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Le Cosquer G, Capirchio L, Rivière P, Denis MA, Poullenot F, Remue C, Zerbib F, Leonard D, Célérier B, Kartheuser A, Laharie D, Dewit O. Time trend in surgical indications and outcomes in ulcerative colitis-A two decades in-depth retrospective analysis. Dig Liver Dis 2023; 55:1338-1344. [PMID: 37029063 DOI: 10.1016/j.dld.2023.03.003] [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: 12/21/2022] [Revised: 02/20/2023] [Accepted: 03/10/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Recent data regarding the impact of biologics and new surgical techniques on the indications and outcomes of colectomy for ulcerative colitis (UC) are limited. AIMS The present study aimed at determining the trend of colectomy in UC by comparing colectomy indications and outcomes between 2000 and 2010 and 2011-2020. METHODS This observational retrospective study was conducted in two tertiary hospitals, including consecutive patients who underwent colectomy between 2000 and 2020. All data concerning UC history, treatment and surgeries were collected. RESULTS Among the 286 patients included, 87 underwent colectomy in 2001-2010 and 199 in 2011-2020. Patients' characteristics were similar between groups, except for prior biologic exposure (50.6 % vs. 74.9%; p<0.001). The indications of colectomy significantly decreased for refractory UC (50.6 % vs. 37.7%; p = 0.042), but were similar for acute severe UC (36.8 % vs. 42.2%; p = 0.390) and (pre)neoplastic lesions (12.6 % vs. 20.1%; p = 0.130). A widespread use of laparoscopy (47.7 % vs. 81.4%; p<0.001) was associated with fewer early complications (12.6 % vs. 5.5%; p = 0.038). CONCLUSION Over the last two decades, the proportion of surgery for refractory UC significantly decreased compared to other surgical indications while surgical outcomes improved despite larger exposure to biologics.
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Affiliation(s)
- Guillaume Le Cosquer
- Department of Gastroenterology, CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Lena Capirchio
- Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Pauline Rivière
- Department of Gastroenterology, CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Marie Armelle Denis
- Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Florian Poullenot
- Department of Gastroenterology, CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Christophe Remue
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Frank Zerbib
- Department of Gastroenterology, CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Daniel Leonard
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bertrand Célérier
- Department of Digestive and Endocrine Surgery, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - Alex Kartheuser
- Colorectal Surgery Unit, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - David Laharie
- Department of Gastroenterology, CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Olivier Dewit
- Department of Hepato-gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
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Rivière P, Le Chevillier A, Rullier A, Marty M, Schurr E, Lapuyade B, Célerier B, Fernandez B, Bessissow T, Treton X, Uzzan M, Poullenot F, Berger A, Zerbib F, Laharie D. Deep ulcers are associated with increased C-reactive protein in active ulcerative colitis. Dig Liver Dis 2023; 55:1194-1200. [PMID: 37244790 DOI: 10.1016/j.dld.2023.05.004] [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: 03/10/2023] [Revised: 05/01/2023] [Accepted: 05/01/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Increased C-reactive protein (CRP) is used to diagnose and predict response to treatment in acute severe ulcerative colitis (UC). AIMS To investigate the connection between CRP elevation and deep ulcers in UC. METHODS Patients with active UC were enrolled in a multicenter prospective cohort and a retrospective cohort of consecutive patients undergoing colectomy from 2012 to 2019. RESULTS Forty-one (9 (22%) with deep ulcers) patients were included in the prospective cohort: 4/5 (80%) patients with CRP > 100 mg/L, 2/10 (20%) patients with CRP between 30 and 100 mg/L and 3/26 (12%) patients with CRP < 30 mg/L had deep ulcers (p = 0.006). In the retrospective cohort [46 patients (31 (67%) with deep ulcers)], 14/14 (100%) patients with CRP > 100 mg/L, 11/17 (65%) patients with CRP between 30 and 100 mg/l and 6/15 (40%) patients with CRP < 30 mg/L had deep ulcers (p = 0.001). Positive predictive value of CRP > 100 mg/l for presence of deep ulcers was 80% and 100% in both cohorts, respectively. CONCLUSIONS CRP elevation is a robust surrogate marker for presence of deep ulcers in UC. Elevated CRP or presence of deep ulcers could influence the choice of medical therapy in acute severe UC.
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Affiliation(s)
- P Rivière
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France; Program in Infectious Diseases and Immunity in Global Health, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - A Le Chevillier
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - A Rullier
- CHU de Bordeaux, Hôpital Pellegrin, Pathology department - Université de Bordeaux, Bordeaux F-33000, France
| | - M Marty
- CHU de Bordeaux, Hôpital Haut-Lévêque, Pathology department - Université de Bordeaux, Bordeaux F-33000, France
| | - E Schurr
- Program in Infectious Diseases and Immunity in Global Health, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - B Lapuyade
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Radiology department - Université de Bordeaux, Bordeaux F-33000, France
| | - B Célerier
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Abdominal surgery department - Université de Bordeaux, Bordeaux F-33000, France
| | - B Fernandez
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Abdominal surgery department - Université de Bordeaux, Bordeaux F-33000, France
| | - T Bessissow
- Division of Gastroenterology and hepatology, McGill University Health Centre, Montreal, Canada
| | - X Treton
- Paris IBD Center, Groupe Hospitalier Privé Ambroise Paré-Hartmann, 25 bd Victor Hugo, Neuilly/Seine 92200, France
| | - M Uzzan
- Paris Est Créteil University UPEC, Assistance Publique-Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Gastroenterology department, Fédération Hospitalo-Universitaire TRUE InnovaTive theRapy for immUne disordErs, Créteil F-94010, France
| | - F Poullenot
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - A Berger
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - F Zerbib
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - D Laharie
- CHU de Bordeaux, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology department, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France.
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Chappe C, Salut C, Amiot A, Gaye D, Frulio N, Lapuyade B, Vuitton L, Altwegg R, Gilletta C, Fumery M, Bouguen G, Serrero M, Nachury M, de Suray N, Caillo L, Simon M, Laharie D, Rivière P, Poullenot F. Preoperative Predictors of Neoplasia in Patients Undergoing Small Bowel Resection for Complicated Crohn’s Disease: A Multicentre Case-Control Study. Cancers (Basel) 2023; 15:cancers15072004. [PMID: 37046666 PMCID: PMC10093720 DOI: 10.3390/cancers15072004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Crohn’s disease (CD) is associated with an increased risk of small bowel neoplasia (SBN). We aimed to assess preoperative predictors of SBN in CD patients. We conducted a retrospective case-control study including CD patients who underwent surgery: cases were diagnosed with SBN on histopathological analysis and controls had no neoplasia. Preoperative cross-sectional imaging was reviewed by a panel of blinded expert radiologists. Fifty cases were matched to one hundred and fifty consecutive controls. In multivariable analysis, predictors of SBN were age ≥ 50 years (OR = 28, 95% CI = 5.05–206), median CD duration ≥ 17.5 years (OR = 4.25, 95% CI = 1.33–14.3), and surgery for stricture (OR = 5.84, 95% CI = 1.27–35.4). The predictors of small bowel adenocarcinoma were age ≥ 50 years (OR = 5.14, 95% CI = 2.12–12.7), CD duration ≥ 15 years (OR = 5.65, 95% CI = 2.33–14.3), and digestive wall thickening > 8 mm (OR = 3.79, 95% CI = 1.45–11.3). A predictive score based on the aforementioned factors was constructed. Almost 73.7% of patients with a high score had SBA. Old age, long small bowel CD duration, and stricture predicted the presence of SBN, particularly adenocarcinoma when patients have digestive wall thickening > 8 mm on preoperative imaging.
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Poullenot F, Laharie D. Management of Inflammatory Bowel Disease in Patients with Current or Past Malignancy. Cancers (Basel) 2023; 15:cancers15041083. [PMID: 36831424 PMCID: PMC9954488 DOI: 10.3390/cancers15041083] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Immunomodulators, conventional immunosuppressants, and/or biologics are used more often, earlier, and longer than before in patients with inflammatory bowel disease (IBD). Along with this, the lifetime risk for cancer is estimated to be 33% in the general population in Europe. Thus, physicians face therapeutic choices in an increasing number of IBD patients with current or past malignancy. Few data are available so far for managing this IBD subpopulation and this clinical concern still remains a critical situation for four reasons: (i) risk of reactivation of dormant micrometastasis with immunomodulators is of major concern, (ii) there is a knowledge gap about the safety of the most recent molecules, (iii) current guidelines do not recommend the use of immunomodulators within 2-5 years after a diagnosis of cancer, (iv) patients with previous cancers are excluded from clinical trials. There is a lack of scientific evidence supporting the non-use of immunomodulators in IBD patients with previous cancer. Indeed, accumulative data suggest that the risk for recurrent and new cancer in patients with a history of cancer is not increased by thiopurines and anti-TNF agents. Most recently, cohort studies have found no differences in incident cancer rates in IBD patients with prior malignancy treated with vedolizumab or ustekinumab compared to those treated with anti-TNF agents. Therefore, decisions should be shared by the oncologist and the patient, considering the natural history of cancer, the time elapsed since cancer diagnosis, and IBD prognosis.
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Affiliation(s)
- Florian Poullenot
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-Gastroentérologie et Oncologie Digestive, Université de Bordeaux, F-33000 Bordeaux, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-Gastroentérologie et Oncologie Digestive, Université de Bordeaux, F-33000 Bordeaux, France
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Poullenot F, Amiot A, Nachury M, Viennot S, Altwegg R, Bouhnik Y, Abitbol V, Nancey S, Vuitton L, Peyrin-Biroulet L, Biron A, Fumery M, Picon L, Vidon M, Reenaers C, Serrero M, Savoye G, Beaugerie L, Rivière P, Laharie D. Comparative Risk of Incident Cancer in Patients with Inflammatory Bowel Disease with Prior Non-digestive Malignancy According to Immunomodulator: a Multicentre Cohort Study. J Crohns Colitis 2022; 16:1523-1530. [PMID: 35512337 DOI: 10.1093/ecco-jcc/jjac061] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/04/2021] [Revised: 03/27/2022] [Accepted: 05/03/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Knowledge about the cancer risk when initiating a biologic in inflammatory bowel disease [IBD] patients with prior malignancy remains scarce, especially for vedolizumab. Our aim was to evaluate the rate of incident cancer in a cohort of IBD patients with prior non-digestive malignancy, according to the subsequent treatment given. METHODS A multicentre retrospective study included consecutive IBD patients with prior non-digestive malignancy. Inclusion date corresponded to the diagnosis of index malignancy. Patients were categorized into different cohorts according to the first treatment [none, conventional immunosuppressant, anti-TNF, or vedolizumab] to which they were exposed after inclusion and before incident cancer [recurrent or new cancer]. RESULTS Among the 538 patients {58% female; mean (standard deviation [SD]) age inclusion: 52 [15] years} analyzed, the most frequent malignancy was breast cancer [25%]. The first immunomodulator given after inclusion was a conventional immunosuppressant in 27% of patients, anti-TNF in 21%, or vedolizumab in 9%. With a median (interquartile range [IQR]) follow-up duration of 55 [23-100] months, 100 incident cancers were observed. Crude cancer incidence rates per 1000 person-years were 47.0 for patients receiving no immunomodulator, 36.6 in the anti-TNF cohort, and 33.6 in the vedolizumab cohort [p = 0.23]. Incident-cancer free survival rates were not different between patients receiving anti-TNF and those receiving vedolizumab [p = 0.56]. After adjustment, incidence rates were not different between patients receiving no immunomodulator, anti-TNF, or vedolizumab. CONCLUSIONS In this large multicentre cohort study, there was no difference of cancer incidence in those IBD patients with prior non-digestive malignancy, treated with vedolizumab or anti-TNF.
