1
|
Vermeire S, Hanzel J, Löwenberg M, Ferrante M, Bossuyt P, Hoentjen F, Franchimont D, Palatka K, Peeters H, Mookhoek A, de Hertogh G, Molnár T, van Moerkercke W, Lobatón T, Clasquin E, Hulshoff MS, Baert F, D'Haens G. Early Versus Late Use of Vedolizumab in Ulcerative Colitis: Clinical, Endoscopic, and Histological Outcomes. J Crohns Colitis 2024; 18:540-547. [PMID: 37934813 DOI: 10.1093/ecco-jcc/jjad179] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND AND AIMS We explored the potential for differential efficacy of vedolizumab between early and late ulcerative colitis [UC] with evaluation of clinical, endoscopic, and histological endpoints. METHODS This was a multicentre, multinational, open-label study in patients with moderately-to-severely active UC, defining early UC by a disease duration <4 years and bio-naïve and late UC by a disease duration > 4 years and additional exposure to tumour necrosis factor antagonists. Patients received standard treatment with intravenous vedolizumab for 52 weeks [300 mg Weeks 0, 2, 6, every 8 weeks thereafter without escalation]. The primary endpoint was corticosteroid-free clinical remission with endoscopic improvement [total Mayo score ≤2 with no subscore >1] at both Weeks 26 and 52. RESULTS A total of 121 patients were included: in the "early" group, 25/59 [42.4%] achieved the primary endpoint versus 19/62 [30.6%] in the "late" group [p = 0.18]. There were no significant differences between the two groups in endoscopic improvement [Week 26: "early" 32/59 [54.2%] versus "late" 29/62 [46.8%]; p = 0.412; Week 52: 27/59 [45.8%] versus 25/62 [40.3%]; p = 0.546] or in histological remission [Robarts Histopathology Index <3 without neutrophils in the epithelium and lamina propria] [Week 26: 24/59 [40.7%] versus 21/62 [33.9%]; p = 0.439; Week 52: 22/59 [37.3%] versus 22/62 [35.5%]; p = 0.837]. CONCLUSIONS No significant differences in clinical, endoscopic, and histological outcomes were observed between "early" and "late" disease.
Collapse
Affiliation(s)
- Séverine Vermeire
- Department of Gastroenterology and Hepatology, Department of Chronic Diseases and Metabolism, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Jurij Hanzel
- Department of Gastroenterology, UMC Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, Department of Chronic Diseases and Metabolism, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Peter Bossuyt
- Imelda Clinical Research Centre, Imelda General Hospital, Bonheiden, Belgium
| | - Frank Hoentjen
- Department of Gastroenterology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Harald Peeters
- Department of Gastroenterology, AZ Sint Lucas, Gent, Belgium
| | - Aart Mookhoek
- Institute of Tissue Medicine and Pathology, Bern University, Bern, Switzerland
| | - Gert de Hertogh
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Tamás Molnár
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Wouter van Moerkercke
- Department of Gastroenterology and Hepatology, Department of Chronic Diseases and Metabolism, University Hospitals Leuven, KU Leuven, Leuven, Belgium
- Department of Gastroenterology, AZ Groeninge, Kortrijk, Belgium
| | - Triana Lobatón
- Department of Gastroenterology and Hepatology, University Hospital Gent, Gent, Belgium
- Department of Internal Medicine and Pediatrics, Gent University, Gent, Belgium
| | - Esmé Clasquin
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Melanie S Hulshoff
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare, Belgium
| | - Geert D'Haens
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Miheller P, Kristóf T, Bor R, Farkas K, Golovics P, Harsányi L, Müller KE, Milassin Á, Palatka K, Schäfer E, Szamosi T, Sarlós P, Molnár T. A fekélyes vastagbélgyulladás gyógyszeres és sebészeti kezelése. Orv Hetil 2024; 165:37-64. [PMID: 38470491 DOI: 10.1556/650.2024.33050] [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] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Pál Miheller
- 1 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Tünde Kristóf
- 2 Borsod-Abaúj-Zemplén Vármegyei Központi Kórház Miskolc Magyarország
| | - Renáta Bor
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Klaudia Farkas
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Petra Golovics
- 4 Észak-Pesti Centrumkórház - Honvédkórház Budapest Magyarország
| | - László Harsányi
- 1 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | | | - Ágnes Milassin
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Károly Palatka
- 6 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Gasztroenterológiai Klinika Debrecen Magyarország
| | - Eszter Schäfer
- 4 Észak-Pesti Centrumkórház - Honvédkórház Budapest Magyarország
| | - Tamás Szamosi
- 4 Észak-Pesti Centrumkórház - Honvédkórház Budapest Magyarország
| | - Patrícia Sarlós
- 7 Pécsi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika Pécs Magyarország
| | - Tamás Molnár
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| |
Collapse
|
3
|
Farkas K, Székely H, Bacsur P, Bánky B, Élthes ZB, Harsányi L, Müllner KE, Milassin Á, Palatka K, Sarlós P, Szamosi T, Molnár T, Miheller P. A Crohn-betegég terápiás stratégiája. Orv Hetil 2024; 165:1-36. [PMID: 38470481 DOI: 10.1556/650.2024.33020] [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] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Klaudia Farkas
- 1 Szegedi Tudományegyetem, Szent Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Hajnal Székely
- 2 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Péter Bacsur
- 1 Szegedi Tudományegyetem, Szent Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Balázs Bánky
- 2 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Zsuzsa Bianka Élthes
- 3 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Gasztroenterológiai Klinika Debrecen Magyarország
| | - László Harsányi
- 2 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Katalin Edit Müllner
- 2 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Ágnes Milassin
- 1 Szegedi Tudományegyetem, Szent Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Károly Palatka
- 3 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Gasztroenterológiai Klinika Debrecen Magyarország
| | - Patrícia Sarlós
- 4 Pécsi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika Pécs Magyarország
| | - Tamás Szamosi
- 5 Észak-Pesti Centrumkórház - Honvédkórház Budapest Magyarország
| | - Tamás Molnár
- 1 Szegedi Tudományegyetem, Szent Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Pál Miheller
- 2 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| |
Collapse
|
4
|
Réka P, Janka EA, Soltész L, Szabó IL, Kapitány A, Dajnoki Z, Emri G, Nagy G, Palatka K, Zouboulis CC, Szegedi A, Gáspár K. Chronic inflammatory intestinal disorders in hidradenitis suppurativa. Dermatology 2023:000530434. [PMID: 37019083 DOI: 10.1159/000530434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/26/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Intestinal symptoms are common in patients with hidradenitis suppurativa (HS). HS patients may experience a broad spectrum of chronic inflammatory intestinal disorders (CIID), not exclusive to inflammatory bowel diseases, which are diagnosed by colonoscopy and intestinal biopsies. The frequency of CIID in patients with HS has not been investigated. OBJECTIVE The objectives of this study were to determine the occurrence of CIID in HS and characterise this clinical population. Furthermore, the feasibility of using fecal calprotectin (FC) test or anti-Saccharomyces cerevisiae antibody (ASCA) levels to assess the colonic inflammation of CIID in HS patients was investigated. METHODS All newly diagnosed and untreated HS patients (n=74) were referred to a gastroenterologist for FC followed by colonoscopy after informed consent. C-reactive protein (CRP), white blood cell count, nucleotide-binding-oligomerisation-domain-containing-protein-2 (NOD2) polymorphism, and ASCA levels were measured. Patients were divided into HS-only and HS with CIID (HS+CIID) groups, based on the absence or presence of CIID. Laboratory and clinical parameters (age, gender, HS onset, clinical stage, family history, body mass index (BMI), smoking) were compared between the groups. RESULTS Thirteen patients complained gastrointestinal symptoms prior to any examination, including 11 in the HS+CIID group. The CIID frequency in HS was 28.4% (n=21/74), based on colonoscopy and histology. Significantly more patients had severe disease state in the HS+CIID group compared with the HS-only group, and BMI was significantly lower in the HS+CIID group (28.20±5.58 vs. 32.74±6.45, p=0.006). FC positivity occurred significantly more in HS+CIID patients compared with HS-only patients (90.48% vs. 3.77%, p<0.001), and ASCA IgG levels were significantly elevated in HS+CIID patients (22.08±23.07 vs 8.41±10.94 U/mL, p=0.001). The FC test identified HS+CIID patients with 96.23% specificity and 91.3% sensitivity, while ASCA displayed 77.8% sensitivity and 76.3% specificity. Blood count, CRP and the presence of NOD2 polymorphisms were indifferent between the two groups. CONCLUSION A high frequency of CIID was detected in the examined HS population. The non-invasive FC test has high sensitivity and specificity for diagnosing CIID in HS patients. Concomitant CIID and HS may indicate the need for an early-start for biological treatment.
Collapse
|
5
|
Kóder G, Olasz J, Tóth L, András C, Bubán T, Palatka K, Karányi Z, Tóth D, Damjanovich L, Tanyi M. Előrehaladott végbéldaganatok neoadjuváns (preoperatív) kemoradioterápiája. Orv Hetil 2022; 163:1196-1205. [DOI: 10.1556/650.2022.32497] [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] [Received: 01/28/2022] [Accepted: 03/02/2022] [Indexed: 11/21/2022]
Abstract
Bevezetés: A végbéldaganatok kezelési protokolljában az elmúlt
évtizedekben jelentős változások történtek, melyek nagymértékben csökkentették a
helyi kiújulások és a távoli áttétek számát, ezzel növelve a teljes túlélést. Az
egyik jelentős előrelépést a kombinált neoadjuváns kezelés bevezetése
jelentette. Módszer: A Debreceni Egyetem Sebészeti Klinikáján
2010. január 1. és 2017. december 31. között lokális neoadjuváns
kemoradioterápiában részesített, majd műtéten átesett 362, rectumtumoros beteg
adatainak retrospektív feldolgozását végeztük statisztikai elemzéssel. A lokális
neoadjuváns kezelésre adott válasz mértékét és késői túlélési eredményeinket
összehasonlítottuk az időközben megjelent nagy nemzetközi tanulmányokban közölt
teljes neoadjuváns kezeléssel elért eredményekkel. Eredmények:
Betegeink között 8,6%-ban tapasztaltunk teljes patológiai regressziót. A műtét
időpontjára, valamint az azt követő 3 hónapon belül betegeink 10,7%-ában
tapasztaltuk távoli áttét kialakulását. Vizsgálataink során a neoadjuváns
kezelésre adott válasz mértéke a felismerési stádiumtól független prognosztikai
faktornak bizonyult. A jobb választ adó csoportok szignifikánsan jobb túlélési
eredményeket produkáltak. Következtetés: A legújabb nemzetközi
tanulmányokban teljes neoadjuváns kezelés hatására a teljes patológiai választ
adó betegek száma megduplázódott, a távoli áttét pedig 7%-kal kevesebb volt a
lokális neoadjuváns csoporthoz képest. Betegeink 85%-a a felismerés pillanatában
T3–4N+ stádiumú volt. Tekintettel a műtét pillanatában vagy 3 hónapon belül
felismert távoli áttétek 10,7%-os arányára megállapítható, hogy betegeink
mintegy felében eredményesebb lett volna a teljes neoadjuváns kezelés
alkalmazása. Ennek megfelelően a jövőben intézetünkben is a teljes neoadjuváns
protokoll szerint kívánunk eljárni. Orv Hetil. 2022; 163(30): 1196–1205.
