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Ben-Horin S, Har-Noy O, Katsanos KH, Roblin X, Chen M, Gao X, Schwartz D, Cheon JH, Cesarini M, Bojic D, Protic M, Theodoropoulou A, Abu-Kaf H, Engel T, Tang J, Veyrard P, Lin X, Mao R, Christodoulou D, Karmiris K, Knezevic-Ivanovski T. Corticosteroids and Mesalamine Versus Corticosteroids for Acute Severe Ulcerative Colitis: A Randomized Controlled Trial. Clin Gastroenterol Hepatol 2022; 20:2868-2875.e1. [PMID: 35272029 DOI: 10.1016/j.cgh.2022.02.055] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Corticosteroids are the mainstay of treatment for hospitalized patients with acute severe ulcerative colitis (ASUC). However, whether the addition/continuation of mesalamine with corticosteroids during hospitalization is superior to corticosteroids alone is unknown. METHODS This was a randomized controlled, investigator-blinded, clinical trial conducted in 10 centers in 7 countries. Patients hospitalized with ASUC (Lichtiger score ≥10) were eligible. Patients received corticosteroids alone or corticosteroid + mesalamine (4 g/day mesalamine) by a stratified randomization according to mesalamine use before admission. The primary outcome was the percentage of patients who responded to treatment by day 7, defined by a drop >3 points in the Lichtiger score and an absolute score <10 without the need for rescue medications or colectomy. RESULTS Three hundred forty-six patients were screened, and 149 were included (70/149 female; median age, 41 years). Of these, 73 received corticosteroids + mesalamine, and 76 received corticosteroids alone. For the primary outcome, 53 of 73 patients (72.6%) receiving corticosteroids with mesalamine responded versus 58 of 76 patients (76.3%) on corticosteroids alone (odds ratio, 0.82; 95% confidence interval, 0.39-1.72; P = .60). There was no difference between groups in duration of hospitalization, C-reactive protein normalization rate, or colectomy rate up to day 90. The need for biologics among patients receiving combination of corticosteroids with mesalamine was numerically lower by day 30 (P = .11) and day 90 (P = .07). CONCLUSIONS In this randomized controlled trial, combination of mesalamine with corticosteroids did not benefit hospitalized patients with ASUC more than corticosteroids alone. An exploratory signal for a reduced need for biologics at 90 days in the mesalamine group merits further evaluation. CLINICALTRIALS gov ID: NCT01941589.
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Affiliation(s)
- Shomron Ben-Horin
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Ofir Har-Noy
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Konstantinos H Katsanos
- Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Xavier Roblin
- Department of Gastroenterology, University-Hospital of Saint-Etienne, Saint Etienne, France
| | - Minhu Chen
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiang Gao
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Jae Hee Cheon
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Monica Cesarini
- Dipartimento di Medicina Interna e Specialità Mediche, "Sapienza", University of Rome, Rome, Italy
| | - Daniela Bojic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia
| | - Marijana Protic
- Department of Gastroenterology, University Hospital Zvezdara, Belgrade, Serbia
| | | | - Heba Abu-Kaf
- Department of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Tal Engel
- Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Jian Tang
- The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Pauline Veyrard
- Department of Gastroenterology, University-Hospital of Saint-Etienne, Saint Etienne, France
| | - Xiaoqing Lin
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ren Mao
- The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Dimitrios Christodoulou
- Division of Gastroenterology, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
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Goren G, Schwartz D, Friger M, Banai H, Sergienko R, Regev S, Abu-Kaf H, Greenberg D, Nemirovsky A, Ilan K, Lerner L, Monsonego A, Dotan I, Yanai H, Eliakim R, Ben Horin S, Slonim-Nevo V, Odes S, Sarid O. Randomized Controlled Trial of Cognitive-Behavioral and Mindfulness-Based Stress Reduction on the Quality of Life of Patients With Crohn Disease. Inflamm Bowel Dis 2022; 28:393-408. [PMID: 33847758 DOI: 10.1093/ibd/izab083] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 12/29/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Patients with Crohn disease have debilitating psychological symptoms, mental fatigue, and poor quality of life. Psychological intervention may improve these symptoms. METHODS We performed a randomized parallel-group physician-blinded trial of cognitive-behavioral and mindfulness-based stress reduction (COBMINDEX) on quality of life and psychological symptoms in adults with mild-moderate Crohn disease. COBMINDEX was taught by social workers in one-on-one video conferences over 3 months; quotidian home practice was mandated. RESULTS Fifty-five COBMINDEX and 61 waitlist control patients completed the study; mean age was 33 years and 65% of participants were women. At 3 months, COBMINDEX patients had significantly reduced disease activity (per Harvey-Bradshaw Index score, C-reactive protein level, and calprotectin level), increased quality of life (Short Inflammatory Bowel Disease Questionnaire [SIBDQ] score increased from baseline 41 to 50; P < 0.001), decreased psychological symptoms (Global Severity Index [GSI], 0.98-0.70; P < 0.001), reduced fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue, 26-33; P < 0.001), and increased mindfulness disposition (Freiburg Mindfulness Inventory, 33-38; P < 0.001). Waitlist patients had a significant but small change in Harvey-Bradshaw Index, SIBDQ, and GSI scores, without improvement in fatigue or mindfulness. There were significant correlations (0.02 > P < 0.002) in COBMINDEX patients between baseline SIBDQ, GSI, Freiburg Mindfulness Inventory, and Functional Assessment of Chronic Illness Therapy-Fatigue scores with a relative change (baseline to 3 months) of the SIBDQ score, but none among waitlist patients. Predictors of relative change of the SIBDQ score in COBMINDEX patients included the GSI score (90% quantile; coefficient 0.52; P < 0.001), somatization (90%; 0.20; P = 0.001), depression (75%; 0.16; P = 0.03), and phobic anxiety (75%; 0.31; P = 0.008). CONCLUSIONS COBMINDEX was effective in increasing patients' quality of life and reducing psychological symptoms and fatigue. Patients with severe baseline psychological symptoms benefited the most from COBMINDEX.
