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Calafat M, Torres P, Tosca-Cuquerella J, Sánchez-Aldehuelo R, Rivero M, Iborra M, González-Vivo M, Vera I, de Castro L, Bujanda L, Barreiro-de Acosta M, González-Muñoza C, Calvet X, Benítez JM, Llorente-Barrio M, Surís G, Cañete F, Arias-García L, Monfort D, Castaño-García A, Garcia-Alonso FJ, Huguet JM, Marín-Jímenez I, Lorente R, Martín-Cardona A, Ferrer JÁ, Camo P, Gisbert JP, Pajares R, Gomollón F, Castro-Poceiro J, Morales-Alvarado J, Llaó J, Rodríguez A, Rodríguez C, Pérez-Galindo P, Navarro M, Jiménez-García N, Carrillo-Palau M, Blázquez-Gómez I, Sesé E, Almela P, Ramírez de la Piscina P, Taxonera C, Rodríguez-Lago I, Cabrinety L, Vela M, Mínguez M, Mesonero F, García MJ, Aguas M, Márquez L, Silva Porto M, Pineda JR, García-Etxebarría K, Bertoletti F, Brunet E, Mañosa M, Domènech E. Clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in patients with ulcerative colitis treated with two consecutive anti-TNF agents: data from the ENEIDA registry. Therap Adv Gastroenterol 2024; 17:17562848231221713. [PMID: 38187926 PMCID: PMC10771049 DOI: 10.1177/17562848231221713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Abstract
Background Infliximab seems to be the most efficacious of the three available anti-TNF agents for ulcerative colitis (UC) but little is known when it is used as the second anti-TNF. Objectives To compare the clinical and treatment outcomes of a second subcutaneous or intravenous anti-TNF in UC patients. Design Retrospective observational study. Methods Patients from the ENEIDA registry treated consecutively with infliximab and a subcutaneous anti-TNF (or vice versa), naïve to other biological agents, were identified and grouped according to the administration route of the first anti-TNF into IVi (intravenous initially) or SCi (subcutaneous initially). Results Overall, 473 UC patients were included (330 IVi and 143 SCi). Clinical response at week 14 was 42.7% and 48.3% in the IVi and SCi groups (non-statistically significant), respectively. Clinical remission rates at week 52 were 32.8% and 31.4% in the IVi and SCi groups (nonsignificant differences), respectively. A propensity-matched score analysis showed a higher clinical response rate at week 14 in the SCi group and higher treatment persistence in the IVi group. Regarding long-term outcomes, dose escalation and discontinuation due to the primary failure of the first anti-TNF and more severe disease activity at the beginning of the second anti-TNF were inversely associated with clinical remission. Conclusion The use of a second anti-TNF for UC seems to be reasonable in terms of efficacy, although it is particularly reduced in the case of the primary failure of the first anti-TNF. Whether the second anti-TNF is infliximab or subcutaneous does not seem to affect efficacy.
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Affiliation(s)
- Margalida Calafat
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Paola Torres
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Joan Tosca-Cuquerella
- Gastroenterology Department, Hospital Clínic Universitari de València, València, Spain
| | | | - Montserrat Rivero
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de investigación IDIVAL, Santander, Spain
| | - Marisa Iborra
- Gastroenterology Department, Hospital Universitari i Politècnic La Fe, València, Spain
| | | | - Isabel Vera
- Gastroenterology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Luisa de Castro
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Luis Bujanda
- Biodonostia Health Research Institute, San Sebastián, Spain
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, San Sebastián, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Manuel Barreiro-de Acosta
- Gastroenterology Department, Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
| | | | - Xavier Calvet
- Gastroenterology Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - José Manuel Benítez
- Gastroenterology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
- Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | | | - Gerard Surís
- Gastroenterology Department, Hospital Universitari de Bellvitge (L’ Hospitalet de Llobregat), Barcelona, Spain
| | - Fiorella Cañete
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Lara Arias-García
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | - David Monfort
- Gastroenterology Department, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Andrés Castaño-García
- Gastroenterology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - José M. Huguet
- Gastroenterology Department, Hospital General Universitari de València, València, Spain
| | | | - Rufo Lorente
- Gastroenterology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Albert Martín-Cardona
- Gastroenterology Department, Hospital Universitari Mútua Terrassa, Terrassa, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Juan Ángel Ferrer
- Gastroenterology Department, Hospital Universitario Fundación de Alcorcón (Madrid), Spain
| | - Patricia Camo
- Gastroenterology Department, Hospital General San Jorge, Huesca, Spain
| | - Javier P. Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, IIS Princesa and UAM, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Ramón Pajares
- Gastroenterology Department, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Fernando Gomollón
- Gastroenterology Department, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Zaragoza, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | | | | | - Jordina Llaó
- Gastroenterology Department, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Spain
| | - Andrés Rodríguez
- Gastroenterology Department, Hospital General Universitari d’Alacant, Alacant, Spain
| | - Cristina Rodríguez
- Gastroenterology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Pablo Pérez-Galindo
- Gastroenterology Department, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Mercè Navarro
- Gastroenterology Department, Hospital Moisès Broggi, Sant Joan Despí, Spain
| | | | - Marta Carrillo-Palau
- Gastroenterology Department, Hospital Universitario de Canarias, La Laguna, Spain
| | | | - Eva Sesé
- Gastroenterology Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Pedro Almela
- Gastroenterology Department, Hospital General Universitari de Castelló, Castellón, Spain
| | | | - Carlos Taxonera
- Gastroenterology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Iago Rodríguez-Lago
- Gastroenterology Department, Hospital Universitario de Galdakao, Biocruces Bizkaia HRI, Galdakao, Spain
| | - Lidia Cabrinety
- Gastroenterology Department, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Milagros Vela
- Gastroenterology Department, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Miguel Mínguez
- Gastroenterology Department, Hospital Clínic Universitari de València, València, Spain
| | | | - María José García
- Gastroenterology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de investigación IDIVAL, Santander, Spain
| | - Mariam Aguas
- Gastroenterology Department, Hospital Universitari i Politècnic La Fe, València, Spain
| | - Lucía Márquez
- Gastroenterology Department, Hospital del Mar, Barcelona, Spain
| | - Marisol Silva Porto
- Gastroenterology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Juan R. Pineda
- Gastroenterology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Koldo García-Etxebarría
- Biodonostia Health Research Institute, San Sebastián, Spain
- Universidad del País Vasco/Euskal Herriko Unibertsitatea, San Sebastián, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Federico Bertoletti
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eduard Brunet
- Gastroenterology Department, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Míriam Mañosa
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Eugeni Domènech
- Gastroenterology and Hepatology Department, Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, Catalonia 08916, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
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Barberio B, Gracie DJ, Black CJ, Ford AC. Maintenance of clinical remission with biologics and small molecules in inflammatory bowel disease according to trial design: Meta-analysis. Dig Liver Dis 2024; 56:7-14. [PMID: 37357037 DOI: 10.1016/j.dld.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 05/02/2023] [Accepted: 06/08/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND AIMS Design of randomised controlled trials (RCTs) examining maintenance of clinical remission in inflammatory bowel disease (IBD) varies, with some trials re-randomising patients who have responded to active drug during induction to either active drug or placebo and others treating patients through with active drug or placebo from baseline. Whether this influences therapeutic gain of drug over placebo is unknown. METHODS We searched the literature to January 2023 for maintenance of remission trials of biologics or small molecules versus placebo in IBD. We extracted maintenance of remission rates according to trial design; either trials re-randomising patients or trials treating patients through. We pooled data in a meta-analysis for all patients, and according to type of IBD. We calculated the number needed to treat (NNT), with a 95% confidence interval (CI), to assess therapeutic gain of active drug over placebo according to trial design. RESULTS We identified 37 maintenance of remission trials (12,075 patients). Rates of maintenance of clinical remission were higher (41.9% with active drug, versus 20.3% with placebo), and NNT lowest (5; 95% CI 4-6), in trials re-randomising patients compared with those treating through (maintenance of remission rate 30.9% with active drug versus 14.6% with placebo, NNT = 7; 95% CI 5-9). Results were similar when trials were analysed according to IBD type but were more marked in ulcerative colitis RCTs (maintenance of remission rates in re-randomised trials 39.4% with active drug versus 17.8% with placebo, NNT = 5; 95% CI 3-7; treat-through trials 27.3% with active drug versus 11.9% with placebo, NNT = 7; 95% CI 5-11.5). CONCLUSION Trials re-randomising patients had generally higher maintenance of remission rates, lower NNTs, and greater therapeutic gains over placebo.
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Affiliation(s)
- Brigida Barberio
- Department of Surgery, Oncology and Gastroenterology (DISCOG), Gastroenterology Unit, University of Padova-Azienda Ospedaliera di Padova, Padova, Italy
| | - David J Gracie
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Christopher J Black
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK
| | - Alexander C Ford
- Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, UK.
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Chu X, Biao Y, Liu C, Zhang Y, Liu C, Ma JZ, Guo Y, Gu Y. Network meta-analysis on efficacy and safety of different biologics for ulcerative colitis. BMC Gastroenterol 2023; 23:346. [PMID: 37803294 PMCID: PMC10557260 DOI: 10.1186/s12876-023-02938-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/29/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Therapeutic options for ulcerative colitis (UC) have increased since the introduction of biologics a few decades ago. Due to the wide range of biologics available, physicians have difficulty in selecting biologics and do not know how to balance the best drug between clinical efficacy and safety. This study aimed to compare the efficacy and safety of biologics in treating ulcerative colitis. METHODS In this study, eight electronic databases (PubMed, Web of Science, Cochrane, Embase, Sinomed, China National Knowledge Infrastructure, Chongqing VIP Information, and WanFang Data) were searched to collect eligible studies without language restrictions. Retrieved 1 June 2023, from inception. All articles included in the mesh analysis are randomised controlled trials (RCTs). The inclusion of drugs for each outcome was ranked using a curved surface under cumulative ranking (SUCRA). Higher SUCRA scores were associated with better outcomes, whereas lower SUCRA scores were associated with better safety. This study has registered with PROSPERO, CRD42023389483. RESULTS Induction Therapy: Among the biologic therapies evaluated for induction therapy, vedolizumab demonstrated the highest efficacy in achieving clinical remission (OR vs daclizumab, 9.09; 95% CI, 1.01-81.61; SUCRA 94.1) and clinical response. Guselkumab showed the lowest risk of recurrence of UC (SUCRA 94.9%), adverse events resulting in treatment discontinuation (SUCRA 94.8%), and serious infections (SUCRA 78.0%). Maintenance Therapy: For maintenance therapy, vedolizumab ranked highest in maintaining clinical remission (OR vs mesalazine 4.36; 95% CI, 1.65-11.49; SUCRA 89.7) and endoscopic improvement (SUCRA 92.6). Infliximab demonstrated the highest efficacy in endoscopic improvement (SUCRA 92.6%). Ustekinumab had the lowest risk of infections (SUCRA 92.9%), serious adverse events (SUCRA 91.3%), and serious infections (SUCRA 67.6%). CONCLUSION Our network meta-analysis suggests that vedolizumab is the most effective biologic therapy for inducing and maintaining clinical remission in UC patients. Guselkumab shows promise in reducing the risk of recurrence and adverse events during induction therapy. Infliximab is effective in improving endoscopic outcomes during maintenance therapy. Ustekinumab appears to have a favorable safety profile. These findings provide valuable insights for clinicians in selecting the most appropriate biologic therapy for UC patients.