Collapse
Affiliation(s)
- Gergely Kóder
- Debreceni Egyetem, Általános Orvostudományi Kar, Sebészeti Intézet Debrecen, Móricz Zs. krt. 22., 4032 Magyarország
| | - Judit Olasz
- Országos Onkológiai Intézet, Patogenetikai Osztály Budapest Magyarország
| | - László Tóth
- Debreceni Egyetem, Általános Orvostudományi Kar, Pathológiai Intézet Debrecen Magyarország
| | - Csilla András
- Debreceni Egyetem, Általános Orvostudományi Kar, Onkológiai Intézet Debrecen Magyarország
| | - Tamás Bubán
- Debreceni Egyetem, Általános Orvostudományi Kar, Belgyógyászati Intézet Debrecen Magyarország
| | - Károly Palatka
- Debreceni Egyetem, Általános Orvostudományi Kar, Belgyógyászati Intézet Debrecen Magyarország
| | - Zsolt Karányi
- Debreceni Egyetem, Általános Orvostudományi Kar, Belgyógyászati Intézet Debrecen Magyarország
| | - Dezső Tóth
- Debreceni Egyetem, Általános Orvostudományi Kar, Sebészeti Intézet Debrecen, Móricz Zs. krt. 22., 4032 Magyarország
| | - László Damjanovich
- Debreceni Egyetem, Általános Orvostudományi Kar, Sebészeti Intézet Debrecen, Móricz Zs. krt. 22., 4032 Magyarország
| | - Miklós Tanyi
- Debreceni Egyetem, Általános Orvostudományi Kar, Sebészeti Intézet Debrecen, Móricz Zs. krt. 22., 4032 Magyarország
| |
Collapse
|
6
|
Péntek M, Gulácsi L, Herszényi L, Banai J, Palatka K, Lakatos PL, Brodszky V, Rencz F. Subjective expectations regarding longevity and future health: a cross-sectional survey among patients with Crohn's disease. Colorectal Dis 2021; 23:105-113. [PMID: 32920967 DOI: 10.1111/codi.15357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/28/2020] [Accepted: 08/31/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to explore the subjective health expectations (sHE) of patients with Crohn's disease (CD) for both the near future and the elderly. METHOD A cross-sectional survey was performed in four gastroenterology centres in Hungary. Consecutive outpatients with CD with age ≥ 18 were recruited. Socio-demographic and disease characteristics were recorded and the Crohn's Disease Activity Index (CDAI), Perianal Disease Activity Index, Patients' Global Assessment (PGA) and current pain visual analogue scale (VAS) were assessed. Subjective life expectancy (sLE) was explored and compared to statistical life expectancy. Current health and sHE for 1 year ahead and for ages 60/70/80/90 were assessed using the descriptive system of the EQ-5D-3L. RESULTS In all, 206 patients (54.9% men) with a mean age of 34.7 (SD 10.5 years) and disease duration of 10.5 (SD 6.3) years were studied. The CDAI score was 110.5 (SD 77.0) and 66% were treated by biologic drugs. Mean current EQ-5D-3L score was 0.80 (SD 0.17) and patients expected a 0.05 (SD 0.15) improvement within a year (P < 0.05). For ages 60/70/80/90, a mean EQ-5D-3L score of 0.59, 0.38, 0.10 and -0.12 respectively was provisioned. Age, current health status, sLE, PGA and pain VAS showed significant correlation with both 1-year and older age sHE (P < 0.05). Long-term sHE and sLE were negatively affected by the presence of extraintestinal manifestations but not by previous CD-related surgery. CONCLUSION Patients with CD expect severe deterioration in health in later life. Given that unrealistic sHE may affect patients' current quality of life and health behaviour, we encourage physicians to explore and consider CD patients' sHE in clinical care.
Collapse
Affiliation(s)
- M Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - L Gulácsi
- University Research and Innovation Center, Óbuda University, Budapest, Hungary.,Corvinus Institute of Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - L Herszényi
- Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - J Banai
- Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - K Palatka
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - P L Lakatos
- McGill University Health Centre, MUHC, Montreal General Hospital, Montreal, Quebec, Canada
| | - V Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - F Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Hungarian Academy of Sciences, Premium Postdoctoral Research Program, Budapest, Hungary
| |
Collapse
|
7
|
Kósa F, Kunovszki P, Borsi A, Iliás Á, Palatka K, Szamosi T, Vincze Á, Molnár T, Lakatos PL. Anti-TNF dose escalation and drug sustainability in Crohn's disease: Data from the nationwide administrative database in Hungary. Dig Liver Dis 2020; 52:274-280. [PMID: 31669077 DOI: 10.1016/j.dld.2019.09.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND A significant percentage of patients receiving anti-tumor necrosis factor alpha (anti-TNFα) agents lose clinical response over time. This study aims to provide representative real-world data on anti-TNFα drug sustainability, prevalence and predictors of anti-TNFα dose escalation. METHODS In this nationwide, retrospective study, patients receiving infliximab or adalimumab therapy between 2013 and 2016 were included using the administrative claims database of the Hungarian National Health Insurance Fund. Demographic characteristics, drug sustainability, dose escalation, use of parallel medications were analyzed. RESULTS 476 infliximab and 397 adalimumab patients were included. Dose escalation was observed in 7%, 9% and 22% of patients receiving originator/biosimilar infliximab and adalimumab during the complete follow-up, respectively. Dose escalation was associated with shorter disease duration (OR = 1.75, p = 0.026) and corticosteroid use. Drug retention rates were 62.7%, 72.3%, 75.4% after 1 year follow-up for Remicade®, Inflectra® and Humira®, which decreased to 38.3% and 52.1% for Remicade® and Humira® at 3 years. Drug sustainability was affected by steroid use prior biologic initiation in adalimumab treated patients (HR = 2.04, p < 0.001), while in infliximab treated patients dose escalation (HR = 0.51, p = 0.02) and gender (HR = 1.39, p = 0.033) were predictors of treatment discontinuation. CONCLUSION Dose escalation rates were lower in this real-world administrative database study for both adalimumab and infliximab compared to published data. Drug retention rates were overall satisfactory, with no apparent difference between the legacy and biosimilar infliximab.
Collapse
Affiliation(s)
- Fruzsina Kósa
- Janssen Global Commercial Strategy Organization, Budapest, Hungary
| | - Péter Kunovszki
- Janssen Global Commercial Strategy Organization, Budapest, Hungary
| | | | - Ákos Iliás
- Semmelweis University, Budapest, Hungary
| | | | | | | | | | - Peter L Lakatos
- Semmelweis University, Budapest, Hungary; McGill University Health Center, Montreal, Canada.
| |
Collapse
|
8
|
Bor R, Fábián A, Matuz M, Szepes Z, Farkas K, Miheller P, Szamosi T, Vincze Á, Rutka M, Szántó K, Bálint A, Nagy F, Milassin Á, Tóth T, Zsigmond F, Bajor J, Müllner K, Lakner L, Papp M, Salamon Á, Horváth G, Sarang K, Schäfer E, Sarlós P, Palatka K, Molnár T. Real-life efficacy of vedolizumab on endoscopic healing in inflammatory bowel disease – A nationwide Hungarian cohort study. Expert Opin Biol Ther 2019; 20:205-213. [PMID: 31782939 DOI: 10.1080/14712598.2020.1699529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Pál Miheller
- First Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Tamás Szamosi
- Department of Gastroenterology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Áron Vincze
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Tóth
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Zsigmond
- Department of Gastroenterology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Judit Bajor
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Katalin Müllner
- Second Department of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Mária Papp
- Second Department of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Gábor Horváth
- Central Hospital of Borsod-Abaúj-Zemplén County, Miskolc, Hungary
| | | | - Eszter Schäfer
- Department of Gastroenterology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Patrícia Sarlós
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Károly Palatka
- Second Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
9
|
Kucserik LP, Márta K, Vincze Á, Lázár G, Czakó L, Szentkereszty Z, Papp M, Palatka K, Izbéki F, Altorjay Á, Török I, Barbu S, Tantau M, Vereczkei A, Bogár L, Dénes M, Németh I, Szentesi A, Zádori N, Antal J, Lerch MM, Neoptolemos J, Sahin-Tóth M, Petersen OH, Kelemen D, Hegyi P. Endoscopic sphincterotoMy for delayIng choLecystectomy in mild acute biliarY pancreatitis (EMILY study): protocol of a multicentre randomised clinical trial. BMJ Open 2019; 9:e025551. [PMID: 31289058 PMCID: PMC6629406 DOI: 10.1136/bmjopen-2018-025551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION According to the literature, early cholecystectomy is necessary to avoid complications related to gallstones after an initial episode of acute biliary pancreatitis (ABP). A randomised, controlled multicentre trial (the PONCHO trial) revealed that in the case of gallstone-induced pancreatitis, early cholecystectomy was safe in patients with mild gallstone pancreatitis and reduced the risk of recurrent gallstone-related complications, as compared with interval cholecystectomy. We hypothesise that carrying out a sphincterotomy (ES) allows us to delay cholecystectomy, thus making it logistically easier to perform and potentially increasing the efficacy and safety of the procedure. METHODS/DESIGN EMILY is a prospective, randomised, controlled multicentre trial. All patients with mild ABP, who underwent ES during the index admission or in the medical history will be informed to take part in EMILY study. The patients will be randomised into two groups: (1) early cholecystectomy (within 6 days after discharge) and (2) patients with delayed (interval) cholecystectomy (between 45 and 60 days after discharge). During a 12-month period, 93 patients will be enrolled from participating clinics. The primary endpoint is a composite endpoint of mortality and recurrent acute biliary events (that is, recurrent ABP, acute cholecystitis, uncomplicated biliary colic and cholangitis). The secondary endpoints are organ failure, biliary leakage, technical difficulty of the cholecystectomy, surgical and other complications. ETHICS AND DISSEMINATION The trial has been registered internationally ISRCTN 10667869, and approved by the relevant organisation, the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (EKU/2018/12176-5). TRIAL REGISTRATION NUMBER ISCRTN 10667869; Pre-results.
Collapse
Affiliation(s)
- Levente Pál Kucserik
- Division of Surgery, Universitatea de Medicina si Farmacie din Targu Mures, Targu Mures, Romania
| | - Katalin Márta
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
- János Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
- Division of Gastroenterology, First Department of Internal Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - György Lázár
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - László Czakó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Mária Papp
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Debreceni Egyetem, Debrecen, Hungary
| | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Debreceni Egyetem, Debrecen, Hungary
| | - Ferenc Izbéki
- Divison of Gastroenterology, Fejer County Saint George Teaching Hospital of University of Pécs, Székesfehérvár, Hungary
| | - Áron Altorjay
- Division of Surgery, Fejer County Saint George Teaching Hospital of University of Pécs, Székesfehérvár, Hungary
| | - Imola Török
- Division of Gastroenterology, Universitatea de Medicina si Farmacie din Targu Mures, Targu Mures, Romania
| | - Sorin Barbu
- 4thSurgery Department, “Iuliu Hatieganu” University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Marcel Tantau
- 4thSurgery Department, “Iuliu Hatieganu” University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - András Vereczkei
- Department for Surgery, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Lajos Bogár
- Department of Anaesthesiology and Intensive Therapy, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Márton Dénes
- Second Department of Surgery, County Hospital Targu Mures, Targu Mures, Romania
| | - Imola Németh
- Data-Management, Pre-Clinical and Clinical Biostatistics, Adware Research Developing and Consulting Ltd, Balatonfüred, Hungary
| | - Andrea Szentesi
- Institute for Translational Medicine, Pecsi Tudomanyegyetem, Pecs, Hungary
- MTA-SZTE Translational Gastroenterology Research Group, Szegedi Tudomanyegyetem, Szeged, Hungary
| | - Noémi Zádori
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Judit Antal
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
| | - Markus M Lerch
- Department of Medicine A, Universitatsmedizin Greifswald, Greifswald, Mecklenburg-Vorpommern, Germany
| | - John Neoptolemos
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, Liverpool, UK
| | - Miklós Sahin-Tóth
- Department of Molecular and Cell Biology, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA
| | - Ole H Petersen
- School of Biosciences, Cardiff University, Cardiff, South Glamorgan, UK
| | - Dezső Kelemen
- Surgery Clinic, Pecsi Tudomanyegyetem, Pecs, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Pecsi Tudomanyegyetem Altalanos Orvostudomanyi Kar, Pecs, Hungary
- MTA-SZTE, Translational Gastroenterology Research Group, Szeged, Hungary
| |
Collapse
|
10
|
Rencz F, Stalmeier PFM, Péntek M, Brodszky V, Ruzsa G, Gönczi L, Palatka K, Herszényi L, Schäfer E, Banai J, Rutka M, Gulácsi L, Lakatos PL. Patient and general population values for luminal and perianal fistulising Crohn's disease health states. Eur J Health Econ 2019; 20:91-100. [PMID: 31102158 PMCID: PMC6544586 DOI: 10.1007/s10198-019-01065-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/13/2019] [Indexed: 05/04/2023]
Abstract
BACKGROUND In patients with Crohn's disease (CD), luminal disease activity paralleled by perianal fistulas may seriously impair health-related quality of life (HRQoL). Health utility values are not available from patients with CD that reflect the health loss associated with both luminal and perianal CD. OBJECTIVE To generate utilities for luminal and concomitant perianal fistulising CD health states directly from patients and from members of the general public. METHODS A cross-sectional survey was undertaken enrolling CD patients and a convenience sample of members of the general population. Respondents were asked to evaluate four common CD heath states [severe luminal disease (sCD), mild luminal disease (mCD), severe luminal disease with active perianal fistulas (sPFCD), and mild luminal disease with active perianal fistulas (mPFCD)] by 10-year time trade-off (TTO). In addition, patients assessed their current HRQoL by the TTO method. RESULTS Responses of 206 patients (40.8% with perianal fistulas) and 221 members of the general population were analysed. Mean ± SD utilities among patients for sPFCD, sCD, mPFCD and mCD states were 0.69 ± 0.33, 0.73 ± 0.31, 0.80 ± 0.29 and 0.87 ± 0.26. Corresponding values in the general public were: 0.59 ± 0.31, 0.65 ± 0.29, 0.80 ± 0.26 and 0.88 ± 0.25. Patients with active perianal fistulas, previous non-resection surgeries, and higher pain intensity scores valued their current health as worse (p < 0.05). CONCLUSIONS TTO is a feasible method to assess HRQoL in patients with perianal fistulising disease, often not captured by health status questionnaires. Utilities from this study are intended to support the optimization of treatment-related decision making in patients with luminal disease paralleled by active perianal fistulas.
