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Martinelli D, Villone G, Fortunato F, Fiorino G, Laurieri N, Prato R, Dattoli V. [Evaluation of a pulsed xenon ultraviolet light- emitting no-touch, portable device for disinfection of surfaces in operating rooms in the Policlinico University Hospital of Foggia, Italy, 2019. Preliminary results]. Ig Sanita Pubbl 2021; 77:414-425. [PMID: 33883751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To evaluate the effectiveness and the frequency of use of a pulsed xenon ultraviolet light-emitting no-touch portable device (PX-UV), applied after perform current cleaning, in reducing environmental bacterial burden and the presence of pathogens on surfaces in the operating rooms at the Policlinico University Hospital of Foggia. DESIGN Prospective before-and-after study with a follow up duration of four months, from May to August 2019. SETTING AND PARTICIPANTS Two operating rooms of an Orthopaedic and a Neurosurgical ward in a 780-bed university hospital in the District of Foggia, Italy (about 600,000 inhabitants). MAIN OUTCOME MEASURES According to the hygienic standards proposed by the Italian Workers Compensation Authority (ISPESL), the total and the average bacterial load and the presence of six pathogens were evaluated between pre- and post- PX-UV use combined with routine manual cleaning. RESULTS The PX-UV system was applied at five distinct time points: t1: start of the experiment, t2: after 28 days, t3: after 13 days, t4: after 7 days, and t5: after 8 days (t2-t5: 28 days in total). About 16-min of PX-UV cycle showed significant reduction in the level of environmental contamination by decreasing the mean colony count by 87.5%, compliant with the standard (5< X ≤15 CFU per plat). Staphylococcus aureus and Acinetobacter baumannii that had been isolated in some of the samplings before PX-UV were no longer detected after t1, t2 and t5 treatments. Before PX-UV, the mean colony count was similar between t1 and t2 (p>0.05); after t3 and t4 treatments, it was lower before t5 in both the Orthopaedic and Neurosurgical operating rooms (= -97% and -75%, respectively; p<0,01). CONCLUSIONS Implication for practice: PX-UV could supplement the standard cleaning process in reducing the microbial burden in the operating rooms and potentially achieving lower healthcare-associated surgical site infections rates.
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Affiliation(s)
- D Martinelli
- Policlinico Riuniti University Hospital of Foggia, Foggia, Italy Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - G Villone
- Policlinico Riuniti University Hospital of Foggia, Foggia, Italy
| | - F Fortunato
- Policlinico Riuniti University Hospital of Foggia, Foggia, Italy Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - G Fiorino
- Item Oxygen S.R.L., Altamura (Ba), Italy
| | - N Laurieri
- Item Oxygen S.R.L., Altamura (Ba), Italy
| | - R Prato
- Policlinico Riuniti University Hospital of Foggia, Foggia, Italy Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - V Dattoli
- Department of Nursing, School of Health Sciences, Cyprus University of Technology
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2
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Goncalves J, Santos M, Acurcio R, Iria I, Gouveia L, Matos Brito P, Catarina Cunha-Santos A, Barbas A, Galvão J, Barbosa I, Aires da Silva F, Alcobia A, Cavaco M, Cardoso M, Delgado Alves J, Carey JJ, Dörner T, Eurico Fonseca J, Palmela C, Torres J, Lima Vieira C, Trabuco D, Fiorino G, Strik A, Yavzori M, Rosa I, Correia L, Magro F, D'Haens G, Ben-Horin S, Lakatos PL, Danese S. Antigenic response to CT-P13 and infliximab originator in inflammatory bowel disease patients shows similar epitope recognition. Aliment Pharmacol Ther 2018; 48:507-522. [PMID: 29873091 DOI: 10.1111/apt.14808] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 03/18/2018] [Accepted: 04/25/2018] [Indexed: 12/14/2022]
Abstract
AIM To test the cross-immunogenicity of anti-CT-P13 IBD patients' sera to CT-P13/infliximab originator and the comparative antigenicity evoked by CT-P13/infliximab originator sera. METHODS Sera of patients with IBD with measurable anti-CT-P13 antibodies were tested for their cross-reactivity to 5 batches of infliximab originator and CT-P13. Anti-drug antibody positive sera from treated patients were used to compare antigenic epitopes. RESULTS All 42 anti-CT-P13 and 37 anti-infliximab originator IBD sera were cross-reactive with infliximab originator and CT-P13 respectively. Concentration of anti-drug antibodies against infliximab originator or CT-P13 were strongly correlated both for IgG1 and IgG4 (P < 0.001). Anti-CT-P13 sera of patients with IBD (n = 32) exerted similar functional inhibition on CT-P13 or infliximab originator TNF binding capacity and showed reduced binding to CT-P13 in the presence of five different batches of CT-P13 and infliximab originator. Anti-CT-P13 and anti-infliximab originator IBD sera selectively enriched phage-peptides from the VH (CDR1 and CDR3) and VL domains (CDR2 and CDR3) of infliximab. Sera reactivity detected major infliximab epitopes in these regions of infliximab in 60%-79% of patients, and no significant differences were identified between CT-P13 and infliximab originator immunogenic sera. Minor epitopes were localised in framework regions of infliximab with reduced antibody reactivity shown, in 30%-50% of patients. Monoclonal antibodies derived from naïve individuals and ADA-positive IBD patients treated with CT-P13 provided comparable epitope specificity to five different batches of CT-P13 and infliximab originator. CONCLUSIONS These results strongly support a similar antigenic profile for infliximab originator and CT-P13, and point toward a safe switching between the two drugs in anti-drug antibody negative patients.