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Affiliation(s)
- Xinqiao Chu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences - No.5, Beixian Pavilion, Xicheng District, Beijing, 100053, China
| | - Yaning Biao
- School of Pharmacy, Hebei University of Chinese Medicine, 326 New Shinan Road, Qiaoxi District, Shijiazhuang, Hebei, 050091, China
| | - Chengjiang Liu
- Department of General Medicine, Affiliated Anqing First People's Hospital of Anhui Medical University, Anqing, Anhui, China
| | - Yixin Zhang
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China
| | - Chenxu Liu
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China
| | - Ji-Zheng Ma
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences - No.5, Beixian Pavilion, Xicheng District, Beijing, 100053, China
| | - Yufeng Guo
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences - No.5, Beixian Pavilion, Xicheng District, Beijing, 100053, China.
| | - Yaru Gu
- School of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, 050200, China.
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Goss Sawhney T, Dobes A, O’Charoen S. Real-World Persistency for Inflammatory Bowel Disease Biologics Using Patient Registry Data. CROHN'S & COLITIS 360 2023; 5:otad051. [PMID: 37941597 PMCID: PMC10629214 DOI: 10.1093/crocol/otad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Indexed: 11/10/2023] Open
Abstract
Background Although it is a truism that drugs benefit patients only when taken, surprisingly little is known about real-world drug-use persistence and discontinuation, even for expensive biologic drugs. Methods We used longitudinal self-reported drug-use data from the inflammatory bowel disease (IBD) Partners registry of people with IBD to construct Kaplan-Meier drug-use persistency graphs for biologic drug-use spans that started between 2017 and 2022. Results We examined 2034 drug-use spans for 1594 survey participants. Most of the biologic drugs had a 75%+ persistency rate around the one-year mark and 60%+ persistency at the 3-year mark. The overall persistency and the differences in persistency between drugs were aligned with published literature. Conclusions This analysis demonstrates the feasibility of collecting IBD-specific patient-reported drug persistency data via a voluntary patient registry. Patient-reported persistency provides real-world drug persistency data and the patient's perspectives as to why they discontinued use of the drug-a combination of data and perspective that is not available from any other real-world medical record, claim, and pharmacy data source that are valuable to physician, patients, payers, healthcare policymakers, and health technology assessment organizations.
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Affiliation(s)
- Tia Goss Sawhney
- Teus Health, LLC, Newark, NJ, USA
- New York University, School of Global Public Health, New York, NY, USA
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Kinzer JL, Halseth TA, Kang J, Kim SY, Kumaran P, Ford M, Saveliev S, Skilton SJ, Schwendeman A. Physicochemical characterization and functionality comparison of Humira®(adalimumab), Remicade®(infliximab) and Simponi Aria®(golimumab). Int J Pharm 2023; 635:122646. [PMID: 36709835 DOI: 10.1016/j.ijpharm.2023.122646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/14/2023] [Accepted: 01/22/2023] [Indexed: 01/27/2023]
Abstract
FDA-approved anti-TNFα biopharmaceuticals are successful in treating a range of autoimmune diseases. However, not all anti-TNFα products are identical in their patient outcomes, suggesting that there may be product-specific differences stemming from protein structural differences, doses and routes of administration. In this work, we focus only on structural and functional differences across three full-length anti-TNFα mAbs (Humira®, Remicade®, and Simponi Aria®) to better understand the implications of such differences on the products' efficacy. For structural characterization, we quantified N-glycans using mass spectrometry and fluorescence labeling. From these studies, we observed that Remicade® had the highest percent of afucosylated glycans (15.5 ± 1.3 %) and the largest number of unique glycans, 28. While Humira® had the fewest unique glycans, 15, and 11.4 ± 0.8 % of afucosylated, high-mannose glycans. For the functional studies we tested TNFα binding via ELISA, FcγRIIIa binding via AlphaLISA and effector function using an ADCC bioreporter assay. Humira® had a significantly lower EC50 (1.9 ± 0.1 pM) for ELISA and IC50 (10.5 ± 1.1 nM) for AlphaLISA, suggesting that Humira® has higher TNFα and FcγRIIIa binding affinity than Remicade® and Simponi Aria®. Humira® was also the most potent in the bioreporter assay with an EC50 value of 0.55 ± 0.03 nM compared to Remicade® (0.64 ± 0.04 nM) and Simponi Aria® (0.67 ± 0.03 nM). This comparison is significant as it highlights functional differences between mAbs with shared mechanisms of action when examined in a single laboratory and under one set of conditions.
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Affiliation(s)
- Jill L Kinzer
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109, United States
| | - Troy A Halseth
- Department of Medicinal Chemistry, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109, United States
| | - Jukyung Kang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109, United States
| | - Sang Yeop Kim
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109, United States
| | - Preethi Kumaran
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109, United States
| | - Michael Ford
- MS Bioworks, 3950 Varsity Dr, Ann Arbor, MI 48108, United States
| | - Sergei Saveliev
- Promega Corporation, 2800 Woods Hollow Rd, Madison, WI 53711, United States
| | - St John Skilton
- Protein Metrics, 20863 Stevens Creek Blvd #450, Cupertino, CA 95014, United States
| | - Anna Schwendeman
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI 48109, United States; Biointerfaces Institute, NCRC, 2800 Plymouth Rd, Ann Arbor, MI 48109, United States.
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Vedolizumab is superior to infliximab in biologic naïve patients with ulcerative colitis. Sci Rep 2023; 13:1816. [PMID: 36725872 PMCID: PMC9892496 DOI: 10.1038/s41598-023-28907-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
There are no prospective, head-to-head, controlled trials comparing the efficacy and safety of Infliximab (IFX) and Vedolizumab (VDZ) for the treatment of moderate-to-severe ulcerative colitis (UC), while only a few real-life retrospective studies have been published so far. We assessed the efficacy of IFX vs. VDZ in two cohorts of biologic-naïve outpatients with moderate-to-severe UC or mild, but refractory, disease. Data were extracted from patients' files and reviewed. The duration of follow-up (FU) was 52 weeks. The primary endpoint was the clinical remission (CR) at the end of FU. Secondary endpoints were: drug persistency, time to obtain CR, clinical response at the end of the induction phase (IP), steroid-free CR (compared to patients who used steroids at baseline) at the end of FU, need for drug optimization, adverse events (AEs), and normalization of C-reactive protein (CRP). We also analyzed the causes of dropping out (primary non-response), or secondary loss of response (immunogenic or not), for each group. We enrolled 82 patients (50 IFX and 32 VDZ) who met the inclusion criteria. At the end of FU, CR was obtained in 32% of the patients on IFX and 75% on VDZ (p = 0.0003). Drug persistency was superior for VDZ compared to IFX (78% vs. 52%, p = 0.033). Clinical response at the end of induction was reached in 54% and in 81% in the IFX and VDZ group, respectively (p = 0.014). Steroid-free clinical remission at the end of FU was 62% and 94% in the IFX vs. VDZ group, respectively (p = 0.036). The need for drug optimization was higher for VDZ than for IFX (28% vs. 57%, p = 0.009), while the time to obtain CR, the incidence of AEs, mean duration of FU, and rate of CRP normalization at the end of IP were comparable between the two groups. There was a prevalence of patients dropping out because of primary non-response in IFX group (p = 0.027), while the incidence of secondary loss of response was similar in the two groups. At the multivariate analysis, CRP and Partial Mayo Score (PMS) at T0 did not correlate with CR at the end of FU in both groups. In this retrospective, real world data study in biologic-naïve patients, VDZ was superior to IFX in CR, clinical response rate at the end of IP, drug persistency, steroid-free remission, and need for optimization at the end of FU.
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Juillerat P, Grueber MM, Ruetsch R, Santi G, Vuillèmoz M, Michetti P. Positioning biologics in the treatment of IBD: A practical guide – Which mechanism of action for whom? CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2022; 3:100104. [PMID: 35570855 PMCID: PMC9092374 DOI: 10.1016/j.crphar.2022.100104] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/04/2022] [Accepted: 04/24/2022] [Indexed: 12/30/2022] Open
Abstract
The number of available biological therapies have doubled over the last 10 years and the arrival of novel molecules (interleukin 23p19 inhibitors) is ongoing alongside the development of small molecules. As a result of this vast landscape of treatment, positioning advanced therapies (according to clinical situation, efficacy and safety) is of paramount importance to providing personalized, appropriate IBD treatment. In this publication the recent available literature is summarized for practical integration into clinical practice including comparative efficacy data, patient and disease demographics. We refer to recent publications and expert opinion in order to facilitate the decision making process of positioning biologicals IBD treatment.
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Affiliation(s)
- Pascal Juillerat
- Gastroenterology, Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Crohn and Colitis Center, Gastro-entérologie Beaulieu SA, Lausanne, Switzerland
- Corresponding author. Clinic for Visceral Surgery and Medicine Inselspital, Bern University Hospital Freiburgstrasse 10, CH-3010, Bern, Switzerland.
| | - Maude Martinho Grueber
- Gastroenterology, Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Crohn and Colitis Center, Gastro-entérologie Beaulieu SA, Lausanne, Switzerland
| | - Roseline Ruetsch
- Crohn and Colitis Center, Gastro-entérologie Beaulieu SA, Lausanne, Switzerland
| | - Giulia Santi
- Gastroenterology, Clinic for Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marianne Vuillèmoz
- Crohn and Colitis Center, Gastro-entérologie Beaulieu SA, Lausanne, Switzerland
| | - Pierre Michetti
- Crohn and Colitis Center, Gastro-entérologie Beaulieu SA, Lausanne, Switzerland
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
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Perrig K, Krupka N, Jordi SBU, Rossel JB, Biedermann L, Greuter T, Schreiner P, Vavricka SR, Juillerat P, Burri E, Zimmermann D, Maillard MH, Sulz MC, Brand S, Rogler G, Misselwitz B. Effectiveness of golimumab in patients with ulcerative colitis: results of a real-life study in Switzerland. Therap Adv Gastroenterol 2022; 15:17562848221074188. [PMID: 35154389 PMCID: PMC8832575 DOI: 10.1177/17562848221074188] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/27/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Tumor necrosis factor (TNF) inhibitors have improved treatment of ulcerative colitis (UC), but loss of response remains a frequent problem. The anti-TNF agent, golimumab, was approved in Switzerland for the treatment of UC in 2014. This study aims to summarize the experience of golimumab in a real-world setting in Switzerland. METHODS We analyzed real-world data from 1769 UC patients from the Swiss Inflammatory Bowel Disease Cohort (SIBDC) study and performed a chart review of golimumab-treated patients. We extracted the partial Mayo score at t0 (baseline), t1 (2-16 weeks), t2 (17-35 weeks), and t3 (36-89 weeks). The primary endpoint was clinical response at t1, defined as marked improvement in partial Mayo score and objective parameters. Clinical remission was defined as resolution of symptoms and normalization of objective parameters. RESULTS Our chart review included 103 UC patients with golimumab treatment (5.8% of all SIBDC UC patients); only 16 (15.5%) were anti-TNF naïve. Sixty-three patients remained on golimumab (61.2%) after 180 days, 51 (44.7%) after 365 days, and 34 (33%) after 630 days after the start of treatment. Upon golimumab treatment, the partial Mayo score decreased from 4 [interquartile range (IQR): 2-6] at t0 to 2 (IQR: 0-4) at t1, 1 (IQR: 0-3.5) at t2, and 1 (IQR: 0-3) at t3 (p < 0.001 for all comparisons with t0). The primary endpoint, clinical response at t1, could be evaluated in 52 patients and was met in 15 individuals (28.8%). Clinical remission at t1 was observed in 8 out of 52 patients (15.4%). Golimumab was generally well tolerated, one patient developed meningitis. The most frequent reasons to stop treatment were primary and secondary non-response. CONCLUSION Golimumab was used in 5.8% of Swiss UC patients, mainly in biologic-experienced individuals. Golimumab treatment was associated with a sustained reduction of symptoms and clinical response in approximately 30% of patients.[ClinicalTrials.gov identifier: NCT00488631].