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Affiliation(s)
- F Poullenot
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
| | - A Amiot
- Département de Gastroentérologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
| | - M Nachury
- Univ. Lille, Institute for Translational Research in Inflammation, France
| | - S Viennot
- Hepato-gastroenterology Department, CHU Caen, Caen, France
| | - R Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, Montpellier, France
| | - Y Bouhnik
- Gastroenterology and Nutrition Support Department, Department of Gastroenterology, Beaujon Hospital, Clichy, France
| | - V Abitbol
- Hôpital Cochin AP-HP Gastro-entérologie, and Université de Paris, Paris, France
| | - S Nancey
- Department of Gastroenterology, CHU, Lyon, France
| | - L Vuitton
- Department of Gastroenterology, CHRU, Besançon, France
| | - L Peyrin-Biroulet
- Gastroenterology Department, Nancy University Hospital, Université de Lorraine, Nancy, France
| | - A Biron
- CHU Reims, Hôpital Robert Debré. Service Hépato-gastroentérologie et cancérologie digestive, Reims, France
| | - M Fumery
- Department of Gastroenterology, CHU, Amiens, France
| | - L Picon
- Hepato-gastroenterology Department, CHRU Tours-TROUSSEAU Hospital, Tours, France
| | - M Vidon
- Departement of Gastroenterology, Hôpital Intercommunal de Créteil, Créteil, France
| | - C Reenaers
- Hepato-gastroenterology Department, CHU Sart Tilman, Liège University, Liège, Belgium
| | - M Serrero
- Hepato-gastroenterology Department, APHM Hôpital Nord, Marseille, France
| | - G Savoye
- Department of Gastroenterology, Normandie University, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - L Beaugerie
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France
| | - P Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
| | - D Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
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Le Cosquer G, Altwegg R, Rivière P, Bournet B, Boivineau L, Poullenot F, Bozon A, Buscail L, Laharie D, Gilletta C. Prevention of post-operative recurrence of Crohn's disease among patients with prior anti-TNFα failure: A retrospective multicenter study. Dig Liver Dis 2022; 55:727-734. [PMID: 36192340 DOI: 10.1016/j.dld.2022.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/27/2022] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anti-TNFα are recommended for preventing Crohn's disease (CD) postoperative recurrence (POR) in patients with risk factors. However, few data exploring anti-TNFα efficacy in patients with preoperative anti-TNFα failure are available so far. AIMS The aim of the present study was to compare the efficacy of anti-TNFα with other biologics and immunosuppressants to prevent POR in this setting. METHODS Consecutive CD patients who underwent bowel resection between January 2010 and December 2019 after failure of at least one anti-TNFα were retrospectively included among three tertiary centers if they started a postoperative medical prophylaxis within the three months after index surgery. The main outcome was to compare rates of objective recurrence (endoscopic or radiological recurrence in absence of colonoscopy) between patients treated with an anti-TNFα agent or another treatment as prevention of POR. RESULTS Among the 119 patients included, 71 patients received an anti-TNFα (26 infliximab, 45 adalimumab) and 48 another treatment (18 ustekinumab, 7 vedolizumab, 20 azathioprine and 3 methotrexate) to prevent POR. Rates of objective recurrence at two years were 23.9% in patients treated with anti-TNFα and 44.9% in the others (p = 0.011). CONCLUSION Anti-TNFα remained an effective option to prevent POR for patients operated upon with previous anti-TNFα failure.
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Affiliation(s)
- Guillaume Le Cosquer
- Department of Gastroenterology and Pancreatology, Hôpital Rangueil, CHU de Toulouse, Université Toulouse Paul Sabatier, Toulouse, France.
| | - Romain Altwegg
- Department of Hepato-gastroenterology, Hôpital Saint-Eloi, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Pauline Rivière
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Barbara Bournet
- Department of Gastroenterology and Pancreatology, Hôpital Rangueil, CHU de Toulouse, Université Toulouse Paul Sabatier, Toulouse, France
| | - Lucile Boivineau
- Department of Hepato-gastroenterology, Hôpital Saint-Eloi, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Florian Poullenot
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Anne Bozon
- Department of Hepato-gastroenterology, Hôpital Saint-Eloi, CHU Montpellier, Université de Montpellier, Montpellier, France
| | - Louis Buscail
- Department of Gastroenterology and Pancreatology, Hôpital Rangueil, CHU de Toulouse, Université Toulouse Paul Sabatier, Toulouse, France
| | - David Laharie
- Department of Gastroenterology and Hepatology, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux; Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Cyrielle Gilletta
- Department of Gastroenterology and Pancreatology, Hôpital Rangueil, CHU de Toulouse, Université Toulouse Paul Sabatier, Toulouse, France
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Amiot A, Laharie D, Malamut G, Serrero M, Poullenot F. Management of immune checkpoint inhibitor in patients with cancer and pre-existing inflammatory bowel disease: Recommendations from the GETAID. Dig Liver Dis 2022; 54:1162-1167. [PMID: 35842365 DOI: 10.1016/j.dld.2022.06.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS There is no consensus on the management of immune checkpoint inhibitor (ICI) for treating cancer in patients with pre-existing inflammatory bowel disease (IBD). The Groupe d'Étude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID) aimed to provide recommendations on this topic. METHODS A dedicated working group performed a comprehensive expert-based review of the literature, generated clinical key question and shaped recommendations that were further voted for approval by the educational and scientific committees of the GETAID. Using consensus methods, treatment modalities were defined by vote. RESULTS Majority of patients with IBD in clinical remission can be treated with ICI after cancer diagnosis. The rate of relapse or immune-related diarrhoea or colitis upon ICI treatment is up to 39.8% and is maximal with ICI combination therapy compared to monotherapies. When starting ICI in a patient with IBD, it is recommended to assess disease activity and pursue ongoing maintenance therapy. In case of relapse or immune-related diarrhoea or colitis upon ICI treatment, treatment depends on grading of diarrhoea or colitis and may include corticosteroid therapy, infliximab and/or vedolizumab. CONCLUSIONS In the present publication, we provided recommendations, which may assist gastroenterologists, haematologists, and oncologists for a better management of patients with pre-existing IBD before and during cancer treatment with ICI.
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Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Hopitaux Universitaires Bicêtre, AP-HP, Universite Paris Est Creteil, Le Kremlin Bicêtre, France; INSERM, Centre for Research in Epidemiology and Population Health, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France.
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - Georgia Malamut
- Department of Gastroenterology, AP-HP-Centre, Université de Paris, Hôpital Cochin, Paris, France
| | - Melanie Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, Aix-Marseille, Marseille University, Marseille, France
| | - Florian Poullenot
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
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Rivière P, Kanters C, Pellet G, Ni A, Hupé M, Aboulhamid N, Poullenot F, Bitton A, Zerbib F, Lakatos PL, Afif W, Laharie D, Bessissow T. Comparative Effectiveness of Ustekinumab and Anti-TNF Agent as First-Line Biological Therapy in Luminal Crohn's Disease: A Retrospective Study From 2 Referral Centers. Inflamm Bowel Dis 2022:6653347. [PMID: 35917111 DOI: 10.1093/ibd/izac167] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Real-life data on the efficacy of ustekinumab as first-line therapy for the treatment of luminal Crohn's disease (CD) compared with anti-tumor necrosis factor (anti-TNF) agents are lacking. We compared the clinical response rates at 3 months in 2 cohorts of biologic-naïve patients treated by ustekinumab and anti-TNF agents. METHODS Biologic-naïve patients starting either ustekinumab or an anti-TNF agent for luminal CD between 2016 and 2019 in 2 tertiary centers were retrospectively included. The primary endpoint was clinical response at 3 months, defined as a Harvey-Bradshaw Index <4 or a 3-point drop in the score without steroids, need for CD-related surgery, or treatment discontinuation owing to failure or intolerance. Patients treated with ustekinumab were matched to patients receiving anti-TNF agents by a propensity score algorithm. RESULTS We included 156 patients starting anti-TNF agents (95 adalimumab and 61 infliximab) and 50 ustekinumab. After matching, clinical response rates at 3 months were 64% and 86% in the ustekinumab and anti-TNF groups, respectively (P = .01). At 12 months, in multivariate analysis adjusted for disease duration, location, concomitant immunosuppressant and steroids, and symptoms, clinical remission was independently associated with the biological therapy received (odds ratio, 2.6 for anti-TNF agent vs ustekinumab; P = .02). With a median follow-up duration of 40 (interquartile range, 23-52) months, no difference was observed in terms of time to drug withdrawal (P = .29) or safety. CONCLUSIONS This retrospective real-world data suggest that an anti-TNF agent as a first-line biological therapy is associated with higher rates of response at 3 months than ustekinumab in patients with CD.