Collapse
Affiliation(s)
- Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary.
- Premium Postdoctoral Research Program, Hungarian Academy of Sciences, Nádor u. 7, 1051, Budapest, Hungary.
| | - Peep F M Stalmeier
- Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Gábor Ruzsa
- Doctoral School of Psychology, Institute of Psychology, Eötvös Loránd University of Sciences, Izabella u. 46, 1064, Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Lóránt Gönczi
- 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, 1083, Budapest, Hungary
| | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Nagyerdei krt. 98, 4032, Debrecen, Hungary
| | - László Herszényi
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - Eszter Schäfer
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - János Banai
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, 1062, Budapest, Hungary
| | - Mariann Rutka
- 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, 6720, Szeged, Hungary
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, 1083, Budapest, Hungary
- Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| |
Collapse
|
11
|
Balog K, Csiszkó A, Krasnyánszky N, Farkas M, Berhés M, László I, Palatka K, Damjanovich L, Sápy P, Szentkereszty Z. [Open transgastric necrosectomy for extended walled-off pancreas necrosis]. Magy Seb 2019; 72:8-12. [PMID: 30869532 DOI: 10.1556/1046.72.2019.1.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS In severe acute pancreatitis the timing of necrosectomy is ideally should be postponed 4-6 weeks after the onset of the disease when the walled-of pancreatic necrosis (WOPN) has developed. The authors present their experience with open transgastric necrosectomy for extended WOPN. PATIENTS AND METHODS The authors performed 17 (12 male, 5 female with a mean age of 61.6 ± 15.1 years) open transgastric necrosectomies for extended WOPN in a period of 1, January 2012 and 31, December 2017. Before the operations conservative and semiconservative therapy was used for an average of 74.6 ± 83.1 days. The mean size of the WOPNs was 13.8 ± 5.2 cm with localisation of the retrocolic and retroduodenal regions. All necroses were septic. RESULTS Complications related to the operation were not observed. The mean time of hospitalization after the surgery was 11.6 ± 12.8 days. The mortality rate was 5.9%. Late operation or other interventions for pseudocyst or pancreas fistula formation was not performed. Two patients needed endoscopic dilatation with lavage in the early postoperative period because of fever. New diabetes mellitus was not observed but worsening of previously existed diabetes developed in 6.3% of the cases. CONCLUSIONS The open transgastric necrosectomy is safe and effective for extended WOPN. The advantage of this type of necrosectomy is the prevention of pancreatic pseudocyst and fistula formation.
Collapse
Affiliation(s)
- Klaudia Balog
- Sebészeti Intézet, Debreceni Egyetem Klinikai Központ 4032 Debrecen, Móricz Zs. krt. 22
| | | | | | - Máté Farkas
- Sebészeti Intézet, Debreceni Egyetem Klinikai Központ 4032 Debrecen, Móricz Zs. krt. 22
| | - Mariann Berhés
- Aneszteziológiai és Intenzív Terápiás Tanszék, Debreceni Egyetem Klinikai Központ Debrecen
| | - István László
- Aneszteziológiai és Intenzív Terápiás Tanszék, Debreceni Egyetem Klinikai Központ Debrecen
| | - Károly Palatka
- Belgyógyászati Klinika, B Épület, Debreceni Egyetem Klinikai Központ Debrecen
| | - László Damjanovich
- Sebészeti Intézet, Debreceni Egyetem Klinikai Központ 4032 Debrecen, Móricz Zs. krt. 22
| | - Péter Sápy
- Sebészeti Intézet, Debreceni Egyetem Klinikai Központ 4032 Debrecen, Móricz Zs. krt. 22
| | - Zsolt Szentkereszty
- Sebészeti Intézet, Debreceni Egyetem Klinikai Központ 4032 Debrecen, Móricz Zs. krt. 22
| |
Collapse
|
12
|
Bálint A, Rutka M, Kolar M, Bortlik M, Duricova D, Hruba V, Lukas M, Mitrova K, Malickova K, Lukas M, Szepes Z, Nagy F, Palatka K, Lovas S, Végh Z, Kürti Z, Csontos Á, Miheller P, Nyári T, Bor R, Milassin Á, Fábián A, Szántó K, Lakatos PL, Molnár T, Farkas K. Infliximab biosimilar CT-P13 therapy is effective in maintaining endoscopic remission in ulcerative colitis - results from multicenter observational cohort. Expert Opin Biol Ther 2018; 18:1181-1187. [PMID: 30277084 DOI: 10.1080/14712598.2018.1530758] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND CT-P13, the first biosimilar monoclonal antibody to infliximab (IFX), has previously been confirmed to be efficacious in inducing mucosal healing in ulcerative colitis (UC) patients. The aim of this study was to evaluate the efficacy of CT-P13 therapy in maintaining mucosal healing in UC. METHODS CT-P13 trough levels, antibody positivity, serum inflammatory markers as CRP level, fecal calprotectin at weeks 14 and 54, concomitant steroid and azathioprine therapy at the time of induction therapy and at weeks 14 and 54, previous use of anti TNF drug and the need of dose intensification as possible predictive factors for mucosal healing at week 54 were evaluated in this prospective study. RESULTS 61 patients had already completed the 54-week treatment period. Mucosal healing was shown in 65.5 % and 62.1 %, complete mucosal healing was present in 31% and 38 % at week 14 and 54, respectively. The median values of CRP, leukocytes, thrombocytes, and albumin showed significant difference between baseline and week 54. Serum antibody positivity was proved in 6.5 % and 19.7 % of cases at week 14 and 54, respectively. CONCLUSION Our study confirmed the long-term efficacy of CT-P13 therapy on mucosal healing in UC.
Collapse
Affiliation(s)
- Anita Bálint
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Mariann Rutka
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Martin Kolar
- b IBD Clinical and Research Centre , Prague , Czech Republic.,c 1st Medical Faculty , Charles University , Prague , Czech Republic
| | - Martin Bortlik
- b IBD Clinical and Research Centre , Prague , Czech Republic.,d Department of Internal Medicine , Military Hospital, Charles University , Prague , Czech Republic
| | - Dana Duricova
- b IBD Clinical and Research Centre , Prague , Czech Republic.,e Institute of Pharmacology, 1st Medical Faculty , Charles University , Prague , Czech Republic
| | - Veronika Hruba
- b IBD Clinical and Research Centre , Prague , Czech Republic
| | - Martin Lukas
- b IBD Clinical and Research Centre , Prague , Czech Republic
| | - Katarina Mitrova
- b IBD Clinical and Research Centre , Prague , Czech Republic.,f Department of Paediatrics, Faculty Hospital Motol, 2nd Medical Faculty , Charles University , Prague , Czech Republic
| | - Karin Malickova
- b IBD Clinical and Research Centre , Prague , Czech Republic.,f Department of Paediatrics, Faculty Hospital Motol, 2nd Medical Faculty , Charles University , Prague , Czech Republic
| | - Milan Lukas
- b IBD Clinical and Research Centre , Prague , Czech Republic
| | - Zoltán Szepes
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Ferenc Nagy
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Károly Palatka
- g Institute of Medicine, Department of Gastroenterology , University of Debrecen, Clinical Center , Debrecen , Hungary
| | - Szilvia Lovas
- g Institute of Medicine, Department of Gastroenterology , University of Debrecen, Clinical Center , Debrecen , Hungary
| | - Zsuzsanna Végh
- h First Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Zsuzsanna Kürti
- h First Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Ágnes Csontos
- i Second Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Pál Miheller
- i Second Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Tibor Nyári
- j Department of Medical Physics and Informatics , University of Szeged , Szeged , Hungary
| | - Renáta Bor
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Ágnes Milassin
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Anna Fábián
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Kata Szántó
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Péter L Lakatos
- h First Department of Internal Medicine , Semmelweis University , Budapest , Hungary
| | - Tamás Molnár
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| | - Klaudia Farkas
- a 1st Department of Medicine , University of Szeged , Szeged , Hungary
| |
Collapse
|
13
|
Rencz F, Lakatos PL, Gulácsi L, Brodszky V, Kürti Z, Lovas S, Banai J, Herszényi L, Cserni T, Molnár T, Péntek M, Palatka K. Validity of the EQ-5D-5L and EQ-5D-3L in patients with Crohn's disease. Qual Life Res 2018; 28:141-152. [PMID: 30225788 DOI: 10.1007/s11136-018-2003-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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] [Accepted: 09/11/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE The EuroQol five-dimension questionnaire (EQ-5D) is the most commonly used instrument to obtain utility values for cost-effectiveness analyses of treatments for Crohn's disease (CD). We aimed to compare the measurement properties of the two adult versions of EQ-5D (EQ-5D-3L and EQ-5D-5L) in patients with CD. METHODS Between 2016 and 2017, a multicentre cross-sectional survey was carried out. Consecutive outpatients with CD completed the 3L, 5L and EQ visual analogue scale (VAS). Disease severity was graded by the Crohn's Disease Activity Index (CDAI) and Perianal Disease Activity Index (PDAI). The 3L and 5L were compared in terms of feasibility, agreement, ceiling effect, redistribution properties, discriminatory power, convergent and known-groups validity. RESULTS Two-hundred and six patients (54.9% male, mean age 35 ± 11 years) participated in the survey. For 3L, 25 unique health states were observed versus 59 for the 5L. The overall ceiling effect decreased from 29.6% (3L) to 25.5% (5L). Absolute discriminatory power improved (mean Shannon index 0.84 vs. 1.18). The 3L correlated stronger with EQ VAS and CDAI scores, whereas the 5L with PDAI. The 5L demonstrated a better known-groups validity on the basis of age, perianal fistulas, extraintestinal manifestations and disability. CONCLUSIONS This is the first study to report the impact of CD on quality of life using the EQ-5D-5L questionnaire. The 5L seems to perform better than 3L in terms of feasibility, ceiling effect, discriminatory power and known-groups validity. Understanding the differences in psychometrics between the 3L and 5L is essential as they have substantial implications for financial decision-making about CD treatments.
Collapse
Affiliation(s)
- Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary.
- Premium Postdoctoral Research Program, Hungarian Academy of Sciences, Nádor u. 7, Budapest, 1051, Hungary.
| | - Peter L Lakatos
- 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, Budapest, 1083, Hungary
- Division of Gastroenterology, McGill University, MUHC, Montreal General Hospital, 1650 Ave. Cedar, D16.173.1, Montreal, QC, H3G 1A4, Canada
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Zsuzsanna Kürti
- 1st Department of Medicine, Semmelweis University, Korányi Sándor u. 2/a, Budapest, 1083, Hungary
| | - Szilvia Lovas
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Nagyerdei krt. 98., Debrecen, 4032, Hungary
| | - János Banai
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, Budapest, 1062, Hungary
| | - László Herszényi
- Medical Centre, Hungarian Defence Forces, Podmaniczky u. 109-111, Budapest, 1062, Hungary
| | - Tamás Cserni
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
- Faculty of Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Tamás Molnár
- 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, Szeged, 6720, Hungary
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, Budapest, 1093, Hungary
| | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, University of Debrecen, Nagyerdei krt. 98., Debrecen, 4032, Hungary
| |
Collapse
|
14
|
Palatka K, Kacska S, Lovas S, Garai I, Varga J, Galuska L. The potential role of FDG PET-CT in the characterization of the activity of Crohn's disease, staging follow-up and prognosis estimation: a pilot study. Scand J Gastroenterol 2018; 53:24-30. [PMID: 29043862 DOI: 10.1080/00365521.2017.1390600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES FDG PET-CT is a global, noninvasive, sensitive method to determine the location and activity of inflammatory lesions. Segmental FDG uptake is proportional with immune cell infiltration of bowel. Our aim was to evaluate prospectively the role of PET in patients with active Crohn's disease (CD) before and after one year's biological therapy, and to compare simple endoscopic score for CD (SES-CD), CD activity index (CDAI) and global PET scores. We also analyzed the prognostic value of initial PET scores. PATIENTS Twelve patients were selected: six male/six female, ages between 18 and 39, average: 24 years, with CDAI values >300. METHODS We scored the FDG uptake in the small intestine and the four colon segments (on a scale 0-3 for each), and summed them thus forming a global PET score. The scoring was based on the maximal standardized uptake value of the intestinal segment, related to the SUVmax of the liver (as a reference for normal tissue activity). The SES-CD, CDAI and global PET scores before and after treatment were statistically compared. RESULTS There were significant changes in CDAI and SES-CD after therapy, PET scores improved only in patients' subgroup with high (>4) initial PET score, indicating good prognosis of biological treatment. In active disease, PET was more informative than endoscopy to access the extent of the inflammation, and small intestine involvement. CONCLUSIONS FDG PET-CT score is a promising, noninvasive complementary method in the staging, treatment planning and follow-up of CD. Limitation of the study is the small number of patients.
