1
|
Tan N, Ngu N, Worland T, Lee T, Abrahams T, Freeman E, Hannah N, Gazelakis K, Madden RG, Lynch KD, Valaydon Z, Sood S, Dev A, Bell S, Thompson AJ, Ding JN, Nicoll AJ, Liu K, Pandya K, Gow P, Lubel J, Kemp W, Roberts SK, Majeed A. Surveillance MRI is associated with improved survival in patients with primary sclerosing cholangitis. Hepatol Commun 2024; 8:e0442. [PMID: 38696372 PMCID: PMC11068143 DOI: 10.1097/hc9.0000000000000442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/16/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND The benefits of regular surveillance imaging for cholangiocarcinoma in patients with primary sclerosing cholangitis (PSC) are unclear. Hence, we aimed to evaluate the impact of regular magnetic resonance cholangiopancreatography (MRCP) on outcomes of patients with PSC in Australia, where the practice of MRCP surveillance is variable. METHODS The relationship between MRCP surveillance and survival outcomes was assessed in a multicenter, retrospective cohort of patients with PSC from 9 tertiary liver centers in Australia. An inverse probability of treatment weighting approach was used to balance groups across potentially confounding covariates. RESULTS A total of 298 patients with PSC with 2117 person-years of follow-up were included. Two hundred and twenty patients (73.8%) had undergone MRCP surveillance. Regular surveillance was associated with a 71% reduced risk of death on multivariate weighted Cox analysis (HR: 0.29, 95% CI: 0.14-0.59, p < 0.001) and increased likelihood of having earlier endoscopic retrograde cholangiopancreatography from the date of PSC diagnosis in patients with a dominant stricture (p < 0.001). However, survival posthepatobiliary cancer diagnosis was not significantly different between both groups (p = 0.74). Patients who had surveillance of less than 1 scan a year (n = 41) had comparable survival (HR: 0.46, 95% CI 0.16-1.35, p = 0.16) compared to patients who had surveillance at least yearly (n = 172). CONCLUSIONS In this multicenter cohort study that employed inverse probability of treatment weighting to minimize selection bias, regular MRCP was associated with improved overall survival in patients with PSC; however, there was no difference in survival after hepatobiliary cancer diagnosis. Further prospective studies are needed to confirm the benefits of regular MRCP and optimal imaging interval in patients with PSC.
Collapse
Affiliation(s)
- Natassia Tan
- Department of Gastroenterology and Hepatology, The Alfred, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Natalie Ngu
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia
| | - Thomas Worland
- Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Australia
| | - Tanya Lee
- Department of Gastroenterology and Hepatology, St Vincent’s Health, Melbourne, Australia
| | - Tobie Abrahams
- Department of Gastroenterology and Hepatology, St Vincent’s Health, Melbourne, Australia
| | - Elliot Freeman
- Department of Gastroenterology and Hepatology, The Alfred, Melbourne, Australia
| | - Nicholas Hannah
- Department of Gastroenterology and Hepatology, Melbourne Health, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Kathryn Gazelakis
- Department of Gastroenterology and Hepatology, Western Health, Melbourne, Australia
| | - Richie G Madden
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Kate D Lynch
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Zina Valaydon
- Department of Gastroenterology and Hepatology, Western Health, Melbourne, Australia
| | - Siddharth Sood
- Department of Gastroenterology and Hepatology, Melbourne Health, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Anouk Dev
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia
| | - Sally Bell
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Australia
| | - Alexander J Thompson
- Department of Gastroenterology and Hepatology, St Vincent’s Health, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - John Nik Ding
- Department of Gastroenterology and Hepatology, St Vincent’s Health, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Amanda J Nicoll
- Central Clinical School, Monash University, Melbourne, Australia
- Department of Gastroenterology and Hepatology, Eastern Health, Melbourne, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Keval Pandya
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul Gow
- Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - John Lubel
- Department of Gastroenterology and Hepatology, The Alfred, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology and Hepatology, The Alfred, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Stuart K Roberts
- Department of Gastroenterology and Hepatology, The Alfred, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ammar Majeed
- Department of Gastroenterology and Hepatology, The Alfred, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| |
Collapse
|
2
|
Winter RJ, Griffin S, Sheehan Y, Nguyen W, Stoové M, Lloyd AR, Thompson AJ. People in community corrections are a population with unmet need for viral hepatitis care. EClinicalMedicine 2024; 70:102548. [PMID: 38516104 PMCID: PMC10955648 DOI: 10.1016/j.eclinm.2024.102548] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
To reach World Health Organization elimination targets for hepatitis C, different strategies are needed to reach people who have not yet been diagnosed and treated. In the context of declining treatment initiation rates, innovation in service design and delivery is necessary: testing and treatment needs to be offered to people in non-traditional settings. The community corrections (probation and parole) population is larger than the prison population, which has high prevalence of hepatitis C and-in some countries-established diagnosis and treatment programs. In this Viewpoint we identify a gap in hepatitis C care for people under community correctional supervision, a group who have either never been imprisoned or need continuity of healthcare provided in prison. We propose that offering hepatitis C screening and treatment would benefit this population, and accelerate progress to hepatitis C elimination.
Collapse
Affiliation(s)
- Rebecca J. Winter
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Samara Griffin
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Yumi Sheehan
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Andrew R. Lloyd
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - National Prisons Hepatitis Network
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Viral Immunology Systems Program, The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
- Hepatitis Queensland, Brisbane, QLD, Australia
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
3
|
Tassone D, Basnayake C, Wright E, Lust M, Kamm MA, Niewiadomski O, Schulberg J, Flanagan E, Samyue T, Fry S, Malcolm R, Stanley A, Thompson AJ, Connell WR, Ding NS. Risk factors for malignancy and serious infection in patients with inflammatory bowel disease: a retrospective analysis. Intern Med J 2024; 54:446-454. [PMID: 37255273 DOI: 10.1111/imj.16141] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/18/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at increased risk of malignancy and infection compared to the general population. AIMS We aim to identify risk factors for malignancy or serious infection in our IBD cohort. METHODS Patients with IBD from a single tertiary referral centre were included. Demographic and clinical details, including immunosuppressant exposure, were collected and medical records retrospectively screened for adverse events, including malignancy or infection requiring hospitalisation. Logistic regression was used to evaluate risk factors for adverse events. RESULTS Five hundred and forty-nine patients with IBD (340 Crohn disease (CD) and 209 ulcerative colitis (UC)) were studied. Forty-eight malignancies, including 39 (81.3%) non-melanoma skin cancers, 3 (6.3%) haematologic malignancies and 6 (15.4%) solid-organ malignancies, were identified, and 92 cases of serious infection were detected. IBD duration (odds ratio (OR) = 1.08; 95% confidence interval (CI) = 1.03-1.13) and ileocolonic CD (OR = 4.96; 95% CI = 1.13-21.71) were associated with increased odds of overall cancer. Compared with patients not previously exposed to the given class of immunosuppression assessed, the development of overall malignancy was not higher with thiopurine exposure (OR = 1.00; 95% CI = 0.50-2.24) or anti-tumour necrosis factor-alpha (TNF-α) exposure (OR = 0.78; 95% CI = 0.37-1.64). Similarly, compared with patients not exposed, infection risk was not affected by thiopurine (OR = 0.74; 95% CI = 0.46-1.20) or anti-TNF exposure (OR = 0.60; 95% CI = 0.38-0.95). CONCLUSIONS Factors including ileocolonic CD and increasing IBD duration were associated with higher malignancy risk in this cohort. Compared with non-exposure, patients exposed to thiopurines were not at increased risk of malignancy or serious infection. Similarly, patients exposed to anti-TNF treatment did not experience increased rates of malignancy or serious infection compared to patients not exposed to this treatment.
Collapse
Affiliation(s)
- Daniel Tassone
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Chamara Basnayake
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily Wright
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Lust
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ola Niewiadomski
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Julien Schulberg
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Emma Flanagan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tamie Samyue
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Stephanie Fry
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Ruth Malcolm
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Annalise Stanley
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - William R Connell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Nik S Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
MacIsaac MB, Whitton B, Anderson J, Cogger S, Vella-Horne D, Penn M, Weeks A, Elmore K, Pemberton D, Winter RJ, Papaluca T, Howell J, Hellard M, Stoové M, Wilson D, Pedrana A, Doyle JS, Clark N, Holmes JA, Thompson AJ. Point-of-care HCV RNA testing improves hepatitis C testing rates and allows rapid treatment initiation among people who inject drugs attending a medically supervised injecting facility. Int J Drug Policy 2024; 125:104317. [PMID: 38281385 DOI: 10.1016/j.drugpo.2024.104317] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/27/2023] [Accepted: 01/01/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND To achieve hepatitis C virus (HCV) elimination targets, simplified care engaging people who inject drugs is required. We evaluated whether fingerstick HCV RNA point-of-care testing (PoCT) increased the proportion of clients attending a supervised injecting facility who were tested for hepatitis C. METHODS Prospective single-arm study with recruitment between 9 November 2020 and 28 January 2021 and follow-up to 31 July 2021. Clients attending the supervised injecting facility were offered HCV RNA testing using the Xpert® HCV Viral Load Fingerstick (Cepheid, Sunnyvale, CA) PoCT. Participants with a positive HCV RNA test were prescribed direct acting antiviral (DAA) therapy. The primary endpoint was the proportion of clients who engaged in HCV RNA PoCT, compared to a historical comparator group when venepuncture-based hepatitis C testing was standard of care. RESULTS Among 1618 clients who attended the supervised injecting facility during the study period, 228 (14%) engaged in PoCT. This was significantly higher than that observed in the historical comparator group (61/1,775, 3%; p < 0.001). Sixty-five (28%) participants were HCV RNA positive, with 40/65 (62%) receiving their result on the same day as testing. Sixty-one (94%) HCV RNA positive participants were commenced on DAA therapy; 14/61 (23%) started treatment on the same day as diagnosis. There was no difference in the proportion of HCV RNA positive participants commenced on treatment with DAA therapy when compared to the historical comparator group (61/65, 94% vs 22/26, 85%; p = 0.153). However, the median time to treatment initiation was significantly shorter in the PoCT cohort (2 days (IQR 1-20) vs 41 days (IQR 22-76), p < 0.001). Among participants who commenced treatment and had complete follow-up data available, 27/36 (75%) achieved hepatitis C cure. CONCLUSIONS HCV RNA PoCT led to a significantly higher proportion of clients attending a supervised injecting facility engaging in hepatitis C testing, whilst also reducing the time to treatment initiation.
Collapse
Affiliation(s)
- Michael B MacIsaac
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Bradley Whitton
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jenine Anderson
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Shelley Cogger
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Dylan Vella-Horne
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Matthew Penn
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Anthony Weeks
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Kasey Elmore
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - David Pemberton
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia
| | - Rebecca J Winter
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Timothy Papaluca
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Jessica Howell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Margaret Hellard
- Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia; Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - David Wilson
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Nicolas Clark
- Medically Supervised Injecting Room, North Richmond Community Health, Richmond, Victoria, Australia; Department of Addiction Medicine, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jacinta A Holmes
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Faculty of Medicine, University of Melbourne, Parkville, Victoria, Australia.
| |
Collapse
|
5
|
Hearps AC, Vootukuru N, Ebrahimnezhaddarzi S, Harney BL, Boo I, Nguyen L, Pavlyshyn D, Dietze PM, Drummer HE, Thompson AJ, Jaworowski A, Hellard ME, Sacks-Davis R, Doyle JS. Injecting drug use and hepatitis C virus infection independently increase biomarkers of inflammatory disease risk which are incompletely restored by curative direct-acting antiviral therapy. Front Immunol 2024; 15:1352440. [PMID: 38420130 PMCID: PMC10899672 DOI: 10.3389/fimmu.2024.1352440] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
Background Hepatitis C virus (HCV) infections are more prevalent in people who inject drugs (PWID) who often experience additional health risks. HCV induces inflammation and immune alterations that contribute to hepatic and non-hepatic morbidities. It remains unclear whether curative direct acting antiviral (DAA) therapy completely reverses immune alterations in PWID. Methods Plasma biomarkers of immune activation associated with chronic disease risk were measured in HCV-seronegative (n=24) and HCV RNA+ (n=32) PWID at baseline and longitudinally after DAA therapy. Adjusted generalised estimating equations were used to assess longitudinal changes in biomarker levels. Comparisons between community controls (n=29) and HCV-seronegative PWID were made using adjusted multiple regression modelling. Results HCV-seronegative PWID exhibited significantly increased levels of inflammatory biomarkers including soluble (s) TNF-RII, IL-6, sCD14 and sCD163 and the diabetes index HbA1c as compared to community controls. CXCL10, sTNF-RII, vascular cell adhesion molecule-1 and lipopolysaccharide binding protein (LBP) were additionally elevated in PWID with viremic HCV infection as compared to HCV- PWID. Whilst curative DAA therapy reversed some biomarkers, others including LBP and sTNF-RII remained elevated 48 weeks after HCV cure. Conclusion Elevated levels of inflammatory and chronic disease biomarkers in PWID suggest an increased risk of chronic morbidities such as diabetes and cardiovascular disease. HCV infection in PWID poses an additional disease burden, amplified by the incomplete reversal of immune dysfunction following DAA therapy. These findings highlight the need for heightened clinical surveillance of PWID for chronic inflammatory diseases, particularly those with a history of HCV infection.
Collapse
Affiliation(s)
- Anna C. Hearps
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - Nikil Vootukuru
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Gastroenterology, Eastern Health and Monash University, Melbourne, VIC, Australia
| | | | - Brendan L. Harney
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Irene Boo
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Long Nguyen
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Damian Pavlyshyn
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
| | - Paul M. Dietze
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- National Drug Research Institute, Curtin University, Melbourne, VIC, Australia
| | - Heidi E. Drummer
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
- Department of Microbiology, Monash University, Melbourne, VIC, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, VIC, Australia
| | - Anthony Jaworowski
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| | - Margaret E. Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Sacks-Davis
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Joseph S. Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, VIC, Australia
| |
Collapse
|
6
|
De Gregorio M, Sidhu A, Behrenbruch C, Connor SJ, Guerra G, Johnston MJ, Keck JO, Ong EJSK, Thompson AJ, Woods R, D'Souza B, Ding NS. Preferred definitive surgical management of Crohn's perianal fistulas and factors influencing surgical decision making in Australia and New Zealand. ANZ J Surg 2024; 94:14-16. [PMID: 37551939 DOI: 10.1111/ans.18640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Michael De Gregorio
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Ankur Sidhu
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Cori Behrenbruch
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Susan J Connor
- South West Sydney Clinical Campuses, University of New South Wales Sydney, Sydney, New South Wales, Australia
- Department of Medicine, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Gastroenterology Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Glen Guerra
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michael J Johnston
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - James O Keck
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Eugene J S K Ong
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alexander J Thompson
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Rodney Woods
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Basil D'Souza
- Colorectal Surgery Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Colorectal Surgery Department, Northern Health, Melbourne, Victoria, Australia
| | - Nik S Ding
- Gastroenterology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Hainsworth R, Thompson AJ, Guthrie B, Payne K, Rogers G. International Systematic Review of Utility Values Associated with Cardiovascular Disease and Reflections on Selecting Evidence for a UK Decision-Analytic Model. Med Decis Making 2024; 44:217-234. [PMID: 38174427 PMCID: PMC10865747 DOI: 10.1177/0272989x231214782] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/19/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Evaluating interventions for cardiovascular disease (CVD) requires estimates of its effect on utility. We aimed to 1) systematically review utility estimates for CVDs published since 2013 and 2) critically appraise UK-relevant estimates and calculate corresponding baseline utility multipliers. METHODS We searched MEDLINE and Embase (April 22, 2021) using CVD and utility terms. We screened results for primary studies reporting utility distributions for people with experience of heart failure, myocardial infarction, peripheral arterial disease, stable angina, stroke, transient ischemic attack, or unstable angina. We extracted characteristics from studies included. For UK estimates based on the EuroQoL 5-dimension (EQ-5D) measure, we assessed risk of bias and applicability to a decision-analytic model, pooled arms/time points as appropriate, and estimated baseline utility multipliers using predicted utility for age- and sex- matched populations without CVD. We sought utility sources from directly applicable studies with low risk of bias, prioritizing plausibility of severity ordering in our base-case model and highest population ascertainment in a sensitivity analysis. RESULTS Most of the 403 studies identified used EQ-5D (n = 217) and most assessed Organisation for Economic Co-operation and Development populations (n = 262), although measures and countries varied widely. UK studies using EQ-5D (n = 29) produced very heterogeneous baseline utility multipliers for each type of CVD, precluding meta-analysis and implying different possible severity orderings. We could find sources that provided a plausible ordering of utilities while adequately representing health states. CONCLUSIONS We cataloged international CVD utility estimates and calculated UK-relevant baseline utility multipliers. Modelers should consider unreported sources of heterogeneity, such as population differences, when selecting utility evidence from reviews. HIGHLIGHTS Published systematic reviews have summarized estimates of utility associated with cardiovascular disease published up to 2013.We 1) reviewed utility estimates for 7 types of cardiovascular disease published since 2013, 2) critically appraised UK-relevant studies, and 3) estimated the effect of each cardiovascular disease on baseline utility.Our review 1) recommends a consistent and reliable set of baseline utility multipliers for 7 types of cardiovascular disease and 2) provides systematically identified reference information for researchers seeking utility evidence for their own context.
