Form Health Survey (SF-12) and Inflammatory Bowel Disease Questionnaire (IBDQ), were analyzed at the time of diagnosis and 1 year later. Results In a sample of 276 patients, the mean age was 38.4 years, and the majority of patients were male (59.8%). HRQL tended to increase in both the IBDQ and SF-12 1 year after diagnosis. A higher partial Mayo score was significantly related to poorer HRQL on the IBDQ and SF-12 in a linear mixed model (p<0.01). Inflammatory markers such as C-reactive protein (CRP) or erythrocyte sedimentation rate also showed a negative correlation on HRQL (p<0.05). Patients whose IBDQ score improved by 16 or more (71.2%) in 1 year were younger, tended to be nonsmokers, and had a lower partial Mayo score and CRP than those whose IBDQ score did not. There was no significant association between HRQL and disease extent, treatments at diagnosis, or the highest treatment step during the 1-year period. Conclusions Optimally controlled disease status improves HRQL in patients with moderate-to-severe UC. The partial Mayo score and inflammatory markers may be potential indicators reflecting the influence of UC on patient`s daily lives.
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Affiliation(s)
- Ik Hyun Jo
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Kang-Moon Lee
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Dae Bum Kim
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Ji Won Kim
- Department of Internal Medicine, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Lee
- Department of Internal Medicine, Chosun University Hospital, Gwangju, Korea
| | - Yoon Tae Jeen
- Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Tae-Oh Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Joo Sung Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Jun Park
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Noh Hong
- Department of Internal Medicine, Samsung Medical Center, Seoul, Korea
| | - Dong Il Park
- Department of Internal Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Hyun-Soo Kim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Wonju, Korea
| | - Yoo Jin Lee
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Youngdoe Kim
- Clinical Research Science Team, Medical Affairs, Janssen Korea Ltd., Seoul, Korea
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Ghoneim S, Weissman S, Wang L, Aziz M, Atoot A, Sandhu D, Swaminath A, Feuerstein JD. Impact of inflammatory bowel disease on hospital outcomes in acute ischemic stroke: a nationwide cohort study. Int J Colorectal Dis 2021; 36:1759-1764. [PMID: 33733312 DOI: 10.1007/s00384-021-03912-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with inflammatory bowel disease (IBD) have an increased risk of venous thrombotic events. The impact IBD has on arterial thrombosis is not well characterized. We aimed to identify the impact of IBD on hospital outcomes in patients admitted for acute ischemic stroke (AIS). METHODS This is a retrospective cohort study utilizing the 2017 National Inpatient Sample. We identified all adult patients with a principal diagnosis of AIS and compared those with a concurrent diagnosis of IBD to those without-subgrouped by ulcerative colitis (UC) and Crohn's disease (CD). Outcomes were mortality and healthcare usage among IBD patients with AIS. Multivariate analysis was used to control for confounders. Analyses were performed using STATA. RESULTS Five hundred twenty-four thousand and forty-five patients were admitted for AIS in 2017; of them 2200 (0.41%) had a concurrent diagnosis of IBD. The presence of IBD did not significantly affect in-hospital mortality (4.09% vs. 4.01%) among patients admitted for AIS [OR 1.07 95% CI: 0.65-1.76], with similar findings upon subgroup analysis of UC [OR 0.91, 95% CI: 0.39-2.09] and CD [OR 1.17, 95% CI: 0.62-2.19]. Mean hospital length of stay and charges/costs in AIS were similar irrespective of IBD. CONCLUSIONS UC and CD do not appear to be associated with a higher risk of mortality or increased healthcare usage in AIS. AIS risk assessment in patients with IBD is important but should be done in a similar fashion to the general population.
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Affiliation(s)
- Sara Ghoneim
- Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH, USA
| | - Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA.
