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Kitayama M, Akazawa Y, Yoshikawa D, Higashi S, Morisaki T, Oda H, Ikeda M, Nakashima Y, Tabuchi M, Hashiguchi K, Matsushima K, Yamaguchi N, Kondo H, Nakao K, Takeshima F. Comparative efficacy of antitumor necrosis factor agents and tacrolimus in naïve steroid-refractory ulcerative colitis patients. Sci Rep 2020; 10:12546. [PMID: 32719413 PMCID: PMC7385627 DOI: 10.1038/s41598-020-68828-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 07/02/2020] [Indexed: 02/07/2023] Open
Abstract
While retrospective studies have compared the efficacy of anti–tumour necrosis factor (TNF) agents and tacrolimus (TAC) in ulcerative colitis (UC), information regarding first-time use of these agents is limited. The aim of our study was to investigate the short- and long-term efficacy of anti-TNF agents [adalimumab (ADA) and infliximab (IFX)] and TAC in anti-TNF agent- and TAC-naïve steroid-refractory UC patients. We evaluated 150 steroid-refractory UC patients receiving anti-TNF agents (IFX: n = 30, ADA: n = 41) or TAC (n = 79) at eight institutions in Japan. Clinical response rates at 8 weeks were 73.2% and 75.9% while remission rates were 30.1% and 25.3% in the anti-TNF and TAC groups, respectively. Logistic regression analysis showed the male sex and higher C-reactive protein to be independent factors for response to anti-TNF agents and TAC, respectively. Use of TAC was an independent factor for relapse. No differences in response to the treatment or relapse were observed between IFX and ADA. In conclusion, TAC and anti-TNF agents promoted similar short-term effects, but anti-TNF agents ensured better long-term outcomes at first-time treatment of steroid-refractory UC patients.
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Affiliation(s)
- Moto Kitayama
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Yuko Akazawa
- Tissue and Histopathology Section, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki City, Japan
| | - Daisuke Yoshikawa
- Department of Gastroenterology and Hepatology, Sasebo City General Hospital, 9-3 Hirase-cho, Sasebo City, Nagasaki, 857-8511, Japan
| | - Shuntaro Higashi
- Department of Gastroenterology, Inoue Hospital, 6-12, Takaramachi, Nagasaki City, Nagasaki, 850-0045, Japan
| | - Tomohito Morisaki
- Department of Gastroenterology and Hepatology, National Hospital Organization Ureshino Medical Center, 2436 Ureshino-cho, Ureshino City, Saga, 843-0393, Japan
| | - Hidetoshi Oda
- Department of Gastroenterology and Hepatology, Sasebo Chuo Hospital, 15 Yamato-cho, Sasebo City, Nagasaki, 857-1195, Japan
| | - Maho Ikeda
- Department of Internal Medicine, Juko Memorial Nagasaki Hospital, 6-17, Maruo, Nagasaki City, Nagasaki, 852-8004, Japan
| | - Yujiro Nakashima
- Department of Gastroenterology, National Hospital Organization Nagasaki Medical Center, 2-1001-1 Kubara, Ohmura City, Nagasaki, 856-8562, Japan
| | - Maiko Tabuchi
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Keiichi Hashiguchi
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Kayoko Matsushima
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Naoyuki Yamaguchi
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Hisayoshi Kondo
- Biostatistics Section, Division of Scientific Data Registry, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Kazuhiko Nakao
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Fuminao Takeshima
- Department of Gastroenterology and Hepatology, Graduate School of Biomedical Science, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan. .,Department of Internal Medicine, Nagasaki Prefecture Goto Central Hospital, 205 Yoshikugi, Goto City, Nagasaki, 853-0031, Japan.
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Verdon C, Bessissow T, Lakatos PL. Management of Acute Severe Colitis in the Era of Biologicals and Small Molecules. J Clin Med 2019; 8:jcm8122169. [PMID: 31817972 PMCID: PMC6947608 DOI: 10.3390/jcm8122169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/02/2019] [Accepted: 12/06/2019] [Indexed: 12/14/2022] Open
Abstract
Acute severe ulcerative colitis (ASUC) is a medical emergency which occurs in about 20%–30% of patients with ulcerative colitis during their lifetime, and does carry a mortality risk of 1%. The management of inflammatory bowel diseases has evolved with changes in objective patient monitoring, as well as the availability of new treatment options with the development of new biological and small molecules; however, data is limited regarding their use in the context of ASUC. This review aims to discuss the emerging data regarding biologicals and small molecules therapies in the context of ASUC.