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Affiliation(s)
- Ganit Goren
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Doron Schwartz
- Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michael Friger
- Department of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Hagar Banai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruslan Sergienko
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shirley Regev
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Heba Abu-Kaf
- Department of Gastroenterology and Hepatology, Soroka Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Dan Greenberg
- Department of Health Systems Management, School of Public Health, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Anna Nemirovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karny Ilan
- The Shraga Segal Department of Microbiology and Immunology, Faculty of Health Sciences, The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Livnat Lerner
- The Shraga Segal Department of Microbiology and Immunology, Faculty of Health Sciences, The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Alon Monsonego
- The Shraga Segal Department of Microbiology and Immunology, Faculty of Health Sciences, The National Institute for Biotechnology in the Negev, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Eliakim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Shomron Ben Horin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Vered Slonim-Nevo
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Shmuel Odes
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Orly Sarid
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Abu-Freha N, Abu Tailakh M, Fich A, Abu Bader N, Shemer-Avni Y, Alsana F, Gasper N, Abu-Kaf H, Etzion O. Adherence to Anti-Viral Treatment for Chronic Hepatitis B. J Clin Med 2020; 9:jcm9061922. [PMID: 32575498 PMCID: PMC7355488 DOI: 10.3390/jcm9061922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/06/2020] [Accepted: 06/15/2020] [Indexed: 12/12/2022] Open
Abstract
Adherence to treatment of chronic Hepatitis B Virus (HBV) is an important issue and can affect the complication rate. Nucleos(t)ide analogue as oral treatments are used for patients with necro-inflammatory activity and high viral load, with the goal of decline the complication rate such cirrhosis and hepatic cancer. We aimed to investigate the adherence to chronic HBV treatment. Chronic HBV patients with dispensing medication rates (DMR) of at least 80% were defined as high adherence group (HAG) and those who dispensed less than 80% as low adherence group (LAG). The study included 273 patients. 90 patients (33%) were in the LAG and 183 (67%) in the HAG. The All-cause mortality in the LAG was 15.6%, and 8.7% among the HAG (p-value = 0.09). 185 patients were of Jewish origin (mean age of 52.96 ±14.6 years, 30% women) and 88 patients of Arab Bedouin (AB) origin (mean age of 40.86 ± 13.96 years (p-value < 0.001), 42% women). The proportion of Jewish patients with high adherence was 71% (131 patients) versus 59% (52 patients) in AB patients (p-value = 0.054). The all-causes mortality was 14.6% among Jewish origin and 3.4% of AB (p-value = 0.01). We conclude that, two third of HBV carriers are with high level adherence to treatment in southern Israel, with lower but marginally significant all-cause mortality. No-significant differences in adherence patterns were noted between Arab Bedouin and Jews.
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Affiliation(s)
- Naim Abu-Freha
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva 84101, Israel; (A.F.); (N.A.B.); (N.G.); (H.A.-K.); (O.E.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (M.A.T.); (Y.S.-A.)
- Correspondence: or ; Tel.: +972-8-640-2251; Fax: +972-8-623-3083
| | - Muhammad Abu Tailakh
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (M.A.T.); (Y.S.-A.)
- Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
- Nursing Research Unit, Soroka University Medical Center, Beer-Sheva 84101, Israel
| | - Alexander Fich
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva 84101, Israel; (A.F.); (N.A.B.); (N.G.); (H.A.-K.); (O.E.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (M.A.T.); (Y.S.-A.)
| | - Nasreen Abu Bader
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva 84101, Israel; (A.F.); (N.A.B.); (N.G.); (H.A.-K.); (O.E.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (M.A.T.); (Y.S.-A.)
| | - Yonat Shemer-Avni
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (M.A.T.); (Y.S.-A.)
- Virology Laboratory, Soroka University Medical Center, Beer Sheva 84101, Israel
| | - Farhan Alsana
- Ministry of Health, Southern Regional Office, Beer Sheva 84101, Israel;
| | - Nava Gasper
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva 84101, Israel; (A.F.); (N.A.B.); (N.G.); (H.A.-K.); (O.E.)
| | - Heba Abu-Kaf
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva 84101, Israel; (A.F.); (N.A.B.); (N.G.); (H.A.-K.); (O.E.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (M.A.T.); (Y.S.-A.)
| | - Ohad Etzion
- The Institute of Gastroenterology and Hepatology, Soroka University Medical Center, Beer-Sheva 84101, Israel; (A.F.); (N.A.B.); (N.G.); (H.A.-K.); (O.E.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel; (M.A.T.); (Y.S.-A.)
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