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Oster M, Hein N, Aksan A, Krammer H, Theodoridou S, Stein J. Efficacy and Safety of Intragastric Balloon Therapy Compared to a Multidisciplinary Weight Loss Program (OPTIFAST) in a Real-World Population: A Propensity Score Matching Analysis. Obes Facts 2023; 16:89-98. [PMID: 36257288 PMCID: PMC9889727 DOI: 10.1159/000524895] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 02/24/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Obesity is a major global health problem associated with comorbidities such as diabetes, cardiovascular disease, and cancer. Bariatric surgery is recognized to be the most effective weight loss intervention, but it is highly invasive and costly and can have serious side effects. Intragastric balloon (IGB) placement by endoscopy and hypocaloric diets are among a number of techniques that have been used in patients unsuitable for, or unwilling to undergo, obesity surgery. In this study, we compared the efficacy, safety, and cost-effectiveness of the hypocaloric OPTIFAST program (OPT) with endoscopic IGB placement for weight loss. METHODS In this retrospective observational cohort propensity score-weighted comparison (performed May 2014 to December 2020), participants with a BMI of 30-55 kg/m2, aged 18-70 years, were randomized to OPT or IGB for 26 weeks, followed by a weight maintenance phase. Patients were matched according to age, gender, and BMI. The study outcomes were percentage excess body weight lost, total body weight lost (TBWL), and percentage TBWL (%TBWL). RESULTS A total of 148 participants (75% of those randomized; 74 OPT, 74 IGB) made up the ITT population. Mean age was 44.1 ± 10.4 years, and the patients were predominantly female (77%). Baseline BMI was 44.1 ± 10.4 kg/m2. At 26 weeks, %TBWL in the OPT group was 19.6 ± 6.8% versus 11.9 ± 6.7% for IGB (p < 0.001). At 52 weeks, %TBWL for OPT was 18.2 ± 9.0% versus 12.0 ± 6.6% for IGB (p < 0.001). The OPT cohort also experienced significantly fewer adverse events compared with the IGB group. CONCLUSION IGB placement and OPT induce clinically meaningful weight loss. However, OPT appears to induce clinically superior weight loss and has economic advantages through lower rates of complications and adverse events.
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Affiliation(s)
- Miriam Oster
- Klinik für Allgemein- und Viszeralchirurgie, Hospital zum Heiligen Geist, Frankfurt am Main, Germany
| | - Nathalena Hein
- Obesity Center, DGD Kliniken Sachsenhausen, Frankfurt am Main, Germany
- Institute of Nutritional Science, Justus-Liebig-Universität, Giessen, Germany
| | - Aysegül Aksan
- Institute of Nutritional Science, Justus-Liebig-Universität, Giessen, Germany
| | | | - Sophia Theodoridou
- Chirurgische Klinik V, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - Jürgen Stein
- Obesity Center, DGD Kliniken Sachsenhausen, Frankfurt am Main, Germany
- Institute of Pharmaceutical Chemistry, Frankfurt am Main, Germany
- *Jürgen Stein,
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2
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Aksan A, Zepp F, Anand S, Stein J. Intravenous ferric carboxymaltose for the management of iron deficiency and iron deficiency anaemia in children and adolescents: a review. Eur J Pediatr 2022; 181:3781-3793. [PMID: 36056175 PMCID: PMC9439269 DOI: 10.1007/s00431-022-04582-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/24/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022]
Abstract
Iron deficiency is the primary cause of anaemia worldwide and is particularly common among children and adolescents. Intravenous (IV) iron therapy is recommended for paediatric patients with certain comorbidities or if oral iron treatment has been unsuccessful. IV ferric carboxymaltose (FCM) has recently been approved by the US Food and Drug Administration for use in children aged > 1 year. This narrative review provides an overview of the available publications on the efficacy and safety of IV FCM in children and adolescents. A literature search using PubMed and Embase yielded 153 publications; 33 contained clinical data or reports on clinical experience relating to IV FCM in subjects < 18 years of age and were included in the review. No prospective, randomised controlled studies on the topic were found. Most publications were retrospective studies or case reports and included patients with various underlying conditions or patients with inflammatory bowel disease. Efficacy data were included in 27/33 publications and improvements in anaemia, and/or iron status parameters were reported in 26 of them. Safety data were included in 25/33 publications and were in line with the adverse events described in the prescribing information. CONCLUSION The available publications indicate that IV FCM, a nanomedicine with a unique and distinctive therapeutic profile, is an effective and generally well-tolerated treatment for iron deficiency or iron deficiency anaemia in children and adolescents. Despite the wealth of retrospective evidence, prospective, randomised controlled trials in the paediatric setting are still necessary. WHAT IS KNOWN • Iron deficiency and iron deficiency anaemia are usually managed using oral iron therapy, but intravenous iron therapy is recommended for certain paediatric patients. • Intravenous ferric carboxymaltose (FCM) has recently been approved in the US for use in children aged > 1 year. WHAT IS NEW • Despite evidence that FCM is effective and generally well tolerated in children and adolescents, so far, only retrospective studies, non-randomised uncontrolled prospective studies, or case reports have been published in full. • There is a strong need for prospective, randomised controlled trials on FCM in the paediatric setting.