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Affiliation(s)
- Kathrin Perrig
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niklas Krupka
- Department of Visceral Surgery and Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastian Bruno Ulrich Jordi
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, SwitzerlandDepartment of Visceral Surgery and Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jean-Benoît Rossel
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Schreiner
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Pascal Juillerat
- Department of Visceral Surgery and Medicine, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emanuel Burri
- Department of Gastroenterology and Hepatology, University Medical Clinic, Kantonsspital Baselland, Liestal, Switzerland
| | | | - Michel H. Maillard
- Service of Gastroenterology and Hepatology, Lausanne University Hospital, Lausanne, Switzerland; Crohn and Colitis Center, Gastroentérologie Beaulieu SA, Lausanne, Switzerland
| | | | - Stephan Brand
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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9
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Park SH, Ye BD, Yang SK. Infliximab versus Adalimumab: Can We Choose the Right One for the Right Patients with Ulcerative Colitis? Gut Liver 2021; 16:138-140. [PMID: 34373365 PMCID: PMC8761918 DOI: 10.5009/gnl210246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/22/2021] [Accepted: 08/11/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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10
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Jairath V, Chan K, Lasch K, Keeping S, Agboton C, Blake A, Patel H. Integrating efficacy and safety of vedolizumab compared with other advanced therapies to assess net clinical benefit of ulcerative colitis treatments: a network meta-analysis. Expert Rev Gastroenterol Hepatol 2021; 15:711-722. [PMID: 33599181 DOI: 10.1080/17474124.2021.1880319] [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
Objectives: Because only one head-to-head randomized trial of biologics for moderate-to-severe UC has been performed, indirect treatment comparisons remain important. This systematic review and network meta-analysis examined efficacy and safety of biologics and tofacitinib for moderate-to-severe UC, using vedolizumab as reference.Methods: Relevant studies (N = 19) of vedolizumab, adalimumab, infliximab, golimumab, ustekinumab, and tofacitinib were identified. Study design differences were addressed by assessing efficacy outcomes conditional on response at maintenance initiation. Primary analysis used fixed-effect models to estimate odds ratios for efficacy and safety endpoints.Results: Compared with vedolizumab 300 mg, adalimumab 160/80 mg was associated with less clinical remission (odds ratio, 0.69 [95% credible interval, 0.54-0.88]), and infliximab 5 mg/kg was associated with more clinical remission (1.67 [1.16-2.42]) and response (1.63 [1.15-2.30]). Adalimumab 40 mg, golimumab 50 mg, and ustekinumab 90 mg Q12W had significantly lower clinical remission rates during maintenance (0.62 [0.45-0.86], 0.55 [0.32-0.95], and 0.59 [0.35-0.99]) versus vedolizumab 300 mg Q8W. Response results were similar. Tofacitinib 10 mg had the highest maintenance treatment efficacy estimates and highest infection risk.Conclusion: Network meta-analysis and novel integrated benefit-risk analysis suggest a potentially favorable efficacy-safety balance for vedolizumab vs adalimumab and other advanced UC therapies.
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Affiliation(s)
- Vipul Jairath
- Western University Schulich School of Medicine and Dentistry, London, ON, Canada
| | | | - Karen Lasch
- Takeda Pharmaceuticals U.S.A., Inc., Lexington, Massachusetts, USA
| | | | | | - Aimee Blake
- Takeda Pharmaceuticals International Inc., Cambridge, Massachusetts, USA
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11
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Sardesai A, Dignass A, Quon P, Milev S, Cappelleri JC, Kisser A, Modesto I, Sharma PP. Cost-effectiveness of tofacitinib compared with infliximab, adalimumab, golimumab, vedolizumab and ustekinumab for the treatment of moderate to severe ulcerative colitis in Germany. J Med Econ 2021; 24:279-290. [PMID: 33502905 DOI: 10.1080/13696998.2021.1881323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Tofacitinib is an oral, small molecule Janus kinase (JAK) inhibitor for the treatment of ulcerative colitis (UC). This study assessed the cost-effectiveness of tofacitinib versus other available treatments for patients with moderate to severe UC following an inadequate response to conventional treatment and who are either naïve to or have failed previous biologics in Germany. METHODS A Markov cohort model was developed to evaluate the differences in long-term costs and outcomes between tofacitinib and its comparators from the perspective of German statutory health insurance (SHI) for patients either naïve or exposed to biologics. Tofacitinib was compared to infliximab, infliximab biosimilar, adalimumab, adalimumab biosimilar, golimumab, vedolizumab, ustekinumab, and conventional therapy. Health states modeled were remission, treatment response, active UC, and post-colectomy. Patients not responding to treatment could switch to a different treatment. Treatment efficacy for induction and maintenance phases were assessed by a systematic literature review (SLR) and network meta-analysis (NMA). The model included costs associated with drug administration, adverse events, and medical resource use. Extensive deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted. RESULTS Over a life-time horizon, patients treated with tofacitinib gained 0.035-0.083 quality-adjusted life-years (QALYs) and had direct cost savings to the SHI of €4,228-€17,184 compared to biologic treatments other than adalimumab biosimilar. When compared to adalimumab biosimilar, treatment with tofacitinib resulted in an incremental cost-effectiveness ratio (ICER) of €17,497 per QALY gained and can be considered a cost-effective alternative. Compared with conventional therapy, tofacitinib resulted in a lower ICER than all other biologics. The DSA showed that the model results were most influenced by differences in treatment efficacy. The PSA suggested confidence in the base-case results considering uncertainty around parameters. CONCLUSIONS The results of this economic model suggest tofacitinib is a cost-effective treatment option for patients with moderate to severe UC in Germany.
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Affiliation(s)
| | - Axel Dignass
- Agaplesion Markus Hospital, Frankfurt/Main, Germany
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12
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Park JJH, Harari O, Siden E, Zoratti M, Dron L, Zannat NE, Lester RT, Thorlund K, Mills EJ. Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis. Gates Open Res 2020; 3:1657. [PMID: 33134854 PMCID: PMC7520556 DOI: 10.12688/gatesopenres.13081.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 01/14/2023] Open
Abstract
Background: Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. Methods: For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants’ characteristics at baseline, and birth outcomes. We compared effects on preterm birth (<37 gestational week), low birthweight (LBW; <2500 g), and birthweight (continuous) using studies conducted in LMICs. Results: Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. Conclusion: We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. Registration: PROSPERO
CRD42018110446; registered on 17 October 2018.
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Affiliation(s)
- Jay J H Park
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada.,Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Ofir Harari
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada
| | - Ellie Siden
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada.,Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Michael Zoratti
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Louis Dron
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada
| | | | - Richard T Lester
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Kristian Thorlund
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada.,Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Edward J Mills
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada.,Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
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13
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Park JJH, Harari O, Siden E, Zoratti M, Dron L, Zannat NE, Lester RT, Thorlund K, Mills EJ. Interventions to improve birth outcomes of pregnant women living in low- and middle-income countries: a systematic review and network meta-analysis. Gates Open Res 2020; 3:1657. [PMID: 33134854 PMCID: PMC7520556 DOI: 10.12688/gatesopenres.13081.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 09/18/2023] Open
Abstract
Background: Improving the health of pregnant women is important to prevent adverse birth outcomes, such as preterm birth and low birthweight. We evaluated the comparative effectiveness of interventions under the domains of micronutrient, balanced energy protein, deworming, maternal education, and water sanitation and hygiene (WASH) for their effects on these adverse birth outcomes. Methods: For this network meta-analysis, we searched for randomized clinical trials (RCTs) of interventions provided to pregnant women in low- and middle-income countries (LMICs). We searched for reports published until September 17, 2019 and hand-searched bibliographies of existing reviews. We extracted data from eligible studies for study characteristics, interventions, participants' characteristics at baseline, and birth outcomes. We compared effects on preterm birth (<37 gestational week), low birthweight (LBW; <2500 g), and birthweight (continuous) using studies conducted in LMICs. Results: Our network meta-analyses were based on 101 RCTs (132 papers) pertaining to 206,531 participants. Several micronutrients and balanced energy food supplement interventions demonstrated effectiveness over standard-of-care. For instance, versus standard-of-care, micronutrient supplements for pregnant women, such as iron and calcium, decreased risks of preterm birth (iron: RR=0.70, 95% credible interval [Crl] 0.47, 1.01; calcium: RR=0.76, 95%Crl 0.56, 0.99). Daily intake of 1500kcal of local food decreased the risks of preterm birth (RR=0.36, 95%Crl 0.16, 0.77) and LBW (RR=0.17, 95%Crl 0.09, 0.29), respectively when compared to standard-of-care. Educational and deworming interventions did not show improvements in birth outcomes, and no WASH intervention trials reported on these adverse birth outcomes. Conclusion: We found several pregnancy interventions that improve birth outcomes. However, most clinical trials have only evaluated interventions under a single domain (e.g. micronutrients) even though the causes of adverse birth outcomes are multi-faceted. There is a need to combine interventions that of different domains as packages and test for their effectiveness. Registration: PROSPERO CRD42018110446; registered on 17 October 2018.