Collapse
Affiliation(s)
- Rob Hainsworth
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Alexander J. Thompson
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Katherine Payne
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| | - Gabriel Rogers
- Manchester Centre for Health Economics, The University of Manchester, Manchester, UK
| |
Collapse
|
8
|
Abdelmalak J, Strasser SI, Ngu N, Dennis C, Sinclair M, Majumdar A, Collins K, Bateman K, Dev A, Abasszade JH, Valaydon Z, Saitta D, Gazelakis K, Byers S, Holmes J, Thompson AJ, Pandiaraja D, Bollipo S, Sharma S, Joseph M, Nicoll A, Batt N, Sawhney R, Tang MJ, Lubel J, Riordan S, Hannah N, Haridy J, Sood S, Lam E, Greenhill E, Majeed A, Kemp W, Zalcberg J, Roberts SK. Improved Survival Outcomes with Surgical Resection Compared to Ablative Therapy in Early-Stage HCC: A Large, Real-World, Propensity-Matched, Multi-Centre, Australian Cohort Study. Cancers (Basel) 2023; 15:5741. [PMID: 38136287 PMCID: PMC10742146 DOI: 10.3390/cancers15245741] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
The optimal treatment approach in very-early and early-stage hepatocellular carcinoma (HCC) is not precisely defined, and there is ambiguity in the literature around the comparative efficacy of surgical resection versus ablation as curative therapies for limited disease. We performed this real-world propensity-matched, multi-centre cohort study to assess for differences in survival outcomes between those undergoing resection and those receiving ablation. Patients with Barcelona Clinic Liver Cancer (BCLC) 0/A HCC first diagnosed between 1 January 2016 and 31 December 2020 who received ablation or resection as initial treatment were included in the study. A total of 450 patients were included in the study from 10 major liver centres including two transplant centres. Following propensity score matching using key covariates, 156 patients were available for analysis with 78 in each group. Patients who underwent resection had significantly improved overall survival (log-rank test p = 0.023) and local recurrence-free survival (log rank test p = 0.027) compared to those who received ablation. Based on real-world data, our study supports the use of surgical resection in preference to ablation as first-line curative therapy in appropriately selected BCLC 0/A HCC patients.
Collapse
Affiliation(s)
- Jonathan Abdelmalak
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - Simone I. Strasser
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Natalie Ngu
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Claude Dennis
- Department of Gastroenterology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW 2050, Australia; (S.I.S.); (N.N.); (C.D.)
| | - Marie Sinclair
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Avik Majumdar
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Kate Collins
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Katherine Bateman
- Department of Gastroenterology, Austin Hospital, Heidelberg, VIC 3084, Australia; (M.S.); (A.M.); (K.C.); (K.B.)
| | - Anouk Dev
- Department of Gastroenterology, Monash Health, Clayton, VIC 3168, Australia; (A.D.); (J.H.A.)
| | - Joshua H. Abasszade
- Department of Gastroenterology, Monash Health, Clayton, VIC 3168, Australia; (A.D.); (J.H.A.)
| | - Zina Valaydon
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Daniel Saitta
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Kathryn Gazelakis
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Susan Byers
- Department of Gastroenterology, Western Health, Footscray, VIC 3011, Australia; (Z.V.); (D.S.); (K.G.); (S.B.)
| | - Jacinta Holmes
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Parkville, VIC 3052, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
- Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Parkville, VIC 3052, Australia
| | - Dhivya Pandiaraja
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (J.H.); (A.J.T.); (D.P.)
| | - Steven Bollipo
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Suresh Sharma
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Merlyn Joseph
- Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, NSW 2305, Australia; (S.B.); (S.S.); (M.J.)
| | - Amanda Nicoll
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
- Department of Medicine, Eastern Health Clinical School, Box Hill, VIC 3128, Australia
| | - Nicholas Batt
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
| | - Rohit Sawhney
- Department of Gastroenterology, Eastern Health, Box Hill, VIC 3128, Australia; (A.N.); (N.B.); (R.S.)
- Department of Medicine, Eastern Health Clinical School, Box Hill, VIC 3128, Australia
| | - Myo J. Tang
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
| | - John Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
| | - Stephen Riordan
- Department of Gastroenterology, Prince of Wales Hospital, Randwick, NSW 2031, Australia;
| | - Nicholas Hannah
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - James Haridy
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - Siddharth Sood
- Department of Gastroenterology, Royal Melbourne Hospital, Parkville, VIC 3052, Australia; (N.H.); (J.H.); (S.S.)
| | - Eileen Lam
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Elysia Greenhill
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
| | - Ammar Majeed
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - William Kemp
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia;
- Department of Medical Oncology, Alfred Health, Melbourne, VIC 3004, Australia
| | - Stuart K. Roberts
- Department of Gastroenterology, Alfred Health, Melbourne, VIC 3004, Australia; (J.A.); (M.J.T.); (J.L.); (A.M.); (W.K.)
- Department of Medicine, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia; (E.L.)
| |
Collapse
|
9
|
Gane EJ, Kim W, Lim TH, Tangkijvanich P, Yoon JH, Sievert W, Sukeepaisarnjaroen W, Thompson AJ, Pavlovic V, Surujbally B, Wat C, Brown BD, Achneck HE, Yuen MF. First-in-human randomized study of RNAi therapeutic RG6346 for chronic hepatitis B virus infection. J Hepatol 2023; 79:1139-1149. [PMID: 37524230 DOI: 10.1016/j.jhep.2023.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/12/2023] [Accepted: 07/09/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND & AIMS RG6346 is an N-acetyl-D-galactosamine (GalNAc)-conjugated, double-stranded RNA interference agent targeting the HBV genome S-region. We investigated the safety, tolerability, pharmacokinetics, and pharmacodynamics of RG6346 in healthy volunteers and patients with chronic HBV infection (CHB). METHODS This first-in-human, adaptive, randomized, double-blinded, phase I study recruited three groups of participants: Group A, 30 healthy volunteers received single-dose RG6346 at 0.1, 1.5, 3.0, 6.0, or 12.0 mg/kg, or placebo; Group B, nucleos(t)ide analogue-naïve participants with CHB received single-dose RG6346 at 3.0 mg/kg (n = 6) or placebo (n = 3); Group C, participants with nucleos(t)ide-suppressed CHB received four doses (every 28 days) of RG6346 at 1.5, 3.0, or 6.0 mg/kg (n = 4 in each cohort) or placebo (n = 6). RESULTS RG6346 treatment for up to 4 months was safe and well tolerated. The most common adverse event was a mild injection site reaction. Several nucleos(t)ide-naïve participants exhibited self-resolving transaminase elevations with preserved liver function. By the end of RG6346 treatment in Group C (Day 112), the mean reduction from baseline in hepatitis B surface antigen (HBsAg) was 1.39, 1.80, and 1.64 log10 IU/ml in the 1.5, 3.0, and 6.0 mg/kg cohorts, respectively. Of the 12 participants in Group C, 11 (91.7%) achieved a ≥1 log10 IU/ml reduction in HBsAg (3 of 11 [27.3%] had the response sustained at conditional follow-up Day 448). No dose-response relationship was apparent between RG6346 and serum HBsAg levels. The RG6346-induced HBsAg response was independent of hepatitis B e antigen status. Moderate-to-marked sustained reductions of hepatitis B core-related antigen, HBV RNA, HBV DNA (in nucleos[t]ide analogue-naïve participants), and hepatitis B e antigen levels were observed. CONCLUSIONS These favorable safety and pharmacodynamic data support the clinical development of RG6346 as the backbone of a finite antiviral treatment regimen, with the goal of sustained HBsAg loss (functional cure) in patients with CHB. CLINICAL TRIAL NUMBER ClinicalTrials.gov NCT03772249. IMPACT AND IMPLICATIONS Currently available therapies for chronic HBV infection are associated with low rates of functional cure and new, more efficacious treatments are needed. This first-in-human study of RG6346, an RNA interference therapy, showed a favorable safety profile as well as marked and durable reductions in hepatitis B surface antigen levels. These results support the continued development of RG6346 as the backbone of a finite treatment regimen targeting high functional cure rates and are important for HBV researchers and physicians.
Collapse
Affiliation(s)
- Edward J Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital and University of Auckland, Auckland, New Zealand
| | - Won Kim
- Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | | | - Pisit Tangkijvanich
- Center of Excellence in Hepatitis and Liver Cancer, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | | | | | - Cynthia Wat
- Roche Products, Welwyn Garden City, United Kingdom
| | - Bob D Brown
- Dicerna Pharmaceuticals Inc., a Novo Nordisk Company, Lexington, Massachusetts, United States
| | - Hardean E Achneck
- Dicerna Pharmaceuticals Inc., a Novo Nordisk Company, Lexington, Massachusetts, United States
| | - Man-Fung Yuen
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong; State Key Laboratory of Liver Research, School of Clinical Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
| |
Collapse
|
10
|
He T, Sundararajan V, Clark NJ, Slavin J, Tsoi EH, Thompson AJ, Holt BA, Desmond PV, Taylor ACF. Location and appearance of dysplastic Barrett's esophagus recurrence after endoscopic eradication therapy: no additional yield from random biopsy sampling neosquamous mucosa. Gastrointest Endosc 2023; 98:722-732. [PMID: 37301519 DOI: 10.1016/j.gie.2023.06.002] [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] [Received: 10/23/2022] [Revised: 04/13/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND AIMS Surveillance after complete remission of intestinal metaplasia (CRIM) is essential. Current recommendations are to sample visible lesions first, followed by random 4-quadrant biopsy sampling of the original Barrett's esophagus (BE) length. To inform post-CRIM surveillance protocols, we aimed to identify the anatomic location, appearance, and histology of BE recurrences. METHODS We performed an analysis of 216 patients who achieved CRIM after endoscopic eradication therapy for dysplastic BE at a Barrett's Referral Unit between 2008 and 2021. The anatomic location, recurrence histology, and endoscopic appearance of dysplastic recurrences were evaluated. RESULTS After a median of 5.5 years (interquartile range, 2.9-7.2) of follow-up after CRIM, 57 patients (26.4%) developed nondysplastic BE (NDBE) recurrence and 18 patients (8.3%) developed dysplastic recurrence. From 8158 routine surveillance biopsy samplings of normal-appearing tubular esophageal neosquamous epithelium, the yield for recurrent NDBE or dysplasia was 0%. One hundred percent of dysplastic tubular esophageal recurrences were visible and in BE islands, whereas 77.8% of gastroesophageal junction dysplastic recurrences were nonvisible. Four distinct endoscopic features suspicious for recurrent advanced dysplasia or neoplasia were identified: buried or subsquamous BE, irregular mucosal pattern, loss of vascular pattern, and nodularity or depression. CONCLUSIONS The yield of routine surveillance biopsy sampling of normal-appearing tubular esophageal neosquamous epithelium was zero. BE islands with indistinct mucosal or loss of vascular pattern, nodularity or depression, and/or signs of buried BE should raise clinician suspicion for advanced dysplasia or neoplasia recurrence. We suggest a new surveillance biopsy sampling protocol with a focus on meticulous inspection, followed by targeted biopsy sampling of visible lesions and random 4-quadrant biopsy sampling of the gastroesophageal junction.
Collapse
Affiliation(s)
- Tony He
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nicholas J Clark
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - John Slavin
- Department of Pathology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Edward H Tsoi
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Bronte A Holt
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Paul V Desmond
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew C F Taylor
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Thompson AJ, Jackson K, Bonanzinga S, Hall SA, Hume S, Burns GS, Sundararajan V, Ratnam D, Levy MT, Lubel J, Nicoll AJ, Strasser SI, Sievert W, Desmond PV, Ngu MC, Sinclair M, Meredith C, Matthews G, Revill PA, Littlejohn M, Bowden DS, Canchola JA, Torres J, Siew P, Lau J, La Brot B, Kuchta A, Visvanathan K. Baseline serum HBV RNA is associated with the risk of hepatitis flare after stopping nucleoside analog therapy in HBeAg-negative participants. Hepatol Commun 2023; 7:e0188. [PMID: 37459199 PMCID: PMC10351945 DOI: 10.1097/hc9.0000000000000188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/11/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND AND AIMS HBV RNA in peripheral blood reflects HBV cccDNA transcriptional activity and may predict clinical outcomes. The prospective Melbourne HBV-STOP trial studied nucleot(s)ide analog discontinuation in HBeAg-negative non-cirrhotic participants with long-term virological suppression. Ninety-six weeks after stopping treatment, the proportion of participants with virological relapse (HBV DNA > 2000 IU/mL), biochemical relapse (ALT > 2 × ULN and HBV DNA > 2000 IU/mL), or hepatitis flare (ALT > 5 × ULN and HBV DNA > 2000 IU/mL) was 89%, 58%, and 38%, respectively. We evaluated the ability of serum HBV RNA levels to predict these outcomes. APPROACH RESULTS HBV RNA levels were measured using the Roche cobas 6800/8800 HBV RNA Investigational Assay. Sixty-five participants had baseline and longitudinal off-treatment specimens available for RNA testing. HBV RNA was detectable at baseline in 25% of participants and was associated with a higher risk of biochemical relapse (81% vs. 51%, p value 0.04) and hepatitis flare (63% vs. 31%, p value 0.04). Participants who had undetectable serum HBV RNA as well as HBsAg ≤ 100 IU/mL at baseline were less likely to experience virological relapse (4 of 9, 44%) than participants with detectable HBV RNA and HBsAg level > 100 IU/mL (15/15, 100%; p value 0.0009). Off-treatment levels of HBV RNA were correlated with HBV DNA and were associated with the risk of hepatitis flare. CONCLUSIONS Serum HBV RNA may be a useful biomarker for guiding clinical decision-making before stopping nucleot(s)ide analog therapy. Baseline HBV RNA and HBsAg levels are associated with the risk of clinical relapse, hepatitis flare, and disease remission off-treatment.
Collapse
Affiliation(s)
- Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Immunology Research Centre, Department of Medicine (St Vincent’s Hospital), The University of Melbourne, Melbourne, Victoria, Australia
| | - Kathy Jackson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sara Bonanzinga
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Sam A.L. Hall
- Department of Gastroenterology, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Immunology Research Centre, Department of Medicine (St Vincent’s Hospital), The University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Hume
- Department of Gastroenterology, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Immunology Research Centre, Department of Medicine (St Vincent’s Hospital), The University of Melbourne, Melbourne, Victoria, Australia
| | - Gareth S. Burns
- Department of Gastroenterology, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Immunology Research Centre, Department of Medicine (St Vincent’s Hospital), The University of Melbourne, Melbourne, Victoria, Australia
| | - Vijaya Sundararajan
- Immunology Research Centre, Department of Medicine (St Vincent’s Hospital), The University of Melbourne, Melbourne, Victoria, Australia
- Department of Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Dilip Ratnam
- Gastroenterology & Hepatology Unit, Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Miriam T. Levy
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, Australia
| | - John Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Amanda J. Nicoll
- Gastroenterology Department of Eastern Health, Melbourne, Victoria, Australia
| | - Simone I. Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - William Sievert
- Gastroenterology & Hepatology Unit, Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Paul V. Desmond
- Department of Gastroenterology, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
| | - Meng C. Ngu
- Department of Gastroenterology, Concord Repatriation General Hospital, Sydney, Australia
| | - Marie Sinclair
- Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Victoria, Australia
| | | | - Gail Matthews
- Department of Infectious Disease, St Vincent’s Hospital Sydney, Sydney, Australia
| | - Peter A. Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Margaret Littlejohn
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - D. Scott Bowden
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | | | - Jason Torres
- Roche Molecular Systems, Inc., Pleasanton, California, USA
| | - Philip Siew
- Roche Diagnostics, Pty Ltd, North Ryde, Australia
| | - Jasmin Lau
- Roche Molecular Systems, Inc., Pleasanton, California, USA
| | | | - Alison Kuchta
- Roche Molecular Systems, Inc., Pleasanton, California, USA
| | - Kumar Visvanathan
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| |
Collapse
|
12
|
Yang LS, Taylor ACF, Thompson AJ, Desmond PV, Holt BA. Direct percutaneous endoscopic gastrostomy for nutritional support in patients with aerodigestive tract cancers. Intern Med J 2023; 53:1218-1223. [PMID: 34897942 DOI: 10.1111/imj.15664] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/02/2021] [Accepted: 12/09/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Conventional pull-through percutaneous endoscopic gastrostomy (PEG) risks infection and tumour implantation in head and neck cancers. Endoscopically inserted direct gastrostomy has lower rates of complications but is underutilised. AIMS To describe the endoscopic steps for direct gastrostomy insertion and review our single-centre experience to assess the technical feasibility and safety. METHODS Patients who underwent endoscopic direct gastrostomy insertion between December 2016 and June 2021 were included. A 24Fr introducer kit for gastrostomy feeding tube (Avanos Healthcare, Australia) was used. Patient and tumour characteristics, procedural data and 30-day outcomes were recorded. RESULTS Thirty patients underwent direct PEG insertion (mean age 64 years and 24 male). All were planned for or currently undergoing radiotherapy. Twenty-six (87%) of 30 cases were performed under conscious sedation over a median procedure time of 21 min (interquartile range 11 min). No tumour seeding was seen, and one case of PEG-site infection was observed. CONCLUSIONS Direct PEG is safe and effective and should be considered for patients with aerodigestive tract cancer in need of nutritional support.