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Affiliation(s)
- Christine Verdon
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (C.V.); (T.B.)
- Department of Gastroenterology, Campbelltown Hospital, Sydney, NSW 2560, Australia
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (C.V.); (T.B.)
| | - Peter L. Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (C.V.); (T.B.)
- 1st Department of Medicine, Semmelweis University, Budapest H1083, Hungary
- Correspondence: ; Tel.: +514-934-1934 (ext. 45567)
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Nishida Y, Hosomi S, Yamagami H, Sugita N, Itani S, Yukawa T, Otani K, Nagami Y, Tanaka F, Taira K, Kamata N, Kakimoto K, Tanigawa T, Watanabe T, Fujiwara Y. Azathioprine Is Useful for Maintaining Long-term Remission Induced by Tacrolimus for the Treatment of Ulcerative Colitis: An Inverse Probability of a Treatment Weighing Analysis. Intern Med 2019; 58:2305-2313. [PMID: 31118391 PMCID: PMC6746627 DOI: 10.2169/internalmedicine.2632-19] [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] [Indexed: 11/22/2022] Open
Abstract
Objective The need for and efficacy of immunomodulators for maintaining remission after tacrolimus therapy have not been sufficiently defined. This study evaluated the efficacy of immunomodulators for maintaining remission in patients with ulcerative colitis after tacrolimus therapy. Methods Patients with active ulcerative colitis who started oral tacrolimus between January 2009 and September 2017 and were responsive were retrospectively evaluated. Long-term outcomes were compared using Cox proportional hazard regression with inverse probability of treatment weighting. Results Among the 63 patients in the study, 45 received immunomodulators. During the follow-up, 30 patients (47.6%) experienced a relapse. The relapse-free survival rate was significantly worse in the group that did not receive immunomodulators than in those that did (p=0.01, log-rank test); the 2-year relapse-free rates were 22.5% and 63.6% in the non-immunomodulator and immunomodulator groups, respectively. A multivariate analysis showed immunomodulator treatment to be an independent protective factor for clinical relapse (adjusted hazard ratio: 0.35, 95% confidence interval: 0.16-0.78, p=0.01). A Cox regression analysis using inverse probability of treatment weighting also showed that immunomodulator maintenance therapy was correlated with a longer relapse-free survival (hazard ratio: 0.31, 95% confidence interval: 0.15-0.64, p<0.01), A similar response was also observed in non-steroid-dependent patients (hazard ratio: 0.36, 95% confidence interval: 0.14-0.99, p=0.047). No serious adverse events occurred due to tacrolimus or immunomodulator, and immunomodulator use did not increase the incidence of adverse events caused by tacrolimus. Conclusion Our data suggest that the use of immunomodulators to maintain remission after tacrolimus therapy is beneficial for patients with ulcerative colitis.
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Affiliation(s)
- Yu Nishida
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Hirokazu Yamagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Naoko Sugita
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Shigehiro Itani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Tomomi Yukawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Kazuki Kakimoto
- Second Department of Internal Medicine, Osaka Medical College, Japan
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Japan
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Pretreatment neutrophil-to-lymphocyte ratio predicts clinical relapse of ulcerative colitis after tacrolimus induction. PLoS One 2019; 14:e0213505. [PMID: 30845259 PMCID: PMC6405082 DOI: 10.1371/journal.pone.0213505] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/24/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives Although tacrolimus is useful as an induction therapy in patients with ulcerative colitis (UC), information regarding the long-term outcome after tacrolimus therapy is insufficient. The aim of this study was to evaluate the clinical significance of the pretreatment neutrophil-to-lymphocyte ratio (NLR) as a prognostic factor in patients with UC receiving tacrolimus, to aid treatment selection. Materials and methods Patients with moderate-to-severe active UC who received oral tacrolimus induction therapy and subsequent immunomodulatory maintenance therapy at our hospital between 2009 and 2017 and who showed clinical response at week 12, were retrospectively enrolled. Cox regression analysis was conducted to study the prognostic role of the pretreatment NLR. The combined impact of the NLR and other known prognostic factors was investigated with multivariate regression. Results Among 45 patients included in this study, 21 patients experienced relapse during a median follow-up period of 16.6 months. Multivariate Cox regression analysis identified the pretreatment NLR (hazard ratio [HR]: 0.82, 95% confidence interval [CI]: 0.72–0.94, P < 0.01) and the use of immunomodulators at the start of tacrolimus treatment (HR: 0.18, 95% CI: 0.05–0.66, P = 0.01) as independent predictors of clinical relapse. Conclusions The pretreatment NLR is an independent prognostic factor in patients with UC treated with tacrolimus.
