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Parra V, Cifuentes S, Avendaño S, Ponce de León E, Florez C, Reyes G, Puentes F, Ballesteros M, Nuñez E, Gómez F, Márquez JR. Real-world experience of vedolizumab use in Colombian patients with inflammatory bowel disease-EXVEDOCOL. GASTROENTEROLOGIA Y HEPATOLOGIA 2024:S0210-5705(24)00025-6. [PMID: 38311006 DOI: 10.1016/j.gastrohep.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Real-world studies about the effectiveness and safety of vedolizumab (VDZ) in the treatment of inflammatory bowel disease (IBD) in Latin America are scarce. Our study describes the effectiveness and safety of VDZ in Colombian patients with IBD. METHODS EXVEDOCOL (EXperience of VEDOlizumab in COLombia) was a retrospective, multicenter, observational study. Adults with IBD receiving a first dose of VDZ between July 2016 and October 2018 were included. The co-primary outcomes clinical response, and remission, were determined at week 14 and last visit during the maintenance phase (LVMP). The secondary outcomes, deep remission and loss of response were recorded at LVMP. RESULTS Thirty-one patients (25 ulcerative colitis (UC), 6 Crohn's disease (CD)) were included. At week 14, clinical response was achieved by 87.1% (27/31) of the patients treated with VDZ, while loss of response was reported in 6.7% (2/30). The remission rate at week 14 was 65.5% (19/29) and 75.9% (22/29) at LVMP. Prior anti-TNF exposure was reported in 61.3% (19 patients) of whom 84.2% (16/19) achieved clinical response at week 14 and 89.5% (17/19) at LVMP. For anti-TNF naïve patients, clinical response was recorded in 91.7% (11/12) at week 14 and 100% (12/12) at LVMP. CONCLUSIONS High clinical remission rates and safety profile highlight VDZ as a valuable treatment option for IBD patients. Anti-TNF naïve patients may derive greater benefit from therapy. Studies with larger cohorts could confirm these findings.
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Affiliation(s)
- Viviana Parra
- Gastroadvanced, Bogotá, Hospital Internacional de Colombia, Bucaramanga, Colombia
| | | | | | | | - Cristian Florez
- Gastroadvanced, Bogotá, Hospital Internacional de Colombia, Bucaramanga, Colombia
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Martins CDA, de Azevedo MFC, Carlos AS, Damião AOMC, Sobrado Junior CW, Nahas SC, Queiroz NSF. Predictive factors of response to infliximab therapy in Brazilian inflammatory bowel disease patients. Therap Adv Gastroenterol 2023; 16:17562848231210053. [PMID: 38026104 PMCID: PMC10652804 DOI: 10.1177/17562848231210053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 10/10/2023] [Indexed: 12/01/2023] Open
Abstract
Background Biological therapies have revolutionized the treatment of patients with inflammatory bowel disease (IBD). Infliximab (IFX) has been shown to be effective in inducing and maintaining remission in patients with Crohn's disease and ulcerative colitis. However, about one-third of the patients are primary non-responders, and up to half can lose response over time. Hence, it is important to assess which factors are related to treatment failure. Objectives We aimed to identify factors predicting clinical and endoscopic remission with IFX treatment during maintenance therapy in a Brazilian IBD referral center. Design We conducted a cross-sectional study to describe demographic, clinical, and IBD therapy-related characteristics of IBD patients treated with IFX for at least 6 months in a Brazilian referral center. Subsequently, we evaluated factors associated with clinical and endoscopic remission (primary and secondary outcomes, respectively). Methods We used descriptive statistics to summarize the essential demographic and clinical characteristics of the population. The association of sociodemographic and clinical variables with outcomes was analyzed using multivariable logistic regression. Results A total of 131 IBD patients (the mean age 41.7 years) were enrolled in this study. Clinical and endoscopic remission were observed in 79.4% and 58.2% of the patients, respectively. In the multivariable analysis, IFX therapy duration and higher albumin levels increased the likelihood of clinical remission, while previous surgery decreased its chance. Prior use of adalimumab and higher C-reactive protein levels reduced the likelihood of endoscopic remission. Conclusion In summary, this study has enhanced our understanding of the predictive factors of treatment response to IFX in a well-characterized Brazilian IBD population. Trial registration 4.254.501 and 2.903.748.