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Affiliation(s)
- Pauline Rivière
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Caitlyn Kanters
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gauthier Pellet
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Alexander Ni
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Marianne Hupé
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Nesrine Aboulhamid
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Florian Poullenot
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Frank Zerbib
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Waqqas Afif
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - David Laharie
- INSERM CIC 1401, Gastroenterology Department, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Talat Bessissow
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
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9
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Le Cosquer G, Grangeon L, Rivière P, Berger A, Zerbib F, Laharie D, Poullenot F. A single dedicated vaccination visit improves vaccination coverage of patients with inflammatory bowel disease. Therap Adv Gastroenterol 2022; 15:17562848221082879. [PMID: 35493617 PMCID: PMC9039447 DOI: 10.1177/17562848221082879] [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: 12/01/2021] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Patients treated with biologics for inflammatory bowel disease (IBD) have an increased risk of severe infections. Real-life vaccination coverage in this population remains low despite international vaccination guidelines. The aim of this study was to evaluate the impact of a dedicated vaccination visit on vaccination coverage. METHODS A dedicated vaccination visit was offered to all patients admitted for an infusion of a biologic in a tertiary IBD center during a 4-week period. At baseline, vaccination status was collected. Patients received specific information on recommended vaccinations. Perceived utility of both vaccination and the dedicated visit were assessed by visual analogue scale (VAS). Vaccination coverage was reassessed 6 months later by phone call. RESULTS Among the 207 patients analyzed (1 patient declined), rates of vaccination at baseline and 6 months later against diphtheria were 52.7% and 68.6% (p < 0.001), tetanus 55.1% and 70% (p < 0.001), poliomyelitis 51.7% and 68.6% (p < 0.001), pertussis 33.3% and 51.2% (p < 0.001), hepatitis B virus (HBV) 61.4% and 66.7% (p < 0.01), pneumococcus 15.5% and 42.0% (p < 0.001), influenza 29.5% and 36.2% (p < 0.01), and meningococcus C 11.6% and 13.0% (p = 0.083), respectively. A quarter of the patients declined at least one recommended vaccination after the visit. The main reason for this refusal was distrust toward one or more vaccines. CONCLUSION A single visit dedicated to vaccination significantly increases rates of vaccination in patients with IBD treated with biologics.
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Affiliation(s)
- Guillaume Le Cosquer
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | - Lionel Grangeon
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | - Pauline Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | - Arthur Berger
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | - Frank Zerbib
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive, Université de Bordeaux, Bordeaux, France
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10
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Enaud R, Tetard C, Dupuis R, Laharie D, Lamireau T, Zerbib F, Rivière P, Shili-Mismoudi S, Poullenot F. Compliance with Gluten Free Diet Is Associated with Better Quality of Life in Celiac Disease. Nutrients 2022; 14:nu14061210. [PMID: 35334866 PMCID: PMC8951042 DOI: 10.3390/nu14061210] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
The quality of life (QOL) of patients with celiac disease (CD) can be altered by both symptoms of the disease and by the restrictions of the gluten-free diet (GFD). The objective was to determine the factors associated with better QOL in a large cohort of CD patients. A link to an online survey was sent to the members of the French Association of Gluten Intolerant People (AFDIAG). The French-Celiac Disease Questionnaire (F-CDQ), scoring from 0 to 100, was used to measure the QOL. Other data collected were sociodemographic characteristics, information on CD, purchasing and consumption habits of gluten-free products, and a self-assessment scale (ranging from 0 to 10) to determine the compliance with the GFD. Among the 907 CD patients who returned the questionnaire, 787 were analyzed (638 women (81%); median age: 49 years; 71% with self-assessed GFD compliance > 8). Their median F-CDQ was 73 (range: 59−82). In multivariate analysis, the main factors associated with a better quality of life were the long duration of the GFD, good compliance with the GFD, and the number of follow-up visits. Compliance with and duration of the GFD are associated with a better quality of life in patients with CD. Taking this into consideration would offset its restrictive aspect and improve its adherence.
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Affiliation(s)
- Raphaël Enaud
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
| | - Candice Tetard
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Raphaël Dupuis
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - David Laharie
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Thierry Lamireau
- CHU de Bordeaux, Hôpital des Enfants, Service d’Hépato-Gastroentérologie Pédiatriques, 33000 Bordeaux, France; (R.E.); (C.T.); (T.L.)
| | - Frank Zerbib
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Pauline Rivière
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Sarah Shili-Mismoudi
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
| | - Florian Poullenot
- CHU de Bordeaux, Centre Médico-chirurgical Magellan, Hôpital Haut-Lévêque, Gastroenterology Department, Université de Bordeaux, INSERM CIC 1401, 33000 Bordeaux, France; (R.D.); (D.L.); (F.Z.); (P.R.); (S.S.-M.)
- Correspondence:
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11
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Joly F, Quilliot D, Chambrier C, Schneider S, Fotsing G, Poullenot F, Layec S, Flori N, Thibault R, Fontaine E, Ressiot E, Campana V, Schmidely N, Seguy D. EQUATIVE : étude française de la qualité de vie des adultes atteints d’un syndrome de grêle court sous Teduglutide. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.004] [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: 11/17/2022]
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Castinel J, Pellet G, Laharie D, Zerbib F, Silvain C, Wilsius E, Kerlogot L, Rivière P, Poullenot F. MALE GENDER IS ASSOCIATED WITH INFORMAL CAREGIVER BURDEN IN CHRONIC INTESTINAL FAILURE PATIENTS TREATED WITH HOME PARENTERAL NUTRITION. JPEN J Parenter Enteral Nutr 2022; 46:1593-1601. [DOI: 10.1002/jpen.2340] [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] [Received: 09/06/2021] [Revised: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Jean Castinel
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
- CHU de Poitiers, Hepato‐Gastroenterology Department; Université de Poitiers Poitiers France
| | - Gauthier Pellet
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - David Laharie
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - Frank Zerbib
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - Christine Silvain
- CHU de Poitiers, Hepato‐Gastroenterology Department; Université de Poitiers Poitiers France
| | - Eva Wilsius
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - Laurianne Kerlogot
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - Pauline Rivière
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
| | - Florian Poullenot
- CHU de Bordeaux, Centre Medico‐chirurgical Magellan, Hôpital Haut‐Lévêque, Gastroenterology Department; Université de Bordeaux; INSERM CIC 1401 Bordeaux France
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13
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Joly F, Quilliot D, Chambrier C, Schneider S, Fotsing G, Poullenot F, Layec S, Flori N, Thibault R, Fontaine E, Ressiot E, Campana V, Schmidely N, Seguy D. Equative: quality of life in adult patients with short bowel syndrome treated by teduglutide, a french real-world study. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.346] [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: 10/19/2022]
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14
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Montes G, Duval F, Eldani C, Amico S, Gérard E, Dutriaux C, Herran C, Poullenot F, Sole G, Carla L, Guerin C, Célerier P, Prey S. Esophageal Achalasia Induced by Ipilimumab and Nivolumab Combination: A Rare Neurological Manifestation of Immune-related Autonomic Neuropathy. J Immunother 2021; 44:348-350. [PMID: 34166302 DOI: 10.1097/cji.0000000000000381] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022]
Abstract
Immunotherapy with immune checkpoint inhibitors (ICIs) has improved the prognosis of many cancers; a combination of nivolumab (anti-programmed cell death protein 1) and ipilimumab (anti-cytotoxic T-lymphocyte-associated protein 4) is approved as first-line therapy for advanced melanoma, with objective responses obtained in more than half of patients. However, this combination is associated with a high rate of immune-related adverse events, which are often severe and multiple. Neurological immune-related adverse events are rare but feared because they can be life-threatening, their diagnosis and management are challenging, and patients can have irreversible sequelae. We reported a case of a young patient treated by nivolumab and ipilimumab combination for metastatic melanoma. Severe dysphagia with regurgitations, major weight loss, uveitis, and vitiligo occurred after 3 infusions of nivolumab and ipilimumab. Magnetic resonance imaging and positron emission tomography scan showed complete remission of melanoma. The endoscopic examination did not find any digestive toxicity. Esophageal manometry revealed achalasia. This was associated with mydriasis, pathologic deep breath test, and alteration of the cutaneous sympathetic response on electromyogram, which was consistent with autonomic neuropathy. This rare etiology of atypical vomiting under ICI should be known by prescribers, as ICI prescription is widening in many new cancers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Sorilla Prey
- Dermatology Department
- University of Bordeaux, Inserm U-1035
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15
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Pironi L, Steiger E, Joly F, Jeppesen PB, Wanten G, Sasdelli AS, Chambrier C, Aimasso U, Mundi MS, Szczepanek K, Jukes A, Theilla M, Kunecki M, Daniels J, Serlie M, Poullenot F, Cooper SC, Rasmussen HH, Compher C, Seguy D, Crivelli A, Santarpia L, Guglielmi FW, Kozjek NR, Schneider SM, Ellegard L, Thibault R, Matras P, Matysiak K, Van Gossum A, Forbes A, Wyer N, Taus M, Virgili NM, O'Callaghan M, Chapman B, Osland E, Cuerda C, Udvarhelyi G, Jones L, Won Lee AD, Masconale L, Orlandoni P, Spaggiari C, Díez MB, Doitchinova-Simeonova M, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Czako L, Kekstas G, Sanz-Paris A, Jáuregui MEP, Murillo AZ, Schafer E, Arends J, Suárez-Llanos JP, Youssef NN, Brillanti G, Nardi E, Lal S. Characteristics of adult patients with chronic intestinal failure due to short bowel syndrome: An international multicenter survey. Clin Nutr ESPEN 2021; 45:433-441. [PMID: 34620351 DOI: 10.1016/j.clnesp.2021.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 06/30/2021] [Accepted: 07/08/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND AIMS The case-mix of patients with intestinal failure due to short bowel syndrome (SBS-IF) can differ among centres and may also be affected by the timeframe of data collection. Therefore, the ESPEN international multicenter cross-sectional survey was analyzed to compare the characteristics of SBS-IF cohorts collected within the same timeframe in different countries. METHODS The study included 1880 adult SBS-IF patients collected in 2015 by 65 centres from 22 countries. The demographic, nutritional, SBS type (end jejunostomy, SBS-J; jejuno-colic anastomosis, SBS-JC; jejunoileal anastomosis with an intact colon and ileocecal valve, SBS-JIC), underlying disease and intravenous supplementation (IVS) characteristics were analyzed. IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorized as <1, 1-2, 2-3 and >3 L/day. RESULTS In the entire group: 60.7% were females and SBS-J comprised 60% of cases, while mesenteric ischaemia (MI) and Crohn' disease (CD) were the main underlying diseases. IVS dependency was longer than 3 years in around 50% of cases; IVS was infused ≥5 days/week in 75% and FE in 10% of cases. Within the SBS-IF cohort: CD was twice and thrice more frequent in SBS-J than SBS-JC and SBS-JIC, respectively, while MI was more frequent in SBS-JC and SBS-JIC. Within countries: SBS-J represented 75% or more of patients in UK and Denmark and 50-60% in the other countries, except Poland where SBS-JC prevailed. CD was the main underlying disease in UK, USA, Denmark and The Netherlands, while MI prevailed in France, Italy and Poland. CONCLUSIONS SBS-IF type is primarily determined by the underlying disease, with significant variation between countries. These novel data will be useful for planning and managing both clinical activity and research studies on SBS.
