1
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Chetwood JD, Tran Y, Subramanian S, Smith PJ, Iborra M, Buisson A, Paramsothy S, Leong RW. Intravenous Versus Subcutaneous Infliximab in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. J Crohns Colitis 2024:jjae059. [PMID: 38656784 DOI: 10.1093/ecco-jcc/jjae059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Indexed: 04/26/2024]
Abstract
BACKGROUND Subcutaneous (SC) infliximab may provide multiple benefits over intravenous (IV) formulations. However, studies for efficacy and safety in inflammatory bowel disease (IBD) have been constrained by small sizes that limit the interpretation of outcomes, especially for subgroups potentially at high-risk of disease relapse. METHODS We conducted a systematic review and random-effects meta-analysis up to January 2023 to evaluate the change in clinical remission after transitioning from IV to SC infliximab in patients with IBD in clinical remission. The primary outcome was measured using the relative risk for meta-analysis. RESULTS 15 studies of patients established ≥3 months on IV infliximab were identified, consisting of 1371 patients and 840 patient-years of follow-up. There was no loss of clinical remission in the IBD cohort overall, Crohn's disease (CD), and perianal CD p=0.55 & p=0.11 at 9-12 months, and p=0.50 at 6 months respectively). Neither prior IV dose (≤10mg/kg 6-weekly) (p=0.48) nor IBD disease subtype was associated with an increased clinical relapse rate at 6 months (p=0.48 and p=0.45 (UC vs CD), respectively). CONCLUSION Changing patients established on IV infliximab to an SC formulation is associated with a high ongoing clinical remission and low adverse event rate. Furthermore, there are no signals for adverse outcomes among different IBD disease subtypes, nor in those on escalated IV infliximab dosing schedules up to 10mg/kg 6-weekly. This data should provide patients and clinicians alike with confidence in SC infliximab use in IBD.
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Affiliation(s)
- John David Chetwood
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Concord Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Yvonne Tran
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia
| | - Sreedhar Subramanian
- Department of Gastroenterology, Cambridge University Hospitals Foundation Trust, Cambridge, UK
| | - Philip J Smith
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Marisa Iborra
- Department of Gastroenterology, La Fe University Hospital of Valencia, Spain
| | - Anthony Buisson
- Service d'Hépato-Gastro Entérologie, 3iHP, INSERM, Centre Hospitalier Universitaire de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
- M2iSH, USC-INRA 2018, INSERM U1071, 3iHP, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Sudarshan Paramsothy
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Concord Clinical School, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Rupert W Leong
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, NSW, Australia
- Concord Clinical School, University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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2
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Chetwood JD, Ko Y, Pudipeddi A, Kariyawasam V, Paramsothy S, Leong RW. Biological Agents in the Treatment of Crohn's Disease: A Propensity Score-Matched Analysis From the Prospective Persistence Australian National IBD Cohort (PANIC3) Study. Am J Gastroenterol 2024:00000434-990000000-00991. [PMID: 38275272 DOI: 10.14309/ajg.0000000000002679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/21/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Comparative effectiveness research provides data on the relative benefits and risks between treatments. In Crohn's disease (CD), however, there are few head-to-head studies comparing advanced therapies and none with long-term follow-up. Real-world effectiveness, defined by treatment persistence, obtained from prospective population-based patient cohorts, may help determine the best sequencing and positioning of biological agents. METHODS We analyzed the prospectively collected population-based Australian national Pharmaceutical Benefits Scheme dispensing data registry (2005-2019) for CD. There is no mandated biological agent prescribing order, and all citizens and permanent residents are eligible for treatment irrespective of insurance status. Propensity score matching was performed to reduce selection bias. RESULTS There were 2,029 lines of therapy in 1,446 patients (median age 43 years, interquartile range 34-58, 44% male patients) over the 15-year period with 5,618 patient-years of follow-up. Per line of therapy, 915/2,029 (45.1%) patients used adalimumab, 722/2,029 (35.6%) used infliximab, 155/2,029 (7.6%) used vedolizumab, and 237/2,029 (11.7%) used ustekinumab. When used in biological agent-naive patients, there was no difference in persistence between any agent ( P > 0.05). Used after first line in biological agent-experienced CD, ustekinumab had significantly better persistence than non-ustekinumab biological agents ( P = 0.0018), vs anti-tumor necrosis factor (TNF) alpha therapy ( P = 0.006) or vedolizumab ( P < 0.001). Ustekinumab persistence was unaffected by prior biological agent exposure ( P = 0.51). After anti-TNF use, ustekinumab had superior persistence to an alternative anti-TNF agent ( P = 0.033) and to vedolizumab ( P = 0.026). Using a propensity score-matched analysis adjusted for age, immunomodulator use, and bio-exposed status, ustekinumab had superior persistence to anti-TNF ( P = 0.01). Multivariate predictors of worse persistence were the use of a non-ustekinumab biological agent (adjusted hazard ratio 2.10, P < 0.001), and bio-experienced status (adjusted hazard ratio 1.23, P < 0.001). DISCUSSION This large national prospective database with nonhierarchical prescribing of biological agents did not identify superior persistence of any agent in bio-naive CD. However, for patients with bio-experienced CD, persistence was greater with ustekinumab.