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Affiliation(s)
- Camilla de Almeida Martins
- Department of Gastroenterology and Division of Colorectal Surgery, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | | | - Alexandre Sousa Carlos
- Department of Gastroenterology and Division of Colorectal Surgery, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | | | - Carlos Walter Sobrado Junior
- Department of Gastroenterology and Division of Colorectal Surgery, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Sergio Carlos Nahas
- Department of Gastroenterology and Division of Colorectal Surgery, University of Sao Paulo School of Medicine, São Paulo, Brazil
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Queiroz NSF, Martins CDA, Quaresma AB, Olivera Sendra PA, Ernest-Suarez K, Kotze PG. IBD barriers across the continents: a continent-specific analysis: Latin America. Therap Adv Gastroenterol 2023; 16:17562848231167953. [PMID: 37124371 PMCID: PMC10134129 DOI: 10.1177/17562848231167953] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 03/20/2023] [Indexed: 05/02/2023] Open
Abstract
Latin America (LATAM) is a large region comprising 47 countries and territories. Each one carries a different cultural and historical background, diverse political systems, and a particular approach to healthcare management. There is a lack of high-quality data on the epidemiology of inflammatory bowel diseases (IBD) in this region, including broad and detailed information about the penetration of biological and advanced therapies as treatment strategies. From an IBD perspective, patients experience, in general, fragmentations and inequities in the healthcare systems, with different and usually delayed access to qualified health services. This review explores the barriers to accessing IBD care throughout LATAM. The authors compiled data from multiple sources, such as studies focusing on epidemiology, biological penetration, and surgical rates. In addition, overall access to IBD treatments was assessed through a questionnaire distributed to physicians in LATAM via email and direct messaging to capture local perspectives.
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Affiliation(s)
| | | | - Abel Botelho Quaresma
- Health Sciences Graduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Brazil
| | - Pablo A. Olivera Sendra
- IBD Unit, Gastroenterology Section, Department of Internal Medicine, Centro de Educación Médica e Investigación Clínica (CEMIC), Buenos Aires, Argentina
- Zane Cohen Centre for Digestive Diseases, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Kenneth Ernest-Suarez
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hospital México, Caja Costarricense de Seguro Social, San José, Costa Rica
- Gastroenterology Postgraduate Program, School of Medicine, Universidad de Costa Rica, San José, Costa Rica
| | - Paulo Gustavo Kotze
- Health Sciences Graduate Program, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
- IBD Outpatient Clinics, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
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Anti-TNF therapy for ulcerative colitis in Brazil: a comparative real-world national retrospective multicentric study from the Brazilian study group of IBD (GEDIIB). BMC Gastroenterol 2022; 22:268. [PMID: 35644668 PMCID: PMC9150299 DOI: 10.1186/s12876-022-02341-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Anti-TNF therapy represented a landmark in medical treatment of ulcerative colitis (UC). There is lack of data on the efficacy and safety of these agents in Brazilian patients. The present study aimed to analyze rates of clinical and endoscopic remission comparatively, between adalimumab (ADA) and infliximab (IFX), in Brazilian patients with UC, and evaluate factors associated with clinical and endoscopic remission after 1 year of treatment.
Methods A national retrospective multicenter study (24 centers) was performed including patients with UC treated with anti-TNF therapy. Outcomes as clinical response and remission, endoscopic remission and secondary loss of response were measured in different time points of the follow-up. Baseline predictive factors of clinical and endoscopic remission at week 52 were evaluated using logistic regression model. Indirect comparisons among groups (ADA and IFX) were performed using Student's t, Pearson χ2 or Fisher's exact test when appropriated, and Kaplan Meier analysis.
Results Overall, 393 patients were included (ADA, n = 111; IFX, n = 282). The mean age was 41.86 ± 13.60 years, 61.58% were female, most patients had extensive colitis (62.40%) and 19.39% had previous exposure to a biological agent. Overall, clinical remission rate was 66.78%, 71.62% and 82.82% at weeks 8, 26 and 52, respectively. Remission rates were higher in the IFX group at weeks 26 (75.12% vs. 62.65%, p < 0.0001) and 52 (65.24% vs. 51.35%, p < 0.0001) when compared to ADA. According to Kaplan–Meier survival curve loss of response was less frequent in the Infliximab compared to Adalimumab group (p = 0.001). Overall, endoscopic remission was observed in 50% of patients at week 26 and in 65.98% at week 52, with no difference between the groups (p = 0.114). Colectomy was performed in 23 patients (5.99%). Age, non-prior exposure to biological therapy, use of IFX and endoscopic remission at week 26 were associated with clinical remission after 52 weeks. Variables associated with endoscopic remission were non-prior exposure to biological therapy, and clinical and endoscopic remission at week 26.