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Affiliation(s)
- Loris Pironi
- CHU Rennes, Nutrition Unit, Clinique Saint Yves, Home Parenteral Nutrition Centre, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France.
| | - Ezra Steiger
- Home Nutrition Support, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Palle B Jeppesen
- Rigshospitalet, Department of Gastroenterology, Copenhagen, Denmark
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Anna S Sasdelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Centre for Chronic Intestinal Failure - Clinical Nutrition and Metabolism Unit, Bologna, Italy
| | - Cecile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Hôpital Lyon Sud, Lyon, France
| | | | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo College of Medicine, Rochester, MN, USA
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Amelia Jukes
- University Hospital of Wales, Cardiff, United Kingdom
| | - Miriam Theilla
- Rabin Medical Center, Petach Tikva, Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | - Mireille Serlie
- Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Florian Poullenot
- Service de Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Henrik H Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene Compher
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - David Seguy
- Service de Nutrition, CHRU de Lille, Lille, France
| | - Adriana Crivelli
- Unidad de Soporte Nutricional, Rehabilitación y Trasplante de Intestino, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | | | | | - Stéphane M Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, Université Côte D'Azur, Nice, France
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ronan Thibault
- CHU Rennes, Nutrition Unit, Clinique Saint Yves, Home Parenteral Nutrition Centre, INRAE, INSERM, Univ Rennes, Nutrition Metabolisms and Cancer, NuMeCan, Rennes, France
| | - Przemysław Matras
- Department of General and Transplant Surgery and Clinical Nutrition, Medical University of Lublin, Lublin, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Department of General, Endocrinological and Gastroenterological Surgery, Poznań University of Medical Science, Poznań, Poland
| | - Andrè Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Alastair Forbes
- Institute of Internal Medicine, University of Tartu, Tartu, Estonia, And Previously at Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Nicola Wyer
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Marina Taus
- SOD Dietetica e Nutrizione Clinica, Centro Riferimento Regionale NAD, Ospedali Riuniti di Ancona, Italy
| | - Nuria M Virgili
- Facultatiu Especialista. Servei D'Endocrinologia I Nutrició, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andre D Won Lee
- Hospital Das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paolo Orlandoni
- Nutrizione Clinica-Centro di Riferimento Regionale NAD, IRCCS-INRCA, Ancona, Italy
| | | | - Marta Bueno Díez
- Servei D'Endocrinologia I Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | | | - Zeljko Krznaric
- Centre of Clinical Nutrition, Department of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Laszlo Czako
- First Department of Internal Medicine, Szeged, Hungary
| | | | | | | | | | - Eszter Schafer
- Magyar Honvedseg Egészségügyi Központ (MHEK), Budapest, Hungary
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | - José P Suárez-Llanos
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Nader N Youssef
- VectivBio AG Basel, Switzerland, Digestive Healthcare Center, NJ, USA
| | - Giorgia Brillanti
- Alma Mater Studiorum, University of Bologna, Department of Medical and Surgical Sciences, Bologna, Italy
| | - Elena Nardi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
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16
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Tilmant M, Serrero M, Poullenot F, Bouguen G, Pariente B, Altwegg R, Basile P, Filippi J, Vanelslander P, Buisson A, Desjeux A, Laharie D, Le Balch E, Nachury M, Boivineau L, Savoye G, Hebuterne X, Poincloux L, Vuitton L, Brazier F, Yzet C, Lamrani A, Peyrin-Biroulet L, Fumery M. Endoscopic balloon dilation of colorectal strictures complicating Crohn's disease: a multicenter study. Clin Res Hepatol Gastroenterol 2021; 45:101561. [PMID: 33214090 DOI: 10.1016/j.clinre.2020.10.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION While endoscopic balloon dilation (EBD) is widely used to manage ileal strictures, EBD of colorectal strictures remains poorly investigated in Crohn's disease (CD). METHODS We performed a retrospective study that included all consecutive CD patients who underwent EBD for native or anastomotic colorectal strictures in 9 tertiary centers between 1999 and 2018. Factors associated with EBD failure were also investigated by logistic regression. RESULTS Fifty-seven patients (25 women, median age: 36 years (InterQuartile Range, 31-48) were included. Among the 60 strictures, 52 (87%) were native, 39 (65%) measured < 5 cm and the most frequent location was the left colon (27%). Fifty-seven (95%) were non-passable by the scope and 35 (58%) were ulcerated. Among the 161 EBDs performed (median number of dilations per stricture: 2, IQR 1-3), technical and clinical success were achieved for 79% (n = 116/147) and 77% (n = 88/115), respectively. One perforation occurred (0.6% per EDB and 2% per patient). After a median follow-up of 4.3 years (IQR 2.0-8.4), 24 patients (42%) underwent colonic resection and 24 (42%) were asymptomatic without surgery. One colon lymphoma and one colorectal cancer were diagnosed (3.5% of patients) from endoscopic biopsies and at the time of surgery, respectively. No factor was associated with technical or clinical success. CONCLUSION EDB of CD-associated colorectal strictures is feasible, efficient and safe, with more than 40% becoming asymptomatic without surgery.
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Affiliation(s)
- Marion Tilmant
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Mélanie Serrero
- Department of Gastroenterology, Hôpital Nord, Université Méditerranée, Marseille, France
| | - Florian Poullenot
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Guillaume Bouguen
- CHU Rennes, University Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), F-35000 Rennes, France
| | | | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Paul Basile
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Jérôme Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | | | - Anthony Buisson
- Université Clermont Auvergne, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - Ariane Desjeux
- Department of Gastroenterology, Hôpital Nord, Université Méditerranée, Marseille, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Eric Le Balch
- CHU Rennes, University Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), F-35000 Rennes, France
| | - Maria Nachury
- CHU Lille, Department of Gastroenterology, F-59000 Lille, France
| | - Lucile Boivineau
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Xavier Hebuterne
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Laurent Poincloux
- Université Clermont Auvergne, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Franck Brazier
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Clara Yzet
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Adnane Lamrani
- Department of Biostatistics, Amiens University Hospital, Amiens, France
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm NGERE, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France.
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Malian A, Rivière P, Bouchard D, Pigot F, Eléouet-Kaplan M, Favreau-Weltzer C, Poullenot F, Laharie D. Erratum to: Predictors of Perianal Fistula Relapse in Crohn's Disease. Inflamm Bowel Dis 2021; 27:1365. [PMID: 33277906 DOI: 10.1093/ibd/izaa272] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Domblides C, Gross-Goupil M, Ravaud A, Poullenot F, Daste A. Colitis presenting 5 months after the final dose of anti-PD-1: long-term monitoring is warranted after adjuvant therapy. Immunotherapy 2021; 13:741-744. [PMID: 33906378 DOI: 10.2217/imt-2020-0282] [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: 11/21/2022] Open
Abstract
Immune checkpoint inhibitors have been approved as adjuvant therapy. Adverse immune events occurred during the administration of treatment, and delayed immune-related events have low incidence. A 66-year-old man was treated for hypopharynx cancer in 2012. In 2019, he was treated for a new oropharynx cancer. After undergoing surgery and complete response, the patient received nivolumab as adjuvant treatment. 5 months after the last dose of nivolumab, he presented with grade III diarrhea and abdominal pain for 3 weeks. Rectoscopy showed infiltration of mucous by lymphocytes. Corticosteroid was started resulting in a rapid decrease in symptom severity. With the increasing immune checkpoint inhibitors in adjuvant therapy, strict surveillance and education of patient in remission is necessary.
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Affiliation(s)
- Charlotte Domblides
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux-University of Bordeaux, Bordeaux, France
| | - Marine Gross-Goupil
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux-University of Bordeaux, Bordeaux, France
| | - Alain Ravaud
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux-University of Bordeaux, Bordeaux, France
| | - Florian Poullenot
- Department of Gastroenterology, Hôpital Haut-Leveque, CHU Bordeaux-University of Bordeaux, Bordeaux, France
| | - Amaury Daste
- Department of Medical Oncology, Hôpital Saint-André, CHU Bordeaux-University of Bordeaux, Bordeaux, France
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Montes G, Duval F, Eldani C, Amico S, Gerard E, Dutriaux C, Herran C, Poullenot F, Sole G, Guerin C, Zerbib F, Celerier P, Prey S. Vomissements incoercibles révélant une achalasie de l’œsophage avec AC anti-GAD65+ : une complication neurologique dysautonomique méconnue de l’association ipilimumab+nivolumab. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.477] [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: 11/27/2022]
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20
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Pironi L, Steiger E, Joly F, Wanten GJA, Chambrier C, Aimasso U, Sasdelli AS, Szczepanek K, Jukes A, Theilla M, Kunecki M, Daniels J, Serlie MJ, Cooper SC, Poullenot F, Rasmussen HH, Compher CW, Crivelli A, Hughes SJ, Santarpia L, Guglielmi FW, Rotovnik Kozjek N, Ellegard L, Schneider SM, Matras P, Forbes A, Wyer N, Zmarzly A, Taus M, O'Callaghan M, Osland E, Thibault R, Cuerda C, Jones L, Chapman B, Sahin P, Virgili NM, Lee ADW, Orlandoni P, Matysiak K, Di Caro S, Doitchinova-Simeonova M, Masconale L, Spaggiari C, Garde C, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Petrina Jáuregui E, Zugasti Murillo A, Suárez-Llanos JP, Nardi E, Van Gossum A, Lal S. Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure. Gut 2020; 69:1787-1795. [PMID: 31964752 DOI: 10.1136/gutjnl-2018-318172] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [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: 12/24/2018] [Revised: 12/23/2019] [Accepted: 01/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM No marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity. METHODS At baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1-2, 2-3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI). RESULTS Fifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients' death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2-3 and PN >3 L/day). CONCLUSIONS The type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.