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Affiliation(s)
| | | | | | | | | | | | | | - A Barbas
- Oeiras, Portugal.,Carnaxide, Portugal
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3
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Chaparro M, Verreth A, Lobaton T, Gravito-Soares E, Julsgaard M, Savarino E, Magro F, Biron AI, Lopez-Serrano P, Casanova MJ, Gompertz M, Vitor S, Arroyo M, Pugliese D, Zabana Y, Vicente R, Aguas M, Shitrit BGA, Gutierrez A, Doherty GA, Fernandez-Salazar L, Cadilla MJ, Huguet JM, OʼToole A, Stasi E, Marcos MN, Villoria A, Karmiris K, Rahier JF, Rodriguez C, Palomares DLM, Fiorino G, Benitez JM, Principi M, Naftali T, Taxonera C, Mantzaris G, Sebkova L, Iade B, Lissner D, Bradley FI, Roman LSA, Marin-Jimenez I, Merino O, Sierra M, Van Domselaar M, Caprioli F, Guerra I, Peixe P, Piqueras M, Rodriguez-Lago I, Ber Y, van Hoeve K, Torres P, Gravito-Soares M, Rudbeck-Resdal D, Bartolo O, Peixoto A, Martin G, Armuzzi A, Garre A, Donday MG, de Carpi MFJ, Gisbert JP. Long-Term Safety of In Utero Exposure to Anti-TNFα Drugs for the Treatment of Inflammatory Bowel Disease: Results from the Multicenter European TEDDY Study. Am J Gastroenterol 2018; 113:396-403. [PMID: 29460920 DOI: 10.1038/ajg.2017.501] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 11/26/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The long-term safety of exposure to anti-tumor necrosis factor (anti-TNFα) drugs during pregnancy has received little attention. We aimed to compare the relative risk of severe infections in children of mothers with inflammatory bowel disease (IBD) who were exposed to anti-TNFα drugs in utero with that of children who were not exposed to the drugs. METHODS Retrospective multicenter cohort study. Exposed cohort: children from mothers with IBD receiving anti-TNFα medication (with or without thiopurines) at any time during pregnancy or during the 3 months before conception. Non-exposed cohort: children from mothers with IBD not treated with anti-TNFα agents or thiopurines at any time during pregnancy or the 3 months before conception. The cumulative incidence of severe infections after birth was estimated using Kaplan-Meier curves, which were compared using the log-rank test. Cox-regression analysis was performed to identify potential predictive factors for severe infections in the offspring. RESULTS The study population comprised 841 children, of whom 388 (46%) had been exposed to anti-TNFα agents. Median follow-up after delivery was 47 months in the exposed group and 68 months in the non-exposed group. Both univariate and multivariate analysis showed the incidence rate of severe infections to be similar in non-exposed and exposed children (1.6% vs. 2.8% per person-year, hazard ratio 1.2 (95% confidence interval 0.8-1.8)). In the multivariate analysis, preterm delivery was the only variable associated with a higher risk of severe infection (2.5% (1.5-4.3)). CONCLUSIONS In utero exposure to anti-TNFα drugs does not seem to be associated with increased short-term or long-term risk of severe infections in children.
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Affiliation(s)
- M Chaparro
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - A Verreth
- Department of Gastroenterology and Department of Pediatric Gastroenterology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - T Lobaton
- Hospital Universitari Germans Trias i Pujol and CIBEREHD, Badalona, Spain
| | | | - M Julsgaard
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - F Magro
- Centro Hospitalar São João, Porto, Portugal
| | - Avni I Biron
- Gastroenterology Devision, Rabin Medical Center, Petach Tikva, Israel
| | | | - M J Casanova
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - M Gompertz
- Hospital Clinic and CIBEREHD, Barcelona, Spain
| | - S Vitor
- Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - M Arroyo
- Hospital Clinico Universitario Lozano Blesa, IIS Aragon, CIBEREHD, Zaragoza, Spain
| | - D Pugliese
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Roma, Italy
| | - Y Zabana
- Hospital Universitari Mutua de Terrassa and CIBEREHD, Terrassa, Spain
| | - R Vicente
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Aguas
- Hospital Universitario La Fe and CIBEREHD, Valencia, Spain
| | | | - A Gutierrez
- Hospital General Universitario de Alicante and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Alicante, Spain
| | - G A Doherty
- St. Vincents University Hospital, Dublin, Ireland
| | | | | | - J M Huguet
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | - E Stasi
- IRCCS Saverio de Bellis, Castellana Grotte, Italy
| | | | - A Villoria
- Hospital Universitari Parc Taulí.Institut d'Investigació i Innovació Parc Taulí. Departament de Medicina, Universitat Autònoma de Barcelona.CIBERehd, Instituto de Salud Carlos III, Sabadell, Spain
| | - K Karmiris
- Venizeleio General Hospital, Heraklion, Greece
| | | | - C Rodriguez
- Complejo Universitario de Navarra, Pamplona, Spain
| | | | - G Fiorino
- IBD Center, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy and Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - J M Benitez
- Hospital Universitario Reina Sofia and IMIBIC, Córdoba, Spain
| | - M Principi
- Azienda Policlinico Ospedaliero-Universitaria di Bari, Bari, Italy
| | - T Naftali
- Meir Hospital Kfar saba Tel Aviv University, Tel Aviv, Israel
| | - C Taxonera
- Hospital Clínico San Carlos and IdISSC, Madrid, Spain
| | - G Mantzaris
- Evangelismos, Ophthalmiatreion Athinon and Polyclinic Hospitals, Athens, Greece
| | - L Sebkova
- Azienda Ospedaliera "Pugliese-Ciaccio", Catanzaro, Italy
| | - B Iade
- Hospital de Clinicas, Montevideo, Uruguay
| | - D Lissner
- Universitatsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | | | | | - I Marin-Jimenez
- Hospital General Universitario Gregorio Marañón and IiSGM, Madrid, Spain
| | - O Merino
- Hospital Universitario de Cruces, Baracaldo, Spain
| | - M Sierra
- Complejo Universitario de León, León, Spain
| | | | - F Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano AND Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - I Guerra
- Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain
| | - P Peixe
- Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - M Piqueras
- Consorci Sanitari de Terrasa, Terrasa, Spain
| | | | - Y Ber
- Hospital San Jorge, Huesca, Spain
| | - K van Hoeve
- Department of Paediatrics, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - P Torres
- Hospital Universitari Germans Trias i Pujol and CIBEREHD, Badalona, Spain
| | | | - D Rudbeck-Resdal
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | | | - A Peixoto
- Centro Hospitalar São João, Porto, Portugal
| | - G Martin
- Gastroenterology Devision, Rabin Medical Center, Petach Tikva, Israel
| | - A Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Gemelli Università Cattolica, Roma, Italy
| | - A Garre
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - M G Donday
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - J P Gisbert
- Gastroenterology Units Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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4
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Fiorino G, Correale C, Radice S, Allocca M, Furfaro F, Gilardi D, Nagore D, Del Rio L, Pascual J, Martínez A, Danese S. Letter: immunogenicity of infliximab originator vs. CT-P13 in IBD patients. Aliment Pharmacol Ther 2017; 46:903-905. [PMID: 29023889 DOI: 10.1111/apt.14262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 07/21/2017] [Accepted: 07/22/2017] [Indexed: 12/11/2022]
Affiliation(s)
- G Fiorino
- Department of Gastroenterology, IBD Centre, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - C Correale
- Department of Gastroenterology, IBD Centre, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - S Radice
- Department of Gastroenterology, IBD Centre, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Allocca
- Department of Gastroenterology, IBD Centre, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - F Furfaro
- Department of Gastroenterology, IBD Centre, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - D Gilardi
- Department of Gastroenterology, IBD Centre, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - D Nagore
- R&D Department, Progenika SA, Derio, Spain
| | - L Del Rio
- R&D Department, Progenika SA, Derio, Spain
| | - J Pascual
- R&D Department, Progenika SA, Derio, Spain
| | - A Martínez
- R&D Department, Progenika SA, Derio, Spain
| | - S Danese
- Department of Gastroenterology, IBD Centre, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
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5
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Bonovas S, Fiorino G, Lytras T, Nikolopoulos G, Peyrin-Biroulet L, Danese S. Editorial: evidence is growing for protective effects of 5-aminosalicylates against colitis-associated cancer-authors' reply. Aliment Pharmacol Ther 2017; 45:1554-1555. [PMID: 28503864 DOI: 10.1111/apt.14084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- S Bonovas
- Department of Gastroenterology, IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | - G Fiorino
- Department of Gastroenterology, IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | - T Lytras
- Hellenic Center for Disease Control and Prevention, Athens, Greece
- Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
- Barcelona Institute for Global Health, Barcelona, Spain
| | | | - L Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - S Danese
- Department of Gastroenterology, IBD Center, Humanitas Clinical and Research Center, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
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6
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Bonovas S, Fiorino G, Lytras T, Nikolopoulos G, Peyrin-Biroulet L, Danese S. Systematic review with meta-analysis: use of 5-aminosalicylates and risk of colorectal neoplasia in patients with inflammatory bowel disease. Aliment Pharmacol Ther 2017; 45:1179-1192. [PMID: 28261835 DOI: 10.1111/apt.14023] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/12/2017] [Accepted: 02/12/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The relationship of 5-aminosalicylates' use with the risk of colorectal neoplasia in patients with inflammatory bowel disease (IBD) has been the focus of a growing body of research. AIM To investigate this association through an updated meta-analysis of observational studies. METHODS PubMed, Scopus and major conference proceedings were searched up to December 2016. The identified studies were evaluated for publication bias and heterogeneity. Pooled relative risk (RR) estimates were calculated using random-effect models. Detailed subgroup analyses were performed. The GRADE approach was used to assess the quality of evidence. RESULTS Thirty-one independent observational studies including 2137 cases of colorectal neoplasia (of which 76% were cancers) were incorporated. Between-study heterogeneity was moderate, while strong suspicion of small-study effects was raised. The overall analysis revealed a protective association between 5-aminosalicylates' use and colorectal neoplasia (RR = 0.57, 95% CI: 0.45-0.71). When the analysis was stratified according to study design and setting, the association was significant in cohort (RR = 0.65, 95% CI: 0.43-0.99; n = 10) and case-control studies (RR = 0.53, 95% CI: 0.40-0.70; n = 21), population-based (RR = 0.70, 95% CI: 0.52-0.94; n = 12) and hospital-based studies (RR = 0.46, 95% CI: 0.34-0.61; n = 19). Exposure to 5-aminosalicylates was protective against cancer (RR = 0.58, 95% CI: 0.45-0.74) and dysplasia (RR = 0.54, 95% CI: 0.35-0.84). The reduction in colorectal neoplasia risk was strong in ulcerative colitis (RR = 0.50, 95% CI: 0.38-0.64), but nonsignificant in Crohn's disease (RR = 0.76, 95% CI: 0.43-1.33). Mesalazine (mesalamine) use was protective (RR = 0.70, 95% CI: 0.51-0.94) with evidence of a dose-effect. The effect of sulfasalazine was marginally nonsignificant (RR = 0.72, 95% CI: 0.51-1.01). CONCLUSIONS Our findings support a potential chemopreventive role of 5-aminosalicylates in IBD. Further, high-quality prospective research is warranted.