Conclusions IFX was associated with higher rates of clinical remission after 1 year in comparison to ADA. Non-prior exposure to biological therapy and early response to anti-TNF treatment were associated with higher rates of clinical and endoscopic remission.
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Queiroz NSF, Martins CDA, Quaresma AB, Hino AAF, Steinwurz F, Ungaro RC, Kotze PG. COVID-19 outcomes in patients with inflammatory bowel diseases in Latin America: Results from SECURE-IBD registry. J Gastroenterol Hepatol 2021; 36:3033-3040. [PMID: 34151470 PMCID: PMC8447321 DOI: 10.1111/jgh.15588] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM One of the most impacted regions by the pandemic globally, Latin America is facing socioeconomic and health-care challenges that can potentially affect disease outcomes. Recent data suggest that inflammatory bowel disease (IBD) patients do not have an increased risk of the development of COVID-19 complications. However, the impact of COVID-19 on IBD patients living in least developed areas remains to be fully elucidated. This study aims to describe the outcomes of IBD patients diagnosed with COVID-19 in countries from Latin America based on data from the SECURE-IBD registry. METHODS Patients from Latin America enrolled in the SECURE-IBD registry were included. Descriptive analyses were used to summarize clinical and sociodemographic characteristics. The studied outcomes were (i) a composite of need for intensive care unit admission, ventilator use, and/or death (primary outcome) and (ii) a composite of any hospitalization and/or death (secondary outcome). Multivariable regression was used to identify risk factors of severe COVID-19. RESULTS During the study period, 230 cases (Crohn's disease: n = 115, ulcerative colitis: n = 114, IBD-unclassified [IBD-U]: n = 1) were reported to the SECURE-IBD database from 13 different countries. Primary outcome was observed in 17 (7.4%) patients, and the case fatality rate was 1.7%. In the adjusted multivariable model, the use of systemic corticosteroids (odds ratio [OR] 10.97; 95% confidence interval [CI]: 3.44-34.99) was significantly associated with the primary outcome. Older age (OR 1.03; 95% CI: 1.00-1.05), systemic corticosteroids (OR 9.33; 95% CI: 3.84-22.63), and the concomitant presence of one (OR 2.14; 95% CI: 0.89-5.15) or two (OR 10.67; 95% CI: 1.74-65.72) comorbidities were associated with the outcome of hospitalization or death. CONCLUSION Inflammatory bowel disease patients with COVID-19 in Latin America appear to have similar outcomes to the overall global data. Risk factors of severe COVID-19 are similar to prior reports.
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Affiliation(s)
- Natália S F Queiroz
- Department of GastroenterologyUniversity of São Paulo School of MedicineSão PauloBrazil
| | | | - Abel B Quaresma
- Health Sciences Postgraduate Program, School of MedicinePontifical Catholic University of Paraná (PUCPR)CuritibaBrazil,Department Health SciencesWestern University of Santa Catarina (UNOESC)JoaçabaBrazil
| | - Adriano A F Hino
- Health Sciences Postgraduate Program, School of MedicinePontifical Catholic University of Paraná (PUCPR)CuritibaBrazil
| | - Flavio Steinwurz
- Department of GastroenterologyAlbert Einstein Israelite HospitalSão PauloBrazil
| | - Ryan C Ungaro
- The Henry D. Janowitz Division of GastroenterologyIchan School of Medicine at Mount SinaiNew YorkUSA
| | - Paulo G Kotze
- Health Sciences Postgraduate Program, School of MedicinePontifical Catholic University of Paraná (PUCPR)CuritibaBrazil,IBD Outpatient ClinicsPontifical Catholic University of Paraná (PUCPR)CuritibaBrazil
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Senger PC, Zacharias P, Quaresma AB, Kotze PG. Inflammatory bowel disease epidemiology data from a prospective registry in Córdoba, Argentina: Raising the bar for future studies in Latin America. Dig Liver Dis 2021; 53:1212-1213. [PMID: 34001445 DOI: 10.1016/j.dld.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Paula Cenira Senger
- IBD outpatient clinics, Health Sciences Postgraduate Program, Pontificia Universidade Católica do Paraná (PUCPR), Postal address: R. Imac. Conceição, 1155 - Prado Velho, 80215-901, Curitiba, PR CEP 80215-901, Brazil.