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Affiliation(s)
- John David Chetwood
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
| | - Yanna Ko
- Canterbury Hospital, Sydney, Australia
| | - Aviv Pudipeddi
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
| | - Viraj Kariyawasam
- Department of Gastroenterology and Hepatology, Blacktown and Mount Druitt Hospital, Sydney, Australia
- Blacktown Clinical School, Western Sydney University, Sydney, Australia
| | - Sudarshan Paramsothy
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Rupert W Leong
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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3
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Chetwood JD, Gupta S, Subramaniam K, De Cruz P, Moore G, An YK, Connor SJ, Kermeen M, Paramsothy S, Leong RW. Ustekinumab as induction and maintenance therapy for ulcerative colitis - national extended follow-up and a review of the literature. Expert Opin Drug Saf 2024; 23:449-456. [PMID: 37909484 DOI: 10.1080/14740338.2023.2278686] [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] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/15/2023] [Indexed: 11/03/2023]
Abstract
INTRODUCTION Ustekinumab use in ulcerative colitis had shown low adverse event and high persistence rates to 3 years via the UNIFI long-term extension study. Outcomes beyond 3 years have not been previously described. We describe the safety signals of the entire UNIFI Australian population beyond 3 years. METHODS This retrospective multicenter observational cohort study recruited from all Australian UNIFI centers. The primary outcome was safety via adverse events. Secondary outcomes included the clinical relapse rate on ustekinumab, and the need to switch from ustekinumab to an alternate agent. RESULTS There were 14 patients [11 male, mean age 47 (±14) years], with a median diagnosis of 10.8 (±4.5) years prior to UNIFI enrollment. Median follow-up was 298 weeks (5.7 years) (Interquartile range (IQR): 220-311 weeks). Within the long-term extension, there were three serious adverse events and one minor event. 42.9% (6/14) patients had clinical relapses, of which clinical remission was recaptured in 83.3% (5/6). 85.7% (12/14) persisted on ustekinumab in the long-term, with 7.1% (1/14) electively ceasing ustekinumab and 7.1% (1/14) changed from ustekinumab due to clinical relapse. CONCLUSION For moderate-to-severe UC in Australia, ustekinumab maintained efficacy beyond 3 years with a high persistence rate and no new safety signals. TRIAL REGISTRATION The trial is registered at ANZCTR (identifier: ACTRN12622001332718).