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Affiliation(s)
- Jay J. H. Park
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Ofir Harari
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada
| | - Ellie Siden
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Michael Zoratti
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Louis Dron
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada
| | | | - Richard T. Lester
- Experimental Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada
| | - Kristian Thorlund
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
| | - Edward J. Mills
- MTEK Sciences, Vancouver, BC, V5Z 1J5, Canada
- Department of Health Research Methodology, Evidence, and Impact, McMaster University, Hamilton, Ontario, L8S 4L8, Canada
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14
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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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15
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Barberio B, Zingone F, Frazzoni L, D'Incà R, Maccarone MC, Ghisa M, Massimi D, Lorenzon G, Savarino EV. Real-Life Comparison of Different Anti-TNF Biologic Therapies for Ulcerative Colitis Treatment: A Retrospective Cohort Study. Dig Dis 2020; 39:16-24. [PMID: 32450562 DOI: 10.1159/000508865] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 05/21/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Head-to-head comparison studies evaluating the effectiveness and tolerability of anti-tumor necrosis factor (anti-TNF) drugs in inflammatory bowel disease patients are lacking. AIM To compare the effectiveness and tolerability of anti-TNF-α drugs used in clinical practice in a cohort of patients with moderate-to-severe ulcerative colitis (UC). METHODS Retrospectively, 122 UC patients treated with infliximab (IFX) originator and biosimilar, adalimumab (ADA), and golimumab (GOL) were included. We performed an ITT analysis to evaluate clinical response and remission, steroid-free clinical remission, and endoscopy response according to the different time points of the follow-up. Baseline and post induction predictor factors of these outcomes were evaluated using multivariate logistic regression models. Moreover, a propensity score-based weighting analysis was performed. Data were analyzed using R and STATA11 software. RESULTS The overall clinical response was 77% after induction, 81.4% at 30 weeks, and 76.9% at 52 weeks, while the steroid-free clinical remission was 39.7, 46, and 54.6%, respectively. After induction, a higher rate of treatment failure was observed in the GOL group. At the end of follow-up, lower rates of steroid-free clinical remission and clinical response were obtained by GOL. At week 52, endoscopic response was achieved by 46.5% of the population. CONCLUSIONS Among the different anti-TNF treatments, moderate-to-severe UC seems to respond better to IFX and ADA, whereas GOL seems to be less effective, despite a similar good safety profile.
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Affiliation(s)
- Brigida Barberio
- Division of Gastroenterology, Department of Surgery, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy
| | - Fabiana Zingone
- Division of Gastroenterology, Department of Surgery, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy,
| | - Leonardo Frazzoni
- Department of Medical and Surgical Sciences DIMEC, University of Bologna, Bologna, Italy
| | - Renata D'Incà
- Division of Gastroenterology, Department of Surgery, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy
| | - Maria Chiara Maccarone
- Division of Gastroenterology, Department of Surgery, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy
| | - Matteo Ghisa
- Division of Gastroenterology, Department of Surgery, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy
| | - Davide Massimi
- Division of Gastroenterology, Department of Surgery, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy
| | - Greta Lorenzon
- Division of Gastroenterology, Department of Surgery, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy
| | - Edoardo Vincenzo Savarino
- Division of Gastroenterology, Department of Surgery, Oncological and Gastroenterological Sciences (DISCOG), University of Padua, Padua, Italy
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16
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Positioning Therapies in Ulcerative Colitis. Clin Gastroenterol Hepatol 2020; 18:1280-1290.e1. [PMID: 31982609 DOI: 10.1016/j.cgh.2020.01.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/30/2019] [Accepted: 01/11/2020] [Indexed: 02/07/2023]
Abstract
Ulcerative colitis (UC) is a chronic, idiopathic inflammatory bowel disease (IBD) that affects the large intestine. Several therapeutic drug classes are available for the treatment of UC: salicylates, corticosteroids, thiopurines, calcineurin inhibitors, anti-tumor necrosis factor (TNF) agents, anti-adhesion molecules, and, more recently, small molecules directed against the Janus kinase (JAK) pathways, and ustekinumab (anti IL12/23). Other drugs are currently in development, and they will be probably available for UC patients in the near future. Several therapeutic algorithms have been proposed for the treatment of UC patients, yet these are predominantly based on expert opinions rather than high-quality evidence, mainly due to the lack of head-to-head trials, especially for monoclonal antibody and small molecule therapies. The optimal position of therapies in these algorithms remains unclear. Therefore, we conducted this review of the literature to provide an up-to-date overview of the available evidence on this topic.
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17
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Berends SE, Strik AS, Löwenberg M, D'Haens GR, Mathôt RAA. Clinical Pharmacokinetic and Pharmacodynamic Considerations in the Treatment of Ulcerative Colitis. Clin Pharmacokinet 2020; 58:15-37. [PMID: 29752633 PMCID: PMC6326086 DOI: 10.1007/s40262-018-0676-z] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) of unknown etiology, probably caused by a combination of genetic and environmental factors. The treatment of patients with active UC depends on the severity, localization and history of IBD medication. According to the classic step-up approach, treatment with 5-aminosalicylic acid compounds is the first step in the treatment of mild to moderately active UC. Corticosteroids, such as prednisolone are used in UC patients with moderate to severe disease activity, but only for remission induction therapy because of side effects associated with long-term use. Thiopurines are the next step in the treatment of active UC but monotherapy during induction therapy in UC patients is not preferred because of their slow onset. Therapeutic drug monitoring (TDM) of the pharmacologically active metabolites of thiopurines, 6-thioguanine nucleotide (6-TGN), has proven to be beneficial. Thiopurine S-methyltransferase (TMPT) plays a role in the metabolic conversion pathway of thiopurines and exhibits genetic polymorphism; however, the clinical benefit and relevance of TPMT genotyping is not well established. In patients with severely active UC refractory to corticosteroids, calcineurin inhibitors such as ciclosporin A (CsA) and tacrolimus are potential therapeutic options. These agents usually have a rather rapid onset of action. Monoclonal antibodies (anti-tumor necrosis factor [TNF] agents, vedolizumab) are the last pharmacotherapeutic option for UC patients before surgery becomes inevitable. Body weight, albumin status and antidrug antibodies contribute to the variability in the pharmacokinetics of anti-TNF agents. Additionally, the use of concomitant immunomodulators (thiopurines/methotrexate) lowers the rate of immunogenicity, and therefore the concomitant use of anti-TNF therapy with an immunomodulator may confer some advantage compared with monotherapy in certain patients. TDM of anti-TNF agents could be beneficial in patients with primary nonresponse and secondary loss of response. The potential benefit of applying TDM during vedolizumab treatment has yet to be determined.
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Affiliation(s)
- Sophie E Berends
- Department Hospital Pharmacy, Academic Medical Center, Amsterdam, The Netherlands.
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Anne S Strik
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ron A A Mathôt
- Department Hospital Pharmacy, Academic Medical Center, Amsterdam, The Netherlands
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18
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Hernandez L, Kuwabara H, Shah A, Yamabe K, Burnett H, Fahrbach K, Koufopoulou M, Iwakiri R. Cost-Effectiveness Analysis of Vedolizumab Compared with Other Biologics in Anti-TNF-Naïve Patients with Moderate-to-Severe Ulcerative Colitis in Japan. PHARMACOECONOMICS 2020; 38:69-84. [PMID: 31552601 PMCID: PMC7081652 DOI: 10.1007/s40273-019-00841-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Vedolizumab (VDZ) was approved by the Japanese Ministry of Health, Labor and Welfare in 2018 for the treatment of patients with moderate-to-severe active ulcerative colitis (UC). The comparative cost-effectiveness of VDZ compared with other biologics is unknown in Japan. This information could be useful for decision makers at the time of repricing biologics for the treatment of patients with moderate-to-severe UC. OBJECTIVE The aim was to assess the cost-effectiveness of VDZ versus other branded biologics for the treatment of patients with moderate-to-severe UC who were anti-tumor necrosis factor (TNF)-naïve, from the Japanese public healthcare payer perspective. METHODS A hybrid decision tree/Markov model was developed to predict the number of patients who achieved response and remission at the end of the induction phase and sustained it during the maintenance phase, translating this into quality-adjusted life-years (QALYs) and costs. Treatment-related adverse events, discontinuation and surgery, and their impact on QALYs and costs were also modeled. A systematic literature review and network meta-analysis were conducted to estimate the comparative efficacy of each treatment versus placebo. Rates of adverse events, surgery, surgery complications, and utilities were from the literature. Costs (2018 Japanese yen) were obtained from the Japanese National Health Insurance drug price list and medical fee table and local claims databases. Clinical and economic outcomes were projected over a lifetime and discounted at 2% annually. RESULTS Over a lifetime, VDZ yielded greater QALYs and cost savings compared with golimumab and was cost-effective compared with adalimumab and infliximab (incremental cost-effectiveness ratios ¥4,821,940 and ¥4,687,692, respectively). Deterministic and probabilistic analyses supported the robustness of the findings in the base-case analysis, indicating that VDZ was either dominant or cost-effective in most scenarios and replications. The main limitations of this analysis include excluding tofacitinib and infliximab biosimilar as comparators, health-state utility estimates were obtained from population studies in the United Kingdom, and the impact of subsequent (i.e., second-line) biologic treatment was not evaluated. CONCLUSION Our analysis suggests that VDZ is dominant or cost-effective compared with other branded biologics for the treatment of anti-TNF-naïve patients with moderate-to-severe UC in Japan.
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Affiliation(s)
- Luis Hernandez
- Evidera Inc, 500 Totten Pond Road, 5th Floor, Waltham, MA 02451 USA
| | - Hiroyo Kuwabara
- Takeda Pharmaceutical Company Ltd, 1-1, Nihonbashi-Honcho 2-chome, Chuo-ku, Tokyo, 103-8668 Japan
| | - Anshul Shah
- Evidera Inc, 500 Totten Pond Road, 5th Floor, Waltham, MA 02451 USA
| | - Kaoru Yamabe
- Takeda Pharmaceutical Company Ltd, 1-1, Nihonbashi-Honcho 2-chome, Chuo-ku, Tokyo, 103-8668 Japan
| | - Heather Burnett
- Evidera Inc, 7575 Trans-Canada Hwy, Suite 404, St-Laurent, QC H4T 1V6 Canada
| | - Kyle Fahrbach
- Evidera Inc, 500 Totten Pond Road, 5th Floor, Waltham, MA 02451 USA
| | - Maria Koufopoulou
- Evidera Inc, The Ark, 201 Talgarth Road, Hammersmith, London, W6 8BJ United Kingdom
| | - Ryuichi Iwakiri
- Takeda Pharmaceutical Company Ltd, 1-1, Nihonbashi-Honcho 2-chome, Chuo-ku, Tokyo, 103-8668 Japan
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19
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Lamb CA, Kennedy NA, Raine T, Hendy PA, Smith PJ, Limdi JK, Hayee B, Lomer MCE, Parkes GC, Selinger C, Barrett KJ, Davies RJ, Bennett C, Gittens S, Dunlop MG, Faiz O, Fraser A, Garrick V, Johnston PD, Parkes M, Sanderson J, Terry H, Gaya DR, Iqbal TH, Taylor SA, Smith M, Brookes M, Hansen R, Hawthorne AB. British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults. Gut 2019; 68:s1-s106. [PMID: 31562236 PMCID: PMC6872448 DOI: 10.1136/gutjnl-2019-318484] [Citation(s) in RCA: 1209] [Impact Index Per Article: 241.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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Affiliation(s)
- Christopher Andrew Lamb
- Newcastle University, Newcastle upon Tyne, UK
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas A Kennedy
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- University of Exeter, Exeter, UK
| | - Tim Raine
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Philip Anthony Hendy
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Imperial College London, London, UK
| | - Philip J Smith
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Jimmy K Limdi
- The Pennine Acute Hospitals NHS Trust, Manchester, UK
- University of Manchester, Manchester, UK
| | - Bu'Hussain Hayee
- King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Miranda C E Lomer
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gareth C Parkes
- Barts Health NHS Trust, London, UK
- Barts and the London School of Medicine and Dentistry, London, UK
| | - Christian Selinger
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - R Justin Davies
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
- University of Cambridge, Cambridge, UK
| | - Cathy Bennett
- Systematic Research Ltd, Quorn, UK
- Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | | | - Malcolm G Dunlop
- University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
| | - Omar Faiz
- Imperial College London, London, UK
- St Mark's Hospital, Harrow, UK
| | - Aileen Fraser
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Miles Parkes
- Cambridge University Hospitals NHS FoundationTrust, Cambridge, UK
| | - Jeremy Sanderson
- King's College London, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Daniel R Gaya
- Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Tariq H Iqbal
- Queen Elizabeth Hospital Birmingham NHSFoundation Trust, Birmingham, UK
- University of Birmingham, Birmingham, UK
| | - Stuart A Taylor
- University College London, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Melissa Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Matthew Brookes
- Royal Wolverhampton NHS Trust, Wolverhampton, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Richard Hansen
- Royal Hospital for Children Glasgow, Glasgow, UK
- University of Glasgow, Glasgow, UK
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20
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Abstract
Ulcerative colitis and Crohn's disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn's and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn's disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn's disease, including patients, their families and friends.