Collapse
Affiliation(s)
- Károly Palatka
- a Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine , University of Debrecen , Debrecen , Hungary
| | - Sándor Kacska
- a Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine , University of Debrecen , Debrecen , Hungary
| | - Szilvia Lovas
- a Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine , University of Debrecen , Debrecen , Hungary
| | | | - József Varga
- c Department of Medical Imaging, Division of Nuclear Medicine, Faculty of Medicine , University of Debrecen , Debrecen , Hungary
| | - László Galuska
- c Department of Medical Imaging, Division of Nuclear Medicine, Faculty of Medicine , University of Debrecen , Debrecen , Hungary
| |
Collapse
|
15
|
Kóder G, Olasz J, Tóth L, Urbancsek H, András C, Bubán T, Palatka K, Damjanovich L, Tanyi M. A hereditaer nonpolyposus colorectalis carcinoma szindrómás betegek szűrésének és szoros utánkövetésének fontossága egy családfa bemutatása kapcsán. Orv Hetil 2017; 158:1182-1187. [DOI: 10.1556/650.2017.30803] [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: 11/19/2022]
Abstract
Abstract: Introduction: Hereditary nonpolyposis colorectal carcinoma (HNPCC) is an autosomal dominant disease, which shows familial clustering. Aim: We would like to emphasize the importance of monitoring the HNPCC syndrome patients by presenting a case of a proven MMR gene mutation carrier and her family tree encompassing 10 years. Materials and method: To screen a suspected HNPCC Hungarian family member we are taking thorough family histories. If the diagnosis of HNPCC was further supported by immunohistology and the microsatellite status, sequencing of the MMR genes was carried out. Results: A novel mutation in exon 6 of the hMSH2 gene leading to the deletion of two nucleotide pairs [c.969-970delTC] was detected in our patient. During the 10-year follow-up period of our patient new HNPCC-associated tumors have developed in several family members. Conslusion: Close surveillance of the patient and its family members at risk was effective, although it requires compliance from the subjects. Orv Hetil. 2017; 158(30): 1182–1187.
Collapse
Affiliation(s)
- Gergely Kóder
- Sebészeti Klinika, Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ Debrecen, Móricz Zsigmond krt. 22., 4032
| | - Judit Olasz
- Pathogenetikai Osztály, Országos Onkológiai Intézet Budapest
| | - László Tóth
- Pathologiai Intézet, Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ Debrecen
| | - Hilda Urbancsek
- Onkológiai Klinika, Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ Debrecen
| | - Csilla András
- Onkológiai Klinika, Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ Debrecen
| | - Tamás Bubán
- Belgyógyászati Klinika, Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ Debrecen
| | - Károly Palatka
- Belgyógyászati Klinika, Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ Debrecen
| | - László Damjanovich
- Sebészeti Klinika, Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ Debrecen, Móricz Zsigmond krt. 22., 4032
| | - Miklós Tanyi
- Sebészeti Klinika, Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ Debrecen, Móricz Zsigmond krt. 22., 4032
| |
Collapse
|
16
|
Gonczi L, Vegh Z, Golovics PA, Rutka M, Gecse KB, Bor R, Farkas K, Szamosi T, Bene L, Gasztonyi B, Kristóf T, Lakatos L, Miheller P, Palatka K, Papp M, Patai Á, Salamon Á, Tóth GT, Vincze Á, Biro E, Lovasz BD, Kurti Z, Szepes Z, Molnár T, Lakatos PL. Prediction of Short- and Medium-term Efficacy of Biosimilar Infliximab Therapy. Do Trough Levels and Antidrug Antibody Levels or Clinical And Biochemical Markers Play the More Important Role? J Crohns Colitis 2017; 11:697-705. [PMID: 27838610 DOI: 10.1093/ecco-jcc/jjw203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/09/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Biosimilar infliximab CT-P13 received European Medicines Agency [EMA] approval in June 2013 for all indications of the originator product. In the present study, we aimed to evaluate the predictors of short- and medium-term clinical outcome in patients treated with the biosimilar infliximab at the participating inflammatory bowel disease [IBD] centres in Hungary. METHODS Demographic data were collected and a harmonised monitoring strategy was applied. Clinical and biochemical activities were evaluated at Weeks 14, 30, and 54. Trough level [TL] and anti-drug antibody [ADA] concentrations were measured by enzyme-linked immunosorbent assay [ELISA] [LT-005, Theradiag, France] at baseline at 14, 30 and 54 weeks and in two centres at Weeks 2 and 6. RESULTS A total of 291 consecutive IBD patients (184 Crohn's disease [CD] and 107 ulcerative colitis [UC]) were included. In UC, TLs at Week 2 predicted both clinical response and remission at Weeks 14 and 30 (clinical response/remission at Week 14: area under the curve [AUC] = 0.81, p < 0.001, cut-off: 11.5 μg/ml/AUC = 0.79, p < 0.001, cut-off: 15.3μg/ml; clinical response/remission at Week 30: AUC = 0.79, p = 0.002, cut-off: 11.5 μg/ml/AUC = 0.74, p = 0.006, cut-off: 14.5 μg/ml), whereas ADA positivity at Week 14 was inversely associated with clinical response at Week 30 [58.3% vs 84.8% ,p = 0.04]. Previous anti-tumour necrosis factor [TNF] exposure was inversely associated with short-term clinical remission [Week 2: 18.8% vs 47.8%, p = 0.03, at Week 6: 38.9% vs 69.7%, p = 0.013, at Week 14: 37.5% vs 2.5%, p = 0.06]. In CD, TLs at Week 2 predicted short-term [Week 14 response/remission, AUCTLweek2 = 0.715-0.721, p = 0.05/0.005] but not medium-term clinical efficacy. In addition, early ADA status by Week 14 [p = 0.04-0.05 for Weeks 14 and 30], early clinical response [p < 0.001 for Weeks 30/54] and normal C-reactive protein [CRP] at Week 14 [p = 0.005-0.0001] and previous anti-TNF exposure [p = 0.03-0.0001 for Weeks 14, 30, and 54] were associated with short-and medium-term clinical response and remission. CONCLUSIONS In UC, early TLs were predictive for short- and medium-term clinical efficacy, whereas in CD, Week 2 TLs were associated only with short-term clinical outcomes.
Collapse
Affiliation(s)
- Lorant Gonczi
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Vegh
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Anna Golovics
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Renata Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Szamosi
- Military Hospital - State Health Centre, Budapest, Hungary
| | - László Bene
- First Department of Medicine, Peterfy Hospital, Budapest, Hungary
| | - Beáta Gasztonyi
- Second Department of Medicine, Zala County Hospital, Zalaegerszeg, Hungary
| | - Tünde Kristóf
- Second Department of Medicine, B-A-Z County and University Teaching Hospital, Miskolc, Hungary
| | - László Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprém, Hungary
| | - Pál Miheller
- Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Károly Palatka
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Mária Papp
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Árpád Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Ágnes Salamon
- Department of Gastroenterology, Tolna County Teaching Hospital, Szekszárd, Hungary
| | - Gábor Tamás Tóth
- Department of Gastroenterology, Janos Hospital, Budapest, Hungary
| | - Áron Vincze
- First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Edina Biro
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | | | - Zsuzsanna Kurti
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltan Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter L Lakatos
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| |
Collapse
|
17
|
Bálint A, Rutka M, Végh Z, Kürti Z, Gecse KB, Banai J, Bene L, Gasztonyi B, Kristóf T, Lakatos L, Miheller P, Palatka K, Patai Á, Salamon Á, Szamosi T, Szepes Z, Tóth GT, Vincze Á, Bor R, Milassin Á, Fábián A, Nagy F, Kolar M, Bortlik M, Duricova D, Hruba V, Lukas M, Mitrova K, Malickova K, Lukas M, Lakatos PL, Molnár T, Farkas K. Frequency and characteristics of infusion reactions during biosimilar infliximab treatment in inflammatory bowel diseases: results from Central European nationwide cohort. Expert Opin Drug Saf 2017; 16:885-890. [PMID: 28504555 DOI: 10.1080/14740338.2017.1323330] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Végh
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kürti
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztina B. Gecse
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - János Banai
- Military Hospital – State Health Centre, Budapest, Hungary
| | - László Bene
- 1st Department of Medicine, Peterfy Hospital, Budapest, Hungary
| | - Beáta Gasztonyi
- 2nd Department of Medicine, Zala County Hospital, Zalaegerszeg, Hungary
| | - Tünde Kristóf
- 2nd Department of Medicine, B-A-Z County and University Teaching Hospital, Miskolc, Hungary
| | - László Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprém, Hungary
| | - Pál Miheller
- Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Károly Palatka
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Árpád Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Ágnes Salamon
- Department of Gastroenterology, Tolna County Teaching Hospital, Szekszárd, Hungary
| | - Tamás Szamosi
- Military Hospital – State Health Centre, Budapest, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Tamás Tóth
- Department of Gastroenterology, Janos Hospital, Budapest, Hungary
| | - Áron Vincze
- 1st Department of Medicine, University of Pécs, Pécs, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Martin Kolar
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Department of Internal Medicine, Military Hospital, Charles University, Prague, Czech Republic
| | - Dana Duricova
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Institute of Pharmacology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Veronika Hruba
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
| | - Martin Lukas
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
| | - Katarina Mitrova
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Department of Paediatrics, Faculty Hospital Motol, 2nd Medical Faculty, Charles University, Prague, Czech Republic
| | - Karin Malickova
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Milan Lukas
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Péter L. Lakatos
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
18
|
Milassin Á, Rutka M, Csontos ÁA, Miheller P, Palatka K, Szűcs M, Szepes Z, Bálint A, Bor R, Fábián A, Farkas K, Nagy F, Molnár T. What Is the Personal Experience of IBD Patients about Their Anti-TNF-Alpha Therapy? Health (London) 2017. [DOI: 10.4236/health.2017.97073] [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: 11/20/2022]
|
19
|
Bálint A, Törőcsik D, Palatka K, Szepes Z, Szűcs M, Tamás F, Nagy F, Farkas K, Fábián A, Bor R, Milassin Á, Rutka M, Molnár T. Prognostic factors, effectiveness and safety of endoscopic balloon dilatation for de novo and anastomotic strictures in Crohn’s disease—A multicenter “real life” study. Cogent Medicine 2016. [DOI: 10.1080/2331205x.2016.1233687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Anita Bálint
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Dalma Törőcsik
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Károly Palatka
- 2nd Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szepes
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Ferenci Tamás
- Physiological Controls Group, John von Neumann Faculty of Informatics, Óbuda University, Budapest, Hungary
| | - Ferenc Nagy
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Klaudia Farkas
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Anna Fábián
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Renáta Bor
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Ágnes Milassin
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Mariann Rutka
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| | - Tamás Molnár
- 1st Department of Medicine, University of Szeged, 8-10 Korányi fasor, H6720 Szeged, Hungary
| |
Collapse
|
20
|
Farkas K, Rutka M, Golovics PA, Végh Z, Lovász BD, Nyári T, Gecse KB, Kolar M, Bortlik M, Duricova D, Machkova N, Hruba V, Lukas M, Mitrova K, Malickova K, Bálint A, Nagy F, Bor R, Milassin Á, Szepes Z, Palatka K, Lakatos PL, Lukas M, Molnár T. Efficacy of Infliximab Biosimilar CT-P13 Induction Therapy on Mucosal Healing in Ulcerative Colitis. J Crohns Colitis 2016; 10:1273-1278. [PMID: 27106537 DOI: 10.1093/ecco-jcc/jjw085] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/29/2016] [Indexed: 12/22/2022]
Abstract
INTRODUCTION CT-P13 is the first biosimilar to infliximab that has been approved for the same indications as its originator infliximab. No data are available on the effect of infliximab biosimilar on mucosal healing. The aim of this study was to evaluate the efficacy of CT-P13 induction therapy on mucosal healing in patients with ulcerative colitis [UC]. PATIENTS AND METHODS UC patients, who received CT-P13 therapy from its local introduction at three Hungarian and one Czech inflammatory bowel disease centres, were prospectively enrolled. Sigmoidoscopy was performed after the end of the induction therapy at week 14. Mucosal healing was defined as Mayo endoscopic subscore 0 or 1. Complete mucosal healing was defined as Mayo endoscopic subscore 0. Trough level of CT-P13 was measured at week 14. RESULTS Sixty-three UC patients who underwent CT-P13 induction therapy were enrolled in the study. Indication for the therapy was acute, severe flare up and chronic, refractory activity in 24 and 39 patients, respectively. Cumulative clinical response and steroid-free remission at week 14 were achieved in 82.5% and 47.6% of the patients, respectively. Sigmoidoscopy revealed steroid-free mucosal healing in 47.6% of the patients, and complete mucosal healing was present in 27%. Mayo endoscopic subscore decreased significantly at week 14 compared to baseline. Trough levels of infliximab correlated with mucosal healing. CONCLUSION This is, to our knowledge, the first study examining the efficacy of CT-P13 induction therapy on mucosal healing in UC. The results indicate that mucosal healing is achieved in two-thirds of UC patients by the end of the induction treatment with CT-P13.