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Affiliation(s)
- Aysegül Aksan
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt, Germany
- Institute of Nutritional Science, Justus-Liebig University, Giessen, Germany
| | - Fred Zepp
- University Medical Center of the Johannes-Gutenberg University, Mainz, Germany
| | | | - Jürgen Stein
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt, Germany.
- Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt, Germany.
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Aksan A, Schoepfer A, Juillerat P, Vavricka S, Bettencourt M, Ramirez de Arellano A, Gavata S, Morin N, Valentine WJ, Hunt B. A Response to: Letter to the Editor Regarding 'Iron Formulations for the Treatment of Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease: A Cost-Effectiveness Analysis in Switzerland'. Adv Ther 2022; 39:815-821. [PMID: 34846708 PMCID: PMC8799560 DOI: 10.1007/s12325-021-02001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 11/16/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Aysegül Aksan
- Interdisciplinary Crohn Colitis Centre, Rhein-Main, Frankfurt am Main, Germany
- Justus-Liebig University, Giessen, Germany
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire de Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Pascal Juillerat
- Gastroenterology, Clinic of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland
| | - Stephan Vavricka
- Zentrum für Gastroenterologie und Hepatologie, Zürich, Switzerland
| | | | | | - Simona Gavata
- Vifor Pharma Group, Flughofstrasse 61, 8152, Glattbrugg, Switzerland
| | - Neige Morin
- Vifor Pharma Group, Villars-sur-Glâne, Switzerland
| | | | - Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
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Aksan A, Farrag K, Blumenstein I, Schröder O, Dignass AU, Stein J. Chronic intestinal failure and short bowel syndrome in Crohn’s disease. World J Gastroenterol 2021; 27:3440-3465. [PMID: 34239262 PMCID: PMC8240052 DOI: 10.3748/wjg.v27.i24.3440] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/24/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023] Open
Abstract
Chronic intestinal failure (CIF) is a rare but feared complication of Crohn’s disease. Depending on the remaining length of the small intestine, the affected intestinal segment, and the residual bowel function, CIF can result in a wide spectrum of symptoms, from single micronutrient malabsorption to complete intestinal failure. Management of CIF has improved significantly in recent years. Advances in home-based parenteral nutrition, in particular, have translated into increased survival and improved quality of life. Nevertheless, 60% of patients are permanently reliant on parenteral nutrition. Encouraging results with new drugs such as teduglutide have added a new dimension to CIF therapy. The outcomes of patients with CIF could be greatly improved by more effective prevention, understanding, and treatment. In complex cases, the care of patients with CIF requires a multidisciplinary approach involving not only physicians but also dietitians and nurses to provide optimal intestinal rehabilitation, nutritional support, and an improved quality of life. Here, we summarize current literature on CIF and short bowel syndrome, encompassing epidemiology, pathophysiology, and advances in surgical and medical management, and elucidate advances in the understanding and therapy of CIF-related complications such as catheter-related bloodstream infections and intestinal failure-associated liver disease.