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21
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Teixeira FV, Vilela EG, Damião AOMC, Vieira A, Albuquerque ICD, Parente JML, Chebli JMF, Ambrogini Junior O, Hossne RS, Miszputen SJ. Ulcerative colitis - treatment with biologicals. ACTA ACUST UNITED AC 2019; 65:547-553. [PMID: 31066808 DOI: 10.1590/1806-9282.65.4.547] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2018] [Indexed: 02/08/2023]
Abstract
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Affiliation(s)
- Fabio Vieira Teixeira
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Eduardo Garcia Vilela
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Aderson Omar Mourão Cintra Damião
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Andrea Vieira
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Idblan Carvalho De Albuquerque
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - José Miguel Luz Parente
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Júlio Maria Fonseca Chebli
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Orlando Ambrogini Junior
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Rogerio Saad Hossne
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Coloproctology Society, Avenida Marechal Câmara, 160 sala 916 - Centro, Rio de Janeiro - RJ, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
| | - Sender Jankiel Miszputen
- Brazilian Study Group on Inflammatory Bowel Disease, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Brazilian Gastroenterology Federation, Avenida Brigadeiro Faria Lima, 2391 CJ 102 - 10o Andar - Jardim Paulistano, São Paulo - SP, Brasil.,Study Group of Intestinal Inflammatory Disease of Brasil
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22
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Varu A, Wilson FR, Dyrda P, Hazel M, Hutton B, Cameron C. Treatment sequence network meta-analysis in Crohn's disease: a methodological case study. Curr Med Res Opin 2019; 35:733-756. [PMID: 30727745 DOI: 10.1080/03007995.2019.1580094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Several biologic therapies are available for the treatment of mild-to-moderate Crohn's disease (CD). This network meta-analysis (NMA) aimed to assess the comparative efficacy of ustekinumab, adalimumab, vedolizumab and infliximab in the maintenance of clinical response and remission after 1 year of treatment. METHODS A systematic literature search was performed to identify relevant randomized controlled trials (RCTs). Key outcomes of interest were clinical response (CD activity index [CDAI] reduction of 100 points; CDAI-100) and remission (CDAI score under 150 points; CDAI < 150). A treatment sequence Bayesian NMA was conducted to account for the re-randomization of patients based on different clinical definitions, the lack of similarity of the common comparator for each trial and the full treatment pathway from the induction phase onwards. RESULTS Thirteen RCTs were identified. Ustekinumab 90 mg q8w was associated with statistically significant improvement in clinical response relative to placebo and vedolizumab 300 mg. For clinical remission, ustekinumab 90 mg q8w was associated with statistically significant improvement relative to placebo and vedolizumab 300 mg q8w. Findings from sub-population analyses had similar results but were not statistically significant. CONCLUSIONS The NMA suggest that ustekinumab is associated with the highest likelihood of reaching response or remission at 1 year compared with placebo, adalimumab and vedolizumab. Results should be interpreted with caution because this is a novel methodology; however, the treatment sequence analysis may be the most methodologically sound analysis to derive estimates of comparative efficacy in CD in the absence of head-to-head evidence.
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Affiliation(s)
- Abhishek Varu
- a Evidence Synthesis , Cornerstone Research Group , Burlington , Ontario , Canada
| | - Florence R Wilson
- a Evidence Synthesis , Cornerstone Research Group , Burlington , Ontario , Canada
| | - Peter Dyrda
- b Janssen Inc., Janssen Canada , Toronto , Ontario , Canada
| | - Maureen Hazel
- b Janssen Inc., Janssen Canada , Toronto , Ontario , Canada
| | - Brian Hutton
- a Evidence Synthesis , Cornerstone Research Group , Burlington , Ontario , Canada
- c Research , Ottawa Hospital Research Institute , Ottawa , Ontario , Canada
- d Public Health and Preventative Medicine , University of Ottawa School of Epidemiology , Ottawa , Ontario , Canada
| | - Chris Cameron
- a Evidence Synthesis , Cornerstone Research Group , Burlington , Ontario , Canada
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23
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A real life comparison of the effectiveness of adalimumab and golimumab in moderate-to-severe ulcerative colitis, supported by propensity score analysis. Dig Liver Dis 2018; 50:1292-1298. [PMID: 30007516 DOI: 10.1016/j.dld.2018.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/27/2018] [Accepted: 06/13/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Adalimumab and golimumab are effective in the treatment of moderate to severe ulcerative colitis. AIMS We reported the comparative effectiveness of adalimumab and golimumab in ulcerative colitis. METHODS 118 patients treated with adalimumab and 79 treated with golimumab were included and evaluated at 8 weeks and at the end of follow up. RESULTS Overall clinical benefit was 72.6% at 8 weeks and 58.9% at the end of follow up. Patients with longer disease duration and those treated with adalimumab had a better outcome. Clinical benefit was 78.8% in adalimumab patients and 63.3% in golimumab patients (p = 0.026) after 8 weeks; it was 66.9% in adalimumab patients and 46.8% in golimumab patients (p = 0.008) at the end of follow up. These data were confirmed by propensity score analysis. A further analysis considering adalimumab optimization as treatment failure showed that the difference between adalimumab and golimumab was not significant. CONCLUSION Adalimumab and golimumab are effective in the treatment of ulcerative colitis. Adalimumab seems to be more effective than golimumab. This difference is probably affected by the impossibility of golimumab to be optimized in Italy while adalimumab is.
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24
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Smith K, Golder S, Sarker A, Loke Y, O'Connor K, Gonzalez-Hernandez G. Methods to Compare Adverse Events in Twitter to FAERS, Drug Information Databases, and Systematic Reviews: Proof of Concept with Adalimumab. Drug Saf 2018; 41:1397-1410. [PMID: 30167992 PMCID: PMC6223697 DOI: 10.1007/s40264-018-0707-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Adverse drug reactions (ADRs) are associated with significant health-related and financial burden, and multiple sources are currently utilized to actively discover them. Social media has been proposed as a potential resource for monitoring ADRs, but drug-specific analytical studies comparing social media with other sources are scarce. OBJECTIVES Our objective was to develop methods to compare ADRs mentioned in social media with those in traditional sources: the US FDA Adverse Event Reporting System (FAERS), drug information databases (DIDs), and systematic reviews. METHODS A total of 10,188 tweets mentioning adalimumab collected between June 2014 and August 2016 were included. ADRs in the corpus were extracted semi-automatically and manually mapped to standardized concepts in the Unified Medical Language System. ADRs were grouped into 16 biologic categories for comparisons. Frequencies, relative frequencies, disproportionality analyses, and rank ordering were used as metrics. RESULTS There was moderate agreement between ADRs in social media and traditional sources. "Local and injection site reactions" was the top ADR in Twitter, DIDs, and systematic reviews by frequency, ranked frequency, and index ranking. The next highest ADR in Twitter-fatigue-ranked fifth and seventh in FAERS and DIDs. CONCLUSION Social media posts often express mild and symptomatic ADRs, but rates are measured differently in scientific sources. ADRs in FAERS are reported as absolute numbers, in DIDs as percentages, and in systematic reviews as percentages, risk ratios, or other metrics, which makes comparisons challenging; however, overlap is substantial. Social media analysis facilitates open-ended investigation of patient perspectives and may reveal concepts (e.g. anxiety) not available in traditional sources.
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Affiliation(s)
- Karen Smith
- Rueckert-Hartman College for Health Professions, Regis University, Denver, CO, USA
| | - Su Golder
- Department of Health Sciences, University of York, York, UK
| | - Abeed Sarker
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yoon Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Karen O'Connor
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Graciela Gonzalez-Hernandez
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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25
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Paschos P, Katsoula A, Salanti G, Giouleme O, Athanasiadou E, Tsapas A. Systematic review with network meta-analysis: the impact of medical interventions for moderate-to-severe ulcerative colitis on health-related quality of life. Aliment Pharmacol Ther 2018; 48:1174-1185. [PMID: 30378141 DOI: 10.1111/apt.15005] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/06/2018] [Accepted: 09/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patient-reported outcomes are important in the assessment of efficacy of intervention for ulcerative colitis (UC). AIM To compare the impact of interventions for moderate-to-severe UC on health-related quality of life (HRQL). METHODS We searched Medline, Embase, CENTRAL and grey literature sources through October 2017. We included randomised controlled trials (RCTs) that compared infliximab, adalimumab, golimumab, vedolizumab or tofacitinib to each other or placebo. Outcomes included the change in quality of life scores and the proportion of patients with improvement in quality of life. We performed random-effect pairwise and network meta-analysis. We assessed confidence in estimates using the CINeMA (Confidence in Network Meta-Analysis) framework. RESULTS Fourteen RCTs assessed HRQL using the Inflammatory Bowel Disease Questionnaire (IBDQ) (14 trials), the Short Form questionnaire-36 (SF-36) (seven trials) or the European Quality of Life-5 Dimensions questionnaire (EQ-5D) (three trials). At induction (13 trials), low to very low confidence evidence suggested that all agents significantly improved both generic and disease-specific HRQL scores compared to placebo. However, only infliximab (MD 18.58; 95% CI 13.19-23.97) and vedolizumab (MD 18.00; 95% CI 11.08-24.92) showed clinically meaningful improvement in IBDQ score. Differences among individual interventions were imprecise. For maintenance (four trials), very low confidence evidence suggested that vedolizumab, tofacitinib and adalimumab maintained improvement in HRQL. CONCLUSIONS Induction treatment with infliximab, adalimumab, golimumab, vedolizumab or tofacitinib improves quality of life compared to placebo. Evidence on maintenance therapy is sparse and uncertain. Head-to-head comparisons could enhance confidence in conclusions about differences between drugs in terms of HRQL.