Collapse
Affiliation(s)
- Linda S Yang
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew C F Taylor
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul V Desmond
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bronte A Holt
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
13
|
Hume SJ, Thompson AJ, Holmes JA. Editorial on "Maximize Donor Cornea Use in a Hepatitis B Endemic Area via Serology Matching". Transplantation 2023; 107:1242-1243. [PMID: 36706076 DOI: 10.1097/tp.0000000000004461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Simon J Hume
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Carlton, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Carlton, Australia
| | - Jacinta A Holmes
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Carlton, Australia
| |
Collapse
|
14
|
Robinson H, Eleuteri A, Sacco JJ, Hussain R, Heimann H, Taktak AFG, Damato B, Thompson AJ, Allen T, Kalirai H, Coupland SE. Sensitivity and Specificity of Different Prognostic Systems in Guiding Surveillance for Metastases in Uveal Melanoma. Cancers (Basel) 2023; 15:cancers15092610. [PMID: 37174076 PMCID: PMC10177440 DOI: 10.3390/cancers15092610] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Uveal melanoma (UM) metastasises in ~50% of patients, most frequently to the liver. Surveillance imaging can provide early detection of hepatic metastases; however, guidance regarding UM patient risk stratification for surveillance is unclear. This study compared sensitivity and specificity of four current prognostic systems, when used for risk stratification for surveillance, on patients treated at the Liverpool Ocular Oncology Centre (LOOC) between 2007-2016 (n = 1047). It found that the Liverpool Uveal Melanoma Prognosticator Online III (LUMPOIII) or Liverpool Parsimonious Model (LPM) offered greater specificity at equal levels of sensitivity than the American Joint Committee on Cancer (AJCC) system or monosomy 3 alone, and suggests guidance to achieve 95% sensitivity and 51% specificity (i.e., how to detect the same number of patients with metastases, while reducing the number of negative scans). For example, 180 scans could be safely avoided over 5 years in 200 patients using the most specific approach. LUMPOIII also offered high sensitivity and improved specificity over the AJCC in the absence of genetic information, making the result relevant to centres that do not perform genetic testing, or where such testing is inappropriate or fails. This study provides valuable information for clinical guidelines for risk stratification for surveillance in UM.
Collapse
Affiliation(s)
- Helena Robinson
- Department of Clinical Engineering, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8YE, UK
| | - Antonio Eleuteri
- NHS Digital, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8YE, UK
| | - Joseph J Sacco
- Liverpool Ocular Oncology Research Group, Department of Molecular and Cancer Medicine, University of Liverpool, Liverpool L7 8TX, UK
| | - Rumana Hussain
- Liverpool Ocular Oncology Research Group, Department of Molecular and Cancer Medicine, University of Liverpool, Liverpool L7 8TX, UK
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8TX, UK
| | - Heinrich Heimann
- Liverpool Ocular Oncology Research Group, Department of Molecular and Cancer Medicine, University of Liverpool, Liverpool L7 8TX, UK
- Liverpool Ocular Oncology Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8TX, UK
| | - Azzam F G Taktak
- Department of Clinical Engineering, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS2 8HW, UK
| | - Bertil Damato
- Consultant Ocular Oncologist, St Erik's Eye Hospital & Karolinska Institutet, 171 64 Stockholm, Sweden
| | - Alexander J Thompson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester M13 9PL, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester M13 9PL, UK
| | - Helen Kalirai
- Liverpool Ocular Oncology Research Group, Department of Molecular and Cancer Medicine, University of Liverpool, Liverpool L7 8TX, UK
| | - Sarah E Coupland
- Liverpool Ocular Oncology Research Group, Department of Molecular and Cancer Medicine, University of Liverpool, Liverpool L7 8TX, UK
| |
Collapse
|
15
|
Winter RJ, Sheehan Y, Papaluca T, Macdonald GA, Rowland J, Colman A, Stoove M, Lloyd AR, Thompson AJ. Consensus recommendations on the management of hepatitis C in Australia's prisons. Med J Aust 2023; 218:231-237. [PMID: 36871200 DOI: 10.5694/mja2.51854] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/04/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Prison settings represent the highest concentration of prevalent hepatitis C cases in Australia due to the high rates of incarceration among people who inject drugs. Highly effective direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection are available to people incarcerated in Australian prisons. However, multiple challenges to health care implementation in the prison sector present barriers to people in prison reliably accessing hepatitis C testing, treatment, and prevention measures. MAIN RECOMMENDATIONS This Consensus statement highlights important considerations for the management of hepatitis C in Australian prisons. High coverage testing, scale-up of streamlined DAA treatment pathways, improved coverage of opioid agonist therapy, and implementation and evaluation of regulated provision of prison needle and syringe programs to reduce HCV infection and reinfection are needed. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT The recommendations set current best practice standards in hepatitis C diagnosis, treatment and prevention in the Australian prison sector based on available evidence. Prison-based health services should strive to simplify and improve efficiency in the provision of the hepatitis C care cascade, including strategies such as universal opt-out testing, point-of-care testing, simplified assessment protocols, and earlier confirmation of cure. Optimising hepatitis C management in prisons is essential to prevent long term adverse outcomes for a marginalised population living with HCV. Scale-up of testing and treatment in prisons will make a major contribution towards Australia's efforts to eliminate hepatitis C as a public health threat by 2030.
Collapse
Affiliation(s)
- Rebecca J Winter
- Monash University, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
- St Vincent's Hospital, Melbourne, VIC
| | - Yumi Sheehan
- Kirby Institute, University of New South Wales, Sydney, NSW
| | - Timothy Papaluca
- St Vincent's Hospital, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Graeme A Macdonald
- University of Queensland, Brisbane, QLD
- Princess Alexandra Hospital, Brisbane, QLD
| | - Joy Rowland
- Department of Justice, Government of Western Australia, Perth, WA
| | | | - Mark Stoove
- Monash University, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
| | - Andrew R Lloyd
- Kirby Institute, University of New South Wales, Sydney, NSW
| | | |
Collapse
|
16
|
MacIsaac MB, Whitton B, Hubble A, Cogger S, Penn M, Weeks A, Elmore K, Pemberton D, Anderson J, Howard R, McKeever U, Papaluca T, Hellard ME, Stoove M, Wilson D, Pedrana A, Doyle J, Clark N, Holmes J, Thompson AJ. Eliminating hepatitis C in Australia: a novel model of hepatitis C testing and treatment for people who inject drugs at a medically supervised injecting facility. Med J Aust 2023; 218:256-261. [PMID: 36919230 DOI: 10.5694/mja2.51885] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/17/2023] [Accepted: 01/27/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE To evaluate the feasibility of testing and treating people who inject drugs at a supervised injecting facility for hepatitis C virus (HCV) infection. DESIGN Retrospective cohort study. SETTING, PARTICIPANTS People who inject drugs who attended the Melbourne supervised injecting facility, 30 June 2018 - 30 June 2020. MAIN OUTCOME MEASURES Proportion of people tested for hepatitis C; proportions of people positive for anti-HCV antibody and HCV RNA, and of eligible people prescribed direct-acting antiviral (DAA) treatment; sustained virological response twelve weeks or more after treatment completion. RESULTS Of 4649 people who attended the supervised injecting facility during 2018-20, 321 were tested for hepatitis C (7%); 279 were anti-HCV antibody-positive (87%), of whom 143 (51%) were also HCV RNA-positive. Sixty-four of 321 had previously been treated for hepatitis C (20%), 21 had clinically identified cirrhosis (7%), eight had hepatitis B infections (2%), and four had human immunodeficiency virus infections (1%). In multivariate analyses, people tested for hepatitis C were more likely than untested clients to report psychiatric illness (adjusted odds ratio [aOR], 9.65; 95% confidence interval [CI], 7.26-12.8), not have a fixed address (aOR, 1.59; 95% CI, 1.18-2.14), and to report significant alcohol use (aOR, 1.57; 95% CI, 1.06-2.32). The median number of injecting facility visits was larger for those tested for hepatitis C (101; interquartile range [IQR], 31-236) than for those not tested (20; IQR, 3-90). DAA treatment was prescribed for 126 of 143 HCV RNA-positive clients (88%); 41 of 54 with complete follow-up data were cured (76%). CONCLUSIONS People who attend supervised injecting facilities can be tested and treated for hepatitis C on site. Models that provide streamlined, convenient hepatitis C care promote engagement with treatment in a group in which the prevalence of hepatitis C is high.
Collapse
Affiliation(s)
- Michael B MacIsaac
- St Vincent's Hospital Melbourne, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| | | | | | | | | | | | | | | | | | | | | | - Timothy Papaluca
- St Vincent's Hospital Melbourne, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| | - Margaret E Hellard
- The Burnet Institute, Melbourne, VIC.,Monash University, Melbourne, VIC.,Alfred Health, Melbourne, VIC
| | - Mark Stoove
- The Burnet Institute, Melbourne, VIC.,Monash University, Melbourne, VIC
| | | | - Alisa Pedrana
- The Burnet Institute, Melbourne, VIC.,Monash University, Melbourne, VIC
| | - Joseph Doyle
- The Burnet Institute, Melbourne, VIC.,Alfred Health, Melbourne, VIC
| | - Nico Clark
- North Richmond Community Health, Melbourne, VIC.,The Royal Melbourne Hospital, Melbourne, VIC
| | - Jacinta Holmes
- St Vincent's Hospital Melbourne, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| | - Alexander J Thompson
- St Vincent's Hospital Melbourne, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| |
Collapse
|
17
|
Xiao Y, Hellard ME, Thompson AJ, Seaman C, Howell J, Scott N. The cost-effectiveness of universal hepatitis B screening for reaching WHO diagnosis targets in Australia by 2030. Med J Aust 2023; 218:168-173. [PMID: 36596568 DOI: 10.5694/mja2.51825] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 11/11/2022] [Accepted: 11/21/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To assess the impact on diagnosis targets, cost, and cost-effectiveness of universal hepatitis B screening in Australia. DESIGN Markov model simulation of disease and care cascade progression for people with chronic hepatitis B in Australia. SETTING Three scenarios were compared: 1. no change to current hepatitis B virus (HBV) testing practice; 2. universal screening strategy, with the aim of achieving the WHO diagnosis target by 2030 (90% of people with chronic hepatitis B diagnosed), based on opportunistic (general practitioner-initiated) screening for HBsAg; 3. universal screening strategy, and also ensuring that 50% of people with chronic hepatitis B are receiving appropriate clinical management by 2030. MAIN OUTCOME MEASURES Projected care cascade for people with chronic hepatitis B, cumulative number of HBV-related deaths, intervention costs, and health utility (quality-adjusted life-years [QALYs] gained during 2020-2030). An incremental cost-effectiveness ratio (ICER) threshold (v scenario 1) of $50 000 per QALY gained was applied. RESULTS Compared with scenario 1, 80 HBV-related deaths (interquartile range [IQR], 41-127 deaths) were averted during 2020-2030 in scenario 2, 315 HBV-related deaths (IQR, 211-454 deaths) in scenario 3. Scenario 2 cost $84 million (IQR, $41-106 million) more than scenario 1 during 2020-2030 (+8%), yielding an ICER of $104 921 (IQR, $49 587-107 952) per QALY gained. Scenario 3 cost $263 million (IQR, $214-316 million) more than scenario 1 during 2020-2030 (+24%), yielding an ICER of $47 341 (IQR, $32 643-58 200) per QALY gained. Scenario 3 remained cost-effective if the test positivity rate was higher than 0.35% or the additional costs per person tested did not exceed $4.02. CONCLUSIONS Universal screening for hepatitis B will be cost-effective only if the cost of testing is kept low and people receive appropriate clinical management.
Collapse
Affiliation(s)
| | - Margaret E Hellard
- The Burnet Institute, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | - Alexander J Thompson
- St Vincent's Hospital, Melbourne, VIC.,The University of Melbourne, Melbourne, VIC
| | | | - Jess Howell
- The Burnet Institute, Melbourne, VIC.,St Vincent's Hospital, Melbourne, VIC
| | - Nick Scott
- The Burnet Institute, Melbourne, VIC.,Monash University, Melbourne, VIC
| |
Collapse
|
18
|
De Gregorio M, Tiang T, Lee T, Stellingwerf ME, Singh S, Thompson AJ, D'Souza B, Ding NS. Autologous fat graft injections for the treatment of perianal fistulas in Crohn's disease: a systematic review and single-arm meta-analysis. ANZ J Surg 2023; 93:1162-1168. [PMID: 36658773 DOI: 10.1111/ans.18231] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Crohn's perianal fistulas are often refractory to standard management. Fat graft injections are hypothesised to improve fistula healing rates. We evaluated the treatment efficacy of fat graft injections for Crohn's perianal fistulas in a systematic review (PRISMA). METHODS We completed database searches of MEDLINE (Ovid), Embase, and PubMed. All studies published in English in full text or abstract, from January 2001 to August 2021, evaluating fat graft injections for Crohn's perianal fistulas were selected. Included randomized controlled trials, single-arm intervention trials, cohort studies, and case series; excluded single case reports. Primary outcome was pooled clinical healing, defined as non-draining treated fistulas, or closure, defined as closure of treated fistulas. Secondary outcomes were clinical healing, clinical closure, radiologic response, and adverse events. RESULTS Of 1258 publications identified, 891 articles were assessed for eligibility, and 107 relevant for manuscript review. Forty-nine patients received fat graft injections for Crohn's perianal fistulas across four single-arm intervention trials. Clinical healing or closure was achieved in 74% in a pooled single-arm meta-analysis (95% confidence interval: 57%, 85%), with moderate heterogeneity between studies. Clinical healing was achieved in 20% and 60% at 3 and 12 months, respectively. Clinical closure was achieved in 83% at 6 months. Variable parameters were used to define radiologic response, with success rates from 20% to 67%. Minimal adverse events were reported. CONCLUSION Fat graft injections show promise as a novel treatment for Crohn's perianal fistulas in this systematic review and meta-analysis. Assessment in controlled matched studies is warranted.
Collapse
Affiliation(s)
- Michael De Gregorio
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas Tiang
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Tanya Lee
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | | | - Siddharth Singh
- Department of Gastroenterology, University of California San Diego, San Diego, California, USA
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Basil D'Souza
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Colorectal Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Nik S Ding
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | | |
Collapse
|
19
|
Clark PJ, Valery PC, Strasser SI, Weltman M, Thompson AJ, Levy M, Leggett B, Zekry A, Rong J, Angus P, George J, Bollipo S, McGarity B, Sievert W, Macquillan G, Tse E, Nicoll A, Wade A, Chu G, Harding D, Cheng W, Farrell G, Roberts SK. Liver Disease and Poor Adherence Limit Hepatitis C Cure: A Real-World Australian Treatment Cohort. Dig Dis Sci 2023; 68:291-303. [PMID: 35552941 PMCID: PMC9883319 DOI: 10.1007/s10620-022-07483-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND AIMS In 2016, direct-acting antiviral (DAA) treatment for hepatitis C (HCV) became available through Australia's universal health care system, with the aim of HCV elimination. We report real-world effectiveness of DAA HCV treatment in Australia from a clinically well-informed cohort, enriched for cirrhosis and prior HCV treatment. METHODS 3413 patients were recruited from 26 hospital liver clinics across Australia from February 2016 to June 2020. Clinical history and sustained viral response (SVR) were obtained from medical records and data linkage to the Australian Pharmaceutical Benefits Scheme. Factors associated with SVR were assessed by multivariable logistic regression (MVR). RESULTS At recruitment, 32.2% had cirrhosis (72.9% Child Pugh class B/C), and 19.9% were treatment experienced. Of the 2,939 with data, 93.3% confirmed SVR. 137 patients received second-line therapy. Patients with cirrhosis had lower SVR rate (88.4 vs. 95.8%; p < 0.001). On MVR, failure to achieve SVR was associated with Genotype 3 (adj-OR = 0.42, 95%CI 0.29-0.61), male gender (adj-OR = 0.49, 95%CI 0.31-0.77), fair/poor adherence (adj-OR = 0.52, 95%CI 0.28-0.94), cirrhosis (adj-OR = 0.57, 95%CI 0.36-0.88), FIB-4 > 3.25 (adj-OR = 0.52, 95%CI 0.33-0.83) and MELD score ≥ 20 (adj-OR = 0.25, 95%CI 0.08-0.80). Consistent results were seen in cirrhotic sub-analysis. CONCLUSIONS Excellent SVR rates were achieved with DAAs in this real-world cohort of patients with chronic HCV infection. More advanced liver disease and clinician impression of poor adherence were associated with HCV treatment failure. Supports to improve liver fibrosis assessment skills for non-specialist DAA prescribers in the community and to optimize patient adherence are likely to enable more effective pursuit of HCV elimination in Australia.
Collapse
Affiliation(s)
- Paul J Clark
- Department of Gastroenterology, Princess Alexandra and Mater Hospitals, and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, and Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Martin Weltman
- Hepatology Services, Nepean Hospital, Penrith, NSW, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Miriam Levy
- Department of Gastroenterology and Liver, Liverpool Hospital, Sydney, NSW, Australia
| | - Barbara Leggett
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Sydney, NSW, Australia
| | - Julian Rong
- Gippsland Gastroenterology, Latrobe Regional Hospital, Traralgon, VIC, 3844, Australia
| | - Peter Angus
- Department of Gastroenterology and Hepatology, Austin Hospital, Melbourne, VIC, Australia
| | - Jacob George
- Storr Liver Unit, Westmead Hospital, Westmead, NSW, Australia
| | - Steven Bollipo
- Gastroenterology Department, John Hunter Hospital, New Lambton, NSW, Australia
| | - Bruce McGarity
- Bathurst Liver Clinic Bathurst Hospital, Bathurst, NSW, Australia
| | - William Sievert
- Gastrointestinal and Liver Unit, Monash Health, Melbourne, VIC, Australia
| | - Gerry Macquillan
- Liver Transplant Unit Sir Charles Gairdner Hospital, Nedlands Perth, WA, Australia
| | - Edmund Tse
- Department of Hepatology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Amanda Wade
- Barwon Health Liver Clinic University Hospital, Geelong, VIC, Australia
| | - Geoff Chu
- Orange Liver Clinic, Orange Hospital, Orange, NSW, Australia
| | - Damian Harding
- Department of Gastroenterology & Hepatology, Lyell McEwin Hospital, Vale, SA, Australia
| | - Wendy Cheng
- Department of Gastroenterology & Hepatology, Royal Perth Hospital, Perth, WA, Australia
| | - Geoff Farrell
- Gastroenterology & Hepatology Unit Canberra Hospital, Canberra, ACT, Australia
| | | |
Collapse
|
20
|
Thompson AJ, Alwan YM, Ramani VAC, Evans DG, Maher ER, Woodward ER. Cost-effectiveness model of renal cell carcinoma (RCC) surveillance in hereditary leiomyomatosis and renal cell carcinoma (HLRCC). J Med Genet 2023; 60:41-47. [PMID: 35121648 DOI: 10.1136/jmedgenet-2021-108215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/11/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine the cost-effectiveness of annual renal imaging surveillance (RIS) in hereditary leiomyomatosis and renal cell cancer (HLRCC). HLRCC is associated with a 21% risk to age 70 years of RCC. Presentations with advanced renal cell cancer (RCC) are associated with poor outcomes whereas RIS detects early-stage RCC; however, evidence for the cost-effectiveness of RIS is lacking. METHODS We developed a decision-analytic model to compare, at different age starting points (11 years, 18 years, 40 years, 60 years), the costs and benefits of lifetime contrast-enhanced renal MRI surveillance (CERMRIS) vs no surveillance in HLRCC. Benefits were measured in life-years gained (LYG), quality-adjusted life years (QALYs) and costs in British Pounds Sterling (GBP). Net monetary benefit (NMB) was calculated using a cost-effectiveness threshold of £20 000/QALY. One-way sensitivity and probabilistic analyses were also performed. RESULTS In the base-case 11-year age cohort, surveillance was cost-effective (Incremental_NMB=£3522 (95% CI -£2747 to £7652); Incremental_LYG=1.25 (95% CI 0.30 to 1.86); Incremental_QALYs=0.29 (95% CI 0.07 to 0.43)] at an additional mean discounted cost of £2185/patient (95% CI £430 to £4144). Surveillance was also cost-effective in other age cohorts and dominated a no surveillance strategy in the 40 year cohort [Incremental_NMB=£12 655 (95% CIs -£709 to £21 134); Incremental_LYG=1.52 (95% CI 0.30 to 2.26); Incremental_QALYs=0.58 (95% CI 0.12 to 0.87) with a cost saving of £965/patient (95% CI -£4202 to £2652). CONCLUSION Annual CERMRI in HLRCC is cost-effective across age groups modelled.