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Affiliation(s)
- Loris Pironi
- Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Ezra Steiger
- Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Francisca Joly
- Service de Gastroentérologie et d'Assistance nutritive, Hôpital Beaujon, Assistance Publique - Hopitaux de Paris, University of Paris, Clichy, France
| | - Geert J A Wanten
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cecile Chambrier
- Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
| | - Umberto Aimasso
- Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, Piemonte, Italy
| | | | | | - Amelia Jukes
- University Hospital of Wales, Cardiff, Cardiff, UK
| | - Miriam Theilla
- Nursing Department, Steyer School of Health Professions, Sackler School of Medicine, Tel Aviv, Israel
| | - Marek Kunecki
- Clinical Nutrition Department, M Pirogow Hospital, Lodz, Poland
| | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Mireille J Serlie
- Endocrinology and Metabolism, Academic Medical Center, Amsterdam, The Netherlands
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Florian Poullenot
- Hôpital Haut-Lévêque, Service d'hépato-gastroentérologie, CHU Bordeaux, Pessac, France
| | - Henrik Højgaard Rasmussen
- Center for Nutrition and Bowel Disease, Department of Medical Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene W Compher
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adriana Crivelli
- Fundacion Favaloro Hospital Universitario, Buenos Aires, Federal District, Argentina
| | | | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, Università degli Studi di Napoli Federico II, Napoli, Campania, Italy
| | | | | | | | - Stéphane M Schneider
- Centre Hospitalier Universitaire de Nice, Nice, Provence-Alpes-Côte d'Azur, France
| | | | - Alastair Forbes
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Nicola Wyer
- University Hospital Coventry, Coventry, Coventry, UK
| | | | - Marina Taus
- Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - Ronan Thibault
- Centre de référence Maladies Rares Digestives, Unité de Nutrition, CHU Rennes, INRAE, INSERM, Universite de Rennes, Nutrition Metabolisms and Cancer institute, NuMeCan, Rennes, Bretagne, France
| | - Cristina Cuerda
- Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Brooke Chapman
- Nutrition and Dietetics, Austin Health, Heidelberg, Victoria, Australia
| | | | - Núria M Virgili
- Unitat de Nutrició i Dietètica, Hospital Universitari Bellvitge, L'Hospitalet Llobregat, Barcelona, Spain
| | - Andre Dong Won Lee
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Konrad Matysiak
- Centre for Intestinal Failure, Uniwersytet Medyczny imienia Karola Marcinkowskiego w Poznaniu, Poznan, Poland
| | | | | | - Luisa Masconale
- Unita' Locale Socio-Sanitaria N° 22, Bussolengo, Verona, Italy
| | - Corrado Spaggiari
- Azienda Unita Sanitaria Locale di Parma, Parma, Emilia-Romagna, Italy
| | - Carmen Garde
- Hospital Universitario de Donostia, San Sebastian, País Vasco, Spain
| | | | - Gabriel Olveira
- Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | | | | | | | - José P Suárez-Llanos
- Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Canarias, Spain
| | - Elena Nardi
- Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - André Van Gossum
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Simon Lal
- Gastroenterology and Intestinal Failure Unit, Salford Royal Foundation Trust, University of Manchester, Manchester, UK
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Fumery M, Peyrin-Biroulet L, Nancey S, Altwegg R, Gilletta C, Veyrard P, Bouguen G, Viennot S, Poullenot F, Filippi J, Buisson A, Bozon A, Brazier F, Pouillon L, Flourie B, Boivineau L, Siproudhis L, Laharie D, Roblin X, Diouf M, Treton X. Effectiveness And Safety Of Ustekinumab Intensification At 90 Mg Every Four Weeks In Crohn's Disease: A Multicenter Study. J Crohns Colitis 2020; 15:jjaa177. [PMID: 32898232 DOI: 10.1093/ecco-jcc/jjaa177] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 05/05/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The approved maintenance regimens for ustekinumab in Crohn's disease (CD) are 90 mg every 8 or 12 weeks. Some patients will partially respond to ustekinumab or will experience a secondary loss of response. It remains poorly known if these patients may benefit from shortening the interval between injections. METHODS All patients with active CD, as defined by Harvey-Bradshaw score ≥ 4 and one objective sign of inflammation (CRP > 5 mg/L and/or fecal calprotectin > 250 µg/g and/or radiologic and/or endoscopic evidence of disease activity) who required ustekinumab dose escalation to 90mg every 4 weeks for loss of response or incomplete response to ustekinumab 90mg every 8 weeks were included in this retrospective multicenter cohort study. RESULTS One hundred patients, with a median age of 35 years (Interquartile Range (IQR), 28 - 49) and median disease duration of 12 (7 - 20) years were included. Dose intensification was performed after a median of 5.0 (2.8 - 9.0) months of ustekinumab treatment and was associated with corticosteroids and immunosuppressants in respectively 29% and 27% of cases. Short-term clinical response and clinical remission were observed in respectively 61% and 31% after a median of 2.4 (1.3 - 3.0) months. After a median follow-up of 8.2 (5.6-12.4) months, 61% of patients were still treated with ustekinumab, and 26% in steroid-free clinical remission. Among the 39 patients with colonoscopy during follow-up, 14 achieved endoscopic remission (no ulcers). At the end of follow-up, 27% of patients were hospitalized, and 19% underwent intestinal resection surgery. Adverse events were reported in 12% of patients, including five serious adverse events. CONCLUSION In this multicenter study, two-thirds of patients recaptured response following treatment intensification with ustekinumab 90 mg every 4 weeks.
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Affiliation(s)
- Mathurin Fumery
- Department of Gastroenterology, and PeriTox, UMR I0-I, Amiens University Hospital, Amiens, France
| | - Laurent Peyrin-Biroulet
- INSERM U1256 NGERE, Department of Gastroenterology, Nancy University Hospital, Lorraine University, Nancy, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, and INSERM U1111, CIRI, Lyon, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Pauline Veyrard
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Guillaume Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Florian Poullenot
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, Bordeaux, France
| | - Jerome Filippi
- Department of Gastroenterology, Archet 2 University Hospital, Nice, France
| | - Anthony Buisson
- Université Clermont Auvergne, Inserm, U1071, M2iSH, USC-INRA 2018 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France
| | - Anne Bozon
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, Université de Paris site Denis Diderot, Clichy, France
| | - Franck Brazier
- Department of Gastroenterology, and PeriTox, UMR I0-I, Amiens University Hospital, Amiens, France
| | - Lieven Pouillon
- INSERM U1256 NGERE, Department of Gastroenterology, Nancy University Hospital, Lorraine University, Nancy, France
| | - Bernard Flourie
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, and INSERM U1111, CIRI, Lyon, France
| | - Lucile Boivineau
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Laurent Siproudhis
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), Rennes, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, Bordeaux, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Momar Diouf
- Department of Biostatistics, Amiens University Hospital, Amiens, France
| | - Xavier Treton
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, Université de Paris site Denis Diderot, Clichy, France
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Martin A, Nachury M, Peyrin-Biroulet L, Bouhnik Y, Nancey S, Bourrier A, Serrero M, Fumery M, Buisson A, Laharie D, Gilletta C, Filippi J, Allez M, Bouguen G, Roblin X, Altwegg R, Dib N, Pineton de Chambrun G, Savoye G, Carbonnel F, Viennot S, Amiot A, Martin A, Gagnière C, Nachury M, Pariente B, Wils P, Peyrin-Biroulet L, Zallot C, Bouhnik Y, Treton X, Stefanescu C, Nancey S, Boschetti G, Seksik P, Beaugerie L, Kirchgesner J, Bourrier A, Sokol H, Serrero M, Fumery M, Yzet C, Brazier F, Laharie D, Rivière P, Poullenot F, Buisson A, Gilletta C, Filippi J, Hebuterne X, Allez M, Gornet JM, Bouguen G, Siproudhis L, Roblin X, Altwegg R, Pineton de Chambrun G, Dib N, Savoye G, Carbonnel F, Meyer A, Viennot S, Lebaut G. Maintenance of Remission Among Patients With Inflammatory Bowel Disease After Vedolizumab Discontinuation: A Multicentre Cohort Study. J Crohns Colitis 2020; 14:896-903. [PMID: 31930285 DOI: 10.1093/ecco-jcc/jjaa005] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM It is unclear whether vedolizumab therapy can be discontinued in patients with inflammatory bowel disease [IBD] after achieving steroid-free clinical remission. The aim was to assess the risk of relapse after vedolizumab therapy was discontinued. METHODS This was a retrospective observational study, collecting data from 21 tertiary centres affiliated with the GETAID from January 2017 to April 2019. Consecutive patients with IBD, who were in steroid-free clinical remission for at least 3 months and were treated with vedolizumab for at least 6 months, were included at the time of vedolizumab discontinuation. RESULTS A total of 95 patients [58 with Crohn's disease] discontinued vedolizumab after a median duration of therapy of 17.5 [10.6-25.4] months. After a median follow-up period of 11.2 [5.8-17.7] months, 61 [64%] patients experienced disease relapse. The probabilities of relapse-free survival were 83%, 59%, and 36% at 6, 12, and 18 months, respectively. According to the multivariate analysis, a C-reactive protein level less than 5 mg/L at vedolizumab discontinuation (hazard ratio [HR] = 0.56, 95% confidence interval [CI] [0.33-0.95], p = 0.03) and discontinuation due to patients' elective choice (HR = 0.41, 95% CI [0.21-0.80], p = 0.009) were significantly associated with a lower risk of relapse. Re-treatment with vedolizumab was noted in 24 patients and provided steroid-free clinical remission in 71% and 62.5% at Week 14 and after a median follow-up of 11.0 [5.4-13.3] months, respectively, without any infusion reactions. CONCLUSIONS In this retrospective study, two-thirds of patients with IBD treated with vedolizumab experienced relapse within the first year after vedolizumab discontinuation. Re-treatment with vedolizumab was effective in two-thirds of patients.