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Affiliation(s)
- Paschalis Paschos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,First Department of Internal Medicine, "Papageorgiou" Hospital, Thessaloniki, Greece
| | - Anastasia Katsoula
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Salanti
- Institute of Social and Preventive Medicine & Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Olga Giouleme
- Second Propaedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Athanasiadou
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece.,Harris Manchester College, University of Oxford, Oxford, UK
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26
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Motaghi E, Ghasemi-Pirbaluti M, Zabihi M. Etrolizumab versus infliximab in the treatment of induction phase of ulcerative colitis: A systematic review and indirect comparison. Pharmacol Res 2018; 139:120-125. [PMID: 30395950 DOI: 10.1016/j.phrs.2018.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/19/2018] [Accepted: 11/01/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES There is still a need to develop new effective medications for the treatment of ulcerative colitis, particularly for patients who are intolerant or resistant to first line therapies. This article compared the efficacy and safety of etrolizumab and infliximab in moderate to severe ulcerative colitis. METHODS This meta-analysis was performed according to the PRISMA statement protocol. A systematic literature search of three major bibliographic databases (Scopus, PubMed, and Cochran) was performed until June 30, 2018. This review included studies that evaluated the efficacy of etrolizumab or infliximab in ulcerative colitis and were placebo controlled randomized trials. Pooled data from each treatment were indirectly compared using Bucher's method. RESULTS Seven trials were sufficiently homogeneous to be used for indirect comparison of the induction phase of the treatment. There were no significant differences in clinical remission and serious adverse events between etrolizumab and infliximab. Moreover, adverse events of etrolizumab were significantly less than those of infliximab. However, further trials are required to compare other parameters of efficacy such as the clinical response and mucosal healing of etrolizumab with infliximab in anti-TNF alpha naïve patients.
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Affiliation(s)
- Ehsan Motaghi
- Department of Physiology and Pharmacology, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
| | - Masoumeh Ghasemi-Pirbaluti
- Department of Immunology, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Mohsen Zabihi
- Department of Pharmacology, School of Pharmacy and Pharmaceutical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Golimumab in inflammatory bowel diseases: present and future scenarios. Clin J Gastroenterol 2018; 12:1-9. [DOI: 10.1007/s12328-018-0906-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/23/2018] [Indexed: 12/31/2022]
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Limdi JK. Golimumab for ulcerative colitis: adding perspective to the pursuit. Frontline Gastroenterol 2018; 9:232-233. [PMID: 30047548 PMCID: PMC6056078 DOI: 10.1136/flgastro-2017-100929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/19/2017] [Indexed: 02/04/2023] Open
Affiliation(s)
- Jimmy K Limdi
- Section of IBD, Gastroenterology, The Pennine Acute Hospitals NHS Trust, Manchester, UK
- Manchester Academic Health Sciences, University of Manchester Institute of Inflammation and Repair, Manchester, UK
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Hodgson R, Walton M, Biswas M, Mebrahtu T, Woolacott N. Ustekinumab for Treating Moderately to Severely Active Crohn's Disease after Prior Therapy: An Evidence Review Group Perspective of a NICE Single Technology Appraisal. PHARMACOECONOMICS 2018; 36:387-398. [PMID: 29192397 DOI: 10.1007/s40273-017-0593-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
As part of the single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited Janssen to submit evidence on the clinical and cost effectiveness of their drug ustekinumab, an interleukin-12/23 inhibitor, for treating moderate-to-severe active Crohn's disease (CD). The Centre for Reviews and Dissemination (CRD) and Centre for Health Economics (CHE) Technology Appraisal Group at the University of York was commissioned to act as the independent Evidence Review Group (ERG). This article provides a description of the Company's submission, the ERG's critical review of submitted evidence, and the resulting NICE guidance. The main supporting clinical evidence was derived from four well conducted, randomised controlled trials, comparing ustekinumab with placebo in two sub-populations (conventional care failure and anti-TNFα failure patients) of adults with moderate-to-severe CD. Three trials assessed treatment induction over 8 weeks, while the fourth recruited successfully induced patients into a maintenance trial for 1 year. These trials showed ustekinumab to be more effective than placebo in terms of its ability to induce and maintain clinical response and remission. In the absence of any direct head-to-head data, the Company conducted a network meta-analysis (NMA), which synthesised induction trial data on ustekinumab and relevant comparators (vedolizumab, adalimumab and infliximab) using placebo data as a common comparator. This analysis found ustekinumab to be of comparable efficacy to previously approved biologics in treatment induction. A 'treatment sequence analysis' compared long-term treatment efficacy, finding ustekinumab to be comparable in maintaining treatment response and remission to the three other biologic therapies. However, the ERG had identified many limitations and potential bias in this analysis, and urged caution when interpreting the results. The Company's economic model estimated ustekinumab to be dominant in both sub-populations compared with conventional care; however, the ERG's preferred base-case estimated an incremental cost-effectiveness ratio of £109,279 in the conventional care failure sub-population, and £110,967 in the anti-TNFα failure sub-population when compared with conventional care. However, the ERG identified significant failings in both the model structure and data inputs, which could not be addressed without complete restructuring. The ERG considered that the economic analysis presented by the Company failed to adequately address the decision problem specified in NICE's scope. The NICE Appraisal Committee recommended ustekinumab within its market authorisation, on the grounds of sufficiently similar efficacy and costs to previously recommended biologic therapies. However, the ERG's analyses demonstrated that all currently recommended biologics are unlikely to be cost effective relative to conventional care, raising broader questions regarding the appropriateness of cost-comparison exercises for decision making.
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Affiliation(s)
- Robert Hodgson
- Centre for Reviews and Dissemination (CRD), University of York, York, YO10 5DD, UK
| | - Matthew Walton
- Centre for Reviews and Dissemination (CRD), University of York, York, YO10 5DD, UK.
| | - Mousumi Biswas
- Centre for Reviews and Dissemination (CRD), University of York, York, YO10 5DD, UK
| | - Teumzghi Mebrahtu
- Centre for Reviews and Dissemination (CRD), University of York, York, YO10 5DD, UK
| | - Nerys Woolacott
- Centre for Reviews and Dissemination (CRD), University of York, York, YO10 5DD, UK
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Greener T, Boland K, Steinhart AH, Silverberg MS. The Unfinished Symphony: Golimumab Therapy for Anti-Tumour Necrosis Factor Refractory Crohn's Disease. J Crohns Colitis 2018; 12:458-464. [PMID: 29293965 DOI: 10.1093/ecco-jcc/jjx176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 12/26/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Golimumab is approved for the treatment of moderate-to-severely active ulcerative colitis. However, there have been no formal trials to assess its utility in Crohn's disease [CD]. Our aim was to determine the efficacy and safety of golimumab in patients with anti-tumour necrosis factor [TNF] refractory CD. METHODS Patients with CD treated with golimumab between 2010 and 2017 were included in a retrospective observational study. The vast majority of patients failed two anti-TNF agents. Clinical response was defined as a significant reduction in symptoms and biochemical markers of CD, and no requirement for surgery or introduction of immune-suppressants. RESULTS Forty-five patients were included, with a median follow-up of 22 months [interquartile range 12-34] following initiation of golimumab. Induction and maintenance regimens were generally higher than standard dosing with first month cumulative doses of 400 mg and above in 75% of the patients. Monthly maintenance doses ≥200 mg were administered in 52% of patients. Clinical response at 3 months was achieved in 35/45 [77.7%] patients. The cumulative probabilities that patients with an initial response maintained their clinical response for 12 and 36 months after introduction of golimumab were 81% and 64%, respectively. Endoscopic improvement and mucosal healing at 12 months was achieved in 73% and 47% of patients, respectively. CONCLUSIONS This study demonstrates the efficacy of golimumab in anti-TNF refractory CD patients. Further studies should be performed in CD to formally assess the efficacy of golimumab in a randomized controlled trial and to establish the optimal dosing regimen.
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Affiliation(s)
- Tomer Greener
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Karen Boland
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - A Hillary Steinhart
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Mark S Silverberg
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital IBD Group, Toronto, Ontario, Canada; Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, Canada
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Stern S, Ward AJ, Saint-Laurent Thibault C, Camacho F, Rahme E, Naessens D, Aumais G, Bernard EJ, Bourdages R, Cohen A, Pare P, Dyrda P. Cost-effectiveness of golimumab for the treatment of patients with moderate-to-severe ulcerative colitis in Quebec using a patient level state transition microsimulation. J Med Econ 2018; 21:27-37. [PMID: 28830258 DOI: 10.1080/13696998.2017.1371033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To conduct cost-effectiveness analyses comparing the addition of golimumab to the standard of care (SoC) for treatment of patients with moderate-to-severe ulcerative colitis (UC) who are refractory to conventional therapies in Quebec (Canada). METHODS An individual patient state transition microsimulation model was developed to project health outcomes and costs over 10 years, using a payer perspective. The incremental benefit estimates for golimumab were driven by induction response and risk of a flare. Flare risks post-induction were derived for golimumab from the PURSUIT maintenance trial and extension study, while those for SoC were derived from the placebo arms of the Active Ulcerative Colitis Trials (ACT) 1 and 2. Other inputs were derived from multiple sources, including retrospective claims analyses and literature. Costs are reported in 2014 Canadian dollars. A 5% annual discount rate was applied to costs and quality-adjusted life-years (QALYs). RESULTS Compared with SoC, golimumab was projected to increase the time spent in mild disease or remission states, decrease flare rates, and increase QALYs. These gains were achieved with higher direct medical costs. The incremental cost-effectiveness ratio for golimumab vs SoC was $63,487 per QALY. LIMITATIONS The long-term flare projections for SoC were based on the data available from the ACT 1 and 2 placebo arms, as data were not available from the PURSUIT maintenance or extension trial. Additionally, the study was limited to only SoC and golimumab, due to the availability of individual patient data to analyze. CONCLUSION This economic analysis concluded that treatment with golimumab is likely more cost-effective vs SoC when considering cost-effectiveness acceptability thresholds from $50,000-$100,000 per QALY.