| | - Linda Wang
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo Medical Center, Toledo, OH, USA
| | - Adam Atoot
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ, 07047, USA
| | - Dalbir Sandhu
- Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Arun Swaminath
- Division of Gastroenterology, Inflammatory Bowel Disease Program, Lenox Hill Hospital, New York, NY, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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12
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Weissman S, Sharma, S, Fung BM, Aziz M, Sciarra M, Swaminath A, Feuerstein JD. Increased Mortality and Healthcare Costs Upon Hospital Readmissions of Ulcerative Colitis Flares: A Large Population-Based Cohort Study. CROHN'S & COLITIS 360 2021; 3:otab029. [PMID: 36776672 PMCID: PMC9802231 DOI: 10.1093/crocol/otab029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Ulcerative colitis (UC) flares often result in prolonged hospitalization and considerable mortality. Nevertheless, large-scale analyses evaluating the frequency and characteristics of hospital readmissions for UC remain limited. We aimed to examine these clinical outcomes in a nationwide cohort of patients hospitalized with UC. Methods We queried the 2017 Nationwide Readmission Database using ICD-10-CM codes to identify all adult patients admitted for UC. Outcomes including mortality, readmission rates, predictors of readmission and mortality, and healthcare usage were assessed. Multivariate analysis was used to adjust for potential confounders. Results From the 31,063 patients hospitalized for UC, 17.38% were readmitted within 30 days and 28.51% in 90 days. UC accounted for 28.17% and 29.82% of readmissions at 30 and 90 days, respectively. Compared to index admission, 30- and 90-day readmissions were characterized by significantly higher mortality (0.42% vs 1.99% and 1.65%, respectively), longer hospital stays (5.05 vs 6.62 and 6.04 days, respectively), and increased hospital cost ($49,999 vs $62,288 and $59,698, respectively) (all P < 0.01). Numerous factors, including chronic steroid use [hazard ratio (HR) 1.35] and opioid use (HR 1.6, were independently associated with increased 30-day readmission (P < 0.01). Numerous factors, including anxiety (HR 1.21) and venous thromboembolism (HR 5.39), were independently associated with increased 30-day mortality (P < 0.01). Conclusions In a large cohort of patients hospitalized for UC, we found that readmission is associated with higher mortality and more lengthy/costly admissions. Additionally, we found independent associations for readmission and mortality that may help identify patients who can benefit from close postdischarge follow-up.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, USA,Address correspondence to: Simcha Weissman, DO, Department of Medicine, Hackensack Meridian Health Palisades Medical Center, 7600 River Road, North Bergen, NJ 07047, USA ()
| | - Sachit Sharma,
- Department of Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Brian M Fung
- Division of Gastroenterology and Hepatology, University of Arizona College of Medicine—Phoenix, Phoenix, Arizona, USA
| | - Muhammad Aziz
- Division of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Michael Sciarra
- Department of Gastroenterology and Hepatology, Hackensack Meridian Health Palisades Medical Center, North Bergen, New Jersey, USA
| | - Arun Swaminath
- Division of Gastroenterology, Inflammatory Bowel Disease Program, Lenox Hill Hospital, New York, New York, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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13
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Asscher VER, Biemans VBC, Pierik MJ, Dijkstra G, Löwenberg M, van der Marel S, de Boer NKH, Bodelier AGL, Jansen JM, West RL, Haans JJL, van Dop WA, Weersma RK, Hoentjen F, Maljaars PWJ. Comorbidity, not patient age, is associated with impaired safety outcomes in vedolizumab- and ustekinumab-treated patients with inflammatory bowel disease-a prospective multicentre cohort study. Aliment Pharmacol Ther 2020; 52:1366-1376. [PMID: 32901983 PMCID: PMC7539998 DOI: 10.1111/apt.16073] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/25/2020] [Accepted: 08/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Few data are available on the effects of age and comorbidity on treatment outcomes of vedolizumab and ustekinumab in inflammatory bowel disease (IBD). AIMS To evaluate the association between age and comorbidity with safety and effectiveness outcomes of vedolizumab and ustekinumab in IBD. METHODS IBD patients initiating vedolizumab or ustekinumab in regular care were enrolled prospectively. Comorbidity prevalence was assessed using the Charlson Comorbidity Index (CCI). Association between age and CCI, both continuously assessed, with safety outcomes (any infection, hospitalisation, adverse events) during treatment, and effectiveness outcomes (clinical response and remission, corticosteroid-free remission, clinical remission combined with biochemical remission) after 52 weeks of treatment were evaluated. Multivariable logistic regression was used to adjust for confounders. RESULTS We included 203 vedolizumab- and 207 ustekinumab-treated IBD patients, mean age 42.2 (SD 16.0) and 41.6 (SD 14.4). Median treatment duration 54.0 (IQR 19.9-104.0) and 48.4 (IQR 24.4-55.1) weeks, median follow-up time 104.0 (IQR 103.1-104.0) and 52.0 weeks (IQR 49.3-100.4). On vedolizumab, CCI associated independently with any infection (OR 1.387, 95% CI 1.022-1.883, P = 0.036) and hospitalisation (OR 1.586, 95% CI 1.127-2.231, P = 0.008). On ustekinumab, CCI associated independently with hospitalisation (OR 1.621, 95% CI 1.034-2.541, P = 0.035). CCI was not associated with effectiveness, and age was not associated with any outcomes. CONCLUSIONS Comorbidity - but not age - is associated with an increased risk of hospitalisations on either treatment, and with any infection on vedolizumab. This underlines the importance of comorbidity assessment and safety monitoring of IBD patients.