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Affiliation(s)
- Antoine Martin
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | | | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Anne Bourrier
- Department of Gastroenterology, Sorbonne Univeristé, Centre de Recherche Saint-Antoine, Paris, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Mathurin Fumery
- Department of Gastroenterology, Peritox UMRI-01, Amiens University Hospital, Amiens, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | | | - Guillaume Savoye
- Department of Gastroenterology, Bicetre University Hospital, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre University Hospital, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | | | - Antoine Martin
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA7375, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Charlotte Gagnière
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA7375, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | - Benjamin Pariente
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | - Pauline Wils
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | | | - Camille Zallot
- INSERM U954 and Department of Gastroenterology, Université de Lorraine, Nancy, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Xavier Treton
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Carmen Stefanescu
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Gilles Boschetti
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Philippe Seksik
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Laurent Beaugerie
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Julien Kirchgesner
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Anne Bourrier
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Harry Sokol
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Melanie Serrero
- Hôpital Nord, Centre d’investigation clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Clara Yzet
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Franck Brazier
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Pauline Rivière
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Florian Poullenot
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Anthony Buisson
- Department of Gastroenterology, University of Clermont Ferrand, Clermont-Ferrand, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Jérôme Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Xavier Hebuterne
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Jean-Marc Gornet
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Laurent Siproudhis
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | | | - Nina Dib
- Department of Gastroenterology, Angers University Hospital, Angers, France
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - Antoine Meyer
- Department of Gastroenterology, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Guillaume Lebaut
- Department of Gastroenterology, Caen University Hospital, Caen, France
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Malian A, Rivière P, Bouchard D, Pigot F, Eléouet-Kaplan M, Favreau-Weltzer C, Poullenot F, Laharie D. Pedictors of Perianal Fistula Relapse in Crohn's Disease. Inflamm Bowel Dis 2020; 26:926-931. [PMID: 31504542 DOI: 10.1093/ibd/izz200] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite an optimal medico-surgical management of perineal Crohn's disease (PCD), fistula relapse still occurs in 30% of patients. Our aim was to determine predictors of fistula relapse in patients in remission after treatment of a PCD lesion. METHODS Consecutive patients treated for fistulizing PCD have been included in a retrospective study when they achieved fistula remission within 3 months after the surgery. Remission was defined as the absence of any draining fistula at clinical examination. Primary outcome was the occurrence of a fistula relapse, defined as a subsequent perianal draining fistula or an abscess confirmed clinically and/or by pelvic MRI. RESULTS One hundred and thirty-seven patients (57% female, median age: 35 years) corresponding to 157 abscess events, including 120 (76.4%) treated by anti-TNF after drainage, achieved fistula remission after surgery. During the follow-up period (median duration: 43 months [interquartile range 26 to 64]), 34 (22%) patients experienced a fistula relapse within a median time of 1.8 years. Survival without fistula was 96.7% at 1 year, 78.4% at 3 years, and 74.4% at 5 years. Fistula relapse rates were not different in patients receiving infliximab or adalimumab (P = 0.66). In patients treated by anti-TNF at inclusion, discontinuation of anti-TNF therapy (odds ratio 3.49, P = 0.04), colonic location (OR 6.25, P = 0.01), and stricturing phenotype (odds ratio 4.39, P = 0.01) were independently associated with fistula relapse in multivariate analysis. CONCLUSION In patients achieving fistula remission of PCD, relapse rates are low and are not different between infliximab and adalimumab. Discontinuation of anti-TNF therapy is associated with increased relapse rate.
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Affiliation(s)
- Audrey Malian
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - Pauline Rivière
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - Dominique Bouchard
- Proctologie, Maison de Santé Protestante Bordeaux-Bagatelle, Talence, France
| | - François Pigot
- Proctologie, Maison de Santé Protestante Bordeaux-Bagatelle, Talence, France
| | | | | | - Florian Poullenot
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - David Laharie
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
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24
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Poullenot F, Ollivier J, Rivière P, Sauvaget L, Berroneau A, Djabarouti S, Xuereb F, Zerbib F, Breilh D, Laharie D. Implementation of infliximab standardized doses after pharmacokinetic modelization in a cohort of patients with Crohn's disease. Dig Liver Dis 2020; 52:408-413. [PMID: 31874834 DOI: 10.1016/j.dld.2019.11.018] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND According to infliximab (IFX) license in Crohn's disease (CD), infusion doses are based on patient's body-weight. Dose banding providing standardized doses (SD) has been implemented in parenteral chemotherapy in order to optimize aseptic unit capacity and reduce drug expenditure, duration of hospital stay and costs without decreasing efficacy. MATERIAL AND METHOD The first part was a single-center retrospective analysis of consecutive CD patients receiving IFX maintenance therapy to determine standardized doses covering more than 50% of infusions. The second part was a prospective cohort study assessing the impact of SD compared to body-weight doses (BWD) on admission duration and costs. RESULTS Six IFX SD covering more than 90% of infusion doses were implemented for dose banding. According to the Monte-Carlo simulation, there was no significant difference between IFX SD and BWD maintenance regimens. When assessed prospectively in 116 patients (75 patients treated with SD and 41 with BWD) corresponding to 128 infusions, hospitalization duration was shortened by 70 min per patient (p < 0.001). CONCLUSION According to a pharmacokinetic model, IFX SD has a pharmacokinetic profile close to BWD and is associated with reduced length of hospitalization in a cohort of patients with CD. IFX SD implementation could optimize infusion units functioning and, save time and costs without decreasing efficacy.
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Affiliation(s)
- Florian Poullenot
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France.
| | - Julien Ollivier
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France
| | - Pauline Rivière
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
| | - Lucie Sauvaget
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France
| | - Aude Berroneau
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - Sarah Djabarouti
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - Fabien Xuereb
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - Frank Zerbib
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
| | - Dominique Breilh
- Pharmacie, Groupe Hospitalier Sud Haut-Lévêque, CHU De Bordeaux, Pessac, France; Laboratoire De Pharmacocinétique Et De Pharmacie Clinique, Université Victor Segalen, Bordeaux Cedex, France; INSERM U1034 Cardiovascular Adaptation to Ischemia, Pessac, France
| | - David Laharie
- CHU De Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
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Pineton de Chambrun G, Amiot A, Bouguen G, Viennot S, Altwegg R, Louis E, Collins M, Fumery M, Poullenot F, Armengol L, Buisson A, Abitbol V, Laharie D, Seksik P, Nancey S, Blanc P, Bouhnik Y, Pariente B, Peyrin-Biroulet L, Boschetti G, Flourié B, Danion P, Savoye G, brazier F, Loreau J, Beaugerie L, Sokol H, Nion-Larmurier I, Bourrier A, Landman C, Lefèvre J, Chafai N, Bouta N, Funakoshi N. Efficacy of Tumor Necrosis Factor Antagonist Treatment in Patients With Refractory Ulcerative Proctitis. Clin Gastroenterol Hepatol 2020; 18:620-627.e1. [PMID: 31202984 DOI: 10.1016/j.cgh.2019.05.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 01/18/2019] [Revised: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS It is a challenge to manage patients with ulcerative proctitis (UP) refractory to standard therapy. We investigated the effectiveness of tumor necrosis factor (TNF) antagonists in a large cohort of patients with refractory UP. METHODS We conducted a nationwide retrospective cohort study of 104 consecutive patients with active UP refractory to conventional therapies, treated at 1 of 15 centers in France or 1 center in Belgium (the GETAID cohort). Patients received at least 1 injection of anti-TNF (infliximab, adalimumab, golimumab) from October 2006 through February 2017. Clinical response was defined as significant improvement in UC-related symptoms, and remission as complete disappearance of UC-related symptoms, each determined by treating physicians. We collected demographic, clinical, and treatment data. The median duration of follow-up was 24 months (interquartile range, 13-51 months). The primary outcome was clinical response of UP to anti-TNF treatment. RESULTS Overall, 80 patients (77%) had a clinical response to anti-TNF therapy and 52 patients (50%) achieved clinical remission. Extra-intestinal manifestations (odds ratio OR, 0.24; 95% CI, 0.08-0.7), ongoing treatment with topical steroids (OR, 0.14; 95% CI, 0.03-0.73), and ongoing treatment with topical 5-aminosalycilates (OR, 0.21; 95% CI, 0.07-0.62) were significantly associated with the absence of clinical remission. Sixty percent (38/63) of the patients who had endoscopic assessment during follow up had mucosal healing. Among the overall population (n = 104), the cumulative probabilities of sustained clinical remission were 87.6% ± 3.4% at 1 year and 74.7% ± 4.8% at 2 years. CONCLUSIONS In a retrospective study of 104 patients with refractory UP, anti-TNF therapy induced clinical remission in 50% and mucosal healing in 60%. About two thirds of the patients were still receiving anti-TNF therapy at 2 years.
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Affiliation(s)
| | - Aurélien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Creteil University, Creteil, France
| | - Guillaume Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000 Rennes, France
| | - Stéphanie Viennot
- Department of Gastroenterology, University Hospital of Caen, Caen, France
| | - Romain Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, Liège, Belgium
| | - Michael Collins
- Department of Gastroenterology, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Florian Poullenot
- Department of Gastroenterology, Haut-Leveque Hospital, Bordeaux University, Pessac, France
| | - Laura Armengol
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anthony Buisson
- Department of Gastroenterology, Estaing Hospital, Clermont-Ferrand University, Clermont-Ferrand, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin Hospital, Paris Descartes University, Paris, France
| | - David Laharie
- Department of Gastroenterology, Haut-Leveque Hospital, Bordeaux University, Pessac, France
| | - Philippe Seksik
- Département de Gastroentérologie, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Lyon University, Lyon, France
| | - Pierre Blanc
- Department of Gastroenterology, Saint-Eloi Hospital, Montpellier University, Montpellier, France
| | - Yoram Bouhnik
- Department of Gastroenterology, Beaujon Hospital, Paris Diderot University, Clichy, France
| | - Benjamin Pariente
- Department of Gastroenterology, Claude Huriez Hospital, Lille 2 University, Lille, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Brabois Hospital, Nancy University, Nancy les Vandoeuvre-lès-Nancy, France
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Joly F, Quilliot D, Beau P, Seguy D, Chambrier C, Poullenot F, Armengol-Debeir L, Nuzzo A, Lallemand J, Layec S, Thibault R, Boehm V, Schneider S. Effet du teduglutide (agoniste du GLP2) à 6 mois dans la cohorte française de patients adultes avec syndrome de grêle court (SGC). NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.037] [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: 11/30/2022]
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Poullenot F, Nivet D, Paul S, Riviere P, Roblin X, Laharie D. Severe endoscopic lesions are not associated with more infliximab fecal loss in acute severe ulcerative colitis. Dig Liver Dis 2018; 50:1100-1103. [PMID: 30077467 DOI: 10.1016/j.dld.2018.07.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND It has been observed that early infliximab (IFX) fecal excretion in patients with acute severe ulcerative colitis (ASUC) was associated with low treatment response. AIM The objective was to assess if severe endoscopic lesions (SEL) were associated with IFX loss in the stool as well as low IFX concentrations in plasma at day 1 and 2 in a cohort of patients admitted for ASUC. METHODS Consecutive patients admitted for a steroid-refractory ASUC requiring IFX and who underwent flexible sigmoidoscopy before starting the drug were included in a case-control, prospective, two-center study. Cases were patients with SEL and controls those without SEL. Plasmatic and fecal IFX concentrations were measured at day 1 and 2. RESULTS Among the 15 patients analyzed (10 men; median age: 49 years), 6 were cases harboring SEL at baseline. IFX was detected in the stool in 2/6 (33%) of cases and 4/9 (44%) of controls (p = 1) and no difference was observed between the two groups regarding plasmatic concentrations at day 1 or 2 (p = 1). CONCLUSION In ASUC, SEL were not associated with more loss of IFX in the stool or lower plasmatic levels. Early IFX pharmacokinetics in this setting does not seem related to endoscopic severity.