| | - Patricia Zacharias
- IBD outpatient clinics, Health Sciences Postgraduate Program, Pontificia Universidade Católica do Paraná (PUCPR), Postal address: R. Imac. Conceição, 1155 - Prado Velho, 80215-901, Curitiba, PR CEP 80215-901, Brazil
| | - Abel Botelho Quaresma
- IBD outpatient clinics, Health Sciences Postgraduate Program, Pontificia Universidade Católica do Paraná (PUCPR), Postal address: R. Imac. Conceição, 1155 - Prado Velho, 80215-901, Curitiba, PR CEP 80215-901, Brazil.
| | - Paulo Gustavo Kotze
- IBD outpatient clinics, Health Sciences Postgraduate Program, Pontificia Universidade Católica do Paraná (PUCPR), Postal address: R. Imac. Conceição, 1155 - Prado Velho, 80215-901, Curitiba, PR CEP 80215-901, Brazil.
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Tong X, Zheng Y, Li Y, Xiong Y, Chen D. Soluble ligands as drug targets for treatment of inflammatory bowel disease. Pharmacol Ther 2021; 226:107859. [PMID: 33895184 DOI: 10.1016/j.pharmthera.2021.107859] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/19/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, is characterized by persistent inflammation in a hereditarily susceptible host. In addition to gastrointestinal symptoms, patients with IBD frequently suffer from extra-intestinal complications such as fibrosis, stenosis or cancer. Mounting evidence supports the targeting of cytokines for effective treatment of IBD. Cytokines can be included in a newly proposed classification "soluble ligands" that has become the third major target of human protein therapeutic drugs after enzymes and receptors. Soluble ligands have potential significance for research and development of anti-IBD drugs. Compared with traditional drug targets for IBD treatment, such as receptors, at least three factors contribute to the increasing importance of soluble ligands as drug targets. Firstly, cytokines are the main soluble ligands and targeting of them has demonstrated efficacy in patients with IBD. Secondly, soluble ligands are more accessible than receptors, which are embedded in the cell membrane and have complex tertiary membrane structures. Lastly, certain potential target proteins that are present in membrane-bound forms can become soluble following cleavage, providing further opportunities for intervention in the treatment of IBD. In this review, 49 drugs targeting 25 distinct ligands have been evaluated, including consideration of the characteristics of the ligands and drugs in respect of IBD treatment. In addition to approved drugs targeting soluble ligands, we have also assessed drugs that are in preclinical research and drugs inhibiting ligand-receptor binding. Some new types of targetable soluble ligands/proteins, such as epoxide hydrolase and p-selectin glycoprotein ligand-1, are also introduced. Targeting soluble ligands not only opens a new field of anti-IBD drug development, but the circulating soluble ligands also provide diagnostic insights for early prediction of treatment response. In conclusion, soluble ligands serve as the third-largest protein target class in medicine, with much potential for the drugs targeting them.
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Affiliation(s)
- Xuhui Tong
- Compartive Medicine Department of Researching and Teaching, Dalian Medical University, Dalian City 116044, Liaoning Province, China
| | - Yuanyuan Zheng
- Compartive Medicine Department of Researching and Teaching, Dalian Medical University, Dalian City 116044, Liaoning Province, China
| | - Yu Li
- Compartive Medicine Department of Researching and Teaching, Dalian Medical University, Dalian City 116044, Liaoning Province, China
| | - Yongjian Xiong
- Central Laboratory, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dapeng Chen
- Compartive Medicine Department of Researching and Teaching, Dalian Medical University, Dalian City 116044, Liaoning Province, China.