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Qin SH, Li XM, Li WL. [Systematic retrospective study of oral cancer-related quality of life scale]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2018; 36:410-420. [PMID: 30182570 PMCID: PMC7048259 DOI: 10.7518/hxkq.2018.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 06/09/2018] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The quality of life (QOL) related to oral cancer has recently become a focus of clinical studies. This study aims to systematically review the current research situation of QOL of local and foreign oral cancer patients and explore the existing related problems and future research directions to provide references and solutions. METHODS Through relevant key words, PubMed, Wiley InterScience, Science Direct, CNKI, and Wanfang databases were first searched. The related target literature from 2000 to 2017 were screened. Finally, the frequency of oral cancer related to QOL scale used in literature was calculated, and the related scales were briefly introduced. RESULTS From the target literature, 218 English target literature, 55 Chinese target literature, 24 English scales, and 12 Chinese scales were selected. The most widely used scales for assessing the QOL of patients with oral cancer were as follows: University of Washington Quality of Life Questionnaire (UW-QOL), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30/Head and Neck 35 (EORTC QLQ-C30/H&N35), 36-Item Short-Form Health Survey (SF-36), Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), and Oral Health Impact Profile (OHIP). CONCLUSIONS The QOL related to oral cancer was well underway, and the study of geographical distribution was widespread. However, the work on self-developed scale remains inadequate. UW-QOL, EORTC QLQ-C30/H&N35, and FACT-H&N can be utilized as the preferred scales for evaluating the QOL of oral cancer patients. A specific disease-related function scale can also be selected according to specific research objectives.
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Affiliation(s)
- Shuai-Hua Qin
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xin-Ming Li
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Wen-Lu Li
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Qin SH, Li XM, Li WL. [Influencing factors on the quality of life and medical coping style of patients with oral cancer]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2018; 36:271-276. [PMID: 29984927 PMCID: PMC7030301 DOI: 10.7518/hxkq.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/15/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the influencing factors on the postoperative quality of life and to analyze the coping styles of patients with oral cancer. METHODS A total of 131 oral cancer cases confirmed through diagnostic criteria were investigated to analyze the influencing factors on the quality of life (QOL) and the relationship between coping style and QOL of these patients by using the fourth edition of the University of Washington Quality of Life Questionnaire (UWQOL) and medical coping modes questionnaires (MCMQ), respectively. RESULTS Among the 131 questionnaires collected, only 126 were valid with a recovery rate of 96.18% (126/131). Single factor analysis showed that age, marital status, educational level, other systemic diseases, personal income level, tooth loss, operation times, adjuvant radiotherapy, cancer staging, cervical lymph node dissection, recurrence, and jaw resection yielded different UWQOL scale scores (P<0.05). Multiple regression analysis showed that the loss of teeth, cancer staging, recurrence, and jaw resection yielded statistically significant differences in the total score of UWQOL (P<0.05). Among the coping styles, the average scores of "confrontation", "avoidance", and "yielding" were 17.54±4.97, 17.79±2.19, and 12.97±5.70, respectively. Compared with the norm, the difference was statistically significant (P<0.05). Correlation analysis showed that "confrontation" and "avoidance" were positively correlated, whereas "yielding" was negatively correlated to QOL (P<0.05). CONCLUSIONS Age, marital status, educational level, other systemic diseases, personal income level, tooth loss, operation times, adjuvant radiotherapy, cancer staging, cervical lymph node dissection, recurrence, and jaw resection have different effects on the quality of QOL. Tooth loss, cancer staging, recurrence, and jaw resection are the main causative factors affecting the patients' perceived QOL. Personalized treatment and nursing care should be strengthened to improve the coping style and quality of life of patients.