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Affiliation(s)
- S Bonovas
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - G Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy
| | - T Lytras
- Hellenic Center for Disease Control and Prevention, Athens, Greece.,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain.,Barcelona Institute for Global Health, Barcelona, Spain
| | | | - L Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - S Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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7
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Vuitton L, Marteau P, Sandborn WJ, Levesque BG, Feagan B, Vermeire S, Danese S, D'Haens G, Lowenberg M, Khanna R, Fiorino G, Travis S, Mary JY, Peyrin-Biroulet L. IOIBD technical review on endoscopic indices for Crohn's disease clinical trials. Gut 2016; 65:1447-55. [PMID: 26353983 DOI: 10.1136/gutjnl-2015-309903] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [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: 06/01/2015] [Accepted: 08/10/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic disabling and progressive IBD. Only strategies looking beyond symptoms and based on tight monitoring of objective signs of inflammation such as mucosal lesions may have the potential for disease modification. Endoscopic evaluation is currently the gold standard to assess mucosal lesions and has become a major therapeutic endpoint in clinical trials. Several endoscopic indices have been proposed to evaluate disease activity; unvalidated and arbitrary definitions have been used in clinical trials for defining endoscopic response and endoscopic remission in CD. METHODS In these recommendations from the International Organization for the Study of Inflammatory Bowel Disease, we first reviewed all technical aspects of available endoscopic scoring systems in the literature. Second, in order to achieve consensus on endoscopic definitions of remission and response in trials, a two-round vote based on a Delphi method was performed among 14 specialists in the field of IBDs. RESULTS At the end of the voting process, the investigators ranked first a >50% decrease in Simple Endoscopic Score for Crohn's Disease (SES-CD) or Crohn's Disease Endoscopic Index of Severity for the definition of endoscopic response, and an SES-CD 0-2 for the definition of endoscopic remission in CD. All experts agreed on a Rutgeerts' score i0-i1 for the definition of endoscopic remission after surgery.
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Affiliation(s)
- L Vuitton
- Department of Gastroenterology and Endoscopy Unit, Besançon University Hospital, Besançon, France Department of Hepato-Gastroenterology, Inserm U954, University Hospital of Nancy-Brabois, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - P Marteau
- Department of Digestive Diseases, AP-HP, Hôpital Lariboisière and University Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - W J Sandborn
- Division of Gastroenterology, University of California-San Diego, La Jolla, California
| | - B G Levesque
- Division of Gastroenterology, University of California-San Diego, La Jolla, California
| | - B Feagan
- Department of Medicine, Robarts Clinical Trials, Robarts Research Institute, Western University, London, Ontario, Canada
| | - S Vermeire
- Department of Gastroenterology, University of Leuven, University Hospitals Leuven, Leuven, Belgium
| | - S Danese
- Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G D'Haens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - M Lowenberg
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - R Khanna
- Department of Medicine, Robarts Clinical Trials, Robarts Research Institute, Western University, London, Ontario, Canada
| | - G Fiorino
- Department of Gastroenterology, IBD Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - S Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - J Y Mary
- Biostatistics and Clinical Epidemiology, Inserm U717, Hôpital Saint-Louis, Paris, France
| | - L Peyrin-Biroulet
- Department of Hepato-Gastroenterology, Inserm U954, University Hospital of Nancy-Brabois, Lorraine University, Vandoeuvre-lès-Nancy, France
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Abstract
Monoclonal antibodies directed against tumor necrosis factor alpha (anti-TNF-α agents) have dramatically changed the therapeutical approach to inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. A new anti-TNF drug, golimumab, has recently been approved for patients with moderate to severe ulcerative colitis. Its efficacy has been demonstrated by preclinical and clinical studies and the drug showed an efficacy and safety profile in line with the other anti-TNF agents, such as infliximab and adalimumab. This review gives an overview on golimumab in the treatment of moderate to severe ulcerative colitis.
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Affiliation(s)
- D Gilardi
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - G Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - M Allocca
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - I Bravatà
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - S Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
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9
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Moja L, Danese S, Fiorino G, Del Giovane C, Bonovas S. Systematic review with network meta-analysis: comparative efficacy and safety of budesonide and mesalazine (mesalamine) for Crohn's disease. Aliment Pharmacol Ther 2015; 41:1055-65. [PMID: 25864873 DOI: 10.1111/apt.13190] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 01/29/2015] [Accepted: 03/17/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Budesonide and mesalazine (mesalamine) are commonly used in the medical management of patients with mild to moderate Crohn's disease. AIM To assess their comparative efficacy and harm using the methodology of network meta-analysis. METHODS A comprehensive search of Medline, Embase, the Cochrane Library and ClinicalTrials.gov, through October 2014, was performed to identify randomised controlled trials (RCTs) that recruited adult patients with active or quiescent Crohn's disease, and compared budesonide or mesalazine with placebo, or against each other, or different dosing strategies of one drug. RESULTS Twenty-five RCTs were combined using Bayesian network meta-analysis. Budesonide 9 mg/day, or at higher doses (15 or 18 mg/day), was shown superior to placebo for induction of remission [odds ratio (OR), 2.93; 95% credible interval (CrI), 1.52-5.39, and OR, 3.28; CrI, 1.46-7.55 respectively] and ranks at the top of the hierarchy of the competing treatments. For maintenance of remission, budesonide 6 mg/day demonstrated superiority over placebo (OR, 1.69; CrI, 1.05-2.75), being also at the best ranking position among all compared treatment strategies. No other comparisons (i.e. different doses of mesalazine vs. placebo or budesonide, for induction or maintenance of remission) reached significance. The occurrence of withdrawals due to adverse events was not shown different between budesonide, mesalazine and placebo, in both the induction and maintenance phases. CONCLUSIONS Budesonide, at the doses of 9 mg/day, or higher, for induction of remission in active mild or moderate Crohn's disease, and at 6 mg/day for maintenance of remission, appears to be the best treatment choice.