Collapse
Affiliation(s)
- Alexander J Thompson
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Yousef M Alwan
- Department of Clinical Radiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Vijay A C Ramani
- Department of Urology, The Christie NHS Foundation Trust, Manchester, UK
| | - D Gareth Evans
- Division of Evolution and Genomic Medicine, The University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emma R Woodward
- Division of Evolution and Genomic Medicine, The University of Manchester, Manchester, UK
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
21
|
Hall SAL, Burns GS, Mooney BJ, Millen R, Morris R, Vogrin S, Sundararajan V, Ratnam D, Levy MT, Lubel JS, Nicoll AJ, Strasser SI, Sievert W, Desmond PV, Ngu MC, Angus P, Sinclair M, Meredith C, Matthews G, Revill PA, Jackson K, Littlejohn M, Bowden S, Locarnini SA, Thompson AJ, Visvanathan K. Hepatitis B Virus Flares After Nucleot(s)ide Analogue Cessation Are Associated With Activation of Toll-Like Receptor Signaling Pathways. J Infect Dis 2022; 227:123-132. [PMID: 36108079 DOI: 10.1093/infdis/jiac375] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We evaluated the patterns of peripheral Toll-like receptor (TLR) signaling activity and the expression of TLRs and natural killer (NK) cell activation in a cohort of patients experiencing severe hepatitis flares after stopping nucleot(s)ide analogues (NAs) therapy. METHODS Samples were collected longitudinally from patients with chronic hepatitis B who were enrolled in a prospective study of NA discontinuation. Patients experiencing hepatitis flares were compared with patients with normal alanine aminotransferase. Peripheral blood mononuclear cells (PBMCs) were stimulated with TLR ligands and cytokine secretion in the cell culture supernatant measured. Expression of TLR2/4, NKG2D, NKp46, and triggering receptor expressed on myeloid cells 1 (TREM-1) on monocytes, NK, and NK-T cells was measured. RESULTS Seventeen patients with severe reactivation hepatitis flares were compared to 12 nonflare patients. Hepatitis flares were associated with increased activity of TLR2-8 and TLR9 signaling in PBMCs at the time of peak flare compared to baseline. Hepatitis flares were also associated with (1) upregulation of TLR2 and (2) TREM-1 receptor expression on NK. There were no differences at baseline between flare patients and nonflare patients. CONCLUSIONS Hepatitis flares off NA therapy have a significant innate inflammatory response with upregulation of TLR signaling on peripheral monocytes and TLR2 and TREM-1 expression on NK cells. This implicates the innate immune system in the immunopathogenesis of hepatitis B flares.
Collapse
Affiliation(s)
- Samuel A L Hall
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | - Gareth S Burns
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | - Benjamin J Mooney
- Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | - Rosemary Millen
- Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | - Rachel Morris
- Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | - Sara Vogrin
- Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | | | - Dilip Ratnam
- Gastroenterology and Hepatology Unit, Monash Health, Melbourne, Australia
| | - Miriam T Levy
- Gastroenterology Department of Liverpool Hospital, Sydney, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Australia.,Central Clinical School, Monash University, The Alfred Centre, Melbourne, Australia
| | - Amanda J Nicoll
- Gastroenterology Department of Eastern Health, Melbourne, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - William Sievert
- Gastroenterology and Hepatology Unit, Monash Health, Melbourne, Australia.,Department of Medicine, Monash University, Melbourne, Australia
| | - Paul V Desmond
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Meng C Ngu
- Gastroenterology Department of Concord Repatriation General Hospital, Sydney, Australia
| | - Peter Angus
- Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Marie Sinclair
- Department of Gastroenterology and Hepatology, Austin Health, Melbourne, Australia
| | | | - Gail Matthews
- Department of infectious Disease, St Vincent's Hospital Sydney, SydneyAustralia
| | - Peter A Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia
| | - Kathy Jackson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia
| | - Margaret Littlejohn
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia
| | - Scott Bowden
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia
| | - Stephen A Locarnini
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia
| | - Alexander J Thompson
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | - Kumar Visvanathan
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| |
Collapse
|
22
|
Howell J, Van H, Pham M, Sawhney R, Li F, Bhat P, Lubel J, Kemp W, Bloom S, Majumdar A, McCaughan G, Hall S, Spelman T, Doyle JS, Hellard M, Visvanathan K, Thompson AJ, Drummer HE, Anderson D. Validation of novel point-of-care test for alanine aminotransferase measurement: A pilot cohort study. Clin Liver Dis (Hoboken) 2022; 20:136-139. [PMID: 36245683 PMCID: PMC9549301 DOI: 10.1002/cld.1261] [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] [Received: 04/25/2022] [Revised: 05/15/2022] [Accepted: 05/28/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jessica Howell
- Disease EliminationBurnet InstituteMelbourneAustralia,Department of GastroenterologySt Vincent's Hospital and University of MelbourneMelbourneAustralia,School of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Huy Van
- Disease EliminationBurnet InstituteMelbourneAustralia
| | - Minh Pham
- Disease EliminationBurnet InstituteMelbourneAustralia,School of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Rohit Sawhney
- Department of GastroenterologySt Vincent's Hospital and University of MelbourneMelbourneAustralia,Department of GastroenterologyEastern HealthMelbourneAustralia,Department of MedicineMonash UniversityMelbourneAustralia
| | - Fan Li
- Disease EliminationBurnet InstituteMelbourneAustralia
| | - Purnima Bhat
- Department of GastroenterologyCanberra HospitalCanberraAustralia
| | - John Lubel
- Central Clinical SchoolMonash UniversityMelbourneAustralia
| | - William Kemp
- Central Clinical SchoolMonash UniversityMelbourneAustralia
| | - Stephen Bloom
- Department of GastroenterologyEastern HealthMelbourneAustralia,Department of MedicineMonash UniversityMelbourneAustralia
| | - Avik Majumdar
- Australian National Liver Transplant UnitRoyal Prince Alfred HospitalSydneyAustralia
| | - Geoff McCaughan
- Australian National Liver Transplant UnitRoyal Prince Alfred HospitalSydneyAustralia,Liver Injury and CancerCentenary InstituteSydneyAustralia
| | - Samuel Hall
- Department of GastroenterologySt Vincent's Hospital and University of MelbourneMelbourneAustralia
| | | | - Joseph S. Doyle
- Disease EliminationBurnet InstituteMelbourneAustralia,School of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia,Department of MedicineMonash UniversityMelbourneAustralia,Department of Infectious DiseasesThe AlfredMelbourneAustralia
| | - Margaret Hellard
- Disease EliminationBurnet InstituteMelbourneAustralia,School of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia,Department of MedicineMonash UniversityMelbourneAustralia,Department of Infectious DiseasesThe AlfredMelbourneAustralia
| | - Kumar Visvanathan
- Department of GastroenterologySt Vincent's Hospital and University of MelbourneMelbourneAustralia
| | - Alexander J. Thompson
- Department of GastroenterologySt Vincent's Hospital and University of MelbourneMelbourneAustralia
| | - Heidi E. Drummer
- Disease EliminationBurnet InstituteMelbourneAustralia,Department of Microbiology and ImmunologyUniversity of MelbourneMelbourneAustralia,Department of MicrobiologyMonash UniversityMelbourneAustralia
| | - David Anderson
- Disease EliminationBurnet InstituteMelbourneAustralia,School of Epidemiology and Preventive MedicineMonash UniversityMelbourneAustralia
| |
Collapse
|
23
|
Ding NS, Tassone D, Al Bakir I, Wu K, Thompson AJ, Connell WR, Malietzis G, Lung P, Singh S, Choi CHR, Gabe S, Jenkins JT, Hart A. Systematic Review: The Impact and Importance of Body Composition in Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:1475-1492. [PMID: 35325076 PMCID: PMC9455788 DOI: 10.1093/ecco-jcc/jjac041] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/06/2022] [Accepted: 03/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Alterations in body composition are common in inflammatory bowel disease [IBD] and have been associated with differences in patient outcomes. We sought to consolidate knowledge on the impact and importance of body composition in IBD. METHODS We performed a systematic search of MEDLINE, EMBASE and conference proceedings by combining two key research themes: inflammatory bowel disease and body composition. RESULTS Fifty-five studies were included in this review. Thirty-one focused on the impact of IBD on body composition with a total of 2279 patients with a mean age 38.4 years. Of these, 1071 [47%] were male. In total, 1470 [64.5%] patients had Crohn's disease and 809 [35.5%] had ulcerative colitis. Notably, fat mass and fat-free mass were reduced, and higher rates of sarcopaenia were observed in those with active IBD compared with those in clinical remission and healthy controls. Twenty-four additional studies focused on the impact of derangements in body composition on IBD outcomes. Alterations in body composition in IBD are associated with poorer prognoses including higher rates of surgical intervention, post-operative complications and reduced muscle strength. In addition, higher rates of early treatment failure and primary non-response are seen in patients with myopaenia. CONCLUSIONS Patients with IBD have alterations in body composition parameters in active disease and clinical remission. The impacts of body composition on disease outcome and therapy are broad and require further investigation. The augmentation of body composition parameters in the clinical setting has the potential to improve IBD outcomes in the future.
Collapse
Affiliation(s)
- Nik Sheng Ding
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, Harrow, UK
- Gastroenterology Department, St Vincent’s Hospital, Melbourne, Australia
| | - Daniel Tassone
- Gastroenterology Department, St Vincent’s Hospital, Melbourne, Australia
| | | | - Kyle Wu
- Gastroenterology Department, St Vincent’s Hospital, Melbourne, Australia
| | | | - William R Connell
- Gastroenterology Department, St Vincent’s Hospital, Melbourne, Australia
| | | | - Phillip Lung
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, Harrow, UK
| | - Siddharth Singh
- Division of Gastroenterology and Division of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | | | - Simon Gabe
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, Harrow, UK
| | - John T Jenkins
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Ailsa Hart
- Inflammatory Bowel Disease Unit, St Mark’s Hospital, Harrow, UK
| |
Collapse
|
24
|
Yang LS, Thompson AJ, Taylor ACF, Desmond PV, Holt BA. Quality of upper GI endoscopy: a prospective cohort study on impact of endoscopist education. Gastrointest Endosc 2022; 96:467-475.e1. [PMID: 35413331 DOI: 10.1016/j.gie.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 12/14/2021] [Accepted: 04/03/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Guidelines on quality of upper GI (UGI) endoscopy have been proposed by the British Society of Gastroenterology (BSG) and European Society of Gastrointestinal Endoscopy (ESGE). However, these guidelines have not been evaluated in clinical practice. We aimed to measure the impact of endoscopist education on the quality of gastroscopy based on these guidelines and the association between compliance with guidelines and the detection of clinically significant premalignant pathology such as Barrett's esophagus (BE), esophageal squamous dysplasia, gastric intestinal metaplasia (GIM), and Helicobacter pylori. METHODS Endoscopists participated in a 1-hour education session on recommended performance measures and endoscopic detection of premalignant pathologies. A controlled before and after study was performed, measuring compliance with guidelines and rates of detection of pathology in control and intervention groups. RESULTS Over 2 years, 2719 procedures were performed: 1412 in the control group and 1307 in the intervention group. The proportion of procedures complying with guidelines was higher in the intervention group. The use of biopsy sampling protocols (eg, management of precancerous conditions of the stomach, 52% vs 91%; P = .007) and standardized terminology (eg, Forrest classification, 24% vs 68%; P < .001) was significantly higher. Detection of H pylori was higher in the intervention group (5.5% vs 9.8%, P = .003). Minimum inspection time of 7 minutes was associated with detection of BE (7.4% vs 2.0%, P < .001). CONCLUSIONS A simple endoscopist education session enhanced the quality of UGI endoscopy by improving compliance with BSG and ESGE recommendations and increasing the detection of clinically significant pathology. A minimum inspection time of 7 minutes was associated with increased diagnostic yield and may be a feasible quality indicator for clinical practice.
Collapse
Affiliation(s)
- Linda S Yang
- Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew C F Taylor
- Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
| | - Paul V Desmond
- Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
| | - Bronte A Holt
- Department of Gastroenterology, St Vincent's Hospital and the University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
25
|
Basnayake C, Kamm MA, Stanley A, Wilson-O'Brien A, Burrell K, Lees-Trinca I, Khera A, Kantidakis J, Wong O, Fox K, Talley NJ, Liew D, Salzberg MR, Thompson AJ. Long-Term Outcome of Multidisciplinary Versus Standard Gastroenterologist Care for Functional Gastrointestinal Disorders: A Randomized Trial. Clin Gastroenterol Hepatol 2022; 20:2102-2111.e9. [PMID: 34896645 DOI: 10.1016/j.cgh.2021.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/28/2021] [Accepted: 12/02/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Functional gastrointestinal disorders are common and costly to the healthcare system. In the Multidisciplinary Treatment of Functional Gastrointestinal Disorders study, we demonstrated that multidisciplinary care resulted in superior clinical and cost outcomes, when compared with standard gastroenterologist-only care at end of treatment. In this study we evaluate the longer-term outcomes. METHODS In a single-center, pragmatic trial patients with Rome IV criteria-defined functional gastrointestinal disorders were randomized 1:2 to a gastroenterologist-only standard care vs a multidisciplinary clinic comprising gastroenterologists, dietitians, gut hypnotherapists, psychiatrists, and biofeedback physiotherapists. Outcomes in this study were assessed 12 months after the end of treatment. Global symptom improvement was assessed by using a 5-point Likert scale. Symptoms, specific disorder status, psychological state, quality of life, and cost were additional outcomes. A modified intention-to-treat analysis was performed. RESULTS Of 188 randomized patients, 143 (46 standard care, 97 multidisciplinary) formed the longer-term modified intention-to-treat analysis. Sixty-two percent of multidisciplinary clinic patients saw allied clinicians. Sixty-five percent (30/46) standard care versus 76% (74/97) multidisciplinary clinic patients achieved global symptom improvement 12 months after end of treatment (P = .17), whereas 20% (9/46) versus 37% (36/97) rated their symptoms as "5/5 much better" (P = .04). A ≥50-point reduction in Irritable Bowel Syndrome Severity Scoring System occurred in 38% versus 66% (P = .02), respectively, for irritable bowel syndrome patients. Anxiety and depression were greater in the standard care than multidisciplinary clinic (12 vs 10, P = .19), and quality of life was lower in standard care than the multidisciplinary clinic (0.75 vs 0.77, P =·.03). An incremental cost-effectivness ratio found that for every additional 3555AUD spent in the multidisciplinary clinic, a further quality-adjusted life year was gained. CONCLUSIONS Twelve months after the completion of treatment, integrated multidisciplinary clinical care achieved a greater proportion of patients with improvement of symptoms, psychological state, quality of life, and cost, compared with gastroenterologist-only care. CLINICAL TRIALS gov: number NCT03078634.