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Affiliation(s)
| | | | | | | | - Elham Rahme
- e McGill University Health Centre , Montreal , QC , Canada
| | | | - Guy Aumais
- g CIUSS est de Montreal at Maisonneuve-Rosemont Hôpital , Montreal , QC , Canada
- h Université de Montréal , QC , Canada
| | - Edmond-Jean Bernard
- h Université de Montréal , QC , Canada
- i IBD Clinic, Hôtel-Dieu de Montreal CHUM , Montreal , QC , Canada
| | - Raymond Bourdages
- j CISSS Chaudière-Apalaches at Hôtel-Dieu de Lévis , Lévis , QC , Canada
- k Université Laval , Québec City , QC , Canada
| | - Albert Cohen
- l Division of Gastroenterology , Jewish General Hospital , Montreal , QC , Canada
- m McGill University , Montreal , QC , Canada
| | - Pierre Pare
- k Université Laval , Québec City , QC , Canada
- n CHU de Québec, Hôpital du Saint-Sacrement , Québec City , QC , Canada
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Osterman MT, Lichtenstein GR. Infliximab vs Adalimumab for UC: Is There A Difference? Clin Gastroenterol Hepatol 2017; 15:1197-1199. [PMID: 28479503 DOI: 10.1016/j.cgh.2017.04.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Mark T Osterman
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Gary R Lichtenstein
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Cameron C, Ewara E, Wilson FR, Varu A, Dyrda P, Hutton B, Ingham M. The Importance of Considering Differences in Study Design in Network Meta-analysis: An Application Using Anti-Tumor Necrosis Factor Drugs for Ulcerative Colitis. Med Decis Making 2017. [DOI: 10.1177/0272989x17711933] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Chris Cameron
- Cornerstone Research Group Inc., Burlington, ON, Canada (CC, FRW, AV)
- Janssen Canada Inc., Toronto, ON, Canada (EE, PD)
- Ottawa Hospital Research Institute, Ottawa, ON, Canada (BH)
- University of Ottawa School of Epidemiology, Public Health and Preventative Medicine, Ottawa, ON, Canada (BH)
- Janssen Scientific Affairs, LLC, Horsham, PA, USA (MI)
| | - Emmanuel Ewara
- Cornerstone Research Group Inc., Burlington, ON, Canada (CC, FRW, AV)
- Janssen Canada Inc., Toronto, ON, Canada (EE, PD)
- Ottawa Hospital Research Institute, Ottawa, ON, Canada (BH)
- University of Ottawa School of Epidemiology, Public Health and Preventative Medicine, Ottawa, ON, Canada (BH)
- Janssen Scientific Affairs, LLC, Horsham, PA, USA (MI)
| | - Florence R. Wilson
- Cornerstone Research Group Inc., Burlington, ON, Canada (CC, FRW, AV)
- Janssen Canada Inc., Toronto, ON, Canada (EE, PD)
- Ottawa Hospital Research Institute, Ottawa, ON, Canada (BH)
- University of Ottawa School of Epidemiology, Public Health and Preventative Medicine, Ottawa, ON, Canada (BH)
- Janssen Scientific Affairs, LLC, Horsham, PA, USA (MI)
| | - Abhishek Varu
- Cornerstone Research Group Inc., Burlington, ON, Canada (CC, FRW, AV)
- Janssen Canada Inc., Toronto, ON, Canada (EE, PD)
- Ottawa Hospital Research Institute, Ottawa, ON, Canada (BH)
- University of Ottawa School of Epidemiology, Public Health and Preventative Medicine, Ottawa, ON, Canada (BH)
- Janssen Scientific Affairs, LLC, Horsham, PA, USA (MI)
| | - Peter Dyrda
- Cornerstone Research Group Inc., Burlington, ON, Canada (CC, FRW, AV)
- Janssen Canada Inc., Toronto, ON, Canada (EE, PD)
- Ottawa Hospital Research Institute, Ottawa, ON, Canada (BH)
- University of Ottawa School of Epidemiology, Public Health and Preventative Medicine, Ottawa, ON, Canada (BH)
- Janssen Scientific Affairs, LLC, Horsham, PA, USA (MI)
| | - Brian Hutton
- Cornerstone Research Group Inc., Burlington, ON, Canada (CC, FRW, AV)
- Janssen Canada Inc., Toronto, ON, Canada (EE, PD)
- Ottawa Hospital Research Institute, Ottawa, ON, Canada (BH)
- University of Ottawa School of Epidemiology, Public Health and Preventative Medicine, Ottawa, ON, Canada (BH)
- Janssen Scientific Affairs, LLC, Horsham, PA, USA (MI)
| | - Michael Ingham
- Cornerstone Research Group Inc., Burlington, ON, Canada (CC, FRW, AV)
- Janssen Canada Inc., Toronto, ON, Canada (EE, PD)
- Ottawa Hospital Research Institute, Ottawa, ON, Canada (BH)
- University of Ottawa School of Epidemiology, Public Health and Preventative Medicine, Ottawa, ON, Canada (BH)
- Janssen Scientific Affairs, LLC, Horsham, PA, USA (MI)
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Komaki Y, Komaki F, Micic D, Yamada A, Suzuki Y, Sakuraba A. Pharmacologic therapies for severe steroid refractory hospitalized ulcerative colitis: A network meta-analysis. J Gastroenterol Hepatol 2017; 32:1143-1151. [PMID: 27957761 DOI: 10.1111/jgh.13674] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 11/20/2016] [Accepted: 12/05/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM A limited option of therapies is available for hospitalized patients with severe steroid refractory ulcerative colitis (UC). Furthermore, there exists a paucity of direct comparisons between them. To provide a comparative evaluation of the efficacy and safety of pharmacologic therapies, we conducted a network meta-analysis combined with a benefit-risk analysis of randomized controlled trials (RCTs) performed in hospitalized patients with severe steroid refractory UC. METHODS Electronic databases were searched through November 2015 for RCTs evaluating the efficacy of therapies for severe steroid refractory hospitalized UC. The outcomes were clinical response, colectomy free rate, and severe adverse events leading to discontinuation of therapy. The primary endpoints were the rank of therapies based on network meta-analysis combined with benefit-risk analysis between clinical response and severe adverse events as well as colectomy free rate and severe adverse events. RESULTS Eight RCTs of 421 patients were identified. Cyclosporine, infliximab, and tacrolimus as well as placebo were included in our analysis. Network meta-analysis with benefit-risk analysis simultaneously assessing clinical response and severe adverse events demonstrated the rank order of efficacy as infliximab, cyclosporine, tacrolimus, and placebo. Similar analysis for colectomy-free rate and severe adverse events demonstrated the same rank order of efficacy. The differences among infliximab, cyclosporine, and tacrolimus were small in all analyses. CONCLUSION The results of the present comprehensive benefit-risk assessment using network meta-analysis provide RCT-based evidence on efficacy and safety of infliximab, cyclosporine, and tacrolimus for hospitalized patients with severe steroid refractory UC.
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Affiliation(s)
- Yuga Komaki
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Fukiko Komaki
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
| | - Dejan Micic
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Akihiro Yamada
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA.,Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Yasuo Suzuki
- Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan
| | - Atsushi Sakuraba
- Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, Illinois, USA
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Abstract
INTRODUCTION Tumor necrosis factor antagonists have revolutionized the therapeutic management of inflammatory bowel disease. Infliximab and adalimumab were the first biological agents used to induce and maintain remission in ulcerative colitis. More recently, a third tumor necrosis factor antagonist, golimumab, was approved, extending the therapeutic approach for moderate-to-severe ulcerative colitis. Areas covered: In this review, the authors review the literature on the efficacy and safety of golimumab in the context of other anti-TNF agents used in the treatment of this disease. The role of therapeutic drug monitoring in the case of loss of response to an anti-TNF agent is also discussed. Expert opinion: Golimumab is currently effective to induce and maintain remission in patients with ulcerative colitis, especially those patients who are naive for an anti-TNF agent. No large studies have evaluated the efficacy of golimumab after failure of a first-line TNF antagonist therapy. In the case of loss of response to a first anti-TNF agent, therapeutic drug monitoring is essential to determine the most suitable therapeutic option.
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Affiliation(s)
- Mathurin Flamant
- a Institut des Maladies de l'Appareil Digestif , Hotel Dieu, CHU de Nantes and Clinique Jules Verne , Nantes , France
| | - Stephane Paul
- b Laboratoire d'Immunologie et Immunomonitoring, CIC 1408INSERM, GIMAP EA3064 , Hôpital universitaire de Saint Etienne , Saint Priest en Jarez , France
| | - Xavier Roblin
- c CIC Inserm et Service d'Hépato-gastroentérologie , Hôpital universitaire de Saint Etienne, Université Jean Monnet , Saint Priest en Jarez , France
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Strik AS, Berends SE, Mathôt RA, D'Haens GR, Löwenberg M. Golimumab for moderate to severe ulcerative colitis. Expert Rev Gastroenterol Hepatol 2017; 11:401-406. [PMID: 28276288 DOI: 10.1080/17474124.2017.1303376] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Golimumab (GLM) is a subcutaneously administered human anti-tumor necrosis factor (TNF) agent that has been approved by the regulatory authorities for the treatment of moderate to severe ulcerative colitis (UC) in 2013. Areas covered: Maintained clinical remission rates up to 50% have been shown in UC patients receiving GLM, and higher GLM serum concentrations have been associated with improved clinical outcomes. Approximately 50% of UC patients do not respond to induction therapy with GLM, and up to 40% of GLM responders will lose response over time. In most patients, loss of response is associated with low serum GLM concentrations, which suggests insufficient exposure to GLM. Low GLM serum concentrations may be avoided by therapeutic drug monitoring. Expert commentary: So far, the therapeutic window for GLM has not yet been defined, but options to dose increase GLM based on therapeutic drug monitoring might result in improved clinical outcome and higher success rates.
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Affiliation(s)
- Anne S Strik
- a Department of Gastroenterology and Hepatology , Academic Medical Center , Amsterdam , The Netherlands
| | - Sophie E Berends
- b Department of Hospital Pharmacy , Academic Medical Center , Amsterdam , The Netherlands
| | - Ron A Mathôt
- b Department of Hospital Pharmacy , Academic Medical Center , Amsterdam , The Netherlands
| | - Geert R D'Haens
- a Department of Gastroenterology and Hepatology , Academic Medical Center , Amsterdam , The Netherlands
| | - Mark Löwenberg
- a Department of Gastroenterology and Hepatology , Academic Medical Center , Amsterdam , The Netherlands
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Mao EJ, Hazlewood GS, Kaplan GG, Peyrin-Biroulet L, Ananthakrishnan AN. Systematic review with meta-analysis: comparative efficacy of immunosuppressants and biologics for reducing hospitalisation and surgery in Crohn's disease and ulcerative colitis. Aliment Pharmacol Ther 2017; 45:3-13. [PMID: 27862107 DOI: 10.1111/apt.13847] [Citation(s) in RCA: 169] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 08/26/2016] [Accepted: 10/09/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Crohn's disease (CD) and ulcerative colitis (UC) have a progressive course leading to hospitalisation and surgery. The ability of existing therapies to alter disease course is not clearly defined. AIM To investigate the comparative efficacy of currently available inflammatory bowel disease (IBD) therapies to reduce hospitalisation and surgery. METHODS We conducted a systematic review in MEDLINE/PubMed for randomised controlled trials (RCT) published between January 1980 and May 2016 examining efficacy of biological or immunomodulator therapy in IBD. We performed direct comparisons of pooled proportions of hospitalisation and surgery. Pair-wise comparisons using a random-effects Bayesian network meta-analysis were performed to assess comparative efficacy of different treatments. RESULTS We identified seven randomised controlled trials (5 CD; 2 UC) comparing three biologics and one immunomodulator with placebo. In CD, anti-TNF biologics significantly reduced hospitalisation [Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.36-0.60] and surgery (OR 0.23, 95% CI 0.13-0.42) compared to placebo. No statistically significant reduction was noted with azathioprine or vedolizumab. Azathioprine was inferior to both infliximab and adalimumab in preventing CD-related hospitalisation (>97.5% probability). Anti-TNF biologics significantly reduced hospitalisation (OR 0.48, 95% CI 0.29-0.80) and surgery (OR 0.67, 95% CI 0.46-0.97) in UC. There were no statistically significant differences in the pair-wise comparisons between active treatments. CONCLUSIONS In CD and UC, anti-TNF biologics are efficacious in reducing the odds of hospitalisation by half and surgery by 33-77%. Azathioprine and vedolizumab were not associated with a similar improvement, but robust conclusions may be limited due to paucity of RCTs.
