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Berinstein JA, Karl T, Patel A, Dolinger M, Barrett TA, Ahmed W, Click B, Steiner CA, Dulaney D, Levine J, Hassan SA, Perry C, Flomenhoft D, Ungaro RC, Berinstein EM, Sheehan J, Cohen-Mekelburg S, Regal RE, Stidham RW, Bishu S, Colombel JF, Higgins PDR. Effectiveness of Upadacitinib for Patients With Acute Severe Ulcerative Colitis: A Multicenter Experience. Am J Gastroenterol 2024:00000434-990000000-00996. [PMID: 38275248 DOI: 10.14309/ajg.0000000000002674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION A significant proportion of patients with acute severe ulcerative colitis (ASUC) require colectomy. METHODS Patients with ASUC treated with upadacitinib and intravenous corticosteroids at 5 hospitals are presented. The primary outcome was 90-day colectomy rate. Secondary outcomes included frequency of steroid-free clinical remission, adverse events, and all-cause readmissions. RESULTS Of the 25 patients with ASUC treated with upadacitinib, 6 (24%) patients underwent colectomy, 15 (83%) of the 18 patients with available data and who did not undergo colectomy experienced steroid-free clinical remission (1 patient did not have complete data), 1 (4%) patient experienced a venous thromboembolic event, while 5 (20%) patients were readmitted. DISCUSSION Upadacitinib along with intravenous corticosteroids may be an effective treatment for ASUC.
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Affiliation(s)
- Jeffrey A Berinstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Taylor Karl
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anish Patel
- Division of Gastroenterology & Hepatology, Brooke Army Medical Center, USA
| | - Michael Dolinger
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Terrence A Barrett
- Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Waseem Ahmed
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ben Click
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Calen A Steiner
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - David Dulaney
- Division of Gastroenterology & Hepatology, Brooke Army Medical Center, USA
| | - Jake Levine
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Syed Adeel Hassan
- Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Courtney Perry
- Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Deborah Flomenhoft
- Division of Digestive Diseases and Nutrition, University of Kentucky, Lexington, Kentucky, USA
| | - Ryan C Ungaro
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Elliot M Berinstein
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jessica Sheehan
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Shirley Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, Michigan, USA
| | - Randolph E Regal
- Department of Pharmacy Services, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Ryan W Stidham
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Shrinivas Bishu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter D R Higgins
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
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Haider SA, Yadav A, Perry C, Su L, Akanbi O, Kudaravalli P, Tripathi N, Hashim MA, Abdelsalam M, Hussein M, Elkheshen A, Patel V, Ali SE, Lamb L, Ingram K, Mayne C, Stuffelbeam AB, Flomenhoft D, Stromberg A, Barrett TA. Ustekinumab dose escalation improves clinical responses in refractory Crohn's disease. Therap Adv Gastroenterol 2020; 13:1756284820959245. [PMID: 33133239 PMCID: PMC7576911 DOI: 10.1177/1756284820959245] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 04/28/2020] [Accepted: 08/24/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Clinicians often utilize off-label dose escalation of ustekinumab (UST) in Crohn's disease (CD) patients with disease refractory to standard dosing. Previous studies report mixed results with dose escalation of UST. METHODS A retrospective observational study of 143 adult patients with CD receiving UST over a 33-month time period was conducted. Patients receiving UST at standard dosage for a minimum of 16 weeks were included in the analysis. Primary outcomes collected were clinical response [Physician Global Assessment Score (PGA) by >1] and remission (PGA = 0). Changes in clinical parameters were calculated for dose-escalated patients beginning with the time of dose switch (~42 weeks) and compared with a group of patients who were classified as "failing" standard dosing at 42 weeks who were not dose escalated. RESULTS Dose escalation improved PGA by 0.47 ± 0.19 compared with patients remaining on every 8 weeks dosing (Q8 week), who worsened by 0.23 ± 0.23 (p < 0.05). Dose escalation decreased CRP 0.33 ± 0.19 mg/L and increased serum albumin 0.23 ± 0.06 g/dL (p < 0.05). Surprisingly, disease duration and prior CD surgeries inversely correlated with the need for dose escalation. CONCLUSION Our results support UST Q4 week dose escalation for selected CD patients who fail to achieve remission on standard Q8 week dosing. Dose escalation improves clinical outcomes, prevents worsening disease severity, and positively impacts CRP and albumin levels. Together these data indicate that clinicians should attempt Q4 week UST dosing in refractory CD patients before switching to an alternative class of biologic therapy.
