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Dignass A, Stremmel W, Horyński M, Poyda O, Armerding P, Fellermann K, Langhorst J, Kuehbacher T, Uebel P, Stein J, Novacek G, Avalueva E, Oliinyk O, Hasselblatt P, Dorofeyev A, Heinemann H, Mueller R, Greinwald R, Reinisch W. Modified-Release Phosphatidylcholine (LT-02) for Ulcerative Colitis: Two Double-Blind, Randomized, Placebo-Controlled Trials. Clin Gastroenterol Hepatol 2024; 22:810-820.e7. [PMID: 37806372 DOI: 10.1016/j.cgh.2023.09.031] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to evaluate the efficacy of LT-02, a novel modified-release phosphatidylcholine (PC) formulation, for induction and maintenance of remission in patients with mild to moderate ulcerative colitis (UC) and inadequate response to mesalamine. METHODS LT-02 was evaluated in a multicenter double-blind, randomized, placebo-controlled study comprising a 12-week induction trial (PCG-2), followed by a 48-week maintenance trial (PCG-4). In PCG-2, patients were randomized 1:1:1 to treatment with 0.8 g LT-02 4 times daily (QID), 1.6 g LT-02 twice daily (BID), or placebo, respectively. All patients continued to take a standard dose of oral mesalamine (≥2.4 g/day). The primary end point in PCG-2 was deep remission. Patients achieving remission at week 12 were randomly assigned 2:1:1 to 1.6 g LT-02 BID, placebo, or 500 mg mesalamine (3 times daily), respectively, in PCG-4; the primary end point was remission at 48 weeks. RESULTS PCG-2 was terminated early for futility after a prespecified interim analysis; 466 patients (of 762 planned) were randomized. There was no statistically significant difference in deep remission at week 12 (placebo, 13.5%; LT-02 BID, 14.2%; LT-02 QID, 9.7%). In PCG-4, 150 patients (of approximately 400 planned) were randomized. There was no statistically significant difference in remission rates at week 48 (LT-02 BID, 49.3%; mesalamine, 50.0%; placebo, 43.2%). LT-02 was safe. CONCLUSIONS Despite prior evidence of beneficial effects of PC in phase 2 trials, our induction study with LT-02 in patients with mild to moderate UC was terminated prematurely for futility. Signals of efficacy in maintenance therapy require confirmation in an adequately powered maintenance trial. LT-02 was safe and well-tolerated. CLINICALTRIALS gov: NCT02280629, NCT02142725.
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Affiliation(s)
- Axel Dignass
- Department of Medicine I, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
| | - Wolfgang Stremmel
- Department of Gastroenterology, University Hospital of Heidelberg, Heidelberg, Germany
| | | | - Oleksandr Poyda
- Department of Proctology, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | | | - Klaus Fellermann
- Division of Gastroenterology, Medical Department I, Campus Lübeck, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Jost Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Essen, Germany
| | - Tanja Kuehbacher
- Internal Medicine/Gastroenterology, Asklepios Westklinikum Hamburg, Hamburg, Germany
| | - Peter Uebel
- Study Center for Internal Medicine, Haus der Gesundheit, Ludwigshafen, Germany
| | - Juergen Stein
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt am Main, Germany
| | - Gottfried Novacek
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Elena Avalueva
- North-Western State Medical University named after I. I. Mechnikov of the Ministry of Health of the Russian Federation, St Petersburg, Russia
| | | | - Peter Hasselblatt
- Department of Medicine II and Medical Faculty, Medical Center University of Freiburg, Freiburg, Germany
| | - Andrey Dorofeyev
- Ukrainian-German Anti-ulcer Gastroenterology Centre, Kyiv, Ukraine
| | - Heidrun Heinemann
- Department of Clinical Research, Dr. Falk Pharma GmbH, Freiburg, Germany
| | - Ralph Mueller
- Department of Clinical Research, Dr. Falk Pharma GmbH, Freiburg, Germany
| | - Roland Greinwald
- Department of Clinical Research, Dr. Falk Pharma GmbH, Freiburg, Germany
| | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Kyrian O, Dorofeyev A, Derkach I, Zhigal Y. Evaluation of the Impact of Some Single-Nucleotide Gene Polymorphisms on the Development of Adenomatous Polyps of the Colon in Patients with Irritable Bowel Syndrome. Turk J Gastroenterol 2023; 34:822-830. [PMID: 37404119 PMCID: PMC10544543 DOI: 10.5152/tjg.2023.21985] [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] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 10/09/2022] [Indexed: 07/06/2023]
Abstract