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Affiliation(s)
- Aysegül Aksan
- Institute of Nutritional Sciences, Justus-Liebig-Universität, Giessen 35392, Germany
- Department of Clinical Research, Interdisziplinäres Crohn Colitis Centrum Rhein-Main, Frankfurt am Main 60594, Germany
| | - Karima Farrag
- Department of Clinical Research, Interdisziplinäres Crohn Colitis Centrum Rhein-Main, Frankfurt am Main 60594, Germany
- Department of Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Teaching Hospital of the JW Goethe University, Frankfurt am Main 60594, Germany
| | - Irina Blumenstein
- Department of Gastroenterology, Hepatology and Clinical Nutrition, First Medical Clinic, JW Goethe University Hospital, Frankfurt am Main 60529, Germany
| | - Oliver Schröder
- Department of Clinical Research, Interdisziplinäres Crohn Colitis Centrum Rhein-Main, Frankfurt am Main 60594, Germany
- Department of Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Teaching Hospital of the JW Goethe University, Frankfurt am Main 60594, Germany
| | - Axel U Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt am Main 60431, Germany
| | - Jürgen Stein
- Department of Clinical Research, Interdisziplinäres Crohn Colitis Centrum Rhein-Main, Frankfurt am Main 60594, Germany
- Department of Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Teaching Hospital of the JW Goethe University, Frankfurt am Main 60594, Germany
- Institute of Pharmaceutical Chemistry, JW Goethe University, 60438 Frankfurt am Main, Germany
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Aksan A, Beales ILP, Baxter G, de Arellano AR, Gavata S, Valentine WJ, Hunt B. Evaluation of the Cost-Effectiveness of Iron Formulations for the Treatment of Iron Deficiency Anaemia in Patients with Inflammatory Bowel Disease in the UK. Clinicoecon Outcomes Res 2021; 13:541-552. [PMID: 34168471 PMCID: PMC8216635 DOI: 10.2147/ceor.s306823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 03/19/2021] [Accepted: 05/06/2021] [Indexed: 12/21/2022] Open
Abstract
Introduction In patients with inflammatory bowel disease (IBD), iron deficiency anaemia (IDA) can impair quality of life and increase healthcare costs. Treatment options for IDA-associated IBD include oral iron and intravenous iron formulations (such as ferric carboxymaltose [FCM], ferric derisomaltose [FD, previously known as iron isomaltoside 1000], and iron sucrose [IS]). The present analysis compared the cost-effectiveness of FCM versus FD, IS, and oral iron sulfate in terms of additional cost per additional responder in the UK setting. Methods Cost-effectiveness was calculated for FCM versus FD, IS, and oral iron individually in terms of the additional cost per additional responder, defined as haemoglobin normalisation or an increase of ≥2 g/dL in haemoglobin levels, in a model developed in Microsoft Excel. Relative efficacy inputs were taken from a previously published network meta-analysis, since there is currently no single head-to-head trial evidence comparing all therapy options. Costs were calculated in 2020 pounds sterling (GBP) capturing the costs of iron preparations, healthcare professional time, and consumables. Results The analysis suggested that FCM may be the most effective intervention, with 81% of patients achieving a response. Response rates with FD, IS, and oral iron were 74%, 75%, and 69%, respectively. Total costs with FCM, FD, IS, and oral iron were GBP 296, GBP 312, GBP 503, and GBP 56, respectively. FCM was found to be more effective and less costly than both FD and IS, and therefore was considered dominant. Compared with oral iron, FCM was associated with an incremental cost-effectiveness ratio of GBP 2045 per additional responder. Conclusions FCM is likely to be the least costly and most effective IV iron therapy in the UK setting. Compared with oral iron, healthcare payers must decide whether the superior treatment efficacy of FCM is worth the additional cost.
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Affiliation(s)
- Aysegül Aksan
- Interdisciplinary Crohn Colitis Centre, Rhein-main, Frankfurt/Main, Germany.,Institute of Nutritional Science, Justus-Liebig University, Giessen, Germany
| | - Ian L P Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Simona Gavata
- Vifor Pharma Group, Market Access, Glattbrugg, Switzerland
| | | | - Barnaby Hunt
- Ossian Health Economics and Communications, Basel, Switzerland
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6
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Farrag K, Ademaj K, Leventi E, Aksan A, Stein J. Diagnostic utility of low hemoglobin density to detect iron deficiency in patients with inflammatory bowel disease. Ann Gastroenterol 2021; 34:521-527. [PMID: 34276191 PMCID: PMC8276368 DOI: 10.20524/aog.2021.0622] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/31/2020] [Indexed: 11/24/2022] Open
Abstract
Background In the absence of a feasible noninvasive gold standard, iron deficiency (ID) anemia (IDA) is best measured using multiple indicators. However, the choice of an appropriate single iron biomarker for ID screening continues to be debated. Low hemoglobin density (LHD%) from Coulter counters has been suggested as a useful tool to detect ID. This study investigated the reliability of LHD% for the assessment of iron status in patients with inflammatory bowel disease (IBD) and IDA, anemia of chronic disease (ACD) or mixed anemia (MIX). Methods The study population consisted of 143 patients with IBD (aged 39.03±12.53 years, 61.5% female). Blood count, transferrin saturation, serum ferritin, and C-reactive protein were determined by routine assays. Patients with anemia were divided into 3 groups: IDA, ACD and MIX, according to specific criteria. Receiver operator characteristic (ROC) curves were constructed. Results ROC analysis for LHD% in the detection of ID yielded a cutoff value of 3.8%. In anemic patients, LHD% values did not differ statistically significantly between groups (IDA, ACD, MIX) and no significant difference in LHD% values was observed between patients with IDA and ID. Conclusions These results demonstrate that LHD% is a reliable biomarker for the detection of iron deficiency in patients with IBD and anemia, regardless of whether inflammation is present. Our findings indicate that LHD% can provide added value in diagnosing iron deficiency.