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Affiliation(s)
- Shuai-Hua Qin
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xin-Ming Li
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Wen-Lu Li
- Dept. of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
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Nguyen NH, Ohno-Machado L, Sandborn WJ, Singh S. Infections and Cardiovascular Complications are Common Causes for Hospitalization in Older Patients with Inflammatory Bowel Diseases. Inflamm Bowel Dis 2018; 24:916-923. [PMID: 29562273 DOI: 10.1093/ibd/izx089] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/03/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Prevalence of inflammatory bowel diseases (IBD) in older patients is increasing. Risk-benefit trade-offs of therapy are poorly understood in older patients, who may be at higher risk of nonIBD and/or treatment-related complications, rather than disease-related complications. We conducted a nationally representative cohort study to estimate and compare annual burden, costs, and causes for hospitalization in older versus younger patients with IBD. METHODS Using the Nationwide Readmissions Database 2013, we created a cohort of 47,402 patients with IBD who had been hospitalized at least once between January-June 2013 and followed for rehospitalization until December 2013. We estimated annual burden (total days spent in hospital), costs, and causes (based on primary discharge diagnosis) of hospitalization in older (>64y, n = 15,428), middle-age (40-64y, n = 18,476), and younger (<40y, n = 13,498) patients. RESULTS Older patients with IBD spent more days in hospital annually [median interquartile range : 7 (3-13) days] than middle-age [6 (3-12) days], and younger patients [5 ([3-11) days], with significantly higher hospitalization-related costs $15,078 (7423-30,955) vs $12,921 (6367-28,182) vs.. $10,070 (5192-22,100), P < 0.01. Older patients were significantly more likely to be hospitalized due to serious infections (14.6% vs 10.6% vs 8.4%; P < 0.01) and cardiovascular complications (9.9% vs 4.3% vs 0.8%; P < 0.01), and they were less likely due to IBD-related complications (11.8% vs 23.5% vs 41.4%; P < 0.01). CONCLUSIONS Older IBD patients have higher burden and costs of hospitalization than younger patients, mainly attributed to serious infections and cardiovascular complications, rather than disease-related complications. Careful assessment of comparative risks-benefits of different IBD therapies in older patients is warranted to identify the optimal treatment approach.
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Affiliation(s)
- Nghia H Nguyen
- Department of Internal Medicine, University of California San Diego, La Jolla, California
| | - Lucila Ohno-Machado
- Division of Biomedical Informatics, University of California San Diego, La Jolla, California
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Siddharth Singh
- Division of Biomedical Informatics, University of California San Diego, La Jolla, California.,Division of Gastroenterology, University of California San Diego, La Jolla, California
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Abstract
BACKGROUND Genetic and other biological factors may lead to differences in disease behavior among children with inflammatory bowel disease of different races, which may be further modified by disparities in care delivery. Using the Kids' Inpatient Database, we aimed to evaluate differences in the management of pediatric patients with inflammatory bowel disease by race, focusing on length of stay (LOS). METHODS We performed a cross-sectional analysis using 2000 to 2012 data from the Kids' Inpatient Database, a nationally representative database. We identified pediatric patients (≤18 years of age) with discharge diagnoses of Crohn's disease (CD) or ulcerative colitis (UC). We used multivariable logistic regression to evaluate the relationship between race and LOS, controlling for age, payer status need for surgery, and year of admission. RESULTS We identified 27,295 hospitalizations for children with inflammatory bowel disease (62% CD and 38% UC), Compared with white patients with CD, black (adjusted odds ratio 1.37; 95% confidence interval, 1.22-1.53; P < 0.001) and Hispanic patients (adjusted odds ratio: 1.37; 95% confidence interval: 1.19-1.59; P < 0.001) with CD demonstrated increased odds of a LOS greater than the 75th percentile. When compared with white patients with UC, Hispanic patients also demonstrated increased odds of a LOS greater than the 75th percentile (adjusted odds ratio: 1.20; 95% confidence interval, 1.02-1.42, P = 0.015). CONCLUSIONS After controlling for age, year of admission, and clinical phenotypes, black and Hispanic patients with CD and Hispanic patients with UC had longer LOS than white patients. These may be due to differences in provider/hospital characteristics, socioeconomic differences, and/or differences in genetics and other biological factors (see Video Abstract, Supplemental Digital Content 1, http://links.lww.com/IBD/B656).