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Affiliation(s)
- L Moja
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Unit of Clinical Epidemiology, IRCCS Galeazzi Orthopedic Institute, Milan, Italy
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10
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van der Woude C, Ardizzone S, Bengtson M, Fiorino G, Fraser G, Katsanos K, Kolacek S, Juillerat P, Mulders A, Pedersen N, Selinger C, Sebastian S, Sturm A, Zelinkova Z, Magro F. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis 2015; 9:107-24. [PMID: 25602023 DOI: 10.1093/ecco-jcc/jju006] [Citation(s) in RCA: 305] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Trying to conceive and being pregnant is an emotional period for those involved. In the majority of patients suffering from inflammatory bowel disease, maintenance therapy is required during pregnancy to control the disease, and disease control might necessitate introduction of new drugs during a vulnerable period. In this updated consensus on the reproduction and pregnancy in inflammatory bowel disease reproductive issues including fertility, the safety of drugs during pregnancy and lactation are discussed.
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Affiliation(s)
- C.J. van der Woude
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, The Netherlands
| | - S. Ardizzone
- Inflammatory Bowel Disease Unit, Department of Gastroenterology, ‘Luigi Sacco’ University Hospital, Milan, Italy
| | - M.B. Bengtson
- Department of Medicine, Vestfold Hospital Trust, Tønsberg, Norway
| | - G. Fiorino
- Department of Gastroenterology, IBD Center, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - G. Fraser
- eIBD Unit, Department of Gastroenterology, Rabin Medical Center and University of Tel-Aviv, Petah Tikva, Israel
| | - K. Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - S. Kolacek
- Children’s Hospital Zagreb, Zagreb University Medical School, Zagreb, Croatia
| | - P. Juillerat
- Department of Gastroenterology, Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland
| | - A.G.M.G.J. Mulders
- Department of Obstetrics and Gynecology, Erasmus MC, Rotterdam, The Netherlands
| | - N. Pedersen
- Gastroenterological Unit, Herlev University Hospital, Herlev, Denmark
| | - C. Selinger
- Department of Gastroenterology, St James’ University Hospital Leeds, Leeds, UK
| | - S. Sebastian
- Hull & East Yorkshire Hospitals and Hull & York Medical School, Hull, UK
| | - A. Sturm
- Department of Internal Medicine and Gastroenterology, Hospital Waldfriede, Berlin, Germany
| | - Z. Zelinkova
- Gastroenterology Unit, 5th Department of Internal Medicine, University Hospital, Bratislava, Slovakia
| | - F. Magro
- Department of Pharmacology & Therapeutics, University of Porto, Porto, Portugal
- MedInUP, Center for Drug Discovery and Innovative Medicines, University of Porto, Porto, Portugal
- Department of Gastroenterology, Hospital de São João, Porto, Portugal
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11
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Lazzaro C, Cappello M, Cortelezzi C, Costantino G, Fiorino G, Mastronardi M, Giannotta M, Galletti B, Cicala M, Vadalà di Prampero S, Gualberti G, Caprioli F, Gasbarrini A, Fattore G. A Health Technology-Related Cost Description Concerning Italian Ibd Centres Dealing With Crohn's Disease Results From Sole Study. Value Health 2014; 17:A370. [PMID: 27200785 DOI: 10.1016/j.jval.2014.08.841] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- C Lazzaro
- Studio di Economia Sanitaria, Milan, Italy
| | | | - C Cortelezzi
- AOU di Circolo - Fondazione Macchi, Varese, Italy
| | | | - G Fiorino
- Istituto Clinico Humanitas, Rozzano (MI), Italy
| | | | - M Giannotta
- Azienda Ospedaliero Universitaria di Careggi, Firenze, Italy
| | | | - M Cicala
- Università Campus Bio Medico, Roma, Italy
| | - S Vadalà di Prampero
- Azienda Ospedaliero-Universitaria S. Maria della Misericordia di Udine, Udine, Italy
| | | | - F Caprioli
- Università degli Studi di Milano, Milano, Italy
| | - A Gasbarrini
- Università Cattolica del Sacro Cuore, Rome, Italy
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12
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Lazzaro C, Cappello M, Cortelezzi C, Costantino G, Fiorino G, Mastronardi M, Giannotta M, Galletti B, Cicala M, Vadalà di Prampero S, Gualberti G, Caprioli F, Gasbarrini A, Meregaglia M. Health-Related Quality of Life in Italian Patients With Moderate and Severe Crohn's Disease: Interim Results from the Sole Study. Value Health 2014; 17:A570-A571. [PMID: 27201899 DOI: 10.1016/j.jval.2014.08.1908] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- C Lazzaro
- Studio di Economia Sanitaria, Milan, Italy
| | | | - C Cortelezzi
- AOU di Circolo - Fondazione Macchi, Varese, Italy
| | | | - G Fiorino
- Istituto Clinico Humanitas, Rozzano (MI), Italy
| | | | - M Giannotta
- Azienda Ospedaliero Universitaria di Careggi, Firenze, Italy
| | | | - M Cicala
- Università Campus Bio Medico, Roma, Italy
| | - S Vadalà di Prampero
- Azienda Ospedaliero-Universitaria S. Maria della Misericordia di Udine, Udine, Italy
| | | | - F Caprioli
- Università degli Studi di Milano, Milano, Italy
| | - A Gasbarrini
- Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Fiorino G, Danese S. Commentary: Adjunct antibiotic combination therapy for ulcerative colitis--is it time to investigate Fusobacterium varium? Aliment Pharmacol Ther 2014; 39:1333. [PMID: 24803247 DOI: 10.1111/apt.12742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 03/19/2014] [Indexed: 12/21/2022]
Affiliation(s)
- G Fiorino
- Department of Gastroenterology, IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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14
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Fiorino G, Allocca M, Danese S. Commentary: anaemia in inflammatory bowel disease--the most common and ignored extra intestinal manifestation. Aliment Pharmacol Ther 2014; 39:227-8. [PMID: 24330239 DOI: 10.1111/apt.12578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 11/17/2013] [Indexed: 02/06/2023]
Affiliation(s)
- G Fiorino
- IBD Center, Gastroenterology, IRCCS Humanitas, Rozzano, Milan, Italy
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15