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Affiliation(s)
- J D Chetwood
- Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
| | - S Gupta
- Gastroenterology and Hepatology Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - K Subramaniam
- Gastroenterology and Hepatology Unit, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
- ANU Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - P De Cruz
- Department of Gastroenterology, Austin Hospital, Melbourne, VIC, Australia
| | - G Moore
- Department of Gastroenterology, Monash Health, Melbourne, VIC, Australia
- School of Clinical Sciences, Monash University, Clayton, VIC, Australia
| | - Y K An
- Department of Gastroenterology, Mater Hospital, Brisbane, QLD, Australia
| | - S J Connor
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, NSW, Australia
| | - M Kermeen
- Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia
| | - S Paramsothy
- Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - R W Leong
- Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney, Australia
- Concord Clinical School, University of Sydney, Sydney, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
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4
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Chalasani A, Chetwood JD, Leong R, Paramsothy S. Gastrointestinal: A discovery hard to swallow: an unusual case of esophageal obstruction. J Gastroenterol Hepatol 2024; 39:219. [PMID: 37675467 DOI: 10.1111/jgh.16351] [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] [Received: 04/18/2023] [Revised: 07/25/2023] [Accepted: 08/26/2023] [Indexed: 09/08/2023]
Affiliation(s)
- A Chalasani
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - J D Chetwood
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - R Leong
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
| | - S Paramsothy
- Department of Gastroenterology and Hepatology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
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5
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Chetwood JD, Paramsothy S, Haifer C, Borody TJ, Kamm MA, Leong RW, Kaakoush NO. Key metabolomic alterations are associated with ulcerative colitis disease state and activity: a validation analysis. Gut 2023:gutjnl-2023-330196. [PMID: 37591699 DOI: 10.1136/gutjnl-2023-330196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Affiliation(s)
- John David Chetwood
- Department of Gastroenterology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Sudarshan Paramsothy
- Department of Gastroenterology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Craig Haifer
- Department of Gastroenterology and Hepatology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Thomas J Borody
- Centre for Digestive Diseases, Sydney, New South Wales, Australia
| | - Michael A Kamm
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia
- Dept of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Rupert W Leong
- Department of Gastroenterology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, NSW, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Nadeem O Kaakoush
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
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6
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Chetwood JD, Sabih AH, Chan K, Salimi S, Sheiban A, Lin E, Chin S, Gu B, Sastry V, Coulshed A, Tsoutsman T, Bowen DG, Majumdar A, Strasser SI, McCaughan GW, Liu K. Epidemiology, characteristics, and outcomes of patients with acute-on-chronic liver failure in Australia. J Gastroenterol Hepatol 2023; 38:1325-1332. [PMID: 37096760 DOI: 10.1111/jgh.16197] [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: 02/07/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND AND AIM Acute-on-chronic liver failure (ACLF) is distinct from acute decompensation (AD) of cirrhosis in its clinical presentation, pathophysiology, and prognosis. There are limited published Australian ACLF data. METHODS We performed a single-center retrospective cohort study of all adults with cirrhosis admitted with a decompensating event to a liver transplantation (LT) centre between 2015 and 2020. ACLF was defined using the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) definition while those who did not meet the definition were classified as AD. The primary outcome of interest was 90-day LT-free survival. RESULTS A total of 615 patients had 1039 admissions for a decompensating event. On their index admission, 34% (209/615) of patients were classified as ACLF. Median admission model for end-stage liver disease (MELD) and MELD-Na scores were higher in ACLF patients compared with AD (21 vs 17 and 25 vs 20 respectively, both P < 0.001). Both the presence and severity of ACLF (grade ≥ 2) significantly predicted worse LT-free survival compared with patients with AD. The EASL-CLIF ACLF score (CLIF-C ACLF), MELD and MELD-Na scores performed similarly in predicting 90-day mortality. Patients with index ACLF had a higher risk of 28-day mortality (28.1% vs 5.1%, P < 0.001) and shorter times to readmission compared with those with AD. CONCLUSION ACLF complicates over a third of hospital admissions for cirrhosis with decompensating events and is associated with a high short-term mortality. The presence and grade of ACLF predicts 90-day mortality and should be identified as those at greatest risk of poor outcome without intervention such as LT.