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Affiliation(s)
- Karima Farrag
- Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Frankfurt am Main (Karima Farrag, Krenare Ademaj, Jürgen Stein).,Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Frankfurt am Main (Karima Farrag, Krenare Ademaj, Jürgen Stein)
| | - Krenare Ademaj
- Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Frankfurt am Main (Karima Farrag, Krenare Ademaj, Jürgen Stein).,Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Frankfurt am Main (Karima Farrag, Krenare Ademaj, Jürgen Stein)
| | - Eleni Leventi
- Interdisziplinäres Crohn Colitis Centrum Rhein-Main, Frankfurt am Main (Karima Farrag, Krenare Ademaj, Eleni Leventi, Aysegül Aksan, Jürgen Stein).,Department of Gastroenterology, Klinikum Hanau (Eleni Leventi)
| | - Aysegül Aksan
- Interdisziplinäres Crohn Colitis Centrum Rhein-Main, Frankfurt am Main (Karima Farrag, Krenare Ademaj, Eleni Leventi, Aysegül Aksan, Jürgen Stein).,Institute of Nutritional Science, Justus-Liebig University Giessen (Aysegül Aksan), Germany
| | - Jürgen Stein
- Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Frankfurt am Main (Karima Farrag, Krenare Ademaj, Jürgen Stein).,Gastroenterology and Clinical Nutrition, DGD Kliniken Sachsenhausen, Frankfurt am Main (Karima Farrag, Krenare Ademaj, Jürgen Stein)
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Aksan A, Farrag K, Aksan S, Schroeder O, Stein J. Flipside of the Coin: Iron Deficiency and Colorectal Cancer. Front Immunol 2021; 12:635899. [PMID: 33777027 PMCID: PMC7991591 DOI: 10.3389/fimmu.2021.635899] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
Iron deficiency, with or without anemia, is the most frequent hematological manifestation in individuals with cancer, and is especially common in patients with colorectal cancer. Iron is a vital micronutrient that plays an essential role in many biological functions, in the context of which it has been found to be intimately linked to cancer biology. To date, however, whereas a large number of studies have comprehensively investigated and reviewed the effects of excess iron on cancer initiation and progression, potential interrelations of iron deficiency with cancer have been largely neglected and are not well-defined. Emerging evidence indicates that reduced iron intake and low systemic iron levels are associated with the pathogenesis of colorectal cancer, suggesting that optimal iron intake must be carefully balanced to avoid both iron deficiency and iron excess. Since iron is vital in the maintenance of immunological functions, insufficient iron availability may enhance oncogenicity by impairing immunosurveillance for neoplastic changes and potentially altering the tumor immune microenvironment. Data from clinical studies support these concepts, showing that iron deficiency is associated with inferior outcomes and reduced response to therapy in patients with colorectal cancer. Here, we elucidate cancer-related effects of iron deficiency, examine preclinical and clinical evidence of its role in tumorigenesis, cancer progression and treatment response. and highlight the importance of adequate iron supplementation to limit these outcomes.