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Iborra M, Bernuzzi F, Correale C, Vetrano S, Fiorino G, Beltrán B, Marabita F, Locati M, Spinelli A, Nos P, Invernizzi P, Danese S. Identification of serum and tissue micro-RNA expression profiles in different stages of inflammatory bowel disease. Clin Exp Immunol 2013; 173:250-8. [PMID: 23607522 DOI: 10.1111/cei.12104] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2013] [Indexed: 12/13/2022] Open
Abstract
The altered expression of micro-RNA (miRNA) has been associated with Crohn's disease (CD) and ulcerative colitis (UC). The aim of this study was to establish specific miRNA expression patterns in the serum and mucosa of inflammatory bowel disease (IBD) patients (UC and CD with colonic involvement) at different stages of the disease. Serum and biopsies from nine active CD (aCD), nine inactive CD (iCD), nine active UC (aUC) and nine inactive UC (iUC) and serum from 33 healthy subjects were collected. Up to 700 miRNAs were evaluated by the TaqMan human miRNA array. The ΔCt values were obtained using the mean expression values of all expressed miRNAs in a given sample as a normalization factor for miRNA real-time quantitative polymerase chain reaction data. The levels of serum miRNAs in CD and UC patients were different to healthy subjects. Thirteen serum miRNAs were expressed commonly in CD and UC patients. Two miRNAs were higher and four miRNAs were lower in the serum of aCD than iCD. No serum miRNA was regulated exclusively in aUC compared with iUC patients. Four miRNAs were higher and three miRNAs were lower in the mucosa of aCD than iCD. Two miRNAs were higher and three miRNAs were lower in the mucosa of aUC than iUC. No serum miRNAs coincided with tissue miRNAs in aCD and aUC patients. Our results suggest the existence of specific miRNA expression patterns associated with IBD and their different stages and support the utility of miRNA as possible biomarkers. This pilot study needs to be validated in a large prospective cohort.
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Affiliation(s)
- M Iborra
- Gastroenterology Unit, La Fe University and Politechnic Hospital, Health Research Institute, Valencia, Spain
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Allocca M, Fiorino G, Danese S. Commentary: antibodies reacting with the infliximab Fab portion--something new? Aliment Pharmacol Ther 2013; 38:552. [PMID: 23937461 DOI: 10.1111/apt.12401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 06/17/2013] [Indexed: 12/30/2022]
Affiliation(s)
- M Allocca
- IBD Center, Gastroenterology, IRCCS Humanitas, Rozzano, Italy
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17
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Indriolo A, Fagiuoli S, Pasulo L, Fiorino G, Danese S, Ravelli P. Letter: infliximab therapy in inflammatory bowel disease patients after liver transplantation. Aliment Pharmacol Ther 2013; 37:840-2. [PMID: 23496317 DOI: 10.1111/apt.12256] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 01/30/2013] [Indexed: 12/16/2022]
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18
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Jovani M, Fiorino G, Danese S. Commentary: associations between immune activation, intestinal permeability and irritable bowel syndrome. Aliment Pharmacol Ther 2013; 37:277-8. [PMID: 23252779 DOI: 10.1111/apt.12136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 10/22/2012] [Indexed: 12/19/2022]
Affiliation(s)
- M Jovani
- Department of Gastroenterology, Istituto Clinico Humanitas, IRCCS, Rozzano, Italy
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19
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Smith V, Tunnicliffe G, Fiorino G, Draper A, Vlahos I, Shannon M, Madden BP. P149 Management Algorithm For Pulmonary Embolism (PE) with Right Heart Strain: A Case Series. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.432] [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: 11/03/2022]
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20
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Fiorino G, Szabò H, Fries W, Malesci A, Peyrin-Biroulet L, Danese S. Adalimumab in Crohn's disease: tips and tricks after 5 years of clinical experience. Curr Med Chem 2011; 18:1230-8. [PMID: 21291363 DOI: 10.2174/092986711795029726] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 02/27/2011] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Three anti TNF-α agents have currently been approved for the treatment of moderate-to-severe or complicated Crohn's disease (CD): infliximab, certolizumab and adalimumab. Infliximab is effective in CD, but for reasons linked to its chimeric structure, response to treatment may be lost overtime and as a result, it can sometimes be unable to provide long term durable treatment of CD. Adalimumab, a fully human anti TNF-α antibody, demonstrates similar treatment efficacy as infliximab and certolizumab, and can easily be self-administered at home. AIM AND METHODS A literature search in the Cochrane, MEDLINE, PUBMED, Ovid MEDLINER® and EMBASE databases has been performed on the efficacy, safety and the impact adalimumab has on the quality of life and natural history of CD. Abstracts presented at the DDW, UEGW and ECCO Congresses have also been reviewed as well as references from review articles, meta-analysis studies and published RCTs. RESULTS Adalimumab induced remission of CD in 64% of patients, and maintained remission in more than 80% of initial responders. Adalimumab did not significantly increase the risk of adverse events compared with conventional medication up to 3 years of follow-up. Adalimumab reduces more than 50% the risk for hospitalisation and surgery due to CD. It is also effective for fistula closure, for the healing of the mucosa, and improving quality of life. CONCLUSION Adalimumab is effective in the induction and maintenance of clinical remission in CD and is generally well tolerated. It has been proved to have a positive impact by improving quality of life of patients, and reducing the need for hospitalisation and surgery due to CD. According to the European Crohn's and Colitis Organisation (ECCO), infliximab or adalimumab can be used for the treatment of fistulizing CD.