BACKGROUND The number of cases of irritable bowel syndrome is growing worldwide, in which adenomatous polyps can develop as a result of microinflammation of the colonic epithelium. Our study was aimed at the identification of the possible effect of single-nucleotide polymorphisms on the risk of the development of irritable bowel syndrome-related colonic adenomatous polyps. MATERIALS AND METHODS The study involved 187 irritable bowel syndrome patients. The single-nucleotide polymorphisms were investigated by the polymerase chain reaction method and DNA was extracted with the phenol-chloroform: interleukin-1β gene-31C/T (rs1143627), -511C/T (rs16944); interleukin-6 gene-174G/C (rs1800795); interleukin-10 gene-592C/A (rs1800872), -819T/C (rs1800871), -1082A/G (rs1800896); Toll-like receptor-2 gene Arg753Gln (rs5743708); Toll-like receptor-4 gene Thr399ile (rs4986791), Asp299Gly (rs4986790); and metalloproteinase-9 gene-8202A/G (rs11697325). The study of polymorphic loci was checked for compliance with the Hardy- Weinberg equilibrium using Fisher's exact test along with the analyses of the frequency of alleles and the genotypes. RESULTS The association of diseases with G allele Toll-like receptor-2 gene Arg753Gln (rs5743708) was revealed in irritable bowel syndrome patients with adenomatous polyps of the colon (P < .0006) and AG single-nucleotide polymorphisms s of Toll-like receptor-2 gene (χ2 = 12.78, P < .002); A allele had a protective effect. The AG genotype metalloproteinase-9 gene-8202A/G (rs11697325) polymorphism in irritable bowel syndrome patients with adenomatous polyps of the colon had a protective effect (P < .05). AA genotype interleukin-10 gene-1082A/G (rs1800896) polymorphism in the irritable bowel syndrome patient (χ2 = 33.97, 4.0E-8) can be considered as the risk for adenomatous polyps of the colon in irritable bowel syndrome. CONCLUSION G allele Toll-like receptor-2 gene Arg753Gln (rs5743708) and AA genotype interleukin-10 gene-1082A/G (rs1800896) polymorphisms can be the marker of the emergence of adenomatous polyps of the colon concomitant with irritable bowel syndrome.
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Affiliation(s)
- Olena Kyrian
- Department of Family Medicine and Therapy, Poltava State Medical University, Poltava, Ukraine
| | - Andrey Dorofeyev
- Chair of Internal Medicine and Gerontology, Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine
| | - Igor Derkach
- Department of Urology, Truskavets City Hospital, Truskavets, Ukraine
| | - Yulia Zhigal
- Chair of Internal Medicine and Gerontology, Shupyk National University of Public Health of Ukraine, Kyiv, Ukraine
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Dorofeyev A, Dorofeyeva A, Borysov A, Tolstanova G, Borisova T. Gastrointestinal health: changes of intestinal mucosa and microbiota in patients with ulcerative colitis and irritable bowel syndrome from PM 2.5-polluted regions of Ukraine. Environ Sci Pollut Res Int 2023; 30:7312-7324. [PMID: 36038689 DOI: 10.1007/s11356-022-22710-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/21/2022] [Indexed: 06/15/2023]
Abstract
Here, clinical studies of patients were conducted to assess changes in patients with ulcerative colitis (UC) and irritable bowel syndrome (IBS) associated with air pollution by PM. A comparative study of 100 patients with UC and 75 with IBS from highly (HPRs) and low (LPRs) PM2.5-polluted regions of Ukraine was conducted. Biopsy of the intestinal mucosa of patients with UC from HPRs showed severe cellular infiltration. Patients with IBS from HPRs had changes in the superficial epithelium (focal desquamation), and inflammatory-cellular infiltration of mucous membrane of the colon. In patients with UC, changes in mucus production were found, which were more significant in HPR patients. PAS response did not depend on the residence; the level of MUC2 was significantly lower in HPR patients with UC (1.12 vs 2.15 au). In patients with UC from HPRs, a decrease in Bacteroidetes (34.0 vs. 39.0 small intestinal bacterial overgrowth (SIBO), ppm) and an increase in Proteobacteria compared to LPRs were shown. In IBS patients, significant differences were found in the level of Proteobacteria, which was higher in HPRs. The level of regulatory flora Akkermansia muciniphila and Faecalibacterium prausnitzii reduced in patients with UC from HPRs. In patients from LPRs, the level of Akkermansia muciniphila raised above normal (2.8 vs 4.7 SIBO, ppm). Similar changes of regulatory flora have been identified in patients with IBS from different regions. Therefore, a more severe course of the disease (more pronounced cellular infiltration and violation of the microbiota) was shown in patients with UC from HPRs as compared to LPRs.