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Suzuki T, Mizoshita T, Tanida S, Sugimura N, Katano T, Nishie H, Kataoka H. The efficacy of maintenance therapy after remission induction with tacrolimus in ulcerative colitis with and without previous tumor necrosis factor-α inhibitor. JGH OPEN 2019; 3:217-223. [PMID: 31276039 PMCID: PMC6586576 DOI: 10.1002/jgh3.12140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/16/2018] [Indexed: 01/08/2023]
Abstract
Background and Aim Tacrolimus (TAC) is an important therapeutic option for remission induction in patients with refractory ulcerative colitis (UC). However, there is little evidence available on long‐term outcomes and maintenance treatments after TAC therapy, especially in cases with previous tumor necrosis factor‐α (TNF‐α) inhibitor therapy. Methods Long‐term outcomes and remission induction after TAC treatment were retrospectively examined in refractory UC patients with and without previous TNF‐α inhibitor therapy. Results The mean disease activity index and the endoscopic activity index scores decreased significantly during the 12‐week treatment after TAC therapy in both groups, showing a significantly greater decrease in the group without TNF‐α inhibitor therapy than in the group with previous TNF‐α inhibitor therapy. One year or more after TAC therapy, TNF‐α inhibitor and/or azathioprine was used as maintenance therapy in most cases in the group without previous TNF‐α inhibitor treatment, while azathioprine was primarily used in the group with previous TNF‐α inhibitor treatment. Colectomy was performed in 45.5% (5/11) and 15.6% (7/45) of the groups with and without previous TNF‐α inhibitor therapy, respectively, and the group without previous TNF‐α inhibitor treatment had a better colectomy‐free rate than the group with previous TNF‐α inhibitor treatment after TAC therapy on Kaplan–Meier analysis. Conclusions TAC is effective for remission induction in refractory UC patients with and without previous TNF‐α inhibitor treatment. Maintenance medication after TAC therapy is an issue for the future, especially in UC cases with previous TNF‐α inhibitor treatment failure.
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Affiliation(s)
- Taketo Suzuki
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Tsutomu Mizoshita
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Satoshi Tanida
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Naomi Sugimura
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Takahito Katano
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Hirotada Nishie
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences Nagoya Japan
| | - Hiromi Kataoka
- Department of Gastroenterology and Metabolism Nagoya City University Graduate School of Medical Sciences Nagoya Japan
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Liu YJ, Fan H, Zhen WW, Yu X, Chen JT, Wang CD. Pooled analysis of the comparative efficacy between tacrolimus and infliximab for ulcerative colitis. Medicine (Baltimore) 2018; 97:e11440. [PMID: 30095612 PMCID: PMC6133612 DOI: 10.1097/md.0000000000011440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Acute moderate-to-severe steroid-refractory ulcerative colitis (UC) has a poor prognosis and requires optimal rescue therapy. A pooled analysis was conducted to assess tacrolimus and infliximab (IFX) as rescue agents in patients with moderate-to-severe and steroid-refractory UC. METHODS A literature search identified studies that investigated tacrolimus and IFX in moderate-to-severe steroid-refractory patients with UC. The primary outcome was short-term clinical response to treatment, including the remission and response rates. Secondary outcomes included the rates of colectomy at 3 months and adverse events rate. RESULTS A total of 6 studies comprising 438 cases were eligible for inclusion. The pooled analysis showed that the short-term clinical response rate, clinical remission rate, and 3-month colectomy rate were 72.1%, 52.4%, and 10.1%, respectively, for those receiving tacrolimus, and 76.9%, 48.8%, and 12.4%, respectively, for those receiving IFX. No significant difference was, however, seen for tacrolimus compared with IFX with regard to clinical remission rate (odds ratio [OR] =1.08, 95% confidence interval [CI] = 0.77-1.49, P = .67), clinical response rate (OR = 0.92, 95% CI = 0.63-1.34, P = .66), and 3-month colectomy rate (OR = 0.86, 95% CI = 0.39-1.93, P = .72). More adverse events were, however, observed in the Tac group (OR = 2.16, 95% CI = 1.25-3.76, P = .006). CONCLUSIONS Our meta-analysis suggested that both tacrolimus and IFX appeared to be effective and safe for the rescue therapy of moderate-to-severe active UC and steroid-refractory UC. Therefore, tacrolimus is another choice for these patients.