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Affiliation(s)
| | | | - Courtney Perry
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Leon Su
- Dr. Bing Zhang Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Olalekan Akanbi
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Praneeth Kudaravalli
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Nishant Tripathi
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Mahmoud A. Hashim
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Mohammed Abdelsalam
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Mohamed Hussein
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Ahmed Elkheshen
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Vihang Patel
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Saad Emhmed Ali
- Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Latoya Lamb
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Karen Ingram
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Casie Mayne
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Amy B. Stuffelbeam
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Deborah Flomenhoft
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Arnold Stromberg
- Dr. Bing Zhang Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Terrence A. Barrett
- Department of Internal Medicine, Division of Digestive Disease and Nutrition, University of Kentucky College of Medicine, Lexington, KY, USA
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Abstract
Arterioenteric fistulas are a rare cause of massive gastrointestinal hemorrhage. We present a patient who developed a fistula between a middle colic artery pseudoaneurysm, a proximal branch of the superior mesenteric artery (SMA), and the third part of the duodenum 2 weeks after a self-inflicted gunshot wound to the abdomen. The patient's presentation, evaluation, treatment, and prognosis are discussed. All prior published cases of SMA-duodenal fistulas are reviewed.
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Affiliation(s)
- Cory M Fielding
- Division of Digestive Diseases and Nutrition in the Department of Internal Medicine (Fielding, Frandah, Flomenhoft) and the Department of Radiology (Krohmer), University of Kentucky, Lexington, Kentucky
| | - Wesam Frandah
- Division of Digestive Diseases and Nutrition in the Department of Internal Medicine (Fielding, Frandah, Flomenhoft) and the Department of Radiology (Krohmer), University of Kentucky, Lexington, Kentucky
| | - Steven Krohmer
- Division of Digestive Diseases and Nutrition in the Department of Internal Medicine (Fielding, Frandah, Flomenhoft) and the Department of Radiology (Krohmer), University of Kentucky, Lexington, Kentucky
| | - Deborah Flomenhoft
- Division of Digestive Diseases and Nutrition in the Department of Internal Medicine (Fielding, Frandah, Flomenhoft) and the Department of Radiology (Krohmer), University of Kentucky, Lexington, Kentucky
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Kumari A, Pasini P, Deo SK, Flomenhoft D, Shashidhar H, Daunert S. Biosensing systems for the detection of bacterial quorum signaling molecules. Anal Chem 2007; 78:7603-9. [PMID: 17105149 DOI: 10.1021/ac061421n] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [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: 12/14/2022]
Abstract
Bacterial quorum sensing (QS) is a cell-to-cell communication phenomenon that allows bacteria to control the expression of certain specialized genes depending on their cell population size. Signaling molecules such N-acylhomoserine lactones (AHLs) mediate the communication, and their concentration reflects the bacterial population density. Quorum sensing regulates several processes including bacterial pathogenicity. We developed a method for the rapid, sensitive, and quantitative detection of AHLs in biological samples such as saliva and stools. The method is based on whole-cell sensing systems that employ QS regulatory systems as recognition elements and the luxCDABE gene cassette as a reporter. The method proved to be reproducible when applied to real samples and was able to detect low analyte concentrations down to 1 x 10(-9) M without requiring extensive sample preparation. We envision that this novel biosensing system could be employed in the diagnosis and management of various bacteria-related disorders, thus supporting the use of quorum sensing molecules as potential biomarkers of disease. Due to cost-effectiveness and high throughput, these biosensing systems could be successfully employed as a new tool for the screening of novel drugs that target quorum sensing mechanisms.
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Affiliation(s)
- Anjali Kumari
- Department of Chemistry, University of Kentucky, Lexington, Kentucky 40506, USA
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Berger JR, Levy RM, Flomenhoft D, Dobbs M. Predictive factors for prolonged survival in acquired immunodeficiency syndrome-associated progressive multifocal leukoencephalopathy. Ann Neurol 1998; 44:341-9. [PMID: 9749600 DOI: 10.1002/ana.410440309] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.1] [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: 11/09/2022]
Abstract
Progressive multifocal leukoencephalopathy (PML) complicating the acquired immunodeficiency syndrome (AIDS) is typically inexorably progressive with death usually occurring within 6 months of symptom onset. Occasional patients have been observed to survive longer than 1 year, often with remission of clinical features. In this study, we identify predictive factors for prolonged survival in patients with biopsy proven, AIDS-associated PML, by comparing 7 patients with survival exceeding 12 months from symptom onset with 45 patients with shorter survivals. PML was the presenting manifestation of AIDS in 5 (71.4%) of 7 long-term survivors compared with 8 (17.8%) of 45 short-term survivors. CD4 T-lymphocyte counts were substantially higher in the long-term survivors, with 3 (42.9%) of 7 having counts exceeding 300 cells/mm3 in comparison with only 1 (4.3%) of 23 short-term survivors. Contrast enhancement on radiographic imaging was observed in 3 (50%) of 6 long-term survivors in comparison with 4 (8.9%) of 45 short-term survivors. Neurological recovery and radiographic improvement were not observed in any short-term survivors but were seen in 5 (71.4%) long-term survivors. There was no association between treatment modalities and survival. Predictors of long-term survival in AIDS patients with PML include PML as the heralding manifestation of AIDS, high CD4 T-lymphocyte count at disease onset, lesion enhancement on computed tomographic scan or magnetic resonance imaging, and evidence of recovery of neurological function.
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Affiliation(s)
- J R Berger
- Department of Neurology, University of Kentucky College of Medicine, Lexington 40536-0284, USA
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