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Affiliation(s)
- Aysegül Aksan
- Institute of Nutritional Science, Justus-Liebig University, Giessen, Germany.,Institute of Pharmaceutical Chemistry, Goethe University, Frankfurt, Germany.,Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany
| | - Karima Farrag
- Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
| | - Sami Aksan
- Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
| | - Oliver Schroeder
- Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
| | - Jürgen Stein
- Institute of Pharmaceutical Chemistry, Goethe University, Frankfurt, Germany.,Interdisziplinäres Crohn Colitis Centrum, Rhein-Main, Frankfurt, Germany.,DGD Kliniken Sachsenhausen, Frankfurt, Germany
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Aksan A, Dignass A, Stein J. Letter to the editor: in response to: Richard F Pollock & Patrick Biggar. Indirect methods of comparison of the safety of ferric derisomaltose, iron sucrose and ferric carboxymaltose in the treatment of iron deficiency anemia. Expert Rev Hematol 2021; 15:383-384. [PMID: 33511892 DOI: 10.1080/17474086.2021.1883948] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Aysegül Aksan
- Institute of Pharmaceutical Chemistry, Goethe University, Frankfurt Am Main, Germany.,Institute of Nutritional Science, Justus-Liebig University, Gießen, Germany.,Interdisciplinary Crohn Colitis Center Rhein-Main, Frankfurt Am Main, Germany
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt Am Main, Germany
| | - Jürgen Stein
- Institute of Pharmaceutical Chemistry, Goethe University, Frankfurt Am Main, Germany.,Interdisciplinary Crohn Colitis Center Rhein-Main, Frankfurt Am Main, Germany.,Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt Am Main, Germany
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Aksan A, Schoepfer A, Juillerat P, Vavricka S, Bettencourt M, Ramirez de Arellano A, Gavata S, Morin N, Valentine WJ, Hunt B. Iron Formulations for the Treatment of Iron Deficiency Anemia in Patients with Inflammatory Bowel Disease: A Cost-Effectiveness Analysis in Switzerland. Adv Ther 2021; 38:660-677. [PMID: 33216324 PMCID: PMC7854431 DOI: 10.1007/s12325-020-01553-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/24/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Iron deficiency anemia (IDA) is a common complication of inflammatory bowel disease (IBD) and can result in reduced quality of life and increased healthcare costs. IDA is treated with iron supplementation, either with oral iron therapy (OI) or intravenous iron formulations, including ferric carboxymaltose (FCM), iron isomaltoside 1000 (IIM), and iron sucrose (IS). This analysis compared the cost-effectiveness of FCM versus IIM, IS, and OI in terms of additional cost per additional responder in Switzerland. METHODS A health economic model was developed to assess the additional cost per additional responder, defined as normalization or an increase of at least 2 g/dL in hemoglobin levels, for FCM versus IIM, IS, and OI. To date, no single head-to-head trial comparing all therapies is available, and therefore relative efficacy data were taken from a published network meta-analysis. Costs of treatment were calculated in 2020 Swiss francs (CHF) using a microcosting approach, and included the costs of iron, healthcare professional time, and consumables. Costs are also presented in euros (EUR) based on an exchange rate of CHF 1 = EUR 0.94. RESULTS Response rates with FCM, IIM, IS, and OI were 81%, 74%, 75%, and 69%, respectively, with FCM projected to be the most effective treatment. FCM was associated with cost savings of CHF 24 (EUR 23) versus IIM and of CHF 147 (EUR 138) versus IS, and increased costs by CHF 345 (EUR 324) versus OI. Therefore FCM was considered dominant versus both IIM and IS, improving clinical outcomes with cost savings. FCM was associated with an incremental cost-effectiveness ratio of CHF 2970 (EUR 2792) per additional responder versus OI. CONCLUSIONS FCM was projected to be the most cost-effective intravenous iron therapy in Switzerland, increasing the number of responders and leading to cost savings for healthcare payers.