Collapse
Affiliation(s)
- Klaudia Farkas
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Petra A Golovics
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Végh
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara D Lovász
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | | | - Martin Kolar
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,1 Medical Faculty, Charles University, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Department of Internal Medicine, Military Hospital, Charles University, Prague, Czech Republic
| | - Dana Duricova
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Institute of Pharmacology, 1 Medical Faculty, Charles University, Prague, Czech Republic
| | - Nadezda Machkova
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic
| | - Veronika Hruba
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic
| | - Martin Lukas
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic
| | - Katarina Mitrova
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Department of Paediatrics, Faculty Hospital Motol, 2 Medical Faculty, Charles University, Prague, Czech Republic
| | - Karin Malickova
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1 Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Anita Bálint
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| | - Károly Palatka
- 2 Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Péter L Lakatos
- 1 Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Milan Lukas
- IBD Clinical and Research Centre, Iscare a.s., Prague, Czech Republic.,Institute of Medical Biochemistry and Laboratory Diagnostics, 1 Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Tamás Molnár
- 1 Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
21
|
Rutka M, Bálint A, Farkas K, Palatka K, Lakner L, Miheller P, Rácz I, Hegede G, Vincze Á, Horváth G, Szabó A, Nagy F, Szepes Z, Gábor Z, Zsigmond F, Zsóri Á, Juhász M, Csontos Á, Szűcs M, Bor R, Milassin Á, Molnár T. [Long-term adalimumab therapy in ulcerative colitis in clinical practice: result of the Hungarian multicenter prospective study]. Orv Hetil 2016; 157:706-711. [PMID: 27106726 DOI: 10.1556/650.2016.30429] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Adalimumab was approved for the treatment of ulcerative colitis refractory to conventional therapy several years later than infliximab in Europe. Due to the relatively low remission rate observed in Ultra trials, data on the efficacy of adalimumab in ulcerative colitis are really helpful in the daily practice. AIM The aim of this study was to prospectively collect data on induction and maintenance adalimumab therapy in patients with ulcerative colitis treated in Hungarian centres. METHOD This prospective study collected data of all patients with ulcerative colitis treated with adalimumab in 10 Hungarian centres. The primary endpoints of the study were rates of remission, response and primary failure at week 12, and the rate of continuous clinical response, remission and loss of response at weeks 30, and 52. Secondary endpoints were endoscopic outcome at week 52 and comparison of the efficacy of adalimumab between treatment naive and infliximab-experienced patients. RESULTS 73 patients with active ulcerative colitis were enrolled in the study. 75.3% of the patients exhibited clinical response after the induction at week 12. The probability of maintaining adalimumab treatment was 48.6% at week 52 with a continuous clinical response in 92% of these patients. Mucosal healing was achieved in 48.1% of the patients at week 52. Dose intensification was performed in 17.6% of the patients. Minor side effects developed in 4% of the patients and 5.4% of the patients underwent colectomy during the 1-year treatment period. CONCLUSIONS These results coming from the real clinical setting demonstrate a favourable efficacy of adalimumab induction and maintenance therapy in patients with ulcerative colitis.
Collapse
Affiliation(s)
- Mariann Rutka
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Anita Bálint
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Klaudia Farkas
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Károly Palatka
- II. Belgyógyászati Klinika, Debreceni Tudományegyetem, Általános Orvostudományi Kar Debrecen
| | | | - Pál Miheller
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | | | - Gábor Hegede
- Péterfy Sándor Utcai Kórház-Rendelőintézet és Sürgősségi Központ Budapest
| | - Áron Vincze
- I. Belgyógyászati Klinika, Pécsi Tudományegyetem, Általános Orvostudományi Kar Pécs
| | | | | | - Ferenc Nagy
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Szepes
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Zoltán Gábor
- Semmelweis Kórház és Egyetemi Oktatókórház Miskolc
| | | | | | - Márk Juhász
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Ágnes Csontos
- II. Belgyógyászati Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Mónika Szűcs
- Orvosi Fizika és Orvosi Informatika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged
| | - Renáta Bor
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Ágnes Milassin
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| | - Tamás Molnár
- I. Belgyógyászati Klinika, Szegedi Tudományegyetem, Általános Orvostudományi Kar Szeged, Korányi fasor 8-10., 6720
| |
Collapse
|
22
|
Gecse KB, Lovász BD, Farkas K, Banai J, Bene L, Gasztonyi B, Golovics PA, Kristóf T, Lakatos L, Csontos ÁA, Juhász M, Nagy F, Palatka K, Papp M, Patai Á, Lakner L, Salamon Á, Szamosi T, Szepes Z, Tóth GT, Vincze Á, Szalay B, Molnár T, Lakatos PL. Efficacy and Safety of the Biosimilar Infliximab CT-P13 Treatment in Inflammatory Bowel Diseases: A Prospective, Multicentre, Nationwide Cohort. J Crohns Colitis 2016; 10:133-40. [PMID: 26661272 DOI: 10.1093/ecco-jcc/jjv220] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [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: 08/13/2015] [Accepted: 10/19/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Biosimilar infliximab CT-P13 is approved for all indications of the originator product in Europe. Prospective data on its efficacy, safety, and immunogenicity in inflammatory bowel diseases are lacking. METHODS A prospective, nationwide, multicentre, observational cohort was designed to examine the efficacy, safety, and immunogenicity of CT-P13 infliximab biosimilar in the induction treatment of Crohn's disease [CD] and ulcerative colitis [UC]. Demographic data were collected and a harmonised monitoring strategy was applied. Early clinical remission, response, and early biochemical response were evaluated at Week 14, steroid-free clinical remission was evaluated at Week 30. Therapeutic drug level was monitored using a conventional enzyme-linked immunosorbent assay. RESULTS In all, 210 consecutive inflammatory bowel disease [126 CD and 84 UC] patients were included in the present cohort. At Week 14, 81.4% of CD and 77.6% of UC patients showed clinical response and 53.6% of CD and 58.6% of UC patients were in clinical remission. Clinical remission rates at Week 14 were significantly higher in CD and UC patients who were infliximab naïve, compared with those with previous exposure to the originator compound [p < 0.05]. Until Week 30, adverse events were experienced in 17.1% of all patients. Infusion reactions and infectious adverse events occurred in 6.6% and 5.7% of all patients, respectively. CONCLUSIONS This prospective multicentre cohort shows that CT-P13 is safe and effective in the induction of clinical remission and response in both CD and UC. Patients with previous infliximab exposure exhibited decreased response rates and were more likely to develop allergic reactions.
Collapse
Affiliation(s)
- Krisztina B Gecse
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara D Lovász
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Klaudia Farkas
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - János Banai
- Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - László Bene
- First Department of Medicine, Peterfy Hospital, Budapest, Hungary
| | - Beáta Gasztonyi
- Second Department of Medicine, Zala County Hospital, Zalaegerszeg, Hungary
| | - Petra Anna Golovics
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Tünde Kristóf
- Second Department of Medicine, B-A-Z County and University Teaching Hospital, Miskolc, Hungary
| | - László Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprém, Hungary
| | - Ágnes Anna Csontos
- Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Márk Juhász
- Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Ferenc Nagy
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Mária Papp
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Árpád Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Lilla Lakner
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Ágnes Salamon
- Department of Gastroenterology, Tolna County Teaching Hospital, Szekszárd, Hungary
| | - Tamás Szamosi
- Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Zoltán Szepes
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Gábor T Tóth
- Department of Gastroenterology, Janos Hospital, Budapest, Hungary
| | - Áron Vincze
- First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Balázs Szalay
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Péter L Lakatos
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| |
Collapse
|
23
|
Bálint A, Farkas K, Palatka K, Lakner L, Miheller P, Rácz I, Hegede G, Vincze Á, Horváth G, Szabó A, Nagy F, Szepes Z, Gábor Z, Zsigmond F, Zsóri Á, Juhász M, Csontos Á, Szűcs M, Bor R, Milassin Á, Rutka M, Molnár T. Efficacy and Safety of Adalimumab in Ulcerative Colitis Refractory to Conventional Therapy in Routine Clinical Practice. J Crohns Colitis 2016; 10:26-30. [PMID: 26392413 DOI: 10.1093/ecco-jcc/jjv169] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [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: 05/24/2015] [Accepted: 09/15/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIM Adalimumab [ADA] was approved for the treatment of ulcerative colitis [UC] refractory to conventional therapy in 2012 in Europe. Due to the observed discrepancies between clinical trials and practice, data on the outcome of ADA therapy are really needed from the real life. The aim of this study was to estimate the short- and long-term efficacy and safety of ADA in UC patients from each Hungarian biological centre. PATIENTS AND METHODS This prospective study consisted of UC patients treated with ADA in 10 Hungarian inflammatory bowel disease centres. The primary endpoints of the study were rates of continuous clinical response, remission, non-response and loss of response at Weeks 12, 30, and 52.The secondary endpoints included mucosal healing at Week 52 and the comparison of the efficacy of ADA between biological naive and infliximab [IFX]-treated groups. Colonoscopy was performed before starting the therapy and at Week 52. RESULTS In all, 73 active UC patients were enrolled in the study: 67.1% of the patients received previous IFX therapy; 75.3% of the patients showed short-term clinical response at Week 12. The probability of maintaining ADA was 48.6% at Week 52 with a continuous clinical response in 92% of these remaining patients. Mucosal healing was achieved in 48.1% of the patients at Week 52. Escalation of ADA was performed in 17.6%, and minor side effects developed in 4% of the patients; 5.4% of the patients underwent colectomy during the 1-year treatment period. CONCLUSION UC is a progressive disease that may need early aggressive therapy to prevent structural and functional complications. The results of our study demonstrated the favourable efficacy of short- and long-term ADA treatment for patients with UC.
Collapse
Affiliation(s)
- Anita Bálint
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Károly Palatka
- 2nd Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Lilla Lakner
- Markusovszky University Hospital, Szombathely, Hungary
| | - Pál Miheller
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Gábor Hegede
- Péterfy Sándor Street Hospital-Clinic and Emergency Center, Budapest, Hungary
| | - Áron Vincze
- 1st Department of Internal Medicine, University of Pécs, Pécs, Hungary
| | - Gábor Horváth
- Semmelweis Hospital and University Hospital [MISEK], Miskolc, Hungary
| | | | - Ferenc Nagy
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zoltán Gábor
- Semmelweis Hospital and University Hospital [MISEK], Miskolc, Hungary
| | | | - Ágnes Zsóri
- Kazincbarcika Hospital, Kazincbarcika, Hungary
| | - Márk Juhász
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Ágnes Csontos
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Mónika Szűcs
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- 1st Department of Medicine, University of Szeged, Szeged, Hungary
| |
Collapse
|
24
|
Váradi C, Guttman A, Hollό Z, Poliska S, Nagy L, Szekanecz Z, Váncsa A, Palatka K. AB0023 Combination of Igg N-Glycomics and Corresponding Transcriptomics Data to Identify Anti-Tnf-Alpha Treatment Responders in Rheumatoid Arthritis and Inflammatory Bowel Disease. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1551] [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]
|
25
|
Váradi C, Holló Z, Póliska S, Nagy L, Szekanecz Z, Váncsa A, Palatka K, Guttman A. Combination of IgG N-glycomics and corresponding transcriptomics data to identify anti-TNF-α treatment responders in inflammatory diseases. Electrophoresis 2015; 36:1330-5. [PMID: 25639738 DOI: 10.1002/elps.201400575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 12/14/2022]
Abstract
Prediction of responsiveness in biological therapies is an important and challenging issue in different diseases. Analyzing glycosylation pattern changes of key serum glycoproteins is one of the possible avenues to follow disease remission. The aim of this study was to investigate the changes of serum IgG glycoforms in Crohn's disease (CD) and rheumatoid arthritis patients in response to antitumor necrosis factor alpha (anti-TNF-α) treatment. IgG was isolated from patient serum samples using Protein A affinity pull-down, followed by the release of N-glycans with peptide-N-glycosidase F. The released glycans were fluorescently tagged with 8-aminopyrene-1,3,6-trisulfonate and analyzed by CGE with laser-induced fluorescent detection. Significant alterations were detected between responders and nonresponders in both disease groups. In CD patients, disease-specific alteration was found in response to anti-TNF-α therapy, which was also confirmed by transcriptomics data analysis of the corresponding glycosyltransferases and glycosidases.