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Affiliation(s)
- John David Chetwood
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Abdul-Hamid Sabih
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Karen Chan
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Shirin Salimi
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Alexander Sheiban
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Elton Lin
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Simone Chin
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Bonita Gu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Vinay Sastry
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Andrew Coulshed
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
| | - Tatiana Tsoutsman
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - David G Bowen
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Geoffrey W McCaughan
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
- Liver Injury and Cancer Program, Centenary Institute, Sydney, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
- Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia
- Liver Injury and Cancer Program, Centenary Institute, Sydney, Australia
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7
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Chetwood JD, Shin JS, Koorey D. Gastrointestinal: Esophageal nodularity in a 32-year-old female patient. J Gastroenterol Hepatol 2022; 37:1840. [PMID: 35307875 DOI: 10.1111/jgh.15807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/08/2022] [Indexed: 12/09/2022]
Affiliation(s)
- J D Chetwood
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - J-S Shin
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.,Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - D Koorey
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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8
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Chetwood JD, Mudaliar S, Staudenmann D, Shin JS, Liu K, Majumdar A, Kaffes A, Strasser S, McCaughan GW, Saxena P. Emerging role of endoscopic ultrasound-guided liver biopsy. Gut 2020; 70:gutjnl-2020-322704. [PMID: 32948619 DOI: 10.1136/gutjnl-2020-322704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 01/27/2023]
Affiliation(s)
- John David Chetwood
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sanjivan Mudaliar
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Dominic Staudenmann
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Joo-Shik Shin
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Department of Tissue Pathology, NSW Health Pathology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Ken Liu
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Avik Majumdar
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Arthur Kaffes
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Simone Strasser
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Geoffrey W McCaughan
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Payal Saxena
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
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9
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Chetwood JD, Myat LL, Lammi H, Panat M, Hughes J. Acute interstitial nephritis with immunotherapy; a growing entity? J Renal Inj Prev 2020. [DOI: 10.34172/jrip.2020.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We report a case of acute kidney injury (AKI) secondary to immune-mediated acute interstitial nephritis (AIN), with supporting diagnostic results and a successful response to treatment. This entity is gaining increasing recognition with the burgeoning use of immunotherapy agents in oncology. The timeline for the development of AIN from the initiation of immunotherapy varies, and may range in severity from asymptomatic to severe, organ-threatening and with life threatening consequences. Renal biopsy should be performed to confirm the diagnosis due to the potential impact of discontinuation of immunotherapy on cancer survival. Re-challenge with immunotherapy is reasonable once renal function recovers.
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Affiliation(s)
- John David Chetwood
- Department of General Medicine, Tamworth Hospital, Dean St, Tamworth, NSW, Australia
| | - Lin Lin Myat
- Department of General Medicine, Tamworth Hospital, Dean St, Tamworth, NSW, Australia
| | - Helen Lammi
- Department of General Medicine, Tamworth Hospital, Dean St, Tamworth, NSW, Australia
| | - Mani Panat
- Department of General Medicine, Tamworth Hospital, Dean St, Tamworth, NSW, Australia
| | - James Hughes
- Department of General Medicine, Tamworth Hospital, Dean St, Tamworth, NSW, Australia
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10
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Bangamwabo JB, Chetwood JD, Dusabejambo V, Ntirenganya C, Nuki G, Nkurunziza A, Kieffer KA, Jones M, Walker TD. Prevalence and sociodemographic determinants of dyspepsia in the general population of Rwanda. BMJ Open Gastroenterol 2020; 7:bmjgast-2020-000387. [PMID: 32381743 PMCID: PMC7222881 DOI: 10.1136/bmjgast-2020-000387] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/09/2020] [Accepted: 03/27/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Dyspepsia accounts for a significant burden of worldwide disease, but there is a relative paucity of data from the sub-Saharan African setting. We undertook to describe the burden, risk factors and severity of dyspepsia across Rwanda. Methods We performed a population-based clustered cross-sectional survey between November 2015 and January 2016, nationwide in Rwanda, using the Short Form Leeds Dyspepsia Questionnaire to describe the presence and severity of dyspepsia, and the Short Form Nepean Dyspepsia Index to describe the concomitant quality of life effects. Univariate and multivariate logistic regression models were constructed to correlate measured sociodemographic factors with dyspepsia. Results The prevalence of clinically significant dyspepsia in the general Rwandan population was 14.2% (283/2000). The univariate factors that significantly predicted severity were gender, profession, socioeconomic status, and non-steroidal anti-inflammatory drug, aspirin and alcohol use, with gender, current smoking, aspirin use both in the past and currently, and alcohol use in the past remaining significant on multivariate modelling. Dyspeptics had a significantly lower gastrointestinal-related quality of life, though the sociodemographic factors measured did not modify the observed quality of life. Conclusion Dyspepsia is prevalent in the Rwandan setting and is associated with a significant burden on quality of life. More work is required to determine the pathological entities involved, and the optimal approach to mitigating this burden.