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Affiliation(s)
- G Fiorino
- IBD Unit, Gastroenterology, IRCCS Humanitas, Rozzano, Milan, Italy
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21
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Danese S, Fiorino G, Reinisch W. Review article: Causative factors and the clinical management of patients with Crohn's disease who lose response to anti-TNF-α therapy. Aliment Pharmacol Ther 2011; 34:1-10. [PMID: 21539588 DOI: 10.1111/j.1365-2036.2011.04679.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The addition of antitumour necrosis factor-α (TNF-α) agents to the therapeutic armamentarium against Crohn's disease has been a revolution in its management. However, approximately 25 to 40% of patients who initially benefit from anti-TNF-α treatment develop intolerable adverse events or lose their response during maintenance therapy. AIM To summarise the current knowledge on the mechanisms underlying loss of response in these patients and the therapeutic strategies available to counteract this clinical challenge. METHOD A literature search using PubMed, MedLine and Embase databases has been performed. RESULTS Anti-infliximab antibodies formation and autoantibodies (ANA, anti-DNA and other autoantibodies) have been associated with loss of response. Individual differences in drug metabolism may contribute to loss of response. Smoking may be a risk factor for loss of response. Dose escalation, reduction of infusion intervals and switch to other anti-TNF-α agents are effective as rescue strategies. CONCLUSIONS Loss of response appears to result from different causes not fully established by now. Optimization of therapies, or switch to other anti-TNF-α, are currently the best studied strategies in case of loss of response, and can be successful in 40-60% of patients who lose response.
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Affiliation(s)
- S Danese
- IBD Unit, IBD Center, Division of Gastroenterology, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
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22
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Fiorino G, Bonifacio C, Peyrin-Biroulet L, Minuti F, Repici A, Spinelli A, Fries W, Balzarini L, Montorsi M, Malesci A, Danese S. Prospective comparison of computed tomography enterography and magnetic resonance enterography for assessment of disease activity and complications in ileocolonic Crohn's disease. Inflamm Bowel Dis 2011; 17:1073-80. [PMID: 21484958 DOI: 10.1002/ibd.21533] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [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: 06/10/2010] [Accepted: 09/22/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Studies comparing magnetic resonance enterography (MRE) and computerized tomography enterography (CTE) for Crohn's disease (CD) are scarce. METHODS The aim of this study was to prospectively compare the sensitivity, specificity, and accuracy of abdominal MRE and CTE to assess disease activity and complications (fistulas, strictures) in ileocolonic CD. A total of 44 patients (23 male; 21 female; mean age 44) with ileocolonic CD underwent both MR and CT in a short time interval (mean 5 days). A 16-slice CT with intravenous contrast and an MRI with oral and paramagnetic intravenous contrast were performed. Ileocolonoscopy was used as the reference standard. Sensitivity values of CT and MR for detection of extraenteric signs of disease were compared with the McNemar test, with results of imaging studies, surgery, and physical examination as reference standards. RESULTS No significant differences in sensitivity, specificity, and accuracy were observed between MRE and CTE regarding the following parameters at the patient level: localization of CD (P = 1.0), bowel wall thickening (P = 1.0), bowel wall enhancement (P = 1.0), enteroenteric fistulas (P = 0.08), detection of abdominal nodes (P = 1.0), and perivisceral fat enhancement (P = 0.31). MR was significantly superior compared to CT in detecting strictures (P = 0.04). Per segment analysis showed that MRE was significantly superior to CTE in detecting ileal wall enhancement (P = 0.02). CONCLUSIONS MR and CT are equally accurate to assess disease activity and bowel damage in CD. MR may be superior to CT in detecting intestinal strictures and ileal wall enhancement. MR may represent an alternative technique to CT in assessing ileocolonic CD.
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Affiliation(s)
- G Fiorino
- IBD Unit, Division of Gastroenterology Istituto Clinico Humanitas, Rozzano, Milan, Italy
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Rahier JF, Papay P, Salleron J, Sebastian S, Ellul P, Teich N, Fiorino G, Blaha B, Garcia-Sanchez V, Haas T, Van Gossum A, Abitbol V, Yazdanpanah Y, Chaparro MC. Influenza A (H1N1)v infection in patients with inflammatory bowel disease: a case series. Aliment Pharmacol Ther 2011; 33:499-500. [PMID: 21235603 DOI: 10.1111/j.1365-2036.2010.04558.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
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Kopylov U, Mantzaris GJ, Katsanos KH, Reenaers C, Ellul P, Rahier JF, Israeli E, Lakatos PL, Fiorino G, Cesarini M, Tsianos EV, Louis E, Ben-Horin S. The efficacy of shortening the dosing interval to once every six weeks in Crohn's patients losing response to maintenance dose of infliximab. Aliment Pharmacol Ther 2011; 33:349-57. [PMID: 21118397 DOI: 10.1111/j.1365-2036.2010.04523.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Patients treated with infliximab for Crohn's disease (CD) frequently require intensified dosage due to loss of response. There are scant data regarding the efficacy of shortening the dosing interval to 6 weeks. AIM We sought to investigate the efficacy of a once every 6 weeks' strategy compared with dose-doubling. METHODS This work was a multicentre retrospective study of infliximab-treated CD patients who required dose escalation. The clinical outcome of patients treated by intensification to 5 mg/kg/6 weeks (6-week group) was compared with the outcome of patients whose infliximab was double-dosed (10 mg/kg/8 weeks or 5 mg/kg/4 weeks). RESULTS Ninety-four patients (mean age: 29.8 years) were included in the study, 55 (59%) in the 6-week group and 39 (41%) in the double-dose group. Demographics and disease characteristics were similar between the two groups, although patients with re-emerging symptoms 5-7 weeks postinfusion were more likely to receive 5 mg/kg/6 weeks dosing (OR: 3.4, 95% CI: 1.4-8.8, P < 0.01). Early response to dose-intensification occurred in 69% of patients in the 6-week group and 67% in the double-dose group (P = N.S.). Regained response was maintained for 12 months in 40% compared with 29% of the patients respectively (P = N.S.). CONCLUSION In CD patients who lost response to standard infliximab dose, especially when symptoms re-emerge 5-7 weeks postinfusion, shortening the dosing interval to 6 weeks appears to be at least as effective as doubling the dose to 10 mg/kg or halving the infusion intervals to once in 4 weeks.
