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Xiao Y, Al Khoury A, Golovics P, Kohen R, Afif W, Wild G, Friedman G, Galiatsatos P, Hilzenrat N, Szilagyi A, Wyse J, Cohen A, Bitton A, Bessissow T, Lakatos PL. A157 REAL-WORLD TIGHT OBJECTIVE MONITORING WITH ADALIMUMAB LEADS TO EARLIER DOSE OPTIMIZATION AND HIGHER CLINICAL REMISSION RATES AT 12 MONTHS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data suggests that tight objective monitoring of inflammatory bowel diseases (IBD) may improve one-year clinical outcomes.
Aims
The goal of this study is to assess the adherence to serial tight objective monitoring, via clinical symptoms and biomarkers, and the effect of such tight monitoring on one year outcome in IBD patients at an academic and an university-affiliated center.
Methods
We retrospectively reviewed the chart of 428 consecutive IBD patients who started adalimumaby at the McGill University Health Center and Jewish General Hospital (Montreal, Canada) between January 1, 2015 and January 1, 2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index and partial Mayo), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) were captured at treatment initiation and at 3, 6, 9, and 12 months. Combined adherence was defined as the evaluation of ≥2 of 3 parameters(clinical, CRP, FCAL). Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method.
Results
Clinical symptoms were assessed in nearly all patients at 3 (CD-UC:95-94%), 6 (90-83%), 9 (86-85%) and 12 (96-89%) months. CRP was also available for most patients but the frequency of assessment decreased in CD patients over the study period. In comparison, compliance to serial FCAL testing was low throughout the follow-up period. Clinical remission at one-year was significantly higher in patients who were adherent to early assessment visit at 3 months (p=0.001 both for CD and UC). Adherence to early follow-up also resulted in earlier dose optimisation in both CD and UC patients(pLogrank=0.026 for UC and p=0.09 for CD). However, the overall drug sustainability did not differ.
Conclusions
Clinical assessment and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization and improved one-year clinical outcomes but did not change drug sustainability rates.
Funding Agencies
None
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Affiliation(s)
- Y Xiao
- Internal Medicine, McGill University, Montreal, QC, Canada
| | | | | | - R Kohen
- McGill University Health Centre, Montreal, QC, Canada
| | - W Afif
- McGill University Health Centre, Montreal, QC, Canada
| | - G Wild
- McGill University Health Centre, Montreal, QC, Canada
| | - G Friedman
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - P Galiatsatos
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - N Hilzenrat
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - A Szilagyi
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - J Wyse
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - A Cohen
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - A Bitton
- McGill University Health Centre, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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2
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Balram B, Al Khoury A, Bessissow T, Afif W, gonczi L, abreu M, Lakatos PL. A174 PATIENT PERSPECTIVES AND EXPECTATIONS IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Shared decision making is gaining favour in clinical practice and increasingly patients want to be involved in their disease process.
Aims
In this systematic review, our objective was to assess inflammatory bowel disease (IBD) patient preferences and perspectives relating to their disease diagnosis, treatment, knowledge needs and telemedicine.
Methods
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Four databases and conference proceedings were searched between January 1, 1980, and May 1, 2020. The methodological quality of the included studies was assessed using the Standards for reporting qualitative research (SRQR) checklist.
Results
Our search identified 240 citations and 51 studies met the inclusion criteria. The major expectations of the patients are symptomatic and pain control, quality of life and normal endoscopy. Patients’ main concerns are access to information and healthcare, and shared decision making. At the time of diagnosis, patients expressed a greater need for knowledge about their IBD, preferentially by their treating gastroenterologist. The main treatment expectations in active disease are efficacy, safety and convenience. Patients are willing to accept relatively high risks of complications from medical therapy to avoid a permanent ostomy and to achieve durable remission. Patients are more interested in disease monitoring, research and development during the time of remission. Telemedicine and self-management with supervised e-health tools are feasible and acceptable amongst IBD patients.
Conclusions
This systematic review demonstrates that IBD patients expect more information about their disease process, shared decision making and symptom control. Further research is needed to help align patient and physician expectations in order to improve the quality of care provided to IBD patients.