Collapse
Affiliation(s)
- Csaba Váradi
- Horváth Laboratory of Bioseparation Sciences, School of Medicine, MMKK, University of Debrecen, Debrecen, Hungary
| | | | - Szilárd Póliska
- Department of Biochemistry and Molecular Biology, University of Debrecen, Debrecen, Hungary
| | - László Nagy
- Department of Biochemistry and Molecular Biology, University of Debrecen, Debrecen, Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, School of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Váncsa
- Department of Rheumatology, School of Medicine, University of Debrecen, Debrecen, Hungary
| | - Károly Palatka
- Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - András Guttman
- Horváth Laboratory of Bioseparation Sciences, School of Medicine, MMKK, University of Debrecen, Debrecen, Hungary.,MTA-PE Translational Glycomics Research Group, MUKKI, University of Pannonia, Veszprém, Hungary
| |
Collapse
|
26
|
Farkas K, Lakatos PL, Nagy F, Szepes Z, Miheller P, Papp M, Palatka K, Bálint A, Bor R, Wittmann T, Molnár T. Predictors of relapse in patients with ulcerative colitis in remission after one-year of infliximab therapy. Scand J Gastroenterol 2013; 48:1394-8. [PMID: 24131338 DOI: 10.3109/00365521.2013.845906] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND. Some of the most important questions relating to the use of biological therapy in inflammatory bowel diseases concern the duration of maintenance therapy. The RASH study revealed that previous use of biological therapy and dose intensification are associated with restarting of biological therapy in Crohn's disease. The aim of the study was to assess the disease course and frequency of relapse of ulcerative colitis (UC) following discontinuation of infliximab in patients with remission and to determine predictive factors for relapse. PATIENTS AND METHODS. Fifty-one UC patients who had achieved clinical remission following 1 year of infliximab therapy and for whom infliximab was then discontinued participated in this prospective observational study. 15.7% of the patients received infliximab before the 1-year period of biological therapy analyzed in the study. Biological therapy was restarted in case of recurrent clinical activity. Data were collected from four Hungarian IBD centers. RESULTS. Thirty-five percent of the patients needed to be retreated with infliximab within 1 year after treatment cessation. Logistic regression analysis revealed that previous biological therapy (p = 0.021) was associated with the need of restarting infliximab. None of the data relating to patients' demographic and clinical characteristics, concomitant therapy and CRP level showed association with the need for restarting biological therapy. CONCLUSIONS. Biological therapy was restarted at a median of 4 months after discontinuation in more than every third UC patients who had been in clinical remission following 1 year of infliximab therapy. Response to retreatment with infliximab was favorable in the majority of the patients who relapsed.
Collapse
Affiliation(s)
- Klaudia Farkas
- 1st Department of Medicine, University of Szeged , Szeged , Hungary
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Szekanecz Z, Meskó B, Poliska S, Váncsa A, Palatka K, Holló Z, Zahuczky G, Podani J, Horváth A, Steiner L, Nagy L. THU0027 Response to Infliximab Therapy can be Predicted Using Distinct, Non-Overlapping Gene Panels of Peripheral Blood Gene Expression in Rheumatoid Arthritis and Crohn’s Disease. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.555] [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: 11/04/2022]
|
28
|
Kovács E, Palatka K, Németh A, Pásztor É, Pfliegler G. [Severe anemia caused by haemorrhoids: the casae of a young man with toxic cirrhosis]. Orv Hetil 2013; 154:382-6. [PMID: 23461979 DOI: 10.1556/oh.2013.29561] [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: 11/19/2022]
Abstract
A 38-year-old alcoholic man with severe iron deficient anaemia, and bloody-mucous stool was found to have haemorrhoidal bleeding. In spite of intravenous iron supplements haemoglobin levels were falling. He was admitted because of deteriorating condition, jaundice, severe anaemia (haemoglobin, 38 g/l) and iron deficiency. Except of toxic (alcohol) agent all other causes of liver disease could be excluded. Sclero-, and medical therapy, and abstinence resulted in a rapid improvement in his condition and subsequently rectal bleeding also disappeared. Bleeding from the upper gastrointestinal tract is a well known and serious complication in liver cirrhosis, however, a voluminous blood loss resulting in a life-threatening anaemia from lower gastrointestinal tract or haemorrhoids, as it was detected in this patient, is quite rare. Sclerotherapy seems to be an effective method with only minor complications when compared with other invasive techniques. However, the patient's compliance even in liver cirrhosis with haemorrhoidal nodes is essential for long-term success.
Collapse
Affiliation(s)
- Erzsébet Kovács
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Ritka Betegségek Tanszék, Belgyógyászati Intézet, Debrecen.
| | | | | | | | | |
Collapse
|
29
|
Szekanecz Z, Meskó B, Poliska S, Váncsa A, Palatka K, Holló Z, Zahuczky G, Podani J, Horváth A, Steiner L, Nagy L. A7.20 Response to Infliximab Therapy can be Predicted using Distinct, Non-Overlapping Gene Panels of Peripheral Blood Gene Expression in Rheumatoid Arthritis and Crohn’s Disease. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-203221.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
30
|
Molnár T, Lakatos PL, Farkas K, Nagy F, Szepes Z, Miheller P, Horváth G, Papp M, Palatka K, Nyári T, Bálint A, Lőrinczy K, Wittmann T. Predictors of relapse in patients with Crohn's disease in remission after 1 year of biological therapy. Aliment Pharmacol Ther 2013. [PMID: 23181359 DOI: 10.1111/apt.12160] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [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: 12/13/2022]
Abstract
BACKGROUND Some of the most important questions relating to the use of biological therapy in inflammatory bowel diseases concern the duration of maintenance therapy. AIM To assess the disease course and frequency of relapse of Crohn's disease (CD) following discontinuation of biological therapy, and to determine predictive factors for relapse. METHODS One hundred twenty-one CD patients who had achieved clinical remission following 1 year of biological therapy and for whom biological therapy was then discontinued participated in this prospective observational study. Eighty-seven CD patients had received infliximab and 34 adalimumab. The definition of relapse was an increase of >100 points in CDAI to at least a CDAI of 150 points. RESULTS Biological therapy was restarted within 1 year of treatment cessation in 45% of patients. Logistic regression analysis revealed that previous biological therapy (P = 0.011) and dose intensification during the 1-year course of biological therapy (P = 0.024) were associated with the need for and the time to the restarting of biological therapy. Smoking was observed to have an effect that was not statistically significant (P = 0.053). CONCLUSIONS Biological therapy was restarted a median of 6 months after discontinuation in almost half of Crohn's disease patients in who had been in clinical remission following 1 year of biological therapy. These results suggest that, in the event of the presence of certain predictive factors, biological therapy should probably be continued for more than 1 year by most patients.
Collapse
Affiliation(s)
- T Molnár
- 1st Department of Medicine, University of Szeged, Szeged, Hungary.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Horváth G, Farkas K, Hollósi R, Nagy F, Szepes Z, Papp M, Palatka K, Miheller P, Lakatos L, Szamosi T, Nyári T, Wittmann T, Molnár T. Is there any association between impaired health-related quality of life and non-adherence to medical therapy in inflammatory bowel disease? Scand J Gastroenterol 2012; 47:1298-303. [PMID: 22935014 DOI: 10.3109/00365521.2012.703233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [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: 02/04/2023]
Abstract
OBJECTIVES Inflammatory bowel diseases (IBD) have a huge impact on the patients' lives and require continuous medication and long-term medical follow-up. The Short Form Health Survey (SF-36) is a commonly used questionnaire measuring health-related quality of life (HRQOL). Our aim was to evaluate whether HRQOL influences medication adherence and vice versa in IBD patients, and to find relationships between demographic parameters, therapeutic modalities and non-adherence or HRQOL. PATIENTS AND METHODS Five hundred ninety-two IBD patients treated at six Hungarian tertiary centers were enrolled. Patients completed the SF-36 questionnaire and a medication adherence report scale during their visits. The associations between demographic parameters, HRQOL, different kinds of therapies and non-adherence were analyzed. RESULTS The most affected dimension was physical functioning and least affected were the social functions. About 42.7% of the patients revealed their HRQOL to be acceptable. About 74.6% of the patients believed that the prescribed medications actually improved their HRQOL. Diarrhea was the most common and most severe symptom during the course of the disease. Non-adherence was reported in 13.4% of the patients. 'Forgetting to take the medication' was the main reason for non-adherence in 67.6% of the cases. Medication adherence was significantly higher among nonsmoker patients, and also in the case of immunomodulator therapy. There was no association between the sum of HRQOL and different subscores and non-adherence. CONCLUSION Inflammatory bowel disease is associated with low HRQOL, which is not affected by drug therapy. The impaired quality of life in IBD is mainly influenced by the disease itself.
Collapse
Affiliation(s)
- Gábor Horváth
- Department of Gastroenterology, Semmelweis Health Centre of Miskolc, Miskolc, Hungary
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Miheller P, Nagy F, Palatka K, Altorjay I, Horváth G, Lőrinczy K, Újszászy L, Virányi Z, Szepes A, Molnár T, Farkas K, Szepes Z, Nyári T, Wittmann T, Tulassay Z. [Hungarian data on inflammatory bowel diseases: analytical data on ulcerative colistis]. Orv Hetil 2012; 153:702-712. [PMID: 22547465 DOI: 10.1556/oh.2012.29361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
UNLABELLED Prospective data collection seems to be essential in evidence-based medicine. Because of the new therapeutic options, the need for standard data collection and testing has significantly increased. In Hungary, a registry for patients with inflammatory bowel disease has already been set up, which makes it possible for clinicians to collect prospective data on their patients. AIM Basic characteristics of the database of patients with ulcerative colitis are presented in this paper. METHODS The inflammatory bowel disease registry uses the programme of Microsoft Access database management system. Data are stored in a central server. RESULTS The incidence of inflammatory bowel diseases has been permanently increasing in Hungary; however, its overall prevalence is still low among the European countries. The frequent administration of immunosuppressive medications (azathioprine and corticosteroids) and their increased doses worsen the estimation of the activity. CONCLUSIONS 1., It would be very useful to gain prospective data from all national centres. This kind of database would be able to give a complete picture regarding the Hungarian therapeutical practice. 2., Medications of patients may alter the clinical value of the laboratory findings in the process of determining the severity of the disease.
Collapse
Affiliation(s)
- Pál Miheller
- Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika, Budapest.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Kiss LS, Szamosi T, Molnar T, Miheller P, Lakatos L, Vincze A, Palatka K, Barta Z, Gasztonyi B, Salamon A, Horvath G, Tóth GT, Farkas K, Banai J, Tulassay Z, Nagy F, Szenes M, Veres G, Lovasz BD, Vegh Z, Golovics PA, Szathmari M, Papp M, Lakatos PL. Early clinical remission and normalisation of CRP are the strongest predictors of efficacy, mucosal healing and dose escalation during the first year of adalimumab therapy in Crohn's disease. Aliment Pharmacol Ther 2011; 34:911-22. [PMID: 21883326 DOI: 10.1111/j.1365-2036.2011.04827.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [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: 12/12/2022]
Abstract
BACKGROUND Adalimumab is a fully human monoclonal antibody targeting tumour necrosis factor with proven efficacy in the treatment of Crohn's disease (CD). AIM To investigate the predictors of medium-term clinical efficacy and mucosal healing during adalimumab therapy, in patients with CD, in specialised centres approved for biological therapy in Hungary. METHODS Data capture of the 201 CD patients was standardised and prospective (male/female: 112/89, median age: 33.0 years, duration: 8 years). Previous infliximab therapy had been administered in 48% of patients, concomitant steroids in 41%, azathioprine in 69% and combined therapy in 27% of patients. RESULTS Overall clinical response and remission rates at 24 weeks were 78% and 52%, respectively; at 52 weeks were 69% and 44%, respectively. Endoscopic improvement and healing were achieved in 43% and 24% of patients. In a logistic regression model, clinical efficacy and CRP at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, whereas CRP at week 12, clinical remission at week 24, inflammatory parameters and nonsmoking were associated to endoscopic improvement/healing. Intensification to weekly dosing was needed in 16% of patients. Parallel azathioprine therapy and clinical remission at week 12 were inversely associated with dose escalation. CONCLUSIONS Clinical efficacy and normalised CRP at week 12 (early deep clinical remission) are associated with medium-term clinical efficacy and mucosal healing during adalimumab therapy, whereas need for combined immunosuppression at induction and smoking status are predictors for non-response. Parallel azathioprine therapy may decrease the probability for dose escalation.