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Affiliation(s)
| | | | - Vincent Dusabejambo
- Department of Internal Medicine, Kigali University Teaching Hospital, Kigali, Rwanda.,Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Cyprien Ntirenganya
- Department of Internal Medicine, University Teaching Hospital of Butare, Butare, Rwanda
| | | | - Arcade Nkurunziza
- Kibungo Hospital, Kibungo, Eastern Province, Rwanda.,Department of Internal Medicine, Kibungo Referral Hospital, Ngoma District, Rwanda
| | - Kelly A Kieffer
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Michael Jones
- Psychology Faculty, Macquarie University, Sydney, New South Wales, Australia
| | - Timothy D Walker
- Calvary Mater Newcastle, Waratah, New South Wales, Australia .,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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Abstract
Esophageal carcinoma causes over 380 000 deaths per year, ranking sixth worldwide in mortality amongst all malignancies. Globally, the squamous cell subtype is most common and accounts for 80% of esophageal cancers. Nonetheless, esophageal squamous cell carcinoma is much more poorly understood than esophageal adenocarcinoma, including what is driving such high prevalences, why it often presents in young patients, and shows such marked geographical delineations Areas covered: The current literature was searched for articles focusing on aetiopathogenesis of squamous cell esophageal carcinoma via a systematic review, particularly in low-resource settings. This was supplemented by papers of interest known to the authors. Expert commentary: Current putative mechanisms include polycyclic aromatic hydrocarbons, nitrosamines, acetaldehyde, cyclo-oxygenase-2 pathways, androgen and their receptor levels, as well as smoking & alcohol, micronutrient deficiencies and diet, mycotoxins, thermal damage, oral hygiene and microbiotal factors, inhaled smoke, viral infections such as HPV, and chronic irritative states. Etiology is likely multifactorial and varies geographically. Though smoking and alcohol play a predominant role in high-income settings, there is strong evidence that mycotoxins, diet and temperature effects may play an under-recognized role in low and middle-income settings.
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Affiliation(s)
- John David Chetwood
- a Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi
| | - Priya Garg
- a Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi
| | | | - Melita Gordon
- a Malawi Liverpool Wellcome Trust Clinical Research Programme , Blantyre , Malawi.,b College of Medicine , Blantyre , Malawi.,c Institute of Infection and Global Health , University of Liverpool , Liverpool , UK
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Chetwood JD, Finch PJ, Kankwatira A, Mallewa J, Gordon MA, Masamba L. Five-year single-centre experience of carcinoma of the oesophagus from Blantyre, Malawi. BMJ Open Gastroenterol 2018; 5:e000232. [PMID: 30397505 PMCID: PMC6203015 DOI: 10.1136/bmjgast-2018-000232] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/20/2018] [Accepted: 09/02/2018] [Indexed: 01/12/2023] Open
Abstract
Background Oesophageal squamous cell carcinoma (OSCC) is increasing worldwide and has an exceptionally high prevalence in certain distinct geographical locations such as the African oesophageal SCC corridor. Despite this, there is a paucity of evidence to characterise the disease particularly in the Malawian context. Method We retrospectively audited our endoscopy database over 5 years, including for patient demographics, endoscopy findings, therapeutic intervention and recommendations for treatment. Results 1586 patients with oesophageal cancer were identified from a total of 5882 endoscopy records from 2013 to 2017. Our cohort showed a larger proportion of oesophageal cancers found higher in the oesophagus compared with other African studies and a female preponderance in this upper-oesophagus disease subset though a male preponderance overall. 39% of patients with oesophageal cancer underwent bougie dilatation and 11% underwent palliative stent placement, which likely reflects local availability of resources. Conclusion This study validates the observation that OSCC predominates in sub-Saharan Africa in Malawi over other forms of oesophageal carcinoma, though our cohort appears to have subtly distinct demographics and disease-specific data. This highlights the need to prioritise preventative and therapeutic strategies for OSCC in this and similar settings.
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Affiliation(s)
- John David Chetwood
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Peter J Finch
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Anstead Kankwatira
- Malawi-Liverpool-Wellcome Trust Major Overseas Programme, Blantyre, Malawi
| | - Jane Mallewa
- Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Melita A Gordon
- Malawi-Liverpool-Wellcome Trust Major Overseas Programme, Blantyre, Malawi.,Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,World Gastroenterology Organisation International Training Centre, Blantyre, Malawi
| | - Leo Masamba
- Department of Medicine, Queen Elizabeth Central Hospital, Blantyre, Malawi
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