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Abstract
There are different types of large registries which can be harnessed for inflammatory bowel disease research. Not one registry can answer all types of research questions. It is important for both the researchers using the registries and readers of the reports generated, to be aware of the different strengths and weaknesses of each registry and whether the questions posed can reliably be answered. In this review, the use of large administrative databases/registries are discussed in the context of studying descriptive epidemiology, outcomes of inflammatory bowel disease, pharmacoepidemiology, and etiologic research.
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Barnes EL, Beery RM, Schulman AR, McCarthy EP, Korzenik JR, Winter RW. Hospitalizations for Acute Myocardial Infarction Are Decreased Among Patients with Inflammatory Bowel Disease Using a Nationwide Inpatient Database. Inflamm Bowel Dis 2016; 22:2229-37. [PMID: 27542135 PMCID: PMC6044732 DOI: 10.1097/mib.0000000000000899] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Questions remain regarding the true prevalence of cardiovascular events such as myocardial infarction (MI) among patients with inflammatory bowel disease (IBD). Using the Nationwide Inpatient Sample (NIS), we aimed to compare the proportion of hospitalizations for acute MI among patients with IBD with that of the general population. METHODS This study used data from years 2000 to 2011 in Nationwide Inpatient Sample, the largest publicly available all-payer inpatient database in the United States. International Classification of Diseases, Ninth Revision, Clinical Modification discharge codes were used to identify adult patients with discharge diagnoses of IBD (ulcerative colitis or Crohn's disease), acute MI, and multiple comorbid risk factors for cardiovascular disease. The independent effect of a diagnosis of IBD on risk of acute MI was examined using a multivariable logistic regression model controlling for multiple confounders. Data were analyzed using SAS survey procedures and weighted to reflect national estimates. RESULTS We identified 567,438 hospitalizations among patients with IBD and 78,121,000 hospitalizations among the general population. Patients with IBD were less likely to be hospitalized for acute MI than patients in the general population (1.3% versus 3.1%, P < 0.001). In adjusted analyses, the odds of hospitalization for acute MI among patients with IBD were decreased when compared with the general population (odds ratio, 0.51; 95% confidence interval, 0.50-0.52). CONCLUSIONS Despite prior reports of a potentially increased risk of acute MI among patients with IBD, in a nationwide inpatient database, lower rates of acute MI were demonstrated in the IBD population when compared with the general population.
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Affiliation(s)
- Edward L. Barnes
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Renee Marchioni Beery
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Allison R. Schulman
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Ellen P. McCarthy
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center; Office for Diversity Inclusion and Community Partnership, Harvard Medical School, Boston, MA, USA
| | - Joshua R. Korzenik
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Rachel W. Winter
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
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Characterization of inflammatory bowel disease in elderly patients: A review of epidemiology, current practices and outcomes of current management strategies. Can J Gastroenterol Hepatol 2015; 29:327-33. [PMID: 26069892 PMCID: PMC4578457 DOI: 10.1155/2015/136960] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The authors review and summarize the current literature regarding the epidemiology, clinical presentation and management of inflammatory bowel disease (IBD) in elderly patients. Among elderly patients, the incidence of ulcerative colitis (UC) is higher than that of Crohn disease (CD). Elderly patients with a new diagnosis of UC are more likely to be male and have left-sided colitis. Elderly patients with a new diagnosis of CD are more likely to be female and have colonic disease. Conversely, increasing age at diagnosis has been associated with a lower likelihood of having any of a family history of IBD, perianal disease in CD and extraintestinal manifestations. Although response to drug therapies appears to be similar in elderly patients and younger individuals, the elderly are more likely to receive 5-aminosalicylic acid agents, and less likely to receive immunomodulators and biologics. Corticosteroid use in the elderly is comparable with use in younger individuals. The rates of surgical intervention appear to be lower for elderly CD patients but not elderly UC patients. Elderly individuals with UC are more likely to need urgent colectomy, which is associated with an increased mortality rate. Elective surgery is associated with similar outcomes among the elderly and young patients with IBD. Therefore, the use of immunomodulators and biologics, and earlier consideration of elective surgery for medically refractory disease in elderly patients with IBD, should be emphasized and further evaluated to prevent complications of chronic corticosteroid(s) use and to prevent emergency surgery.
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Should we establish standards of care for management of elderly patients with inflammatory bowel disease? Can J Gastroenterol Hepatol 2015; 29:236. [PMID: 26076222 PMCID: PMC4467482 DOI: 10.1155/2015/862458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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