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Affiliation(s)
- E J Mao
- Division of Gastroenterology, Alpert Medical School of Brown University, Providence, RI, USA
| | - G S Hazlewood
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - G G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - L Peyrin-Biroulet
- Inserm U954 and Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Vandoeuvre, France
| | - A N Ananthakrishnan
- Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Mitrev N, Leong RW. Therapeutic drug monitoring of anti-tumour necrosis factor-α agents in inflammatory bowel disease. Expert Opin Drug Saf 2016; 16:303-317. [PMID: 27922765 DOI: 10.1080/14740338.2017.1269169] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Anti-TNFα therapy has revolutionised treatment of inflammatory bowel disease, however primary non-response and secondary loss of response are a significant problem. Therapeutic drug monitoring (TDM) has recently emerged as a means of optimising use of anti-TNFα agents. Areas covered: TDM of anti-TNFα agents can guide clinical decisions during treatment failure events, prevent treatment failure events, and potentially result in significant healthcare cost saving. TDM for anti-TNFα agent involves measurement of drug levels and anti-drug antibodies, and can be performed reactively or proactively. Reactive TDM reserves testing for treatment failure events, while proactive TDM also consists of periodic TDM for patients responding to anti-TNFα therapy to allow treatment optimisation. Generation of anti-drug antibodies is recognised as one important mechanism of treatment failure and adverse events. Expert opinion: Evidence strongly supports TDM at time of treatment failure, while studies employing proactive TDM have demonstrated conflicting results. TDM can also help better select patients likely to remain in clinical remission on anti-TNFα treatment interruption. Currently TDM is used to optimise anti-TNFα treatment, but it is not used by most clinicians to prevent adverse reactions to anti-TNFα agents.
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Affiliation(s)
- Nikola Mitrev
- a Concord Hospital IBD Service, Department of Gastroenterology , Concord Repatriation General Hospital , Sydney , Australia
| | - Rupert W Leong
- a Concord Hospital IBD Service, Department of Gastroenterology , Concord Repatriation General Hospital , Sydney , Australia
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Kedia S, Ahuja V, Makharia GK. Golimumab for moderately to severely active ulcerative colitis. Expert Rev Clin Pharmacol 2016; 9:1273-82. [PMID: 27498886 DOI: 10.1080/17512433.2016.1221759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Anti-TNF agents are the mainstay of therapy in patients with moderate to severe ulcerative colitis (UC) not responding to 5-aminosalisylic acid, corticosteroids, immunmodulators and for patients dependent on corticosteroids. There is a therapeutic gap of 30%- 60% with infliximab and adalimumab, which is required to be bridged by newer agents. The present review summarizes the literature on the role of golimumab, a new anti TNF agent, in ulcerative colitis. AREAS COVERED Literature search was done on PubMed using the search terms 'golimumab' AND 'ulcerative colitis' from inception till March 2016. Golimumab, a fully human monoclonal antibody against TNF-α, was approved by FDA for clinical use in UC in 2013. In vitro studies showed golimumab to be better than infliximab and adalimumab in terms of affinity and neutralization of TNF-α and its conformational stability. Golimumab was found to be effective and safe in inducing and maintaining clinical remission, clinical response and mucosal healing in patients with UC in the two registration trials. Expert commentary: Although there is no difference in terms of efficacy between golimumab, infliximab and adalimumab, golimumab is better than infliximab in terms of route of administration (subcutaneous vs intravenous) and better than adalimumab in terms of frequency of dosing (4 weeks vs 2 weeks).
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Affiliation(s)
- Saurabh Kedia
- a Department of Gastroenterology and Human Nutrition , All India Institute of Medical Sciences , New Delhi , India
| | - Vineet Ahuja
- a Department of Gastroenterology and Human Nutrition , All India Institute of Medical Sciences , New Delhi , India
| | - Govind K Makharia
- a Department of Gastroenterology and Human Nutrition , All India Institute of Medical Sciences , New Delhi , India
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Renna S, Orlando E, Macaluso FS, Maida M, Affronti M, Giunta M, Sapienza C, Rizzuto G, Orlando R, Dimarco M, Cottone M, Orlando A. Letter: a prospective real life comparison of the efficacy of adalimumab vs. golimumab in moderate to severe ulcerative colitis. Aliment Pharmacol Ther 2016; 44:310-1. [PMID: 27375103 DOI: 10.1111/apt.13692] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- S Renna
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - E Orlando
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - F S Macaluso
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - M Maida
- Gastroenterology and Endoscopy Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - M Affronti
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - M Giunta
- Gastroenterology and Endoscopy Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - C Sapienza
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - G Rizzuto
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - R Orlando
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - M Dimarco
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - M Cottone
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy
| | - A Orlando
- DiBiMis, Division of Internal Medicine, "Villa Sofia-Cervello" Hospital, Palermo University, Palermo, Italy.
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Abstract
BACKGROUND The availability of monoclonal antibodies to tumor necrosis factor α has revolutionized management of Crohn's disease (CD) and ulcerative colitis. However, limited data exist regarding comparative effectiveness of these agents to inform clinical practice. METHODS This study consisted of patients with CD or ulcerative colitis initiation either infliximab (IFX) or adalimumab (ADA) between 1998 and 2010. A validated likelihood of nonresponse classification score using frequency of narrative mentions of relevant symptoms in the electronic health record was applied to assess comparative effectiveness at 1 year. Inflammatory bowel disease-related surgery, hospitalization, and use of steroids were determined during this period. RESULTS Our final cohort included 1060 new initiations of IFX (68% for CD) and 391 of ADA (79% for CD). In CD, the likelihood of nonresponse was higher in ADA than IFX (odds ratio, 1.62 and 95% CI, 1.21-2.17). Similar differences favoring efficacy of IFX were observed for the individual symptoms of diarrhea, pain, bleeding, and fatigue. However, there was no difference in inflammatory bowel disease-related surgery, hospitalizations, or prednisone use within 1 year after initiation of IFX or ADA in CD. There was no difference in narrative or codified outcomes between the 2 agents in ulcerative colitis. CONCLUSIONS We identified a modestly higher likelihood of symptomatic nonresponse at 1 year for ADA compared with IFX in patients with CD. However, there were no differences in inflammatory bowel disease-related surgery or hospitalizations, suggesting these treatments are broadly comparable in effectiveness in routine clinical practice.
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Pugliese D, Felice C, Landi R, Papa A, Guidi L, Armuzzi A. Benefit-risk assessment of golimumab in the treatment of refractory ulcerative colitis. DRUG HEALTHCARE AND PATIENT SAFETY 2016; 8:1-7. [PMID: 26893582 PMCID: PMC4745853 DOI: 10.2147/dhps.s62649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Significant advances in the management of patients with ulcerative colitis (UC) have been made since the introduction of anti-tumor necrosis factor (TNF)-alpha agents, especially for those who fail or do not tolerate conventional therapies. Two drugs, infliximab first, then adalimumab afterward, showed effectiveness in inducing and maintaining long-term remission both in pivotal trials as well as in clinical practice. However, approximately 25% of patients with UC, who fail or do not tolerate all available therapies, require a colectomy for refractory disease. The therapeutic scenario of UC has been recently upgraded by the introduction of golimumab, the latest anti TNF-alpha agent to be approved. Golimumab is a totally humanized monoclonal antibody, administered by a subcutaneous injection every 4 weeks. Treatment with golimumab has shown to be effective to induce sustained clinical benefit in tough-to-treat patients with UC, including steroid and/or immunosuppressive refractory and steroid-dependent patients. In this review, we summarize all available efficacy and safety data of golimumab in UC, analyzing the potential therapeutic position for the treatment of refractory patients with UC.
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Affiliation(s)
- Daniela Pugliese
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Carla Felice
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Rosario Landi
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Alfredo Papa
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Luisa Guidi
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
| | - Alessandro Armuzzi
- Inflammatory Bowel Disease Unit, Complesso Integrato Columbus, Catholic University, Rome, Italy
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Strik AS, Bots SJA, D’Haens G, Löwenberg M. Optimization of anti-TNF therapy in patients with Inflammatory Bowel Disease. Expert Rev Clin Pharmacol 2016; 9:429-39. [DOI: 10.1586/17512433.2016.1133288] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Olesen CM, Coskun M, Peyrin-Biroulet L, Nielsen OH. Mechanisms behind efficacy of tumor necrosis factor inhibitors in inflammatory bowel diseases. Pharmacol Ther 2016; 159:110-9. [PMID: 26808166 DOI: 10.1016/j.pharmthera.2016.01.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Biological treatment with tumor necrosis factor (TNF) inhibitors is successful in the management of inflammatory bowel disease (IBD). All TNF inhibitors antagonize the pro-inflammatory cytokine TNF-α but with varying efficacies in IBD. The variations in efficacy probably are caused by structural differences between the agents that affect their mechanisms of action and pharmacokinetic properties. Several mechanisms have been proposed, such as modulation of the expression of pro-inflammatory mediators and a reduction in the number of activated immune cells. However, it seems that clinical efficacy is the result of a number of different mechanisms and that binding of transmembrane TNF by TNF inhibitors. Knowledge of the mechanisms of action has been obtained mainly through the use of in vitro assays that may differ significantly from the situation in vivo. This review discusses the available data on TNF inhibitors in order to identify mechanisms of importance for their efficacy in IBD. Thus, a better understanding of the mechanistic basis for clinical efficacy can lead to a more rational use of TNF inhibitors in the management of IBD.
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Affiliation(s)
- Caroline Meyer Olesen
- Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Mehmet Coskun
- Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm U954, Nancy University Hospital, Lorraine University, Vandoeuvre, France
| | - Ole Haagen Nielsen
- Department of Gastroenterology, Medical Section, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Bürger M, Schmidt C, Teich N, Stallmach A. Medical Therapy of Active Ulcerative Colitis. VISZERALMEDIZIN 2015; 31:236-45. [PMID: 26557831 PMCID: PMC4608602 DOI: 10.1159/000436959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Medical therapy of mild and moderate ulcerative colitis (UC) of any extent is evidence-based and standardized by national and international guidelines. However, patients with steroid-refractory UC still represent a challenge. Methods A literature search using PubMed (search terms: ulcerative colitis, therapy, new, 1-2008-2015) resulted in 821 publications. For the current article, 88 citations were extracted including 36 randomized controlled studies, 18 reviews, and 8 meta-analyses. Results In steroid-refractory UC, early intensive therapy using anti-tumor necrosis factor (TNF) antibodies or the calcineurin inhibitors cyclosporine and tacrolimus is indicated in any case to prevent progression to a toxic megacolon and/or to avoid proctocolectomy. In patients with chronic disease activity, treatment with anti-TNF antibodies has a higher level of evidence than azathioprine therapy and should therefore be preferred. However, there is a subgroup of UC patients who may achieve prolonged steroid-free remission on azathioprine monotherapy. The importance of vedolizumab, a newly registered inhibiting antibody against integrin, has not yet been fully clarified since direct comparison studies are lacking, in particular in relation to anti-TNF antibodies. Conclusion There is a great need for additional innovative therapies, especially in cases of primary non-response or secondary loss of response to anti-TNF antibodies. New small molecules (Janus kinase inhibitors) are promising with an acceptable safety profile and efficacy in UC. Further, strategies that target the intestinal microbiome are currently considered for patients with active or relapsing UC, and may in the future open up new therapeutic options.
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Affiliation(s)
- Martin Bürger
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Carsten Schmidt
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
| | - Niels Teich
- Group Practice for Digestive and Metabolic Diseases, Leipzig, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV, Jena University Hospital, Jena, Germany
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