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Aksan A, Boettger K, Hein N, Caicedo-Zea Y, Diehl I, Schumann C, Armbruster FP, Stein J. SUN-PO128: Determining Vitamin D Status in Chronic Inflammatory Conditions. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32762-1] [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: 11/29/2022]
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Hausmann J, Waechtershaeuser A, Behnken I, Aksan A, Blumenstein I, Brenner M, Loitsch SM, Stein J. The role of adipokines in the improvement of diabetic and cardiovascular risk factors within a 52-week weight-loss programme for obesity. Obes Res Clin Pract 2019; 13:440-447. [PMID: 31591082 DOI: 10.1016/j.orcp.2019.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 01/01/2023]
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Aksan A, Isik H, Radeke H, Dignass A, Stein J. A84 UPDATED SYSTEMATIC REVIEW WITH NETWORK METAANALYSIS ON COMPARATIVE EFFICACY AND TOLERABILITY OF DIFFERENT INTRAVENOUS IRON PRODUCTS FOR THE TREATMENT OF IRON DEFICIENCY ANEMIA IN PATIENTS WITH IBD. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A Aksan
- Hacettepe University, Ankara, Turkey
| | - H Isik
- Hacettepe University, Ankara, Turkey
| | - H Radeke
- Pharmazentrum Frankfurt, Institute of Pharmacology and Toxicology, Hospital of the Goethe University, Frankfurt/Main, Germany
| | - A Dignass
- Agaplesion Markus Hospital, Frankfurt/Main, Germany
| | - J Stein
- Interdisciplinary Crohn-Colitis Center Rhein-Main, Frankfurt/Main, Germany
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Aksan A, Isik H, Farrag K, Dignass A, Stein J. A101 SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS: SAFETY OF DIFFERENT INTRAVENOUS IRON PREPARATIONS FOR THE TREATMENT OF IRON DEFICIENCY ANEMIA IN IBD. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Aksan
- Hacettape University, Ankara, Turkey
| | - H Isik
- Hacettape University, Ankara, Turkey
| | - K Farrag
- Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
| | - A Dignass
- Agaplesion Markus Hospital, Frankfurt/Main, Germany
| | - J Stein
- Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
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Stein J, Aksan A, Klemm W, Nip K, Weber-Mangal S, Dignass A. Safety and Efficacy of Ferric Carboxymaltose in the Treatment of Iron Deficiency Anaemia in Patients with Inflammatory Bowel Disease, in Routine Daily Practice. J Crohns Colitis 2018; 12:826-834. [PMID: 29955835 DOI: 10.1093/ecco-jcc/jjy042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/18/2017] [Accepted: 04/20/2018] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Iron deficiency and iron deficiency anaemia are common complications in inflammatory bowel disease [IBD] patients. Anaemia in IBD is attributable to chronic blood loss and/or impaired iron intake and absorption. International guidelines recommend intravenous iron supplementation in IBD patients, since oral supplements are frequently poorly tolerated and can exacerbate inflammation. Intravenous ferric carboxymaltose [FCM; Ferinject® 50 mg ferric iron[III]/mL suspension] was approved in Europe in 2007 for correction of iron deficiency, and can be administered in single 15-min infusions of up to 1000 mg. METHODS A prospective non-interventional post-marketing study was performed in 101 centres in Germany to assess the efficacy, tolerability, and convenience of Ferinject® in clinical practice in a large cohort of IBD patients. Primary endpoints were haemoglobin [Hb] normalisation or increase ≥2 g/dL [responders], and normalisation of serum ferritin [s-ferritin] and transferrin saturation. Adverse events [AEs], clinical signs/symptoms, and disease activity indices were also analysed. RESULTS In all, 224 subjects (127 Crohn's disease [CD]; 97 ulcerative colitis [UC]) were treated. Mean total iron dose was 1139 mg [range: 100 mg-4800 mg], with 76.7% of doses between 500 mg and 2000 mg; 63.3% of patients responded, and no adverse drug reactions or drug-attributed serious adverse events [SAEs] or deaths occurred. Mean increases of Hb [10.0 to 12.3 g/dL], ferritin [52 μg/L to 103 μg/L], transferrin saturation [TSAT, 15% to 25%], and s-iron [6.1 to 12.4 μmol/L] were significant [p = 0.0001]. Clinical scores and quality of life improved due to the amelioration of anaemia symptoms. CONCLUSIONS Ferinject®-therapy was proven to be effective and safe in a large cohort of patients with IBD-associated anaemia in routine practice. Rapid, high-dose application is convenient for physicians and reduces patients' time lost from work.