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Affiliation(s)
| | - Anna Dorofeyeva
- D. F. Chebotarev State Institute of Gerontology of the National Academy of Medical Sciences of Ukraine, Kiev, Ukraine
| | - Arsenii Borysov
- Department of Neurochemistry, Palladin Institute of Biochemistry, National Academy of Sciences of Ukraine, 9 Leontovicha Street, Kiev, 01054, Ukraine
| | | | - Tatiana Borisova
- Department of Neurochemistry, Palladin Institute of Biochemistry, National Academy of Sciences of Ukraine, 9 Leontovicha Street, Kiev, 01054, Ukraine.
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Dignass A, Schnabel R, Romatowski J, Pavlenko V, Dorofeyev A, Derova J, Jonaitis L, Dilger K, Nacak T, Greinwald R. Efficacy and safety of a novel high-dose mesalazine tablet in mild to moderate active ulcerative colitis: a double-blind, multicentre, randomised trial. United European Gastroenterol J 2018. [PMID: 29435324 DOI: 10.1177/2050640617703842,] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background Adherence to mesalazine treatment is essential for the successful treatment of ulcerative colitis. Objective The objective of this study was to compare the efficacy, safety and preference of a novel high-dose 1000 mg mesalazine tablet versus conventional treatment for ulcerative colitis remission. Methods This pivotal phase III trial compared one 1000 mg mesalazine tablet (M1000 group) versus two registered 500 mg mesalazine tablets (M2x500 group), both taken three times daily, in patients with mild to moderately active ulcerative colitis. The primary efficacy variable was clinical remission at week 8. Results A total of 306 patients were considered for intent-to-treat analysis. Clinical remission was achieved in 45.0% of the patients in the M1000 group versus 41.9% in the M2x500 group (P < 0.001 for non-inferiority). Mucosal healing was achieved by 68.9% of the patients in the M1000 group and 68.4% in the M2x500 group. The majority of patients preferred the intake of one high-dose tablet (47.7%) over two low-dose tablets (10.5%). Oral treatment with high-dose 1000 mg mesalazine tablets was well tolerated without new safety signals. Conclusions The novel high-dose 1000 mg mesalazine tablet is effective, non-inferior to the registered 500 mg mesalazine tablet, and safe for ulcerative colitis treatment. It was preferred by a majority of patients and may improve ulcerative colitis treatment adherence.
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Affiliation(s)
- Axel Dignass
- Department of Medicine 1, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | | | | | - Vladimir Pavlenko
- State Budgetary Educational Institution of Higher Professional Education, Stavropol, Russian Federation
| | - Andrey Dorofeyev
- Regional Bowel Diseases Centre, Donetsk State Medical University, Donetsk, Ukraine
| | | | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Karin Dilger
- Drug Safety, Dr Falk Pharma GmbH, Freiburg, Germany
| | - Tanju Nacak
- Clinical Research and Development Department, Dr Falk Pharma GmbH, Freiburg, Germany
| | - Roland Greinwald
- Clinical Research and Development Department, Dr Falk Pharma GmbH, Freiburg, Germany
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Dignass A, Schnabel R, Romatowski J, Pavlenko V, Dorofeyev A, Derova J, Jonaitis L, Dilger K, Nacak T, Greinwald R. Efficacy and safety of a novel high-dose mesalazine tablet in mild to moderate active ulcerative colitis: a double-blind, multicentre, randomised trial. United European Gastroenterol J 2017; 6:138-147. [PMID: 29435324 DOI: 10.1177/2050640617703842] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/11/2017] [Indexed: 01/15/2023] Open
Abstract
Background Adherence to mesalazine treatment is essential for the successful treatment of ulcerative colitis. Objective The objective of this study was to compare the efficacy, safety and preference of a novel high-dose 1000 mg mesalazine tablet versus conventional treatment for ulcerative colitis remission. Methods This pivotal phase III trial compared one 1000 mg mesalazine tablet (M1000 group) versus two registered 500 mg mesalazine tablets (M2x500 group), both taken three times daily, in patients with mild to moderately active ulcerative colitis. The primary efficacy variable was clinical remission at week 8. Results A total of 306 patients were considered for intent-to-treat analysis. Clinical remission was achieved in 45.0% of the patients in the M1000 group versus 41.9% in the M2x500 group (P < 0.001 for non-inferiority). Mucosal healing was achieved by 68.9% of the patients in the M1000 group and 68.4% in the M2x500 group. The majority of patients preferred the intake of one high-dose tablet (47.7%) over two low-dose tablets (10.5%). Oral treatment with high-dose 1000 mg mesalazine tablets was well tolerated without new safety signals. Conclusions The novel high-dose 1000 mg mesalazine tablet is effective, non-inferior to the registered 500 mg mesalazine tablet, and safe for ulcerative colitis treatment. It was preferred by a majority of patients and may improve ulcerative colitis treatment adherence.