Collapse
Affiliation(s)
- Chamara Basnayake
- St Vincent's Hospital Melbourne, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | - Michael A Kamm
- St Vincent's Hospital Melbourne, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
| | | | | | | | | | - Angela Khera
- St Vincent's Hospital Melbourne, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| | | | - Olivia Wong
- St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Kate Fox
- St Vincent's Hospital Melbourne, Melbourne, Australia
| | | | | | | | - Alexander J Thompson
- St Vincent's Hospital Melbourne, Melbourne, Australia; University of Melbourne, Melbourne, Australia
| |
Collapse
|
26
|
Yang LS, Perry E, Shan L, Wilding H, Connell W, Thompson AJ, Taylor ACF, Desmond PV, Holt BA. Clinical application and diagnostic accuracy of artificial intelligence in colonoscopy for inflammatory bowel disease: systematic review. Endosc Int Open 2022; 10:E1004-E1013. [PMID: 35845028 PMCID: PMC9286774 DOI: 10.1055/a-1846-0642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/02/2022] [Indexed: 12/15/2022] Open
Abstract
Background and aims Artificial intelligence (AI) technology is being evaluated for its potential to improve colonoscopic assessment of inflammatory bowel disease (IBD), particularly with computer-aided image classifiers. This review evaluates the clinical application and diagnostic test accuracy (DTA) of AI algorithms in colonoscopy for IBD. Methods A systematic review was performed on studies evaluating AI in colonoscopy of adult patients with IBD. MEDLINE, Embase, Emcare, PsycINFO, CINAHL, Cochrane Library and Clinicaltrials.gov databases were searched on 28 th April 2021 for English language articles published between January 1, 2000 and April 28, 2021. Risk of bias and applicability were assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Diagnostic accuracy was presented as median (interquartile range). Results Of 1029 records screened, nine studies with 7813 patients were included for review. AI was used to predict endoscopic and histologic disease activity in ulcerative colitis, and differentiation of Crohn's disease from Behcet's disease and intestinal tuberculosis. DTA of AI algorithms ranged between 52-91 %. The sensitivity and specificity for AI algorithms predicting endoscopic severity of disease were 78 % (range 72-83, interquartile range 5.5) and 91 % (range 86-96, interquartile range 5), respectively. Conclusions AI has been primarily used to assess disease activity in ulcerative colitis. The diagnostic performance is promising and suggests potential for other clinical application of AI in IBD colonoscopy such as dysplasia detection. However, current evidence is limited by retrospective data and models trained on still images only. Future prospective multicenter studies with full-motion videos are needed to replicate the real-world clinical setting.
Collapse
Affiliation(s)
- Linda S. Yang
- Department of Gastroenterology, St. Vincent’s Hospital and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Evelyn Perry
- Department of Gastroenterology, St. Vincent’s Hospital and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Leonard Shan
- Department of Surgery, Faculty of Medicine, Dentistry and Health Sciences, the University of Melbourne, Fitzroy, Victoria, Australia
| | - Helen Wilding
- Library Service, St. Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
| | - William Connell
- Department of Gastroenterology, St. Vincent’s Hospital and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St. Vincent’s Hospital and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Andrew C. F. Taylor
- Department of Gastroenterology, St. Vincent’s Hospital and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Paul V. Desmond
- Department of Gastroenterology, St. Vincent’s Hospital and the University of Melbourne, Fitzroy, Victoria, Australia
| | - Bronte A. Holt
- Department of Gastroenterology, St. Vincent’s Hospital and the University of Melbourne, Fitzroy, Victoria, Australia
| |
Collapse
|
27
|
Hall SAL, Burns GS, Anagnostou D, Vogrin S, Sundararajan V, Ratnam D, Levy MT, Lubel JS, Nicoll AJ, Strasser SI, Sievert W, Desmond PV, Ngu MC, Angus P, Sinclair M, Meredith C, Matthews G, Revill PA, Jackson K, Littlejohn M, Bowden DS, Locarnini SA, Visvanathan K, Thompson AJ. Stopping nucleot(s)ide analogues in non-cirrhotic HBeAg-negative chronic hepatitis B patients: HBsAg loss at 96 weeks is associated with low baseline HBsAg levels. Aliment Pharmacol Ther 2022; 56:310-320. [PMID: 35521992 DOI: 10.1111/apt.16968] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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] [Received: 01/24/2022] [Revised: 03/06/2022] [Accepted: 04/28/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND AIMS Current guidelines recommend long-term nucleot(s)ide analogue (NA) therapy for patients with HBeAg-negative chronic hepatitis B (CHB). However, disease remission has been described after stopping NA therapy, as well as HBsAg loss. METHODS We performed a prospective multi-centre cohort study of stopping NA therapy. Inclusion criteria were HBeAg-negative CHB, the absence of cirrhosis and HBVDNA<lower limit of quantification for ≥18 months. We assessed virological and biochemical outcomes including HBsAg loss, as well as NA restart rates, over 96 weeks. RESULTS In total, 110 patients [62% entecavir (ETV); 28% tenofovir (TDF), 10% other] were enrolled. Median age was 56 years, 57% were male, 85% were Asian, median baseline HBsAg level was 705 (214-2325) IU/ml. Virological reactivation occurred in 109/110 patients, median time to detection was 8 (4-12) weeks, and occurred earlier after stopping TDF versus ETV (median 4 vs. 12 weeks p < 0.001). At week 96, 77 (70%) remained off-treatment, 65 (59%) had ALT <2× ULN, 31 (28%) patients were in disease remission with HBVDNA <2000 IU/ml plus ALT <2× ULN and 7 (6%) patients had lost HBsAg. Baseline HBsAg ≤10 IU/ml was associated with HBsAg loss (6/9 vs. 1/101 p < 0.001). ALT >5× ULN occurred in 35 (32%); ALT flares were not associated with HBsAg loss. There were no unexpected safety issues. CONCLUSION Virological reactivation was very common after stopping NA therapy and occurred earlier after stopping TDF versus ETV. The majority of patients had ALT <2× ULN at week 96, but only one-third achieved disease remission and HBsAg loss was rare. Very low HBsAg levels at baseline were uncommon but predicted for HBsAg loss and disease remission.
Collapse
Affiliation(s)
- Samuel A L Hall
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | - Gareth S Burns
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | - Despina Anagnostou
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Sara Vogrin
- Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | - Vijaya Sundararajan
- Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia.,The Department of Public Health, La Trobe University, Melbourne, Australia
| | - Dilip Ratnam
- Gastroenterology & Hepatology Unit, Monash Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Miriam T Levy
- Gastroenterology Department of Liverpool Hospital, Sydney, Australia
| | - John S Lubel
- Department of Gastroenterology, Alfred Health, Melbourne, Australia.,Central Clinical School, Monash University, The Alfred Centre, Melbourne, Australia
| | - Amanda J Nicoll
- Gastroenterology Department of Eastern Health, Melbourne, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia.,University of Sydney, Sydney, Australia
| | - William Sievert
- Gastroenterology & Hepatology Unit, Monash Health, Melbourne, Australia.,Monash University, Melbourne, Australia
| | - Paul V Desmond
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Meng C Ngu
- Gastroenterology Department of Concord Repatriation General Hospital, Sydney, Australia
| | - Peter Angus
- Department of Gastroenterology & Hepatology, Austin Health, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Marie Sinclair
- Department of Gastroenterology & Hepatology, Austin Health, Melbourne, Australia
| | | | - Gail Matthews
- Department of infectious Disease, St Vincent's Hospital Sydney, Sydney, Australia
| | - Peter A Revill
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia
| | - Kathy Jackson
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia
| | - Margaret Littlejohn
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia
| | - D Scott Bowden
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia
| | - Stephen A Locarnini
- Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital, The Doherty Institute, Melbourne, Australia
| | - Kumar Visvanathan
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| | - Alexander J Thompson
- Gastroenterology Department of St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Infectious Disease and Immunology Research Centre, St Vincent's Hospital, Melbourne, Australia
| |
Collapse
|
28
|
De Gregorio M, Lee T, Krishnaprasad K, Amos G, An YK, Bastian-Jordan M, Begun J, Borok N, Brown DJM, Cheung W, Connor SJ, Gerstenmaier J, Gilbert LE, Gilmore R, Gu B, Kutaiba N, Lee A, Mahy G, Srinivasan A, Thin L, Thompson AJ, Welman CJ, Yong EXZ, De Cruz P, van Langenberg D, Sparrow MP, Ding NS. Higher Anti-tumor Necrosis Factor-α Levels Correlate With Improved Radiologic Outcomes in Crohn's Perianal Fistulas. Clin Gastroenterol Hepatol 2022; 20:1306-1314. [PMID: 34389484 DOI: 10.1016/j.cgh.2021.07.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/08/2021] [Accepted: 07/28/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Higher anti-tumor necrosis factor-α (TNF) drug levels are associated with improved clinical healing of Crohn's perianal fistulas. It is unclear whether this leads to improved healing on radiologic assessment. We aimed to evaluate the association between anti-TNF drug levels and radiologic outcomes in perianal fistulising Crohn's disease. METHODS A cross-sectional retrospective multicenter study was undertaken. Patients with perianal fistulising Crohn's disease on maintenance infliximab or adalimumab, with drug levels within 6 months of perianal magnetic resonance imaging were included. Patients receiving dose changes or fistula surgery between drug level and imaging were excluded. Radiologic disease activity was scored using the Van Assche Index, with an inflammatory subscore calculated using indices: T2-weighted imaging hyperintensity, collections >3 mm diameter, rectal wall involvement. Primary endpoint was radiologic healing (inflammatory subscore ≤6). Secondary endpoint was radiologic remission (inflammatory subscore = 0). RESULTS Of 193 patients (infliximab, n = 117; adalimumab, n = 76), patients with radiologic healing had higher median drug levels compared with those with active disease (infliximab 6.0 vs 3.9 μg/mL; adalimumab 9.1 vs 6.2 μg/mL; both P < .05). Patients with radiologic remission also had higher median drug levels compared with those with active disease (infliximab 7.4 vs 3.9 μg/mL; P < .05; adalimumab 9.8 vs 6.2 μg/mL; P = .07). There was a significant incremental reduction in median inflammatory subscores with higher anti-TNF drug level tertiles. CONCLUSIONS Higher anti-TNF drug levels were associated with improved radiologic outcomes on magnetic resonance imaging in perianal fistulising Crohn's disease, with an incremental improvement at higher drug level tertiles for both infliximab and adalimumab.
Collapse
Affiliation(s)
- Michael De Gregorio
- St Vincent's Hospital Melbourne, Department of Gastroenterology, Fitzroy, Australia; University of Melbourne, Medicine, Parkville, Australia.
| | - Tanya Lee
- St Vincent's Hospital Melbourne, Department of Gastroenterology, Fitzroy, Australia
| | - Krupa Krishnaprasad
- St Vincent's Hospital Melbourne, Department of Gastroenterology, Fitzroy, Australia; QIMR Berghofer Medical Research Institute, Gut Health Lab, Brisbane, Australia
| | - Gregory Amos
- University of Queensland, Medicine, St Lucia, Australia; Queensland X-ray, Medical Imaging, Brisbane, Australia
| | - Yoon-Kyo An
- University of Queensland, Medicine, St Lucia, Australia; Mater Hospital Brisbane, Gastroenterology, South Brisbane, Australia
| | - Matthew Bastian-Jordan
- University of Queensland, Medicine, St Lucia, Australia; Queensland X-ray, Medical Imaging, Brisbane, Australia
| | - Jakob Begun
- Mater Hospital Brisbane, Gastroenterology, South Brisbane, Australia; University of Queensland, Mater Research Institute, St Lucia, Australia
| | - Nira Borok
- Liverpool Hospital, Medical Imaging, Liverpool, Australia; South Western Sydney Local Health District, Medicine, Liverpool, Australia
| | - Dougal J M Brown
- Townsville University Hospital, Medical Imaging, Douglas, Australia
| | - Wa Cheung
- Alfred Health, Medical Imaging, Melbourne, Australia
| | - Susan J Connor
- Liverpool Hospital, Gastroenterology and Hepatology, Liverpool, Australia; Ingham Institute for Applied Medical Research, Medicine, Liverpool, Australia; University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
| | | | | | | | - Bonita Gu
- Liverpool Hospital, Gastroenterology and Hepatology, Liverpool, Australia; University of New South Wales, South Western Sydney Clinical School, Sydney, Australia; Royal Prince Alfred Hospital, Gastroenterology and Hepatology, Camperdown, Australia
| | - Numan Kutaiba
- Austin Health, Radiology, Heidelberg, Australia; Eastern Health, Radiology, Box Hill, Australia
| | - Allan Lee
- Imaging Associates Eastern Health, Medical Imaging, Melbourne, Australia; Peter MacCallum Cancer Centre, Cancer Imaging, Melbourne, Australia
| | - Gillian Mahy
- Townsville University Hospital, Gastroenterology, Douglas, Australia
| | - Ashish Srinivasan
- Austin Health, Gastroenterology, Heidelberg, Australia; Eastern Health, Gastroenterology, Box Hill, Australia; Monash University, Medicine, Clayton, Australia
| | - Lena Thin
- Fiona Stanley Hospital, Gastroenterology, Murdoch, Australia; University of Western Australia, School of Medicine and Pharmacology, Crawley, Australia
| | - Alexander J Thompson
- St Vincent's Hospital Melbourne, Department of Gastroenterology, Fitzroy, Australia; University of Melbourne, Medicine, Parkville, Australia
| | | | - Eric X Z Yong
- St Vincent's Hospital Melbourne, Medical Imaging, Fitzroy, Australia
| | - Peter De Cruz
- University of Melbourne, Medicine, Parkville, Australia; Austin Health, Gastroenterology, Heidelberg, Australia
| | - Daniel van Langenberg
- Eastern Health, Gastroenterology, Box Hill, Australia; Monash University, Medicine, Clayton, Australia
| | - Miles P Sparrow
- Alfred Health, Gastroenterology, Melbourne, Australia; Monash University, Medicine, Clayton, Australia
| | - Nik S Ding
- St Vincent's Hospital Melbourne, Department of Gastroenterology, Fitzroy, Australia; University of Melbourne, Medicine, Parkville, Australia
| |
Collapse
|
29
|
Flores JE, Thompson AJ, Ryan M, Howell J. The Global Impact of Hepatitis B Vaccination on Hepatocellular Carcinoma. Vaccines (Basel) 2022; 10:vaccines10050793. [PMID: 35632549 PMCID: PMC9144632 DOI: 10.3390/vaccines10050793] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 12/17/2022] Open
Abstract
Over 1.5 million preventable new hepatitis B infections continue to occur each year and there are an estimated 296 million people living with chronic hepatitis B infection worldwide, resulting in more than 820,000 deaths annually due to liver cirrhosis and hepatocellular carcinoma (HCC). Hepatitis B vaccination remains the cornerstone of public health policy to prevent HCC and a vital component of the global hepatitis B elimination response. The WHO has set a 90% vaccination target to achieve hepatitis B elimination by 2030; however, there is wide variability in reported birth dose coverage, with global coverage at only 42%. In this review, we outline the global trends in hepatitis B vaccination coverage and the impact of hepatitis B vaccination on HCC incidence and discuss the challenges and enabling factors for achieving WHO 2030 hepatitis B vaccination coverage targets.
Collapse
Affiliation(s)
- Joan Ericka Flores
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (A.J.T.); (M.R.); (J.H.)
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- Correspondence:
| | - Alexander J. Thompson
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (A.J.T.); (M.R.); (J.H.)
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Marno Ryan
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (A.J.T.); (M.R.); (J.H.)
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, VIC 3004, Australia
| | - Jessica Howell
- Department of Gastroenterology, St. Vincent’s Hospital Melbourne, Fitzroy, VIC 3065, Australia; (A.J.T.); (M.R.); (J.H.)
- Department of Medicine, University of Melbourne, Parkville, VIC 3010, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, VIC 3004, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Clayton, VIC 3800, Australia
| |
Collapse
|
30
|
Lubel JS, Strasser SI, Thompson AJ, Cowie BC, MacLachlan J, Allard NL, Holmes J, Kemp WW, Majumdar A, Iser D, Howell J, Matthews GV. Australian consensus recommendations for the management of hepatitis B. Med J Aust 2022; 216:478-486. [PMID: 35249220 DOI: 10.5694/mja2.51430] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The prevalence of hepatitis B virus (HBV) infection in Australia is nearly 1%. In certain well defined groups the prevalence is far greater, yet an estimated 27% of people living with HBV infection remain undiagnosed. Appropriate screening improves detection, increases opportunity for treatment, and ultimately reduces the significant morbidity and mortality associated with the development of liver fibrosis and hepatocellular carcinoma (HCC). MAIN RECOMMENDATIONS This statement highlights important aspects of HBV infection management in Australia. There have been recent changes in nomenclature and understanding of natural history, as well as a newly defined upper limit of normal for liver tests that determine phase classification and threshold for antiviral treatment. As the main burden of hepatitis B in Australia is within migrant and Indigenous communities, early identification and management of people living with hepatitis B is essential to prevent adverse outcomes including liver cancer and cirrhosis. CHANGE IN MANAGEMENT AS A RESULT OF THIS GUIDELINE These recommendations aim to raise awareness of the current management of hepatitis B in Australia. Critically, the timely identification of individuals living with hepatitis B, and where appropriate, commencement of antiviral therapy, can prevent the development of cirrhosis, HCC and mother-to-child transmission as well as hepatitis B reactivation in immunocompromised individuals. Recognising patient and viral factors that predispose to the development of cirrhosis and HCC will enable clinicians to risk-stratify and appropriately implement surveillance strategies to prevent these complications of hepatitis B.