Collapse
Affiliation(s)
- L S Kiss
- Semmelweis University, Budapest, Hungary
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Kiss LS, Szamosi T, Molnár T, Miheller P, Lakatos L, Vincze A, Palatka K, Bartha Z, Gasztonyi B, Salamon A, Horváth G, Tóth GT, Farkas K, Banai J, Tulassay Z, Nagy F, Szenes M, Veres G, Lovász BD, Végh Z, Golovics PA, Szathmári M, Papp M, Lakatos PL. [Predictors of efficacy, mucosal healing and dose intensification during the first year of adalimumab therapy in patients with luminal and fistulizing Crohn's disease. National data from Hungary]. Orv Hetil 2011; 152:1433-42. [PMID: 21865144 DOI: 10.1556/oh.2011.29200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED Adalimumab is a fully human monoclonal antibody targeting tumor necrosis factor with proven efficacy in the treatment of Crohn's disease in clinical trials. The aim of the present study was to investigate the predictors of medium term clinical efficacy and mucosal healing during adalimumab therapy in patients with Crohn's disease in specialized centers approved for biological therapy in Hungary. METHODS Data of 201 Crohn's disease patients were prospectively captured (male/female: 112/89, median age: 24 years, duration: 8 years). Previous infliximab therapy was given in 97 (48.3%) patients, concomitant steroids in 41.3% and azathioprine in 69.2% (combined: 26.4%) of patients. RESULTS Overall clinical response and remission rates at 24 and 52 weeks were 78% and 52%, and 69.4% and 44.4%, respectively. Endoscopic improvement and healing was achieved in 43.1% and 23.6%, respectively. In a logistic regression model, clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, while normalized C-reactive protein at week 12, clinical remission at week 24, frequency of previous relapses and smoking were associated to endoscopic improvement/healing. Dose intensification to weekly dosing was needed in 16.4%. Parallel azathioprine therapy and clinical remission at week 12 was inversely associated to dose escalation to weekly dosing. CONCLUSION Clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression, luminal disease and smoking are predictors for medium term clinical efficacy/mucosal healing during adalimumab therapy, while parallel azathioprine therapy may decrease the probability for dose escalation.
Collapse
Affiliation(s)
- Lajos Sándor Kiss
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Altorjay I, Veréb Z, Serfozo Z, Bacskai I, Bátori R, Erdodi F, Udvardy M, Sipka S, Lányi Á, Rajnavölgyi É, Palatka K. Anti-TNF-alpha antibody (infliximab) therapy supports the recovery of eNOS and VEGFR2 protein expression in endothelial cells. Int J Immunopathol Pharmacol 2011; 24:323-35. [PMID: 21658307 DOI: 10.1177/039463201102400206] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The aim of this study is to investigate the effect of sera obtained from patients of Crohn's disease treated by anti-TNF-alpha antibody (Infliximab) on the expression of endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor receptor-2 (VEGFR2) protein in human umbilical vein endothelial cells (HUVEC) cultured in vitro. HUVEC was cultured in the presence of sera derived from patients before and after treatment, or from healthy individuals. Effects of sera on the expression of eNOS and VEGFR2 were monitored by determination of mRNA and protein levels using real time quantitative PCR and Western blot analysis, respectively. The serum of Crohn's patients contained elevated levels of TNF-alpha (34±1.80 pg/mL), which resulted in a decrease in the protein level of eNOS in HUVEC with a simultaneous induction of VEGFR2. Infliximab treatment normalized the expression level of these proteins by decreasing TNF-alpha level, particularly in those cases when clinical healing was also recorded, and it also conferred restitution of the level of angiogenic cytokines. Results suggest that altered angiogenesis possibly contributes to the initiation and perpetuation of inflammatory processes in inflammatory bowel disease (IBD). Endothelial dysfunction, a selective feature of Crohn's disease is beneficially affected by intravascular TNF-alpha neutralization.
Collapse
Affiliation(s)
- I Altorjay
- 2nd Department of Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Lakatos L, Czeglédi Z, Dávid G, Kispál Z, Kiss LS, Palatka K, Kristóf T, Molnár T, Salamon A, Demeter P, Miheller P, Szamosi T, Banai J, Papp M, Bene L, Kovács A, Rácz I, Lakatos PL. [Treatment adherence and use of complementary and alternative medicine in patients with inflammatory bowel disease]. Orv Hetil 2010; 151:250-8. [PMID: 20133244 DOI: 10.1556/oh.2010.28805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
UNLABELLED Previous studies have suggested an increasing use of complementary and alternative medicine (CAM) in patients with inflammatory bowel disease (IBD). Furthermore, a significant number of IBD patients fail to comply with treatment. The aim of our study was to evaluate the prevalence of non-adherence the use of CAM in Hungarian patients with IBD. METHODS A total of 655 consecutive IBD patients (Crohn's disease [CD]: 344, age: 38.2 + or - 12.9 years; ulcerative colitis [UC]: 311, age: 44.9 + or - 15.3 years) were interviewed during the visit at specialists by self-administered questionnaire including demographic and disease-related data, as well as items analyzing the extent of non-adherence and CAM use. Patients taking more then 80% of each prescribed medicine were classified as adherent. RESULTS The overall rate of self reported non-adherence (CD: 20.9%, UC: 20.6%) and CAM (CD: 31.7%, UC: 30.9%) use was not different between CD and UC. The most common causes of non-adherence were: forgetfulness (47.8%), too many/unnecessary pills (39.7%), being afraid of side effects (27.9%) and too frequent dosing. Most common forms of CAM were herbal tee (47.3%), homeopathy (14.6%), special diet (12.2%), and acupuncture (5.8%). In CD, disease duration, date of last follow-up visit, educational level and previous surgeries were predicting factors for non-adherence. Alternative medicine use was associated in both diseases with younger age, higher educational level and immunosuppressant use. In addition, CAM use in UC was more common in females and in patients with supportive psychiatric/psychological therapy. CONCLUSIONS Non-adherence and CAM use is common in patients with IBD. Special attention should be paid to explore the identified predictive factors during follow-up visits to improve adherence to therapy and improving patient-doctor relationship.
Collapse
Affiliation(s)
- László Lakatos
- Csolnoky Ferenc Megyei Kórház Belgyógyászati Centrum, Veszprém, Kórház u, 1, 8200
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Miheller P, Lakatos PL, Horváth G, Molnár T, Szamosi T, Czeglédi Z, Salamon A, Czimmer J, Rumi G, Palatka K, Papp M, Jakab Z, Szabó A, Gelley A, Lakatos L, Barta Z, Balázs C, Rácz I, Zeher M, Döbrönte Z, Altorjay I, Hunyady B, Simon L, Papp J, Banai J, Nagy F, Lonovics J, Ujszászy L, Muzes G, Herszényi L, Tulassay Z. Efficacy and safety of infliximab induction therapy in Crohn's Disease in Central Europe--a Hungarian nationwide observational study. BMC Gastroenterol 2009; 9:66. [PMID: 19740450 PMCID: PMC2755473 DOI: 10.1186/1471-230x-9-66] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 09/10/2009] [Indexed: 02/08/2023] Open
Abstract
Background Infliximab (IFX) has proven to be an effective addition to the therapeutic arsenal for refractory, fistulizing, and steroid dependent Crohn's disease (CD), with efficacy in the induction and maintenance of clinical remission of CD. Our objective in this study is to report the nationwide, multicenter experience with IFX induction therapy for CD in Hungary. Methods During a 6-year-period, beginning in 2000, a total of 363 CD patients were treated with IFX as induction therapy (5 mg/kg IFX infusions given at week 0, 2 and 6) at eleven centers in Hungary in this observational study. Data analysis included patient demographics, important disease parameters and the outcome of IFX induction therapy. Results Three hundred and sixty three patients (183 women and 180 men) were treated with IFX since 2000. Mean age was 33.5 ± 11.2 years and the mean duration of disease was 6.7 ± 6.1 years. The population included 114 patients (31.4%) with therapy-refractory CD, 195 patients (53.7%) with fistulas, 16 patients (4.4%) with both therapy-refractory CD and fistulas, and 26 patients (7.2%) with steroid dependent CD. Overall response rate was 86.2% (313/363). A higher response rate was observed in patients with shorter disease duration (p = 0.05, OR:0.54, 95%CI:0.29-0.99) and concomitant immunosuppressant therapy (p = 0.05, OR: 2.03, 95%CI:0.165-0.596). Concomitant steroid treatment did not enhance the efficacy of IFX induction therapy. Adverse events included 34 allergic reactions (9.4%), 17 delayed type hypersensitivity (4.7%), 16 infections (4.4%), and 3 malignancies (0.8%). Conclusion IFX was safe and effective treatment in this cohort of Hungarian CD patients. Based on our experience co-administration of immunosuppressant therapy is suggested in patients receiving IFX induction therapy. However, concomitant steroid treatment did not enhanced the efficacy of IFX induction therapy.
Collapse
Affiliation(s)
- Pál Miheller
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Lakatos PL, Altorjay I, Mándi Y, Lakatos L, Tumpek J, Kovacs A, Molnar T, Tulassay Z, Miheller P, Palatka K, Szamosi T, Fischer S, Papp J, Papp M. Interaction between seroreactivity to microbial antigens and genetics in Crohn’s disease: is there a role for defensins? ACTA ACUST UNITED AC 2008; 71:552-9. [PMID: 18397186 DOI: 10.1111/j.1399-0039.2008.01049.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
|
39
|
Jakubec P, Palatka K, Jakubcová T, Kolek V. [Laboratory diagnostics of pleural effusion]. Vnitr Lek 2008; 54:265-272. [PMID: 18522295] [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: 05/26/2023]
Abstract
Pleural effusion is a frequent reason for a pulmonologist's investigation. Many pulmonary and extrapulmonary causes of pleural effusion exist. Heart failure, pneumonia and malignancies are the most frequent among them. Laboratory examination of pleural liquid is a corner stone of diagnostics. We use various biochemical, microbiological, cytologic and other methods. The first step is a differentiation between transudate and exudate. If the laboratory examinations are unsuccessful, we can use invasive procedures - pleural biopsy and thoracoscopy. Despite all modern diagnostic methods the causes of about 15% pleural effusions remain unclear.
Collapse
Affiliation(s)
- P Jakubec
- Klinika plicních nemocí a tuberkulózy Lékarské fakulty UP a FN, Olomouc.
| | | | | | | |
Collapse
|
40
|
Molnar T, Hofner P, Nagy F, Lakatos PL, Fischer S, Lakatos L, Kovacs A, Altorjay I, Papp M, Palatka K, Demeter P, Tulassay Z, Nyari T, Miheller P, Papp J, Mandi Y, Lonovics J. NOD1 gene E266K polymorphism is associated with disease susceptibility but not with disease phenotype or NOD2/CARD15 in Hungarian patients with Crohn's disease. Dig Liver Dis 2007; 39:1064-70. [PMID: 17964870 DOI: 10.1016/j.dld.2007.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [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] [Received: 03/08/2007] [Revised: 06/27/2007] [Accepted: 09/07/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND NOD1/CARD4, a member of the pattern-recognition receptor family, is a perfect candidate as a susceptibility gene for Crohn's disease. Since only limited and conflicting data are available on G796A polymorphisms in inflammatory bowel disease patients, we set out to study the effect of this polymorphism on the susceptibility and course of Crohn's disease in the Hungarian population. METHODS Four hundred thirty-four unrelated Crohn's disease patients (age at presentation: 28.6+/-9.6 years, female/male: 210/224, duration of Crohn's disease: 8.2+/-6.9 years) and 200 healthy subjects (blood donors) and 136 non-inflammatory bowel disease gastrointestinal controls with chronic gastritis were investigated. NOD1 G796A was detected by using polymerase chain reaction/restriction fragment length polymorphism. Detailed clinical phenotypes were determined by reviewing the medical charts. RESULTS The frequencies of the variant alleles of NOD1 G796A differed significantly between the Crohn's disease patients and both healthy (GG 49.5% vs. 67%; AG 41.5% vs. 28%; and AA 9.0% vs. 5.2%; p<0.0001) and non-inflammatory bowel disease controls with chronic gastritis. Carriage of the single nucleotide polymorphism of NOD1 G796A proved to be a highly significant risk factor for Crohn's disease compared to both healthy (p<0.0001, OR: 2.1, 95% CI: 1.5-2.9) and non-inflammatory bowel disease controls with chronic gastritis (p=0.008). Significant associations were not found between the different genotypes and the demographic data on the patients or the clinical characteristics of Crohn's disease. The different polymorphisms of pattern-recognition receptors (e.g. NOD2/CARD15 SNP8, SNP12 and SNP13 mutations, the TLR4 D299G polymorphism and NOD1 G796A) did not reveal a mutual basis. CONCLUSIONS Our results suggest that carriage of the NOD1 G796A mutation increases susceptibility for Crohn's disease in the Hungarian population.