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Affiliation(s)
- Jürgen Stein
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
| | - Aysegül Aksan
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Hacettepe University, Faculty of Health Sciences, Ankara, Turkey
| | | | - Kerry Nip
- Department of Medical Affairs, Vifor Pharma, Munich, Germany
| | | | - Axel Dignass
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Department of Gastroenterology, Agaplesion Markus Hospital, Frankfurt/Main, Germany
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Aksan A, Işık H, Radeke HH, Dignass A, Stein J. Letter: the importance of dosing and baseline haemoglobin when establishing the relative efficacy of intravenous iron therapies-authors' reply. Aliment Pharmacol Ther 2017; 46:705-706. [PMID: 28880453 DOI: 10.1111/apt.14269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- A Aksan
- Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.,Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany
| | - H Işık
- Faculty of Sciences, Hacettepe University, Ankara, Turkey
| | - H H Radeke
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Pharmazentrum frankfurt, Institute of Pharmacology and Toxicology, Hospital of the Goethe University, Frankfurt/Main, Germany
| | - A Dignass
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Department of Gastroenterology, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany
| | - J Stein
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
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Ede G, Türkoğlu I, Açıkgöz A, Yalçın T, Ilgaz F, Aksan A, Yürük A, Tel Adıgüzel K, Kabasakal Çetin A, Gökmen Özel H, Yıldız E, Samur G. SUN-P191: Does Adherence to Mediterranean Diet Affect Anthropometric Measurements in University Students? Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30437-5] [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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Aksan A, Işık H, Radeke HH, Dignass A, Stein J. Letter: inconsistency in reporting of hypophosphataemia after intravenous iron-authors' reply. Aliment Pharmacol Ther 2017; 46:643-644. [PMID: 28805331 DOI: 10.1111/apt.14254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- A Aksan
- Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.,Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany
| | - H Işık
- Faculty of Sciences, Hacettepe University, Ankara, Turkey
| | - H H Radeke
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Pharmazentrum frankfurt, Institute of Pharmacology and Toxicology, Hospital of the Goethe University, Frankfurt/Main, Germany
| | - A Dignass
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Department of Gastroenterology, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany
| | - J Stein
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
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Affiliation(s)
- A Aksan
- Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.,Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany
| | - H Işık
- Faculty of Sciences, Hacettepe University, Ankara, Turkey
| | - H H Radeke
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Pharmazentrum Frankfurt, Institute of Pharmacology and Toxicology, Hospital of the Goethe University, Frankfurt/Main, Germany
| | - A Dignass
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Department of Gastroenterology, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany
| | - J Stein
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Department of Gastroenterology and Clinical Nutrition, DGD Clinics Sachsenhausen, Frankfurt/Main, Germany
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Aksan A, Işık H, Radeke HH, Dignass A, Stein J. Systematic review with network meta-analysis: comparative efficacy and tolerability of different intravenous iron formulations for the treatment of iron deficiency anaemia in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2017; 45:1303-1318. [PMID: 28326596 DOI: 10.1111/apt.14043] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [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: 10/03/2016] [Revised: 11/01/2016] [Accepted: 02/22/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Iron deficiency anaemia (IDA) is a common complication of inflammatory bowel disease (IBD) associated with reduced quality of life and increased hospitalisation rates. While the best way of treating IDA in IBD patients is not clearly established, current European guidelines recommend intravenous iron therapy in IBD patients with severe anaemia or intolerance to oral iron compounds. AIM To compare the efficacy and tolerability of different intravenous iron formulations used to treat IDA in IBD patients in a systematic review and Bayesian network meta-analysis (NMA), PROSPERO registration number: 42016046565. METHODS In June 2016, we systematically searched for studies analysing efficacy and safety of intravenous iron for IDA therapy in IBD. Primary outcome was therapy response, defined as Hb normalisation or increase ≥2 g/dL. RESULTS Five randomised, controlled trials (n = 1143 patients) were included in a network meta-analysis. Only ferric carboxymaltose was significantly more effective than oral iron [OR=1.9, 95% CrI: (1.1;3.2)]. Rank probabilities showed ferric carboxymaltose to be most effective, followed by iron sucrose, iron isomaltose and oral iron. Pooled data from the systematic review (n = 1746 patients) revealed adverse event rates of 12.0%, 15.3%, 12.0%, 17.0% for ferric carboxymaltose, iron sucrose, iron dextran and iron isomaltose respectively. One drug-related serious adverse event (SAE) each was reported for ferric carboxymaltose and iron isomaltoside, and one possibly drug-related SAE for iron sucrose. CONCLUSIONS Ferric carboxymaltose was the most effective intravenous iron formulation, followed by iron sucrose. In addition, ferric carboxymaltose tended to be better tolerated. Thus, nanocolloidal IV iron products exhibit differing therapeutic and safety characteristics and are not interchangeable.