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Affiliation(s)
- U Kopylov
- Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Ramat-Gan, Israel
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Fiorino G, Fries W, De La Rue SA, Malesci AC, Repici A, Danese S. New drug delivery systems in inflammatory bowel disease: MMX and tailored delivery to the gut. Curr Med Chem 2010; 17:1851-7. [PMID: 20353384 DOI: 10.2174/092986710791111170] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 03/17/2010] [Indexed: 11/22/2022]
Abstract
UNLABELLED Inflammatory bowel diseases are chronic diseases that affect the gastrointestinal tract. Mesalamine, corticosteroids, immunosuppressants and biological agents are currently used to treat these diseases. Due to inadequacies of the currently available delivery systems, a large number of patients do not respond to treatment, especially when they are affected by distal colonic disease. Multimatrix (MMX) technology comprises hydrophilic and lipophilic excipients, enclosed within a gastro-resistant, pH-dependent coating. This new delivery technology has been used to modify some commonly used drugs, including mesalamine and budesonide, as well as heparin, which are now being investigated for their utility in the management of IBD. AIM The aim of this review is to explore the MMX delivery technology and its efficacy for the treatment of IBD. RESULTS The results of various studies involving MMX drugs have been published. Mesalamine MMX induces clinical and endoscopic remission in patients with mild to moderate ulcerative colitis (UC) compared with placebo. Positive results have also been observed with MMX budesonide in two phase I studies. In a pilot study involving ten patients with UC, efficacy of heparin-MMX as an IBD therapy was observed. CONCLUSION MMX is a promising new delivery system that can improve efficacy of current and new drugs, augmenting targeting to the affected tract, thereby increasing response and remission rates for those drugs in patients with IBD.
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Affiliation(s)
- G Fiorino
- Gastroenterology Unit, Istituto Clinico Humanitas, Rozzano, Milan, Italy
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Sorrentino D, Paviotti A, Fiorino G. Anti-TNFs for Postoperative Recurrence in Crohns Disease: The Ifs and Hows. Curr Drug Targets 2010; 11:219-26. [DOI: 10.2174/138945010790309920] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 10/01/2009] [Indexed: 11/22/2022]
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Szabò H, Fiorino G, Spinelli A, Rovida S, Repici A, Malesci AC, Danese S. Review article: anti-fibrotic agents for the treatment of Crohn's disease - lessons learnt from other diseases. Aliment Pharmacol Ther 2010; 31:189-201. [PMID: 19832726 DOI: 10.1111/j.1365-2036.2009.04171.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The current therapies for Crohn's disease (CD) are mainly focused on blockade of inflammation. Fibrosis remains one of the major complications of CD often leading to surgery, affecting patients' quality-of-life. AIM To summarize the published data regarding the potential anti-fibrotic role of drugs commonly used in CD and the most effective anti-fibrotic drugs used in other diseases evaluating their potential use to treat intestinal fibrosis in CD. METHODS A literature search was performed in the PubMed, Medline, Cochrane and EMBASE databases, considering in vitro, animal and human studies on fibrosis in inflammatory bowel disease and other similar chronic pathologies. RESULTS Treatment of fibrosis in CD is limited to surgery or endoscopic dilatation, although some of the drugs currently used may have anti-fibrotic activity. In other diseases, anti-fibrotic agents are already used or are in preclinical or clinical trials. ACE inhibitors, Angiotensin Receptor Blockers, and HMG-CoA inhibitors merit further investigation in CD because of their role in preventing fibrosis in cardiovascular and renal diseases. CONCLUSIONS Anti-fibrotic drugs are under evaluation or already used in clinical practice in other chronic inflammatory diseases. In CD, there is a great need for investigation into agents that may prevent, reduce or reverse intestinal fibrosis.
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Affiliation(s)
- H Szabò
- Istituto Clinico Humanitas IRCCS, Rozzano, Milan, Italy
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Abstract
BACKGROUND Anti TNF-alpha agents are used successfully for several autoimmune diseases, including IBD and psoriasis. An emerging challenge is the increasing incidence of anti TNF-alpha induced psoriasis. A total of 120 cases have been currently reported, of whom 18 patients were treated with biological agents for IBD. OBJECTIVES To analyse all cases of anti TNF-alpha induced psoriasis in patients with IBD in the literature and to investigate potential mechanisms of action. METHODS A literature review was performed in the PubMed, Medline, Cochrane and EMBASE databases, with simple analysis of demographic data, drug administration and psoriasis onset. Risk and incidence patient/year/duration (pyd) was calculated. RESULTS A total of 18 patients with IBD treated by anti TNF-alpha agents developed drug-induced psoriasis of which, 17 patients developed with infliximab, one with adalimumab. The most frequent time of onset is between 3rd and 4th infusion of infliximab. Withdrawal of infliximab led to regression of lesions in 16 patients. In six patients, infliximab was reintroduced with no further recurrence of psoriasis. CONCLUSIONS Although anti TNF-alpha induced psoriasis is extremely rare, understanding the mechanism will be a key step towards better realizing the role played by TNF-alpha and its pharmacological inhibitors in immune-mediated diseases.
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Affiliation(s)
- G Fiorino
- GI Unit, Dipartimento di Scienze Cliniche, Policlinico Umberto I, Rome, Italy
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