Funding Agencies
None
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Affiliation(s)
- B Balram
- Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - A Al Khoury
- University of Miami School of Medicine, Miami, FL
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - l gonczi
- Semmelweis Egyetem, Budapest, Hungary
| | - m abreu
- University of Miami School of Medicine, Miami, FL
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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Singh K, Al Khoury A, Kurti Z, Gonczi L, Reinglas J, Verdon C, Kohen R, Bessissow T, Afif W, Wild G, Seidman EG, Bitton A, Lakatos P. A134 HIGH ADHERENCE TO SURVEILLANCE GUIDELINES IN IBD RESULTS IN LOW CRC AND DYSPLASIA RATES, WHILE RATES OF DYSPLASIA AND CANCER ARE LOW BEFORE THE SUGGESTED START OF SURVEILLANCE. RESULTS FROM A TERTIARY IBD CENTER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Singh
- McGill University Health Center, Montreal, QC, Canada
| | - A Al Khoury
- McGill University Health Center, Montreal, QC, Canada
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | - J Reinglas
- McGill University Health Center, Montreal, QC, Canada
| | - C Verdon
- McGill University Health Center, Montreal, QC, Canada
| | - R Kohen
- McGill University Health Center, Montreal, QC, Canada
| | - T Bessissow
- McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- McGill University Health Center, Montreal, QC, Canada
| | - E G Seidman
- McGill University Health Center, Montreal, QC, Canada
| | - A Bitton
- Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - P Lakatos
- McGill University Health Center, Montreal, QC, Canada
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Singh K, Al Khoury A, Kurti Z, Gonczi L, Reinglas J, Verdon C, Kohen R, Bessissow T, Afif W, Wild G, Seidman EG, Bitton A, Lakatos P. A76 HIGH ADHERENCE TO SURVEILLANCE GUIDELINES IN IBD RESULTS IN LOW CRC AND DYSPLASIA RATES, WHILE RATES OF DYSPLASIA AND CANCER ARE LOW BEFORE THE SUGGESTED START OF SURVEILLANCE. RESULTS FROM A TERTIARY IBD CENTER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- K Singh
- McGill University, Montreal, QC, Canada
| | | | - Z Kurti
- Semmelweis University , Budapest, Hungary
| | - L Gonczi
- Semmelweis University , Budapest, Hungary
| | | | - C Verdon
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - R Kohen
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - G Wild
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - E G Seidman
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - A Bitton
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - P Lakatos
- Gastroenterology, McGill University, Montreal, QC, Canada
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Al Khoury A, Singh K, Kurti Z, Gonczi L, Reinglas J, Verdon C, Kohen R, Bessissow T, Afif W, Wild G, Seidman EG, Bitton A, Lakatos P. A105 HIGH ADHERENCE TO SURVEILLANCE GUIDELINES IN IBD RESULTS IN LOW CRC AND DYSPLASIA RATES, WHILE RATES OF DYSPLASIA AND CANCER ARE LOW BEFORE THE SUGGESTED START OF SURVEILLANCE. RESULTS FROM A TERTIARY IBD CENTER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - K Singh
- McGill University, Montreal, QC, Canada
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | | | - C Verdon
- McGill University, Montreal, QC, Canada
| | - R Kohen
- McGill University, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - G Wild
- McGill University, Montreal, QC, Canada
| | - E G Seidman
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - A Bitton
- Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - P Lakatos
- Gastroenterology, McGill University, Montreal, QC, Canada
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Taheri Tanjani M, Al Khoury A, Hari B, Martel M, Barkun AN. A226 PERCEPTION OF PPI PRESCRIBING AMONGST RESIDENTS AND FELLOWS TRAINING IN PRIMARY AND SPECIALTY CARE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - A Al Khoury
- McGill University Health Center, Montreal, QC, Canada
| | - B Hari
- Queen’s University, Kingston, ON, Canada
| | - M Martel
- McGill University Health Center, Montreal, QC, Canada
| | - A N Barkun
- McGill University Health Center, Montreal, QC, Canada
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Al Khoury A, Chao CY, Camilleri-Broet S, Bessissow T. An unusual case of hamartomatous polyposis with malignancy complication in a patient with ulcerative colitis treated with golimumab. Acta Gastroenterol Belg 2017; 80:530-532. [PMID: 29560650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We report an unusual case of hamartomatous polyposis with malignant complications in a patient with ulcerative colitis on golimumab and previous thiopurine therapy. This patient was evaluated for iron deficiency anemia and underwent hemicolectomy for extensive right-side predominant inflammatory pseudopolyps. Anemia persisted post-colectomy and subsequent gastroscopy showed a fungating polypoid lesion along with numerous carpet-like strawberry appearing polyps in the stomach extending from the gastro-esophageal junction to the distal part of the antrum, necessitating a gastrectomy. Histology showed extensive hamartomatous-like polyps with adenocarcinoma and nodal metastases. Presence of alopecia totalis and hamartomas in this patient raise the possibility of Cronkhite-Canada Syndrome although this may also represent an undescribed hamartomatous polyposis associated with ulcerative colitis. Even though thiopurine analogue and anti-tumor necrosis factor agents have not been associated with increased risk of solid tumors, immunosuppression in patients with extensive polyposis should be cautiously used due to the potential accelerated malignancy risk. This case also highlights the importance of performing additional imaging of the gastrointestinal tract, in inflammatory bowel disease patients with anemia, particularly if the severity is incongruent with disease activity.
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Affiliation(s)
- A Al Khoury
- Division of Gastroenterology, McGill University Health Center, 1650 Avenue Cedar, H3G 1A4, Montreal QC, Canada
| | - C-Y Chao
- Division of Gastroenterology, McGill University Health Center, 1650 Avenue Cedar, H3G 1A4, Montreal QC, Canada
| | - S Camilleri-Broet
- Department of Pathology, McGill University Health Center, 1650 Avenue Cedar, H3G 1A4, Montreal QC, Canada
| | - T Bessissow
- Division of Gastroenterology, McGill University Health Center, 1650 Avenue Cedar, H3G 1A4, Montreal QC, Canada
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