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Affiliation(s)
- A Aksan
- Hacettepe University, Faculty of Health Sciences, Ankara, Turkey.,Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany
| | - H Işık
- Hacettepe University, Faculty of Sciences, Ankara, Turkey
| | - H H Radeke
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Pharmazentrum frankfurt, Institute of Pharmacology and Toxicology, Hospital of the Goethe University, Frankfurt/Main, Germany
| | - A Dignass
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,Agaplesion Markus Krankenhaus, Department of Gastroenterology, Frankfurt/Main, Germany
| | - J Stein
- Interdisciplinary Crohn Colitis Centre Rhein-Main, Frankfurt/Main, Germany.,DGD Clinics Sachsenhausen, Department of Gastroenterology and Clinical Nutrition, Frankfurt/Main, Germany
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Türkoğlu I, Ilgaz F, Aksan A, Çerçi A, Yalçın T, Yürük A, Gökmen-Özel H, Akal-Yıldız E, Samur G. MON-PP155: Comparison of Four Nutritional Screening Tools to Assess Malnutrition Risk in Hospitalized Adult Patients. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30587-2] [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: 11/25/2022]
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Ragoonanan V, Srikanth S, Wolkers W, Bond D, Flickinger M, Aksan A. Effect of carbohydrates on biothermodynamic properties of bacteria. J Biomech 2006. [DOI: 10.1016/s0021-9290(06)84532-x] [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: 10/24/2022]
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Arnoczky SP, Aksan A. Thermal modification of connective tissues: basic science considerations and clinical implications. Instr Course Lect 2001; 50:3-11. [PMID: 11372329] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Wound healing is a natural and well-orchestrated biologic event. Indeed, the ability of wounds to heal is the foundation on which the practice of surgery is predicated. The successful surgeon maintains a delicate alliance with nature, balancing the magnitude of the surgical insult against the capacity of the tissue for repair. Thermal injury is one of the most traumatic insults a tissue can sustain and the high degree of cell death and matrix alteration associated with thermal burns have been shown to result in a protracted healing time. Thus, the use of thermal energy as a stimulant for tissue shrinkage must be tempered with an appreciation of the biologic events that accompany this phenomenon. Furthermore, it must be realized that the initial degree of capsular shrinkage observed following the application of thermal energy may have little bearing on the long-term biologic and biomechanical status of the joint capsule. Therefore, the desire to see a redundant capsule shrink and become taut at surgery should be weighed very carefully against the level of damage imparted to the tissue to achieve this result. The simple initiation of the healing response may be sufficient to rehabilitate an incompetent structure via the creation of new cellular tissue. While the ultimate application(s) of thermal modification of connective tissues has yet to be completely defined, its ultimate role may be best suited to that of a low level stimulant for inducing a biologic repair response rather than a highly aggressive mechanism for primary tissue shrinkage.
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Affiliation(s)
- S P Arnoczky
- Laboratory for Comparative Orthopaedic Research, Michigan State University, East Lansing, Michigan, USA
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Abstract
Thermal modification (shrinkage) of capsular connective tissue has gained increasing popularity as an adjunctive or even a primary procedure in the arthroscopic treatment of shoulder instability. Although the physical effects of heat on collagenous tissues are well known, the long-term biologic fate of these shrunken tissues is still a matter of debate. The temperatures required to alter the molecular bonding of collagen and thus cause tissue shrinkage (65 degrees C to 70 degrees C) are also known to destroy cellular viability. Therefore, thermally modified tissues are devitalized and must undergo a biologic remodeling process. During this remodeling, the mechanical properties of the treated tissues are altered (decreased stiffness) and can be at risk for elongation if the postoperative rehabilitation regimen is too aggressive. Although anecdotal reports suggest that thermal capsular shrinkage does have a beneficial effect, the exact mechanism responsible for this clinical improvement has yet to be fully defined. The reported improvement could be due to the maintenance of initial capsular shrinkage, secondary fibroplasia and resultant thickening of the joint capsule, a loss of afferent sensory stimulation due to the destruction of sensory receptors, or a combination of all three. The clinical role for thermal modification of connective tissues has not yet been defined, but it appears that it may prove most useful as a stimulant for inducing a biologic repair response.
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Affiliation(s)
- S P Arnoczky
- Laboratory for Comparative Orthopaedic Research, College of Veterinary Medicine, Michigan State University, East Lansing 48824, USA
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