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Affiliation(s)
- Florian Poullenot
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France.
| | - Dorothée Nivet
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
| | - Stéphane Paul
- Department of Immunology, CIC1408, GIMAP/EA3064 University Hospital of Saint Etienne, France
| | - Pauline Riviere
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
| | - Xavier Roblin
- CHU de Saint-Etienne, Hôpital Nord, Service de Gastro-entérologie et Hépatologie, Saint-Etienne, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie, CMC Magellan, Bordeaux, Pessac, France
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28
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Thicoïpé A, Laharie D, Smith D, Chabrun E, Rullier A, Poullenot F, Rullier E, Denost Q. Oncological outcomes of IBD-associated versus sporadic colorectal cancer in modern era: a matched case-control study. Int J Colorectal Dis 2018; 33:963-966. [PMID: 29675590 DOI: 10.1007/s00384-018-3049-z] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 02/04/2023]
Abstract
AIM Inflammatory bowel diseases (IBD) are associated with an increased risk for colorectal cancer (CRC). However and despite significant advances in the management of IBD and CRC, the prognosis of IBD-related CRC (IBD-CRC) remains controversial. The aim of the present case-control study was to compare the prognosis of IBD-CRC to sporadic CRC. METHODS Consecutive patients operated for IBD-CRC from 2004 to 2014 were recruited and matched with sporadic CRC (ratio 3:1) from the same center. Matching was performed on gender, tumor stage, and location and period of surgery. Endpoints were postoperative morbidity (Dindo-Clavien III-V), quality of surgery, and long-term oncological outcomes. RESULTS Among 1498 CRC patients operated during the study period, 21 patients were identified with IBD-CRC and matched to 63 patients with sporadic CRC (S-CRC). Patients with IBD-CRC were significantly younger (p < 0.001), had multifocal lesions more frequently (p = 0.04), and undergone abdominoperineal excision and coloproctectomy more often (p = 0.001). Postoperative morbidity was not significantly different between the two groups (25 vs. 14%; p = 0.309), as well as the rate of R0 resection (86 vs. 95%; p = 0.162). Five-year disease-free and overall survival were 71 and 81% in patients with IBD-CRC and 69% (p = 0.801) and 78% (p = 0.845) in those with S-CRC, respectively. CONCLUSION In a case-control study of patients operated for CRC within the last decade, the prognosis of cancer associated with IBD is similar to sporadic cancer.
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Affiliation(s)
- Antoine Thicoïpé
- CHU of Bordeaux, Colorectal Unit, Department of Surgery, Magellan Hospital, University of Bordeaux, Bordeaux, France
| | - David Laharie
- CHU of Bordeaux, Department of Gastroenterology, Magellan Hospital, University of Bordeaux, Bordeaux, France
| | - Denis Smith
- CHU of Bordeaux, Department of Oncology, Magellan Hospital, University of Bordeaux, Bordeaux, France
| | - Edouard Chabrun
- CHU of Bordeaux, Department of Gastroenterology, Magellan Hospital, University of Bordeaux, Bordeaux, France
| | - Anne Rullier
- CHU of Bordeaux, Department of Pathology, Pellegrin Hospital, University of Bordeaux, Bordeaux, France
| | - Florian Poullenot
- CHU of Bordeaux, Department of Gastroenterology, Magellan Hospital, University of Bordeaux, Bordeaux, France
| | - Eric Rullier
- CHU of Bordeaux, Colorectal Unit, Department of Surgery, Magellan Hospital, University of Bordeaux, Bordeaux, France
| | - Quentin Denost
- CHU of Bordeaux, Colorectal Unit, Department of Surgery, Magellan Hospital, University of Bordeaux, Bordeaux, France.
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Rivière P, Zallot C, Desobry P, Sabaté JM, Vergniol J, Zerbib F, Peyrin-Biroulet L, Laharie D, Poullenot F. Frequency of and Factors Associated With Sexual Dysfunction in Patients With Inflammatory Bowel Disease. J Crohns Colitis 2017; 11:1347-1352. [PMID: 28981625 DOI: 10.1093/ecco-jcc/jjx100] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [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: 04/03/2017] [Accepted: 07/18/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Improvement of quality of life is a main objective in inflammatory bowel disease [IBD] management. Data on sexual dysfunction [SD] in IBD are scarce. This study compared rates of SD between IBD patients and healthy controls [HC], and searched for predictors of SD. METHODS All consecutive IBD patients seen in two tertiary centres during 2 months were invited to fill an anonymous validated questionnaire on their sexual function [Female Sexual Index Function and International Index of Erectile Function]. The same questionnaires were filled by HC and by patients with irritable bowel syndrome [IBS] enrolled as a second comparative group. RESULTS In all, 358 IBD patients filled the questionnaire [192 women]-including 238 with Crohn's disease and 120 with ulcerative colitis-and 110 HC [54 women] and 107 IBS patients [54 women]. In women, SD rates were 53.6% in IBD vs 28% in HC [p < 0.01] and 77.5% in IBS [p = 0.10] patients; in men, figures were 16.9% in IBD, 7.4% in HC [p = 0.64], and 26.4% in IBS [p = 0.60]. An erectile dysfunction [ED] was reported by 43% of IBD patients, 13% of HC [p < 0.01] and 55% of IBS patients [p = 0.60 vs IBD]. Predictors of SD and ED were social and emotional functioning, anxiety in women and depression in men. IBD activity was not associated with SD. CONCLUSIONS In IBD, 54% of women have an SD and 43% of men an ED. These rates are significantly higher than in HC, mostly driven by psychological factors, and independent from disease severity.
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Affiliation(s)
- P Rivière
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - C Zallot
- Hépato-gastro-entérologie and Inserm U954, Lorraine University, Nancy, France
| | - P Desobry
- Médecine du travail ERDF-GRDF, Lille, France
| | - J M Sabaté
- Hépato-gastro-entérologie, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Vergniol
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - F Zerbib
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - L Peyrin-Biroulet
- Hépato-gastro-entérologie and Inserm U954, Lorraine University, Nancy, France
| | - D Laharie
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
| | - F Poullenot
- Hépato-gastro-entérologie, Centre Hospitalier Universitaire, Bordeaux, France
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Joly F, Quilliot D, Beau P, Poullenot F, Armengol-Debeir L, Chambrier C, Lallemand J, Boehm V, Nuzzo A, Corcos O, Schneider S. OR11: First Study in ‘Real Life’ on the Effect of Teduglutide at 3 Months in Acohort of Adult Patients with Short Bowel Syndrome (SBS). Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30776-8] [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: 10/18/2022]
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Joly F, Quilliot D, Beau P, Poullenot F, Armengol-Debeir L, Chambrier C, Lallemand J, Nuzzo A, Boehm V, Bataille J, Schneider S. Première étude en “vie réelle” sur l’effet du téduglutide (agoniste du GLP2) à 3 mois dans une cohorte nationale de patients adultes avec syndrome de grêle court. NUTR CLIN METAB 2017. [DOI: 10.1016/j.nupar.2017.06.069] [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: 12/01/2022]
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Billiauws L, Armengol Debeir L, Poullenot F, Chambrier C, Cury N, Ceccaldi PF, Latour Beaudet E, Corcos O, Marinier E, Goulet O, Lerebours E, Joly F. Pregnancy is possible on long-term home parenteral nutrition in patients with chronic intestinal failure: Results of a long term retrospective observational study. Clin Nutr 2017; 36:1165-1169. [DOI: 10.1016/j.clnu.2016.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 10/21/2022]
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Pironi L, Konrad D, Brandt C, Joly F, Wanten G, Agostini F, Chambrier C, Aimasso U, Zeraschi S, Kelly D, Szczepanek K, Jukes A, Di Caro S, Theilla M, Kunecki M, Daniels J, Serlie M, Poullenot F, Wu J, Cooper SC, Rasmussen HH, Compher C, Seguy D, Crivelli A, Pagano MC, Hughes SJ, Guglielmi FW, Kozjek NR, Schneider SM, Gillanders L, Ellegard L, Thibault R, Matras P, Zmarzly A, Matysiak K, Van Gossum A, Forbes A, Wyer N, Taus M, Virgili NM, O'Callaghan M, Chapman B, Osland E, Cuerda C, Sahin P, Jones L, Lee ADW, Bertasi V, Orlandoni P, Izbéki F, Spaggiari C, Díez MB, Doitchinova-Simeonova M, Garde C, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Czako L, Kekstas G, Sanz-Paris A, Jáuregui EP, Murillo AZ, Schafer E, Arends J, Suárez-Llanos JP, Shaffer J, Lal S. Clinical classification of adult patients with chronic intestinal failure due to benign disease: An international multicenter cross-sectional survey. Clin Nutr 2017; 37:728-738. [PMID: 28483328 DOI: 10.1016/j.clnu.2017.04.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [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: 01/12/2017] [Revised: 03/19/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements. METHODS ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need. RESULTS Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume. CONCLUSIONS Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Denise Konrad
- Home Nutrition Support, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Federica Agostini
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Cecile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | | | - Sarah Zeraschi
- Nutrition Team Office, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Darlene Kelly
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Amelia Jukes
- University Hospital of Wales, Cardiff, United Kingdom
| | | | | | | | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | | | - Florian Poullenot
- Service de Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Jian Wu
- Intestinal Failure Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Henrik H Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene Compher
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David Seguy
- Service de Nutrition, CHRU de Lille, Lille, France
| | - Adriana Crivelli
- Unidad de Soporte Nutricional, Rehabilitación y Trasplante de Intestino, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | - Sarah-Jane Hughes
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | | | | | - Stéphane M Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France
| | - Lyn Gillanders
- National Intestinal Failure Service, Auckland City Hospital, Auckland, New Zealand
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ronan Thibault
- Gastrointestinal and Nutritional Rehabilitation Medicine, Clinique Saint Yves, Rennes Cedex, France
| | - Przemysław Matras
- Department of General and Transplant Surgery and Clinical Nutrition, Medical University of Lublin, Lublin, Poland
| | - Anna Zmarzly
- Department of Clinical Nutrition, J. Gromkowski City Hospital, Wroclaw, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Department of General, Endocrinological and Gastroenterological Surgery, Poznan University of Medical Science, Poznań, Poland
| | - Andrè Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Alastair Forbes
- Norfolk and Norwich University Hospital, University of East Anglia, Norwich, United Kingdom
| | - Nicola Wyer
- University Hospital, Coventry, United Kingdom
| | - Marina Taus
- Centro di Riferimento Regionale NAD Ospedali Riuniti Ancona, Ancona, Italy
| | - Nuria M Virgili
- Unitat Nutrició i Dietética, Servei Endocrinologia i Nutrició, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andre D W Lee
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paolo Orlandoni
- Centro di Riferimento Regionale NAD, INRCA -IRCCS, Ancona, Italy
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | | | - Marta Bueno Díez
- Servei d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Carmen Garde
- Hospital Universitario Donostia, San Sebastian, Spain
| | | | | | - Zeljko Krznaric
- Centre of Clinical Nutrition, Department of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Laszlo Czako
- First Department of Internal Medicine, Szeged, Hungary
| | | | | | | | | | - Eszter Schafer
- Magyar Honvedseg Egészségügyi Központ (MHEK), Budapest, Hungary
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | - José P Suárez-Llanos
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Jon Shaffer
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
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Fron C, Pierry C, Poullenot F, Chabrun E, Subtil C, Capdepont M, Zerbib F, Belleannée G, Laharie D. Endoscopic and histologic response to cyclosporine in ulcerative colitis and their impact on disease outcome: A cohort study. Dig Liver Dis 2016; 48:734-9. [PMID: 27052254 DOI: 10.1016/j.dld.2016.03.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cyclosporine (CsA) is an effective agent for treating patients with acute steroid-refractory ulcerative colitis (UC). The aim was to assess endoscopic and histologic responses to CsA and to determine their predictive value on UC outcome. PATIENTS AND METHODS Consecutive UC patients who received intravenous CsA for an acute refractory UC were included when they had endoscopic assessments with biopsies at entry and, at CsA interruption in responders. Mucosal healing (MH) was defined by Mayo endoscopic subscore ≤1 and, histologic response (HR) by the absence of basal plasmocytosis or a Geboes score <3.1. RESULTS Among 21 patients who responded to CsA, MH was achieved in 81%. Survival rates without relapse at 2 years were 79% and 25% in patients with MH and without MH, respectively (p=0.04). HR was observed in 84% of patients according to basal plasmocytosis and in 68% according to Geboes score. Multivariate analysis revealed that a Mayo endoscopic subscore of 0 was the only prognostic factor associated with absence of relapse (RR=12; 95%CI: 1.05-136.79). CONCLUSION CsA provides MH and HR in most of UC patients responding to this drug. As suggested with other UC treatments, a complete MH with CsA has a good prognostic value.