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Saifuddin A, Harris A. Tacrolimus therapy in moderate to subacute ulcerative proctocolitis: a large single-centre cohort study. Frontline Gastroenterol 2018; 9:148-153. [PMID: 29588844 PMCID: PMC5868452 DOI: 10.1136/flgastro-2017-100888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/15/2017] [Accepted: 11/19/2017] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To explore the 'real world' effectiveness of tacrolimus therapy for refractory ulcerative proctocolitis (UC). DESIGN Retrospective cohort study using prospectively collated clinical data. SETTING A single district general hospital in Kent, UK. Clinical decisions and regular monitoring were undertaken by a single expert in inflammatory bowel disease. PATIENTS All patients started on tacrolimus between January 2010 and August 2016 at Tunbridge Wells Hospital. INTERVENTIONS Following failure of conventional medication, tacrolimus was commenced at 0.5 mg/kg twice daily. Drug trough levels of 5-20 ng/mL were targeted. Other immunomodulation was stopped and steroids were weaned over 4-6 weeks. MAIN OUTCOME MEASURES Treatment duration was measured for each patient. If the drug was stopped, the rationale, including specific side effects, was recorded. The patient's subsequent management plan was noted. RESULTS Thirty-five patients were started on tacrolimus (range: 18-85, median: 36 years). Disease extent included proctitis to pancolitis. Twenty-five patients derived no benefit. Four patients responded, but drug side effects necessitated withdrawal. Eighteen of these 29 patients (62%) underwent surgery. One patient, who had previously responded, stopped the drug after becoming pregnant (healthy subsequent birth). Therefore, 5 of 35 patients (14%) remain on tacrolimus with sustained clinical response, ranging from 6 to 76 (median: 32) months of treatment. Treatment was most effective for proctosigmoiditis. There were no other demographic or biological markers for success. CONCLUSIONS In line with UK and European guidelines, tacrolimus can be beneficial for refractory UC. With appropriate monitoring, it appears treatment can be continued safely long term.
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Affiliation(s)
- Aamir Saifuddin
- Department of Gastroenterology, Tunbridge Wells Hospital, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
| | - Adam Harris
- Department of Gastroenterology, Tunbridge Wells Hospital, Maidstone and Tunbridge Wells NHS Trust, Kent, UK
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Takeuchi K, Shimoyama T, Yamamoto T. Comparison of Safety and Efficacy of Tacrolimus versus Infliximab for Active Ulcerative Colitis. Dig Dis 2017; 36:106-112. [PMID: 29050007 DOI: 10.1159/000481815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/25/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND This narrative review was to determine which medication, tacrolimus (TAC) or infliximab (IFX), is safer and more effective in the management of active UC. Our literature search identified 5 studies directly comparing the outcomes of TAC versus IFX for active UC. A review of the 5 studies was undertaken. SUMMARY The incidence of serious adverse events was not significantly different between the TAC and IFX groups. The short-term clinical remission and response rates and the colectomy-free rates were similar between the groups. TAC was usually withdrawn at week 12 and, therefore, the long-term efficacy of TAC could not be properly evaluated. The majority of patients in the IFX group maintained clinical remission in the long-term. The efficacy of IFX as second-line salvage therapy after failure of TAC appeared to be favourable, but the efficacy of TAC after failure of IFX was questionable. Key Messages: Both TAC and IFX appeared to be equally safe and effective in the short-term for patients with active UC. For the moment, treatment choice, TAC or IFX, should be guided by physician and centre experience. Randomised controlled trials are urgently warranted to rigorously compare the efficacy of TAC versus IFX for active UC.
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Affiliation(s)
- Ken Takeuchi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Centre, Sakura, Japan
| | - Takahiro Shimoyama
- Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan
| | - Takayuki Yamamoto
- Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan
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