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Kotze PG, DamiÃo AOMC. Research in inflammatory bowel disease in Brazil: a step forward towards patient care. ARQUIVOS DE GASTROENTEROLOGIA 2020; 57:225-226. [PMID: 33206810 DOI: 10.1590/s0004-2803.202000000-43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Paulo Gustavo Kotze
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brasil
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Miranda EF, Nones RB, Kotze PG. Correlation of serum levels of anti-tumor necrosis factor agents with perianal fistula healing in Crohn's disease: a narrative review. Intest Res 2020; 19:255-264. [PMID: 33147899 PMCID: PMC8322024 DOI: 10.5217/ir.2020.00029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023] Open
Abstract
With the overspread use of measurement of serum levels of anti-tumor necrosis factor (TNF) agents (therapeutic drug monitoring, TDM), new therapeutic strategies have been used in the management of Crohn’s disease (CD). Different targets are correlated with increased levels of circulating drugs. Recent evidence demonstrated that higher serum levels of anti-TNF agents may be associated to better outcomes in perianal fistulizing CD (PFCD). Overall, patients with healed fistulas had higher serum levels of infliximab and adalimumab as compared to those with active drainage. This was demonstrated in some cohort studies, in induction and maintenance, in adults and children with PFCD. In this narrative review, authors summarize current evidence on the use of serum level measurement of anti-TNF agents and its correlation with perianal fistula healing in CD patients. Data on the use of TDM in PFCD is discussed in detail. The retrospective design of the studies and the lack of objective parameters to measure fistula healing are the main limitations of published data. Prospective studies, with central reading of objective radiological parameters, such as pelvic magnetic resonance imaging scores, can improve the level of evidence on the possible advantages of TDM in perianal fistula in CD and are warranted.
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Affiliation(s)
- Eron Fabio Miranda
- Colorectal Surgery Unit, IBD Outpatient Clinics, Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | | | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, IBD Outpatient Clinics, Catholic University of Paraná (PUCPR), Curitiba, Brazil
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Quaresma AB, Kotze PG. Reduction of surgical rates in inflammatory bowel diseases biologic era: Similarities between Spain and Latin America. J Gastroenterol Hepatol 2020; 35:1453. [PMID: 32410307 DOI: 10.1111/jgh.15098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/09/2022]
Affiliation(s)
- A B Quaresma
- Universidade do Oeste de Santa Catarina (UNOESC), Joaçaba, Brazil.,Universidade Católica do Paraná (PUCPR), Programa de Pós-Graduação em Ciências da Saúde, Curitiba, Brazil
| | - P G Kotze
- IBD Outpatient Clinics, Colorectal Surgery Unit, Pontificia Universidade Católica do Paraná (PUCPR), Programa de Pós-Graduação em Ciências da Saúde, Curitiba, Brazil
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Kotze PG, Steinwurz F, Francisconi C, Zaltman C, Pinheiro M, Salese L, Ponce de Leon D. Review of the epidemiology and burden of ulcerative colitis in Latin America. Therap Adv Gastroenterol 2020; 13:1756284820931739. [PMID: 32695230 PMCID: PMC7350039 DOI: 10.1177/1756284820931739] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 05/12/2020] [Indexed: 02/04/2023] Open
Abstract
The incidence and prevalence of ulcerative colitis (UC) has been reported to be rising in newly industrialised regions, such as Latin America. Here, we review data from published studies reporting demographics and clinical aspects of UC in Latin America to further understand epidemiology and disease burden. The incidence and prevalence of UC in Latin America varied between regions and studies, ranging between 0.04 to 8.00/100,000 and 0.23 to 76.1/100,000, respectively, and generally increased over the period from 1986 to 2015. The majority of patients with UC were female (53.6-72.6%) and urban residents (77.8-97.4%). Extraintestinal manifestations were reported in approximately 26-89.4% of patients. Use of biologic therapies was generally low (0.8-16.2%), with the exception of Mato Grosso do Sul, Brazil, with a greater proportion of patients tending to receive 5-aminosalicylates, immunosuppressants or corticosteroids; colectomy rates varied between studies (1.5-22%). A high proportion of patients had moderate to severe UC (45.9-73.0%) and, in 11 of 19 studies, the greatest proportion of patients had extensive disease (pancolitis). Colorectal cancer (0-1.7%) and mortality rates (0-7.6%) were low. This evaluation of published studies may influence therapeutic approaches and the development of strategies to improve healthcare access and patient outcomes, although further high-quality studies are required in patients with UC in Latin America.
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Affiliation(s)
| | - Flavio Steinwurz
- Unit of Inflammatory Bowel Disease, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Cyrla Zaltman
- IBD Outpatient Clinic, Division of Gastroenterology, Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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