Collapse
Affiliation(s)
- John S Lubel
- Alfred Health, Melbourne, VIC
- Monash University, Melbourne, VIC
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Alexander J Thompson
- St Vincent's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - Benjamin C Cowie
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
- Royal Melbourne Hospital, Melbourne, VIC
| | - Jennifer MacLachlan
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
| | - Nicole L Allard
- University of Melbourne, Melbourne, VIC
- WHO Collaborating Centre for Viral Hepatitis, Peter Doherty Institute for Infection and Immunity, Melbourne, VIC
| | - Jacinta Holmes
- St Vincent's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | | | - Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW
| | - David Iser
- St Vincent's Hospital Melbourne, Melbourne, VIC
| | - Jess Howell
- Monash University, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
- Burnet Institute, Melbourne, VIC
| | - Gail V Matthews
- Kirby Institute, University of New South Wales, Sydney, NSW
- St Vincent's Hospital Sydney, Sydney, NSW
| |
Collapse
|
31
|
Yang LS, Hartley I, Thompson AJ, Desmond P, Taylor ACF, Moss A, Holt BA. Evaluation of Endoscopic Practices and Outcomes in Follow-up of Gastric Ulcers. J Clin Gastroenterol 2022; 56:412-418. [PMID: 34334762 DOI: 10.1097/mcg.0000000000001595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/17/2021] [Indexed: 12/10/2022]
Abstract
GOAL The aim of this study was to evaluate current practice in gastric ulcer follow-up to establish diagnostic yield and predictors of malignancy. BACKGROUND Repeat gastroscopy is routinely performed to confirm gastric ulcer healing and exclude malignancy. However, the incidence of malignancy at follow-up endoscopy is low, without consensus regarding case selection and timing. STUDY New gastric ulcers diagnosed on gastroscopy at 2 institutions in Australia were identified through keyword search of endoscopy reports over a 5-year period (2013 to 2017). Data collected included patient demographics, clinical presentation, and endoscopic and histologic findings from initial and subsequent gastroscopies. RESULTS Of 795 patients, repeat gastroscopy was performed in 440 (55%). Malignancy was diagnosed in 52 (7%) with 83% identified at initial gastroscopy. Eight cancers were identified at repeat gastroscopy with malignancy yield of 2% (8/440). Three were diagnosed in patients with benign initial ulcer histology (3/286, 1%). One cancer was diagnosed during follow-up in a patient with benign histology but no repeat gastroscopy (1/286, 0.3%). Predictors of benign ulcers were absence of endoscopic suspicion [odds ratio (OR) 0.1 (0.03-0.13), P≤0.005], complete healing on repeat gastroscopy [OR 0.5 (0.34-0.70), P=0.036] and benign initial histology [OR 0.12 (0.43-0.90), P≤0.005]. CONCLUSIONS Seven percent of new gastric ulcers were malignant with most identified with biopsy on initial gastroscopy. Malignancy yield from follow-up gastroscopy was 2%. Diagnostic yield of endoscopic follow-up may be low in ulcers with benign appearance and adequate histology. However, current practice of repeat gastroscopy is warranted in the absence of patient-based and lesion-based predictors of malignancy.
Collapse
Affiliation(s)
- Linda S Yang
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy
- The University of Melbourne, Parkville, Vic., Australia
| | - Imogen Hartley
- Department of Gastroenterology, Western Health, Footscray
- The University of Melbourne, Parkville, Vic., Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy
- The University of Melbourne, Parkville, Vic., Australia
| | - Paul Desmond
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy
- The University of Melbourne, Parkville, Vic., Australia
| | - Andrew C F Taylor
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy
- The University of Melbourne, Parkville, Vic., Australia
| | - Alan Moss
- Department of Gastroenterology, Western Health, Footscray
- The University of Melbourne, Parkville, Vic., Australia
| | - Bronte A Holt
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy
- The University of Melbourne, Parkville, Vic., Australia
| |
Collapse
|
32
|
Howell J, Traeger MW, Williams B, Layton C, Doyle JS, Latham N, Draper B, Bramwell F, Membrey D, McPherson M, Roney J, Stoové M, Thompson AJ, Hellard ME, Pedrana A. The impact of point-of-care hepatitis C testing in needle and syringe exchange programs on linkage to care and treatment uptake among people who inject drugs: An Australian pilot study. J Viral Hepat 2022; 29:375-384. [PMID: 35274403 DOI: 10.1111/jvh.13664] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/20/2022] [Indexed: 12/13/2022]
Abstract
Point-of-care (POC) diagnostics overcome barriers to conventional hepatitis C (HCV) testing in people who inject drugs. This study assessed impact on hepatitis C treatment uptake of POC HCV testing in needle and syringe exchange programs (NSPs). Rapid EC was a single-arm interventional pilot study of HCV POC testing conducted in three inner-city community clinics with NSPs. Twelve months after the POC testing, a retrospective medical record and Pharmaceutical Benefits Scheme audit was performed to determine the number of HCV RNA-positive participants who were prescribed HCV treatment. 70 HCV RNA-positive Rapid EC study participants were included. 44 (63%) were prescribed DAAs; 26 (59%) completed treatment and 15 (34%) had SVR testing, all of whom were cured. Age ≥ 40 years (aOR 3.45, 95% CI 1.10-11.05, p = .03) and secondary school education (aOR 5.8, 95% CI 1.54-21.80, p = .009) had higher likelihood of being prescribed DAAs, whereas homelessness was inversely associated with prescription of DAAs (aOR 0.30, 95% CI 0.09-1.04, p = .057). Median time to receive a DAA script from date of diagnosis was seven days (IQR 0 to 14 days), and time to filling the DAA prescription was 2 days (IQR 0-12 days). In conclusion, provision of POC testing through NSPs was effective for linking new clients to HCV treatment and reduced the time to treatment. Further studies are needed to define the most cost-effective use of POC testing in models of care for people who inject drugs to increase HCV treatment uptake.
Collapse
Affiliation(s)
- Jessica Howell
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael W Traeger
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bridget Williams
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Chloe Layton
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, Australia
| | - Ned Latham
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Bridget Draper
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Dean Membrey
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Maggie McPherson
- North Richmond Community Health, General Practice, Melbourne, Victoria, Australia
| | - Janine Roney
- Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia
| | - Mark Stoové
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Cohealth, General Practice, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The Alfred, Melbourne, Victoria, Australia.,Doherty Institute and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute, Melbourne, Victoria, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
33
|
Thompson AJ, Zhu J, Poulsen CJ, Tierney JE, Skinner CB. Northern Hemisphere vegetation change drives a Holocene thermal maximum. Sci Adv 2022; 8:eabj6535. [PMID: 35427164 PMCID: PMC9012463 DOI: 10.1126/sciadv.abj6535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/24/2022] [Indexed: 06/14/2023]
Abstract
The Holocene thermal maximum, a period of global warmth evident in early to mid-Holocene proxy reconstructions, is controversial. Most model simulations of the Holocene have not reproduced this warming, leading to a disagreement known as the Holocene Temperature Conundrum. Pollen records document the expansion of vegetation in the early and mid-Holocene African Sahara and Northern Hemisphere mid- and high latitudes, which has been overlooked in previous modeling studies. Here, we use time slice simulations of the Community Earth System Model to assess the impact of Northern Hemisphere vegetation change on Holocene annual mean temperatures. Our simulations indicate that expansion of Northern Hemisphere vegetation 9000 and 6000 years ago warms Earth's surface by ~0.8° and 0.7°C, respectively, producing a better match with proxy-based reconstructions. Our results suggest that vegetation change is critical for modeling Holocene temperature evolution and highlight its role in driving a mid-Holocene temperature maximum.
Collapse
Affiliation(s)
- Alexander J. Thompson
- Department of Earth and Environmental Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jiang Zhu
- Climate and Global Dynamic Laboratory, National Center for Atmospheric Research, Boulder, CO 80305, USA
| | - Christopher J. Poulsen
- Department of Earth and Environmental Sciences, University of Michigan, Ann Arbor, MI 48109, USA
| | - Jessica E. Tierney
- Department of Geosciences, The University of Arizona, Tucson, AZ 85721, USA
| | - Christopher B. Skinner
- Department of Environmental, Earth and Atmospheric Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA
| |
Collapse
|
34
|
Farrell AM, Magliano DJ, Shaw JE, Thompson AJ, Croagh C, Ryan MC, Howell J. A problem of proportions: estimates of metabolic associated fatty liver disease and liver fibrosis in Australian adults in the nationwide 2012 AusDiab Study. Sci Rep 2022; 12:1956. [PMID: 35121749 PMCID: PMC8817026 DOI: 10.1038/s41598-022-05168-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Metabolic Associated Fatty Liver Disease (MAFLD) is the most common cause of liver disease in Australia, but prevalence data are limited. We aimed to describe the frequency of alanine aminotransferase (ALT) elevation, and MAFLD within a large prospective Australian cohort. Cross-sectional analysis of the 2012 survey of the Australian Diabetes, Obesity and Lifestyle (AusDiab) study which included 4747 Australian adults (aged 34–97 yrs) was performed. Frequency of ALT elevation (men ≥ 40 IU/L, women ≥ 30 IU/L) and MAFLD (Fatty Liver Index (FLI) > 60 alongside metabolic risk factors) was determined and risk of advanced fibrosis stratified using the BARD score. Elevated ALT was found in 13% of the cohort, including 22% of people with diabetes, 18% with obesity, and 17% with the metabolic syndrome. 37% of the cohort had MAFLD, and those with MAFLD were more likely to be older (OR 1.01 per 1 year (95% CI 1.00–1.02)), male (OR 1.37 (95% CI 1.17–1.59)), have ALT elevation (OR 3.21 (95% CI 2.59–3.99)), diabetes (OR 3.39 (95% CI 2.61–4.39)), lower HDL-C (OR 0.15 per 1 mmol/L (95% CI 0.12–0.19)), higher diastolic blood pressure (OR 1.05 per 10 mmHg (95% CI 1.05–1.06)), a sedentary lifestyle (OR 1.99 (95% CI 1.59–2.50)) and less likely to have tertiary education (OR 0.81 (95% CI 0.7–0.94) compared to those without MAFLD. Of those with MAFLD, 61% had a BARD score suggesting risk of advanced fibrosis and 22% had an elevated ALT. Over 10% of this Australian cohort had elevated ALT, and 37% had MAFLD, with many at risk for advanced fibrosis.
Collapse
Affiliation(s)
- Ann M Farrell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, 41 Victoria Pde, Melbourne, 3065, Australia. .,University of Melbourne, Melbourne, Australia.
| | | | | | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital Melbourne, 41 Victoria Pde, Melbourne, 3065, Australia.,University of Melbourne, Melbourne, Australia
| | - Catherine Croagh
- Department of Gastroenterology, St Vincent's Hospital Melbourne, 41 Victoria Pde, Melbourne, 3065, Australia.,University of Melbourne, Melbourne, Australia
| | - Marno C Ryan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, 41 Victoria Pde, Melbourne, 3065, Australia.,University of Melbourne, Melbourne, Australia
| | - Jessica Howell
- Department of Gastroenterology, St Vincent's Hospital Melbourne, 41 Victoria Pde, Melbourne, 3065, Australia.,University of Melbourne, Melbourne, Australia.,Disease Elimination, Burnett Institute, Melbourne, Australia.,Department of epidemiology and preventive medicine, Monash university, Clayton, 3168, Australia
| |
Collapse
|
35
|
Draper B, Yee WL, Pedrana A, Kyi KP, Qureshi H, Htay H, Naing W, Thompson AJ, Hellard M, Howell J. Reducing liver disease-related deaths in the Asia-Pacific: the important role of decentralised and non-specialist led hepatitis C treatment for cirrhotic patients. Lancet Reg Health West Pac 2022; 20:100359. [PMID: 35024676 PMCID: PMC8733182 DOI: 10.1016/j.lanwpc.2021.100359] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Bridget Draper
- Disease Elimination Program, Burnet Institute Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University Melbourne, Australia
| | | | - Alisa Pedrana
- Disease Elimination Program, Burnet Institute Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University Melbourne, Australia.,Health Services Research and Implementation, Monash Partners, Melbourne, Australia
| | | | - Huma Qureshi
- Gastroenterologist, Doctors Plaza, Clifton, Karachi, Pakistan
| | - Hla Htay
- Burnet Institute Yangon, Myanmar
| | - Win Naing
- Myanmar Liver Foundation.,Yangon Specialty Hospital, Myanmar
| | - Alexander J Thompson
- St Vincent's Hospital Melbourne, Australia.,Department of Medicine, University of Melbourne, Australia
| | - Margaret Hellard
- Disease Elimination Program, Burnet Institute Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University Melbourne, Australia.,Hepatitis Services, Department of Infectious Diseases Alfred Hospital Melbourne Australia.,Doherty Institute, Melbourne, Australia.,School of Population and Global Health, University of Melbourne, Australia
| | - Jessica Howell
- Disease Elimination Program, Burnet Institute Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University Melbourne, Australia.,St Vincent's Hospital Melbourne, Australia.,Department of Medicine, University of Melbourne, Australia
| |
Collapse
|
36
|
Xu H, Locarnini S, Wong D, Hammond R, Colledge D, Soppe S, Huynh T, Shaw T, Thompson AJ, Revill PA, Hogarth PM, Wines BD, Walsh R, Warner N. Role of anti-HBs in functional cure of HBeAg+ chronic hepatitis B patients infected with HBV genotype A. J Hepatol 2022; 76:34-45. [PMID: 34371070 DOI: 10.1016/j.jhep.2021.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND & AIMS HBsAg-specific antibody responses are difficult to detect during chronic hepatitis B infection (CHB) and are often overlooked. The aim of this study was to examine whether anti-HBs may be involved in functional cure (FC) by profiling anti-HBs responses in patients with CHB using a panel of specific assays. METHODS Longitudinal serum samples were obtained from 25 patients with CHB who were infected with HBV genotype A and were undergoing nucleos(t)ide analogue (NA) treatment: 14 achieved FC while 11 remained infected (non-FC). Anti-HBs immune complexes (HBsAg-IC), FcγRIIIa dimer binding, epitope specificity and neutralisation efficacy were measured. RESULTS HBsAg-IC peaks were detected prior to HBsAg loss in 10/14 FC patients. These HBsAg-IC peaks overlapped with either an alanine aminotransferase (ALT) flare (8/10 patients), or a rise in ALT (2/10 patients). HBsAg-IC peaks were detected in 7/11 non-FC patients, but were not associated with an ALT flare. FCγRIIIa binding was detected in 9/14 FC patients, independent from detection of overlapping HBsAg-IC/ALT peaks. FC patients had stable HBsAg epitope occupancy across the study, whereas non-FC patients had a reduction in HBsAg epitope occupancy within the first 12-24 weeks of NA treatment. Convalescent sera from FC patients recognised more HBsAg epitopes and neutralised HBV infection more potently than anti-HBs derived from vaccinees. Neutralisation potency appeared to increase post-HBsAg loss in 4/5 FC patients examined. CONCLUSIONS Using these assays, we confirm that anti-HBs responses are present and fluctuate over time in this cohort of patients with HBeAg+ CHB, who were infected with HBV genotype A and treated with NAs. Key anti-HBs profiles associated with either FC or failure to achieve FC were also identified, suggesting a role for anti-HBs responses in FC. LAY SUMMARY Using a panel of assays to characterise hepatitis B surface antibody (anti-HBs) responses in a group of patients with chronic hepatitis B, we identified anti-HBs profiles associated with either functional cure, or failure to achieve functional cure. Functional cure was associated with immune complex peaks which overlapped with alanine aminotransferase flares. Conversely, in those who did not achieve functional cure, immune complex peaks were present, but were not associated with alanine aminotransferase flares, and a decline in anti-HBs diversity was observed early during treatment.
Collapse
Affiliation(s)
- Hui Xu
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Stephen Locarnini
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Darren Wong
- Department of Gastroenterology, Royal Melbourne Hospital, Victoria, Australia
| | - Rachel Hammond
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Danni Colledge
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Sally Soppe
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Victoria, Australia; WHO Collaborating Centre for Reference and Research on Influenza, The Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Thao Huynh
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Tim Shaw
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | | | - Peter A Revill
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - P Mark Hogarth
- Immune Therapies Group, Burnet Institute, Victoria, Australia; Department of Clinical Pathology, University of Melbourne, Victoria, Australia; Department of Immunology and Pathology, Monash University, Victoria, Australia
| | - Bruce D Wines
- Immune Therapies Group, Burnet Institute, Victoria, Australia; Department of Clinical Pathology, University of Melbourne, Victoria, Australia; Department of Immunology and Pathology, Monash University, Victoria, Australia
| | - Renae Walsh
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Victoria, Australia; ClearB Therapeutics, Boston, MA, USA
| | - Nadia Warner
- Research and Molecular Development, Victorian Infectious Diseases Reference Laboratory, Royal Melbourne Hospital at The Peter Doherty Institute for Infection and Immunity, Victoria, Australia.
| |
Collapse
|
37
|
Flanagan E, Wright EK, Sparrow MP, Moore GT, Connell WR, De Cruz P, Christensen B, Shelton E, Kamm MA, Ward MG, Dowling D, Brown S, Kashkooli S, Thompson AJ, Ross AL, Kiburg KV, Bell SJ. A Single Educational Intervention Improves Pregnancy-Related Knowledge and Emotional Health Among Women With IBD Who Are Pregnant or Wish to Conceive. Inflamm Bowel Dis 2021; 27:1909-1918. [PMID: 33704467 DOI: 10.1093/ibd/izab021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is considerable interest in improving the education and care of women with inflammatory bowel disease (IBD) to improve pregnancy outcomes. Despite increased awareness, not all women with IBD have access to pregnancy-related education and the quality of counseling is variable. We aimed to assess the effectiveness of a simple educational intervention for improving pregnancy-related knowledge and to evaluate the effect of education on patient outcomes including anxiety, depression, and quality of life in women with IBD. METHODS This prospective study of women with IBD who were pregnant or planning a pregnancy evaluated the effectiveness of a single gastroenterologist-led educational intervention in improving pregnancy-related knowledge, measured using the Crohn's and Colitis Pregnancy Knowledge score 1 month postintervention. Secondary outcomes included the effect on anxiety and depression, quality of life, medication adherence, and patient satisfaction. RESULTS One hundred women with IBD were recruited. Fifty percent were pregnant at the time of the intervention. Baseline knowledge scores were similar independent of the patients' pregnancy status or whether they had previously received counseling from their gastroenterologist. Median Crohn's and Colitis Pregnancy Knowledge scores postintervention (n = 82) were higher than preintervention scores (14/17 vs 10/17; P < 0.001). In addition, 32% of patients had poor knowledge at baseline (score ≤7/17), compared to only 5% after the intervention (P < 0.001). There was a significant improvement in total anxiety and depression and quality of life scores postintervention. Medication adherence and patient satisfaction were excellent. CONCLUSIONS Uptake of this gastroenterologist-led educational intervention has the potential to improve pregnancy knowledge, promote medication adherence, and enhance quality of life for women with IBD globally.