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Affiliation(s)
- Clémence Fron
- CHU de Bordeaux, Gastroenterology Department, Hôpital Haut-Lévêque, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Clémence Pierry
- CHU de Bordeaux, Pathology Department, Hôpital Haut-Lévêque, Bordeaux, France
| | - Florian Poullenot
- CHU de Bordeaux, Gastroenterology Department, Hôpital Haut-Lévêque, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Edouard Chabrun
- CHU de Bordeaux, Gastroenterology Department, Hôpital Haut-Lévêque, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Clément Subtil
- CHU de Bordeaux, Gastroenterology Department, Hôpital Haut-Lévêque, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Maylis Capdepont
- CHU de Bordeaux, Gastroenterology Department, Hôpital Haut-Lévêque, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | - Frank Zerbib
- CHU de Bordeaux, Gastroenterology Department, Hôpital Haut-Lévêque, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France
| | | | - David Laharie
- CHU de Bordeaux, Gastroenterology Department, Hôpital Haut-Lévêque, Université de Bordeaux, INSERM CIC 1401, Bordeaux, France.
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Affiliation(s)
- D Laharie
- Service d'Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France.
| | - F Poullenot
- Service d'Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
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Coutzac C, Chapuis J, Poullenot F, Chabrun E, Capdepont M, Blanco P, Laharie D. Association Between Infliximab Trough Levels and the Occurrence of Paradoxical Manifestations in Patients with Inflammatory Bowel Disease: a Case-Control Study. J Crohns Colitis 2015; 9:982-7. [PMID: 26351388 DOI: 10.1093/ecco-jcc/jjv159] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [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: 06/30/2015] [Accepted: 08/17/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Anti-tumour necrosis factor [TNF] agents have dramatically improved the prognosis of inflammatory bowel disease [IBD]. However, despite their good safety profile, use of these agents may lead to paradoxical manifestations involving skin or joints. Pathogenesis of such side effects is poorly understood and may involve anti-TNF pharmacokinetics. The aim of the present study was to look for an association between infliximab trough levels [ITL] and cutaneous [CPM] or rheumatological [RPM] paradoxical manifestations. METHODS IBD patients receiving infliximab as maintenance therapy were included in a cross-sectional prospective monocentre study. At inclusion, patients had an ITL measurement [LISA-TRACKER®, Biomedical Diagnostics BMD] and were assessed for paradoxical manifestations: a CPM was defined by new onset or exacerbation of pre-existing psoriasis lesions during IFX therapy, and an RPM by new onset of severe poly-arthralgia during IFX therapy. RESULTS Among the 121 patients included [69 female; median age: 38.9 years; 92 with Crohn's disease], 7% had CPM and 8% RPM. Median ITL values were 5.87 [range: 0.52-19.53] µg/ml in patients with CPM and 1.90 [0.00-13.5] µg/ml in those with RPM, as compared respectively with 5.12 [0.00-49.12] µg/ml in patients without CPM [p = 0.56] and 5.57 [0.00-49.12] µg/ml in those without RPM [p = 0.058]. No prognostic factor was associated with CPM. The single factor associated with RPM was elevated antinuclear antibodies. CONCLUSION ITL were not elevated in IBD patients developing cutaneous or rheumatological paradoxical manifestations when receiving IFX as maintenance therapy. As suggested by the high level of antinuclear antibodies, RPM could be related to an induced autoimmune disorder.
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Affiliation(s)
- C Coutzac
- Service d'Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - J Chapuis
- Service d'Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - F Poullenot
- Service d'Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - E Chabrun
- Service d'Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - M Capdepont
- Service d'Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
| | - P Blanco
- Laboratoire d'immunologie, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - D Laharie
- Service d'Hépato-gastroentérologie, CHU de Bordeaux, Hôpital Haut-Lévêque, Pessac, France
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Billiauws L, Armengol Debeir L, Poullenot F, Luton D, Corcos O, Goulet O, Lerebours E, Joly F. MON-PP119: Pregnancy is Possible During Long Term Home Parenteral Nutrition in Patients Having Chronic Intestinal Failure. Clin Nutr 2015. [DOI: 10.1016/s0261-5614(15)30551-3] [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: 10/23/2022]
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Poullenot F, Laharie D. [First line therapy of inflammatory bowel disease]. Rev Prat 2014; 64:1242-1248. [PMID: 25638863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
During the last decade, anti-TNF agents and emergence of new therapeutic concepts have dramatically changed inflammatory bowel disease (IBD) management, especially at their early phase. Salicylates remain the therapeutic basis in ulcerative colitis while their efficacy in Crohn's disease has not been confirmed. A rapid step-up approach is considered for managing IBD at early phase providing early immunomodulators--such as immunosuppressant and anti-TNF--in case of poor disease course. Some specific situations (severe, extended or complicated forms) require the most efficient first-line therapy that is combination between anti-TNF and immunosuppressant. A close follow-up not only based on clinical symptoms, but also on objective inflammatory tools (endoscopy, cross-sectional imaging, biomarkers), is needed to adjust medical therapy rapidly in order to prevent complications and surgery.
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Poullenot F, Bioulac-Sage P, Laumonier H, Saric J, Carteret T, Blanc JF. Hepatocellular carcinoma treated by sorafenib with complete radiological response according to mRECIST criteria: could we stop the treatment? About four cases. Acta Oncol 2014; 53:420-3. [PMID: 23713857 DOI: 10.3109/0284186x.2013.795286] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Florian Poullenot
- Department of Gastroenterology and Hepatology, Saint-André Hospital, University Hospital of Bordeaux and Victor Segalen University , Bordeaux , France
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Puymirat Y, Hachouf M, Doassans-Cazaban G, Poullenot F, Lefévre L, Winnock S, Ouattara A. [Predictive factors of organ failure in patients admitted in intensive care unit for acute gastrointestinal bleeding]. ACTA ACUST UNITED AC 2013; 32:560-4. [PMID: 23948027 DOI: 10.1016/j.annfar.2013.06.009] [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: 12/08/2012] [Accepted: 06/14/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Gastrointestinal hemorrhage is an emergency requiring usually an admission in intensive care unit (ICU), which may prove abusive secondarily. The aim of this study was to identify predictive risk factors of organ failure in patients admitted for GH in our ICU. DESIGN Retrospective and observational METHODS AND MEASUREMENTS Between January 2008 and December 2011, all patients admitted in our ICU for gastrointestinal hemorrhage were consecutively included. The primary endpoint was the occurrence of at least an organ failure. We realized an univariate analysis then a backward regression to identify independent risk factors associated with the occurrence of at least one organ failure during the ICU hospitalization. RESULTS During this period study, 441 consecutive patients with a mean age of 67±15years were included. The median ICU length of stay was of 4 (3-7) days and 116 (26% [IC95%: 22-30]) patients presented at least one organ failure. The multivariate analysis identified predictive risk factors of organ failure: history of cirrhosis (OR=3.5 [IC95%: 1.9-6.7], P<0.001) and an increase in troponin at the admission above the 99th percentile (OR=3.1 [IC95%: 1.8-5.5], P<0.001). CONCLUSION Our results confirmed that a large proportion of patients admitted in ICU for the primary diagnosis of gastrointestinal hemorrhage developed any organ failure. The history of cirrhosis and the systemic consequences of the hemorrhagic syndrome as myocardial damage represents important risk factors of morbidity and mortality and thus should be considered during the management.
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Affiliation(s)
- Y Puymirat
- Service d'anesthésie-réanimation II, hôpital du Haut-Lévêque, CHU de Bordeaux, avenue Magellan, 33000 Bordeaux, France; U1034, adaptation cardiovasculaire à l'ischémie, université de Bordeaux, 33000 Bordeaux, France
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