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Affiliation(s)
- Axel Dignass
- Department of Medicine 1, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | | | | | - Vladimir Pavlenko
- State Budgetary Educational Institution of Higher Professional Education, Stavropol, Russian Federation
| | - Andrey Dorofeyev
- Regional Bowel Diseases Centre, Donetsk State Medical University, Donetsk, Ukraine
| | | | - Laimas Jonaitis
- Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Karin Dilger
- Drug Safety, Dr Falk Pharma GmbH, Freiburg, Germany
| | - Tanju Nacak
- Clinical Research and Development Department, Dr Falk Pharma GmbH, Freiburg, Germany
| | - Roland Greinwald
- Clinical Research and Development Department, Dr Falk Pharma GmbH, Freiburg, Germany
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Borota O, Polunin G, Dorofeyev A, Sedakov I, Borota O. The Combined Treatment of the Colorectal Cancer Associated with Ulcerative Colitis and Crohn'S Disease. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt202.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dorofeyev A. P305 MICROBIOLOGICAL AND MUCUS BARRIER MODIFICATIONS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES AND EXTRAINTESTINAL MANIFESTATIONS. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/s1873-9954(08)70316-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Rudenko N, Dorofeyev A. Prevention of recurrent lower urinary tract infections by long-term administration of fosfomycin trometamol. Double blind, randomized, parallel group, placebo controlled study. ACTA ACUST UNITED AC 2005; 55:420-7. [PMID: 16080282 DOI: 10.1055/s-0031-1296881] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Three hundred and seventeen non pregnant females, suffering of recurrent lower urinary tract infections (UTIs; at least three episodes in the preceding 12 months) were enrolled in a double blind, randomized placebo (PL) controlled, parallel group clinical study, addressed to evaluate the efficacy and safety of fosfomycin trometamol (CAS 78964-85-9, FT, Monuril) in the prevention of infectious recurrences of lower urinary tract. One hundred and sixty six and 151 patients were allocated at random to FT or to PL treatment. The assigned treatment, i.e. one sachet containing FT equivalent to 3 g. of fosfomycin or PL, was taken by patients every 10 days during 6 months; thereafter they were followed up for another 6 consecutive months. Three hundred and two evaluable patients, completed the study as per protocol, 158 in the FT and 144 in the PL group, respectively. The analysis of the number of urinary tract infections/patient-year (primary end point) showed a result of 0.14 infections/patient-year in the FT group and of 2.97 infections/patient-year in the PL group. The difference was highly significant (p < 0.001). The time to first infection recurrence was significantly longer in the FT (38 days) than in the PL group (6 days); p < 0.01. The number of patients with at least one episode of recurrent infection and the number of episodes/patient during the treatment as well as during the follow-up period were statistically significantly lower in the FT group than in the PL group. Both treatments were well tolerated; only one adverse reaction possibly treatment related, i.e. an allergic skin reaction, was reported in both groups. Haematology and blood chemistry variables explored for safety at the end of the study did not show any significant difference between the two groups. The compliance with the treatment in the 302 evaluable patients was excellent. The results of this trial indicate that FT is higly effective in the prophylaxis of UTI recurrences; this beneficial effect is evident also in the 6 months of the follow-up.
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Affiliation(s)
- Nikolay Rudenko
- Department of Internal Medicine II, Medical University of Donetsk, Ukraine.
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