Collapse
Affiliation(s)
- Emma Flanagan
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Emily K Wright
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Miles P Sparrow
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia.,Department of Gastroenterology, Monash University, Melbourne, Australia
| | - Gregory T Moore
- Department of Gastroenterology, Monash University, Melbourne, Australia.,Department of Gastroenterology, Monash Health, Melbourne, Australia
| | - William R Connell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
| | - Peter De Cruz
- Department of Medicine, University of Melbourne, Melbourne, Australia.,Department of Gastroenterology, Austin Health, Melbourne, Australia
| | - Britt Christensen
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Edward Shelton
- Department of Gastroenterology, Monash Health, Melbourne, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Mark G Ward
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia.,Department of Gastroenterology, Monash University, Melbourne, Australia
| | - Damian Dowling
- Department of Gastroenterology, Barwon Health, Geelong, Australia
| | - Steven Brown
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
| | | | - Alexander J Thompson
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Alyson L Ross
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
| | - Katerina V Kiburg
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Sally J Bell
- Department of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia.,Department of Gastroenterology, Monash Health, Melbourne, Australia
| |
Collapse
|
38
|
Xiao Y, Wallace J, Ahad M, van Gemert C, Thompson AJ, Doyle J, Lam HY, Chan K, Bennett G, Adamson E, Yussf N, Tang A, Pedrana A, Stoove M, Hellard M, Howell J. Assessing the feasibility, acceptability and impacts of an education program on hepatitis B testing uptake among ethnic Chinese in Australia: results of a randomised controlled pilot study. BMC Public Health 2021; 21:1861. [PMID: 34654385 PMCID: PMC8518279 DOI: 10.1186/s12889-021-11916-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 10/01/2021] [Indexed: 01/07/2023] Open
Abstract
Background In Australia, Chinese migrants are among the populations most affected by hepatitis B virus (HBV) infection but often experience late diagnosis or access to clinical care. This study aims to explore approaches to increase HBV testing in Australia’s Chinese community and inform evaluation planning, specifically to i) assess the feasibility and acceptability of HBV educational programs, and ii) compare HBV testing uptake in people receiving a tailored education resource focussing on liver cancer prevention compared with a standard HBV education package. Methods This is a pre-post mixed-methods pilot and feasibility study. People of Chinese ethnicity and unsure of their HBV infection or immunity status were recruited from ten community sites in Melbourne, Australia in 2019–2020. Participants were randomised to receive an education package (comprised of a leaflet and in-person one-on-one educational session) with a focus on either 1) standard HBV-related information, or 2) liver cancer prevention. Participants completed a baseline questionnaire prior to receiving the intervention and were followed up at 6 months’ time for a questionnaire and an opt-in semi-structured interview. Primary study outcomes included feasibility of study procedures, measured by recruitment, participation, and retention rates; acceptability of the education program assessed by acceptability scores; and HBV testing uptake rate in each arm. Secondary outcomes include HBV-related knowledge change, assessed by pre-post comparison; and factors affecting participants’ testing behaviour analysed using qualitative data. Results Fifty-four participants received an education package; baseline and follow-up data from 33 (61%) were available. The study procedures of recruitment and retention were feasible; the acceptability of the education program was moderate with improved HBV-related knowledge observed. Four participants self-reported being tested: one (1/15, 7%) in the standard HBV information group and three (3/18, 17%) in the liver cancer prevention information group. Factors identified as affecting testing included perceived relevance and seriousness of HBV, healthcare access and costs of testing, and perceptions of the role of primary care providers in HBV-related care. Conclusion A tailored education program targeting ethnic Chinese in Australia was feasible with moderate acceptability. A larger study is required to determine if a liver cancer prevention message would improve HBV testing uptake in Chinese community than standard HBV education message. Supports from healthcare providers, community-based testing programs, and public health education programs are likely needed to motivate diagnostic testing among Chinese people at risk of HBV infection. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11916-0.
Collapse
Affiliation(s)
- Yinzong Xiao
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia.,University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,La Trobe University, Bundoora, Victoria, 3086, Australia.,Centre for Social Research in Health, UNSW Australia, Kensington, New South Wales, 2052, Australia
| | - Marvad Ahad
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia
| | - Caroline van Gemert
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia.,University of Melbourne, Parkville, Victoria, 3010, Australia
| | - Joseph Doyle
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, 3004, Australia
| | - Ho Yin Lam
- Burnet Institute, Melbourne, Victoria, 3004, Australia
| | - Kico Chan
- Burnet Institute, Melbourne, Victoria, 3004, Australia
| | - Gabrielle Bennett
- Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia
| | - Emily Adamson
- Burnet Institute, Melbourne, Victoria, 3004, Australia.,Cancer Council Victoria, Melbourne, Victoria, 3004, Australia
| | - Nafisa Yussf
- Cancer Council Victoria, Melbourne, Victoria, 3004, Australia.,The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia
| | - Aurora Tang
- Hepatitis Victoria, North Melbourne, Victoria, 3051, Australia
| | - Alisa Pedrana
- Burnet Institute, Melbourne, Victoria, 3004, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Victoria, 3004, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Victoria, 3004, Australia. .,University of Melbourne, Parkville, Victoria, 3010, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia. .,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Victoria, 3004, Australia. .,The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, 3000, Australia.
| | - Jessica Howell
- Burnet Institute, Melbourne, Victoria, 3004, Australia. .,Department of Gastroenterology, St Vincent's Hospital, Fitzroy, Victoria, 3065, Australia. .,University of Melbourne, Parkville, Victoria, 3010, Australia. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia.
| |
Collapse
|
39
|
He T, MacIsaac MB, Hume SJ, Thompson AJ, Schulberg JD. COVID-19 and its impact on endoscopy services: what is the threshold for missed malignant diagnosis? Gut 2021; 70:1414-1415. [PMID: 32847844 DOI: 10.1136/gutjnl-2020-322769] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Tony He
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Michael B MacIsaac
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Simon J Hume
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Julien D Schulberg
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia .,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
40
|
Livingstone S, Morales DR, Donnan PT, Payne K, Thompson AJ, Youn JH, Guthrie B. Effect of competing mortality risks on predictive performance of the QRISK3 cardiovascular risk prediction tool in older people and those with comorbidity: external validation population cohort study. Lancet Healthy Longev 2021; 2:e352-e361. [PMID: 34100008 PMCID: PMC8175241 DOI: 10.1016/s2666-7568(21)00088-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Primary prevention of cardiovascular disease (CVD) is guided by risk-prediction tools, but these rarely account for the risk of dying from other conditions (ie, competing mortality risk). In England and Wales, the recommended risk-prediction tool is QRISK2, and a new version (QRISK3) has been derived and internally validated. We aimed to externally validate QRISK3 and to assess the effects of competing mortality risk on its predictive performance. METHODS For this retrospective population cohort study, we used data from the Clinical Practice Research Datalink. We included patients aged 25-84 years with no previous history of CVD or statin treatment who were permanently registered with a primary care practice, had up-to-standard data for at least 1 year, and had linkage to Hospital Episode Statistics discharge and Office of National Statistics mortality data. We compared the QRISK3-predicted 10-year CVD risk with the observed 10-year risk in the whole population and in important subgroups of age and multimorbidity. QRISK3 discrimination and calibration were examined with and without accounting for competing risks. FINDINGS Our study population included 1 484 597 women with 42 451 incident CVD events (4·9 cases per 1000 person-years of follow-up, 95% CI 4·89-4·99), and 1 420 176 men with 53 066 incident CVD events (6·7 cases per 1000 person-years, 6·66-6·78), with median follow-up of 5·0 years (IQR 1·9-9·2). Non-CVD death rose markedly with age (0·4% of women and 0·5% of men aged 25-44 years had a non-CVD death vs 20·1% of women and 19·6% of men aged 75-84 years). QRISK3 discrimination in the whole population was excellent (Harrell's C-statistic 0·865 in women and 0·834 in men) but was poor in older age groups (<0·65 in all subgroups aged 65 years or older). Ignoring competing risks, QRISK3 calibration in the whole population and in younger people was excellent, but there was significant over-prediction in older people. Accounting for competing risks, QRISK3 systematically over-predicted CVD risk, particularly in older people and in those with high multimorbidity. INTERPRETATION QRISK3 performed well at the whole population level when ignoring competing mortality risk. The tool performed considerably less well in important subgroups, including older people and people with multimorbidity, and less well again after accounting for competing mortality risk. FUNDING National Institute for Health Research.
Collapse
Affiliation(s)
- Shona Livingstone
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Daniel R Morales
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Peter T Donnan
- Division of Population Health and Genomics, University of Dundee, Dundee, UK
| | - Katherine Payne
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Alexander J Thompson
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ji-Hee Youn
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Usher Institute, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
41
|
Bennett G, Richmond J, Thompson AJ. Producing health information in consultation with health workers and the hepatitis B-affected communities is worthwhile. Aust J Prim Health 2021; 27:PY20188. [PMID: 33583486 DOI: 10.1071/py20188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/13/2020] [Indexed: 11/23/2022]
Abstract
Globally, approximately 257 million people are living with chronic hepatitis B. Many people are undiagnosed, have low health literacy and experience barriers to engaging in care. In Australia, there is a lack of culturally and linguistically appropriate resources to support people living with the infection to increase their understanding and build their capacity. This innovative practice paper describes the process of developing a culturally and linguistically appropriate resource using the principles of participatory action research. The hepatitis B story was designed to facilitate discussion between healthcare workers and consumers, and to increase the knowledge and understanding of both. Consultation with consumers and a broad range of health services contributed to the quality of and demand for the resource. A case study tells the story of 'Thuy'. This case study demonstrates the practical application of the resource and describes the positive affect its use had on Thuy and her family. Increasing our understandings of how people experience chronic hepatitis B is crucial to improving health information, testing and engagement in care. Producing health information with consumers is a worthwhile process to increase consumers' health literacy and improve service delivery.
Collapse
Affiliation(s)
- Gabrielle Bennett
- Department of Gastroenterology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Vic. 3065, Australia; and Corresponding author. Emails: ,
| | - Jacqueline Richmond
- The Burnet Institute, Disease Elimination, Commercial Road, Melbourne, Vic. 3000, Australia; and La Trobe University, The Australian Research Centre in Sex, Health and Society, Bundoora, Vic. 3083, Australia; and Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic. 3000, Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital and Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Vic. 3000, Australia
| |
Collapse
|
42
|
Flanagan EK, Richmond J, Thompson AJ, Desmond PV, Bell SJ. Addressing pregnancy-related concerns in women with inflammatory bowel disease: Insights from the patient's perspective. JGH Open 2021; 5:28-33. [PMID: 33490610 PMCID: PMC7812482 DOI: 10.1002/jgh3.12442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 12/17/2022]
Abstract
Background and Aim Therapeutic options for inflammatory bowel disease (IBD) have expanded, as has the use of IBD medications in women during the reproductive period. However, no qualitative data exist that examine the pregnancy‐related concerns of women with IBD in the current era of widespread immunomodulator and biologic use. Hence, we aimed to explore in detail the impact of IBD on pregnancy from the patient's perspective. Methods This qualitative study used semistructured interviews to explore participants' experiences regarding IBD and pregnancy until no new themes emerged. Key themes were identified using thematic analysis. Results Fifteen women with IBD were interviewed. The majority of participants reported lingering concerns regarding their IBD medications, despite advice from their gastroenterologist that the drugs were considered safe in pregnancy. Participants more often reported medication‐related fears, such as potential negative effects on their child's immune system, than concerns regarding the effect of the disease itself on their pregnancy outcomes. A common theme was a perceived lack of knowledge among non‐IBD clinicians regarding IBD medications during pregnancy, which augmented pre‐existing anxiety. Conclusions This study is the first of its kind to provide an in‐depth assessment of female patients' perspectives of IBD in relation to conception, pregnancy, and caring for offspring. In particular, this research characterizes the unique fears and persisting anxieties regarding IBD medications in pregnancy. The study has unearthed important insights into the specific concerns and support needs of women with IBD in order to facilitate nonjudgmental counseling designed around patient concerns and beliefs.
Collapse
Affiliation(s)
- Emma K Flanagan
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia
| | - Jacqui Richmond
- Disease Elimination The Burnet Institute Melbourne Victoria Australia.,The Australian Research Centre in Sex, Health and Society La Trobe University Melbourne Victoria Australia
| | - Alexander J Thompson
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia
| | - Paul V Desmond
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia
| | - Sally J Bell
- Department of Gastroenterology St Vincent's Hospital Melbourne Victoria Australia.,Department of Gastroenterology, Monash Health Melbourne Victoria Australia
| |
Collapse
|
43
|
Wade AJ, Doyle JS, Draper B, Howell J, Iser D, Roberts SK, Kemp W, Thompson AJ, Hellard ME. In support of community-based hepatitis C treatment with triage of people at risk of cirrhosis to specialist care. J Viral Hepat 2021; 28:217-218. [PMID: 32860312 DOI: 10.1111/jvh.13391] [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] [Received: 07/08/2020] [Accepted: 08/02/2020] [Indexed: 12/09/2022]
Affiliation(s)
- Amanda J Wade
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Infectious Diseases, Barwon Health, Geelong, Vic., Australia
| | - Joseph S Doyle
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia
| | - Bridget Draper
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia
| | - Jessica Howell
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Vic., Australia
| | - David Iser
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Vic., Australia.,Department of Gastroenterology, St Vincent's Hospital, Melbourne, Vic., Australia
| | - Stuart K Roberts
- Department of Gastroenterology, The Alfred, Melbourne, Vic., Australia.,Department of Medicine, Monash University, Melbourne, Vic., Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred, Melbourne, Vic., Australia.,Department of Medicine, Monash University, Melbourne, Vic., Australia
| | - Alexander J Thompson
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Vic., Australia.,Department of Medicine, University of Melbourne, Melbourne, Vic., Australia
| | - Margaret E Hellard
- Disease Elimination Program, Burnet Institute, Melbourne, Vic., Australia.,Department of Infectious Diseases, Barwon Health, Geelong, Vic., Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| |
Collapse
|
44
|
Lubel JS, Roberts SK, Strasser SI, Thompson AJ, Philip J, Goodwin M, Clarke S, Crawford DH, Levy MT, Shackel N. Australian recommendations for the management of hepatocellular carcinoma: a consensus statement. Med J Aust 2020; 214:475-483. [PMID: 33314233 DOI: 10.5694/mja2.50885] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is a leading cause of cancer deaths both globally and in Australia. Surveillance for HCC in at-risk populations allows diagnosis at an early stage, when potentially curable. However, most Australians diagnosed with HCC die of the cancer or of liver disease. In the changing landscape of HCC management, unique challenges may lead to clinical practice variation. As a result, there is a need to identify best practice management of HCC in an Australian context. This consensus statement has been developed for health professionals involved in the care of adult patients with HCC in Australia. It is applicable to specialists, general medical practitioners, nurses, health coordinators and hospital administrators. METHODS AND RECOMMENDATIONS This statement has been developed by specialists in hepatology, radiology, surgery, oncology, palliative care, and primary care, including medical practitioners and nurses. The statement addresses four main areas relevant to HCC management: epidemiology and incidence, diagnosis, treatment, and patient management. A modified Delphi process was used to reach consensus on 31 recommendations. Principal recommendations include the adoption of surveillance strategies, use of multidisciplinary meetings, diagnosis, treatment options and patient management. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT This consensus statement will simplify HCC patient management and reduce clinical variation. Ultimately, this should result in better outcomes for patients with HCC.
Collapse
Affiliation(s)
- John S Lubel
- Alfred Health, Melbourne, VIC.,Monash University, Melbourne, VIC
| | | | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, NSW.,University of Sydney, Sydney, NSW
| | | | - Jennifer Philip
- University of Melbourne, Melbourne, VIC.,Royal Melbourne Hospital, Melbourne, VIC
| | | | | | | | | | | |
Collapse
|
45
|
Papaluca T, Craigie A, McDonald L, Edwards A, MacIsaac M, Holmes JA, Jarman M, Lee T, Huang H, Chan A, Lai M, Sundararajan V, Doyle JS, Hellard M, Stoove M, Howell J, Desmond P, Iser D, Thompson AJ. Non-invasive fibrosis algorithms are clinically useful for excluding cirrhosis in prisoners living with hepatitis C. PLoS One 2020; 15:e0242101. [PMID: 33206696 PMCID: PMC7673506 DOI: 10.1371/journal.pone.0242101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023] Open
Abstract
Background and aims Prison-based HCV treatment rates remain low due to multiple barriers, including accessing transient elastography for cirrhosis determination. The AST-to-platelet ratio index (APRI) and FIB-4 scores have excellent negative predictive value (NPV) in hospital cohorts to exclude cirrhosis. We investigated their performance in a large cohort of prisoners with HCV infection. Methods This was a retrospective cohort study of participants assessed by a prison-based hepatitis program. The sensitivity, specificity, NPV and positive predictive value (PPV) of APRI and FIB-4 for cirrhosis were then analysed, with transient elastography as the reference standard. The utility of age thresholds as a trigger for transient elastography was also explored. Results Data from 1007 prisoners were included. The median age was 41, 89% were male, and 12% had cirrhosis. An APRI cut-off of 1.0 and FIB-4 cut-off of 1.45 had NPVs for cirrhosis of 96.1% and 96.6%, respectively, and if used to triage prisoners for transient elastography, could reduce the need for this investigation by 71%. The PPVs of APRI and FIB-4 for cirrhosis at these cut-offs were low. Age ≤35 years alone had a NPV for cirrhosis of 96.5%. In those >35 years, the APRI cut-off of 1.0 alone had a high NPV >95%. Conclusion APRI and FIB-4 scores can reliably exclude cirrhosis in prisoners and reduce requirement for transient elastography. This finding will simplify the cascade of care for prisoners living with hepatitis C.
Collapse
Affiliation(s)
- Timothy Papaluca
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Anne Craigie
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Lucy McDonald
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Amy Edwards
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Michael MacIsaac
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Jacinta A. Holmes
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Matthew Jarman
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Tanya Lee
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Hannah Huang
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Andrew Chan
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Mark Lai
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Vijaya Sundararajan
- Department of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Margaret Hellard
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
- Department of Infectious Diseases, The Alfred and Monash University, Melbourne, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jessica Howell
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia
| | - Paul Desmond
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - David Iser
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital and the University of Melbourne, Melbourne, Australia
- * E-mail:
| |
Collapse
|
46
|
Abstract
Despite the heavy disease burden posed by hepatitis B, around 90% of people living with hepatitis B are not diagnosed globally. Many of the affected populations still have limited or no access to essential blood tests for hepatitis B. Compared to conventional blood tests which heavily rely on centralised laboratory facilities, point-of-care testing for hepatitis B has the potential to broaden testing access in low-resource settings and to engage hard-to-reach populations. Few hepatitis B point-of-care tests have been ratified for clinical use by international and regional regulatory bodies, and countries have been slow to adopt point-of-care testing into hepatitis B programs. This review presents currently available point-of-care tests for hepatitis B and their roles in the care cascade, reviewing evidence for testing performance, utility, acceptability, costs and cost-effectiveness when integrated into hepatitis B diagnosis and monitoring programs. We further discuss challenges and future directions in aspects of technology, implementation, and regulation when adopting point-of-care testing in hepatitis B programs.
Collapse
Affiliation(s)
- Yinzong Xiao
- Burnet Institute, 3004 Melbourne, VIC, Australia;
- Department of Gastroenterology, St Vincent’s Hospital, 3065 Fitzroy, VIC, Australia;
- Faculty of Medicine, University of Melbourne, 3010 Parkville, VIC, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital, 3065 Fitzroy, VIC, Australia;
- Faculty of Medicine, University of Melbourne, 3010 Parkville, VIC, Australia
| | - Jessica Howell
- Burnet Institute, 3004 Melbourne, VIC, Australia;
- Department of Gastroenterology, St Vincent’s Hospital, 3065 Fitzroy, VIC, Australia;
- Faculty of Medicine, University of Melbourne, 3010 Parkville, VIC, Australia
- School of Public Health and Preventive Medicine, Monash University, 3004 Melbourne, VIC, Australia
- Correspondence:
| |
Collapse
|
47
|
Lam KT, Taylor EL, Thompson AJ, Ruepp MD, Lochner M, Martinez MJ, Brozik JA. Direct Measurement of Single-Molecule Ligand-Receptor Interactions. J Phys Chem B 2020; 124:7791-7802. [PMID: 32790373 DOI: 10.1021/acs.jpcb.0c05474] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Measuring the kinetics that govern ligand-receptor interactions is fundamental to our understanding of pharmacology. For ligand-gated ion channels, binding of an agonist triggers allosteric motions that open an integral ion-permeable pore. By mathematically modeling stochastic electrophysiological responses with high temporal resolution (ms), previous single channel studies have been able to infer the rate constants of ligands binding to these receptors. However, there are no reports of the direct measurement of the single-molecule binding events that are vital to how agonists exert their functional effects. For the first time, we report these direct measurements, the rate constants, and corresponding free energy changes, which describe the transitions between the different binding states. To achieve this, we use the super resolution technique: points accumulation for imaging in nanoscale topography (PAINT) to observe binding of ATP to orthosteric binding sites on the P2X1 receptor. Furthermore, an analysis of time-resolved single-molecule interactions is used to measure elementary rate constants and thermodynamic forces that drive the allosteric motions. These single-molecule measurements unequivocally establish the location of each binding states of the P2X1 receptor and the stochastic nature of the interaction with its native ligand. The analysis leads to the measurement of the forward and reverse rates from a weak ligand-binding state to a strong ligand binding state that is linked to allosteric motion and ion pore formation. These rates (kα = 1.41 sec-1 and kβ = 0.32 sec-1) were then used to determine the free energy associated with this critical mechanistic step (3.7 kJ/mol). Importantly, the described methods can be readily applied to all ligand-gated ion channels, and more broadly to the molecular interactions of other classes of membrane proteins.
Collapse
Affiliation(s)
- K-T Lam
- Department of Chemistry, Washington State University, PO Box 644630, Pullman, Washington 99164-4630United States
| | - E L Taylor
- Department of Chemistry, Washington State University, PO Box 644630, Pullman, Washington 99164-4630United States
| | - A J Thompson
- Department of Pharmacology, University of Cambridge, Cambridge CB2 1TN United Kingdom
| | - M-D Ruepp
- UK Dementia Research Institute at King's College London, London WC2R 2LS U.K.,Institute of Biochemistry and Molecular Medicine, University of Bern, Bühlstrasse 28, 3012 Bern, Switzerland
| | - M Lochner
- Institute of Biochemistry and Molecular Medicine, University of Bern, Bühlstrasse 28, 3012 Bern, Switzerland
| | - Michael J Martinez
- Department of Chemistry, Washington State University, PO Box 644630, Pullman, Washington 99164-4630United States
| | - J A Brozik
- Department of Chemistry, Washington State University, PO Box 644630, Pullman, Washington 99164-4630United States
| |
Collapse
|
48
|
Papaluca T, Roberts SK, Strasser SI, Stuart KA, Farrell G, MacQuillan G, Dore GJ, Wade AJ, George J, Hazeldine S, O'Beirne J, Wigg A, Fisher L, McGarity B, Sawhney R, Sinclair M, Thomas J, Valiozis I, Weltman M, Wilson M, Woodward A, Ahlenstiel G, Haque M, Levy M, Prewett E, Sievert W, Sood S, Tse E, Valaydon Z, Bowden S, Douglas M, New K, O'Keefe J, Hellard M, Doyle J, Stoove M, Thompson AJ. Efficacy and safety of sofosbuvir/velpatasvir/voxilaprevir for HCV NS5A-inhibitor experienced patients with difficult to cure characteristics. Clin Infect Dis 2020; 73:e3288-e3295. [PMID: 32887983 DOI: 10.1093/cid/ciaa1318] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In clinical trials, HCV salvage treatment with Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX) achieved an SVR12 rate of >95% in NS5A-experienced participants. Lower SVR12 rates have been reported in real-world studies, particularly for genotype (GT)3 infection and cirrhosis. We determined the efficacy and safety of SOF/VEL/VOX in a large real-world cohort. METHODS We assessed the efficacy of salvage SOF/VEL/VOX for HCV infection in NS5A-inhibitor experienced participants with cirrhosis and portal hypertension, prior liver transplantation (LT) or severe extra-hepatic manifestations. SOF/VEL/VOX was available via an early access program. The primary outcome was SVR12. Secondary outcome was frequency of adverse events (AE). FINDINGS Ninety-seven participants were included. Median age was 58, 82% were male, 78% had cirrhosis, most with portal hypertension (61%, n=46/76), and 18% had prior-LT. Of the cirrhotic participants, 96% were Child-Turcotte-Pugh class A and 4% were class B. Of the 72% with GT3, 76% were also cirrhotic. By intention-to-treat analysis, SVR12 rate was 85% (n=82/97). Per protocol, the SVR12 rate was 90%, including 91% in GT1 (GT1a n=18/18, GT1b n=2/4), 89% in GT3 (n=59/66) and 100% in GT6 (n=3/3). SVR12 in participants with GT3 and cirrhosis was 90%. No predictors of non-SVR12 were identified. There were four serious AEs including one death and three hepatic decompensation events. NS5A resistance-associated substitutions detected at baseline did not affect SVR12. CONCLUSION This real-world study confirms high efficacy of SOF/VEL/VOX for the treatment of difficult-to-cure NS5A-inhibitor experienced patients, including those with GT3 and cirrhosis. Treatment was well tolerated in most however serious AEs can occur in those with advanced liver disease.
Collapse
Affiliation(s)
- Timothy Papaluca
- St Vincent's Hospital Melbourne, Victoria, Australia.,The University of Melbourne, Victoria, Australia
| | - Stuart K Roberts
- The Alfred Hospital Melbourne, Victoria, Australia.,Monash University, Victoria, Australia
| | - Simone I Strasser
- Royal Prince Alfred Hospital, New South Wales, Australia.,The University of Sydney, New South Wales, Australia
| | | | | | - Gerry MacQuillan
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,Medical School, University of Western Australia, Nedlands, Western Australia, Australia
| | - Gregory J Dore
- Kirby Institute, UNSW Sydney, New South Wales, Australia.,St Vincent's Hospital Sydney, New South Wales, Australia
| | - Amanda J Wade
- University Hospital Geelong, Victoria, Australia.,Burnet Institute, Victoria, Australia
| | - Jacob George
- Westmead Hospital, New South Wales, Australia.,Westmead Institute for Medical Research, The University of Sydney, New South Wales, Australia
| | | | - James O'Beirne
- Sunshine Coast University Hospital, Queensland, Australia.,University of Sunshine Coast, Queensland, Australia
| | - Alan Wigg
- Flinders Medical Centre, South Australia, Australia
| | - Leslie Fisher
- The University of Melbourne, Victoria, Australia.,Bendigo Health, Victoria, Australia
| | | | - Rohit Sawhney
- Monash University, Victoria, Australia.,Eastern Health, Victoria, Australia
| | - Marie Sinclair
- The University of Melbourne, Victoria, Australia.,Austin Health, Victoria, Australia
| | - James Thomas
- Princess Alexandra Hospital, Queensland, Australia.,Sunshine Coast University Hospital, Queensland, Australia.,The Prince Charles Hospital, Queensland, Australia.,University of Queensland, St Lucia, Queensland, Australia
| | | | | | | | - Aidan Woodward
- University of Queensland, St Lucia, Queensland, Australia.,Mater Hospital Brisbane, Queensland Australia
| | | | - Mazhar Haque
- University of Queensland, St Lucia, Queensland, Australia.,Mater Hospital Brisbane, Queensland Australia
| | - Miriam Levy
- Liverpool Hospital, New South Wales, Australia
| | - Emily Prewett
- University Hospital Geelong, Victoria, Australia.,Deakin University, Victoria, Australia
| | - William Sievert
- Monash University, Victoria, Australia.,Monash Health, Victoria, Australia
| | - Siddharth Sood
- The University of Melbourne, Victoria, Australia.,Royal Melbourne Hospital, Victoria, Australia
| | - Edmund Tse
- Royal Adelaide Hospital, South Australia, Australia
| | - Zina Valaydon
- The University of Melbourne, Victoria, Australia.,Western Health, Victoria, Australia
| | - Scott Bowden
- Victorian Infectious Diseases Reference Laboratory, Victoria, Australia
| | - Mark Douglas
- Westmead Hospital, New South Wales, Australia.,Westmead Institute for Medical Research, The University of Sydney, New South Wales, Australia
| | - Kate New
- St Vincent's Hospital Melbourne, Victoria, Australia
| | - Jacinta O'Keefe
- Victorian Infectious Diseases Reference Laboratory, Victoria, Australia
| | - Margaret Hellard
- The Alfred Hospital Melbourne, Victoria, Australia.,Monash University, Victoria, Australia.,Burnet Institute, Victoria, Australia
| | - Joseph Doyle
- The Alfred Hospital Melbourne, Victoria, Australia.,Monash University, Victoria, Australia.,Burnet Institute, Victoria, Australia
| | - Mark Stoove
- Monash University, Victoria, Australia.,Burnet Institute, Victoria, Australia
| | - Alexander J Thompson
- St Vincent's Hospital Melbourne, Victoria, Australia.,The University of Melbourne, Victoria, Australia
| |
Collapse
|
49
|
Wright EK, Wang I, Wong D, Bell SJ, Connell WR, Thompson AJ, Novak KL, Kamm MA. Accuracy of point-of-care intestinal ultrasound for Crohn's disease. Australas J Ultrasound Med 2020; 23:176-182. [PMID: 34760597 DOI: 10.1002/ajum.12218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS), performed by a gastroenterologist, provides safe and convenient imaging allowing for immediate clinical decision in Crohn's disease. The minimum training required to gain competency, its accuracy and clinical utility requires evaluation. Methods In this pilot study, Crohn's disease activity and extent were assessed using POCUS (performed by a single gastroenterologist following the completion of 200 supervised scans), magnetic resonance enterography (MRE) and ileo-colonoscopy. The presence of complications was assessed by POCUS and MRE. Accuracy of POCUS was analysed with respect to MRE and ileo-colonoscopy. Agreement between modalities was assessed using kappa coefficient. Results Forty-two patients had a POCUS paired with MRE. Thirty-eight patients had a POCUS paired with ileo-colonoscopy. When compared to MRE, POCUS was accurate in the assessment of disease activity (sensitivity 87.5%, specificity 61.1%, ROC 0.74), extent (sensitivity 77.8%, specificity 83.3%, ROC 0.81) and complications (sensitivity 85.7%, specificity 94.3%, ROC 0.90). Agreement between POCUS and MRE was moderate (kappa estimates 0.50, P < 0.001, 0.61, P < 0.001 and 0.76, P < 0.001) for disease activity, extent and complications, respectively. When compared to ileo-colonoscopy, POCUS was accurate in the assessment of disease activity (sensitivity 72%, specificity 86%, ROC 0.79) and extent (sensitivity 85.7%, specificity 86%, ROC 0.86). For POCUS and ileo-colonoscopy, kappa estimates were 0.55, P < 0.001 for disease activity and 0.62, P < 0.001 for disease extent. Conclusion POCUS performed by a gastroenterologist after completion of limited training is accurate for assessing Crohn's disease activity, extent and the presence of complications.
Collapse
Affiliation(s)
- Emily K Wright
- Department of Gastroenterology St Vincent's Hospital Victoria Pde Fitzroy Victoria Fitzroy 3065 Australia.,The University of Melbourne Grattan Street Melbourne Victoria Parkville Victoria 3010 Australia
| | - Ian Wang
- Department of Gastroenterology St Vincent's Hospital Victoria Pde Fitzroy Victoria Fitzroy 3065 Australia
| | - Darren Wong
- Department of Gastroenterology St Vincent's Hospital Victoria Pde Fitzroy Victoria Fitzroy 3065 Australia.,The University of Melbourne Grattan Street Melbourne Victoria Parkville Victoria 3010 Australia
| | - Sally J Bell
- Department of Gastroenterology St Vincent's Hospital Victoria Pde Fitzroy Victoria Fitzroy 3065 Australia
| | - William R Connell
- Department of Gastroenterology St Vincent's Hospital Victoria Pde Fitzroy Victoria Fitzroy 3065 Australia
| | - Alexander J Thompson
- Department of Gastroenterology St Vincent's Hospital Victoria Pde Fitzroy Victoria Fitzroy 3065 Australia.,The University of Melbourne Grattan Street Melbourne Victoria Parkville Victoria 3010 Australia
| | - Kerri L Novak
- Division of Gastroenterology University of Calgary University Drive NW Calgary Alberta T2N 1N4 Canada
| | - Michael A Kamm
- Department of Gastroenterology St Vincent's Hospital Victoria Pde Fitzroy Victoria Fitzroy 3065 Australia.,The University of Melbourne Grattan Street Melbourne Victoria Parkville Victoria 3010 Australia
| |
Collapse
|
50
|
Traeger MW, Pedrana AE, van Santen DK, Doyle JS, Howell J, Thompson AJ, El-Hayek C, Asselin J, Polkinghorne V, Membrey D, Bramwell F, Carter A, Guy R, Stoové MA, Hellard ME. The impact of universal access to direct-acting antiviral therapy on the hepatitis C cascade of care among individuals attending primary and community health services. PLoS One 2020; 15:e0235445. [PMID: 32603349 PMCID: PMC7326180 DOI: 10.1371/journal.pone.0235445] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Hepatitis C elimination will require widespread access to treatment and responses at the health-service level to increase testing among populations at risk. We explored changes in hepatitis C testing and the cascade of care before and after the introduction of direct-acting antiviral treatments in Victoria, Australia. METHODS De-identified clinical data were retrospectively extracted from eighteen primary care clinics providing services targeted towards people who inject drugs. We explored hepatitis C testing within three-year periods immediately prior to (pre-DAA period) and following (post-DAA period) universal access to DAA treatments on 1st March 2016. Among ever RNA-positive individuals, we constructed two care cascades at the end of the pre-DAA and post-DAA periods. RESULTS The number of individuals HCV-tested was 13,784 (12.2% of those with a consultation) in the pre-DAA period and 14,507 (10.4% of those with a consultation) in the post-DAA period. The pre-DAA care cascade included 2,515 RNA-positive individuals; 1,977 (78.6%) were HCV viral load/genotype tested; 19 (0.8%) were prescribed treatment; and 12 had evidence of cure (0.5% of those RNA-positive and 63.6% of those eligible for cure). The post-DAA care cascade included 3,713 RNA-positive individuals; 3,276 (88.2%) were HCV viral load/genotype tested; 1,674 (45.1%) were prescribed treatment; and 863 had evidence of cure (23.2% of those RNA-positive and 94.9% of those eligible for cure). CONCLUSION Marked improvements in the cascade of hepatitis C care among patients attending primary care clinics were observed following the universal access of DAA treatments in Australia, although improvements in testing were less pronounced.
Collapse
Affiliation(s)
- Michael W. Traeger
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alisa E. Pedrana
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Daniela K. van Santen
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joseph S. Doyle
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Jessica Howell
- Burnet Institute, Melbourne, Victoria, Australia
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | - Alexander J. Thompson
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, Victoria, Australia
| | | | | | | | - Dean Membrey
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Fran Bramwell
- Cohealth, General Practice, Melbourne, Victoria, Australia
| | - Allison Carter
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca Guy
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark A. Stoové
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Margaret E. Hellard
- Burnet Institute, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | | |
Collapse
|