Collapse
Affiliation(s)
- T Molnar
- 1st Department of Medicine, University of Szeged, Faculty of Medicine, Szeged, Hungary
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Udvardy M, Kaplar M, Rejto L, Tornai I, Palatka K, Laszlo P, Huszka M. Increased in vivo platelet activation and reduced intravascular endothelium-derived relaxing factor and nitrate/nitrite production in patients with insulin-dependent diabetes mellitus. Platelets 2007; 9:257-60. [PMID: 16793713 DOI: 10.1080/09537109876807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Limited information seems to be available about the role of reduced endothelial production of endotheliumderived relaxing factor (EDRF)-nitrate/nitrite (NO) in the pathogenesis of diabetic angiopathy in insulindependent diabetes. A report of urinary and serum nitrate/nitrite, glucometabolic parameters, endothelial and in vivo platelet activation markers of 22 insulin dependent diabetics (IDDM) patients are given. Urinary and serum nitrate/nitrite concentrations were reduced in IDDM. This was independent of disease duration, presence of angiopathy and the glucometabolic parameters. A significant and inverse correlation of nitrate/nitrite excretion with endothelial markers (von Willebrand factor, soluble thrombomodulin) was documented. Moreover, reduced nitrate/nitrite excretion was strongly associated with elevated plasmatic beta -thromboglobulin levels. EDRF-NO production is reduced in IDDM and this reduction correlates with endothelial damage. Decreased nitrate/nitrite excretion may also influence in vivo platelet function, which results in increased in vivo platelet activation and suggests that the reduced intravascular production of EDRF-NO might play a role in the pathogenesis of angiopathy in IDDM.
Collapse
Affiliation(s)
- M Udvardy
- 2nd Department of Medicine, University Medical School, Debrecen, Hungary.
| | | | | | | | | | | | | |
Collapse
|
42
|
Papp M, Lakatos PL, Palatka K, Földi I, Udvardy M, Hársfalvi J, Tornai I, Vitális Z, Dinya T, Kovács A, Molnár T, Demeter P, Papp J, Lakatos L, Altorjay I. [Haptoglobin polymorphism in patients with inflammatory bowel diseases]. Orv Hetil 2006; 147:1745-50. [PMID: 17087019] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Since functional differences were found among three major haptoglobin phenotypes, haptoglobin polymorphism was reported to be associated with the risk and clinical course of different inflammatory diseases. The aim of the study was to investigate the Hp polymorphism distribution in Hungarian Crohn's disease patients. METHODS 511 Hungarian IBD patients were investigated (Crohn's disease patients: 468, m/f ratio: 233/235, duration 8.2 +/- 6.7 ys, and ulcerative colitis patients: 43, m/f: 22/21, duration: 9.5 +/- 10.6 ys) and 384 healthy subjects served as controls. Hp phenotypes were determined by sodium dodecyl sulphate-polyacrylamide gel electrophoresis of sera followed by immunoblotting. Clinical data were come by the questionnaires prepared by the physicians. RESULTS The frequency of haptoglobin-1 allele was significantly higher in Crohn's disease (0.395) compared to the controls (0.345; OR: 1.24, 95%CI: 1.02-1.52, p = 0.03), but the phenotype distribution showed no such differences. Haptoglobin phenotype was associated to disease behavior in Crohn's disease (B1 and B2, in haptoglobin 1-1 and 2-2: 36.6%-34.3% and 32.4%-32.5% vs. in 2-1: 44.9% and 20.3%; ORB1Hp2-1 vs. others: 2.06, 95%CI: 1.29-3.28). Furthermore, an increased frequency of primary sclerosing cholangitis was observed in haptoglobin 2-2, compared to the 1-1 (6.5% vs. 0.0%, p = 0.039). No associations were found in ulcerative colitis. CONCLUSIONS haptoglobin-1 allele was associated with Crohn's disease, whereas the phenotypes with the disease behavior and frequency of primary sclerosing cholangitis, exhibiting a disease-modifying effect.
Collapse
Affiliation(s)
- Mária Papp
- Debreceni Egyetem, Orvos- es Egészségtudományi Centrum, Belgyógyászati Intézet, Gasztroenterológiai Tanszék, Debrecen.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Palatka K, Serfozo Z, Veréb Z, Bátori R, Lontay B, Hargitay Z, Nemes Z, Udvardy M, Erdodi F, Altorjay I. Effect of IBD sera on expression of inducible and endothelial nitric oxide synthase in human umbilical vein endothelial cells. World J Gastroenterol 2006; 12:1730-8. [PMID: 16586542 PMCID: PMC4124348 DOI: 10.3748/wjg.v12.i11.1730] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AIM: To study the expression of endothelial and inducible nitric oxide synthases (eNOS and iNOS) and their role in inflammatory bowel disease (IBD).
METHODS: We examined the effect of sera obtained from patients with active Crohn’s disease (CD) and ulcerative colitis (UC) on the function and viability of human umbilical vein endothelial cells (HUVEC). HUVECs were cultured for 0-48 h in the presence of a medium containing pooled serum of healthy controls, or serum from patients with active CD or UC. Expression of eNOS and iNOS was visualized by immunofluorescence, and quantified by the densitometry of Western blots. Proliferation activity was assessed by computerized image analyses of Ki-67 immunoreactive cells, and also tested in the presence of the NOS inhibitor, 10-4 mol/L L-NAME. Apoptosis and necrosis was examined by the annexin-V-biotin method and by propidium iodide staining, respectively.
RESULTS: In HUVEC immediately after exposure to UC, serum eNOS was markedly induced, reaching a peak at 12 h. In contrast, a decrease in eNOS was observed after incubation with CD sera and the eNOS level was minimal at 20 h compared to control (18% ± 16% vs 23% ± 15% P<0.01). UC or CD serum caused a significant increase in iNOS compared to control (UC: 300% ± 21%; CD: 275% ± 27% vs 108% ± 14%, P<0.01). Apoptosis/necrosis characteristics did not differ significantly in either experiment. Increased proliferation activity was detected in the presence of CD serum or after treatment with L-NAME. Cultures showed tube-like formations after 24 h treatment with CD serum.
CONCLUSION: IBD sera evoked changes in the ratio of eNOS/iNOS, whereas did not influence the viability of HUVEC. These involved down-regulation of eNOS and up-regulation of iNOS simultaneously, leading to increased proliferation activity and possibly a reduced anti-inflammatory protection of endothelial cells.
Collapse
Affiliation(s)
- Károly Palatka
- 2nd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Nagyerdei körút 98, Debrecen H-4001, Hungary.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Palatka K, Serfozo Z, Veréb Z, Hargitay Z, Lontay B, Erdodi F, Bánfalvi G, Nemes Z, Udvardy M, Altorjay I. Changes in the expression and distribution of the inducible and endothelial nitric oxide synthase in mucosal biopsy specimens of inflammatory bowel disease. Scand J Gastroenterol 2005; 40:670-80. [PMID: 16036527 DOI: 10.1080/00365520510015539] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The role of nitric oxide (NO) in the pathophysiology of inflammatory bowel disease (IBD) is controversial. The aim of this study was to investigate the expression and localization of nitric oxide synthase isoforms (iNOS, eNOS) in IBD colonic mucosa. MATERIAL AND METHODS Forty-four patients with IBD (24 ulcerative colitis (UC), 20 Crohn's disease (CD) and 16 controls) were investigated by colonoscopy. iNOS and eNOS in tissue sections was demonstrated by histochemistry (NADPH-diaphorase reaction) and immunohistochemistry. Cell type analysis and quantitative assessment of the iNOS immunoreactive (IR) cells and densitometry of iNOS in immunoblots were also performed. RESULTS iNOS-IR cells were significantly numerous in inflamed mucosa of UC (64+/-4 cells/mm2) than in CD (4+/-2 cells/mm2). iNOS-IR/CD15-IR cells showed significant elevation in inflamed (i) versus uninflamed (u) UC mucosa (UCu 8+/-3%, UCi 85+/-10%) In CD, the percentage of iNOS-IR/CD68-IR cells was lower in inflamed sites (CDu 23+/-8%, CDi 4+/-3%). Immunoblot of biopsies revealed significant elevation of iNOS in active UC compared with uninflamed sites, whereas in CD no significant changes were detected. Differences were observed in eNOS and endothelial marker CD31 immunoreactivity. In patients with UC and in controls the ratios of eNOS/CD31-IR vessels were 82.3% and 92.0% respectively, whereas in CD the ratio was 8.3% with a concomitantly significant increase of CD31-IR vessels. The distribution and morphological characteristics of the NOS-IR inflammatory cells and endothelia were similar to those showing NADPH-diaphorase reactivity. CONCLUSIONS Differences observed in the expression and distribution of NOS isoforms in immune and endothelial cells may contribute to better understanding of the structural and physiological changes in UC and CD.
Collapse
Affiliation(s)
- Károly Palatka
- 2nd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Hungary.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Udvardy M, Palatka K, Tornai I, Altorjay I. [Acute gastrointestinal bleeding in patients with antithrombotic therapy]. Orv Hetil 2002; 143:183-7. [PMID: 11865754] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Approximately one-fifth of the patients, referred to the acute gastrointestinal bleeding unit took antithrombotic drugs (anticoagulants and antiplatelet agents) in a dose or with an effect, which made the causal relationship with acute bleeding episodes unequivocal. This paper analyzes the data of the first 100 such patients of the ward. The majority used acethyl-salicylic acid derivatives, however, a substantial number were on coumarol, and some bleeding patients with prosthetic heart valves were also observed. Haemostasis was forced by urgent, accurate, intervention based endoscopy along with simultaneous rapid efforts to correct the underlying clotting abnormalities. Prosthetic valve patients needed special care and attendance, and the reinstitution of anticoagulant treatment as soon as possible to maintain valve patency. The experiences and schedules of the authors, as well as the proposals of the literature are reviewed and summarized.
Collapse
Affiliation(s)
- Miklós Udvardy
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Orvostudományi Kar, II. Belgyógyászati Klinika
| | | | | | | |
Collapse
|
46
|
Udvardy M, Altorjay I, Palatka K. [Hematologic aspects of inflammatory bowel diseases]. Orv Hetil 2001; 142:883-6. [PMID: 11373889] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Anaemia, thrombocytosis are common secondary changes in inflammatory bowel disease (IBD), reflecting the clinical severity of the IBD cases, too. On the other hand, increased platelet function, fibrinolytic abnormalities, hypercoagulation of IBD patients predispose to thromboembolic events, and they may as well contribute to the local microcirculatory alterations leading to IBD itself. Reduced FXIII levels have been observed in IBD, which seems to be correlated with mucosal repair and might have therapeutic importance, too. Genetic thrombophilia received much attention recently, however, much less is known how frequent they are in IBD, what their clinical significance is, do they modify the clinical course itself. A short, concise review about links between haematology and IBD is given.
Collapse
Affiliation(s)
- M Udvardy
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, II. Belgyógyászati Klinika
| | | | | |
Collapse
|
47
|
Pásztor E, Décsy J, Dévényi K, Sikula J, Altorjay I, Mikita J, Palatka K, Reményi G, Péter M. [Diagnostic possibilities in gastric leiomyoma in relation to two of our cases]. Orv Hetil 1999; 140:2525-7. [PMID: 10586620] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Two cases of rare, benignant gastric tumors are reported. The suggest that while in the diagnosis of tumors with a mucous membrane involvement endoscopy has doubtless a leading role, tumors not infiltrating the mucous membrane are usually better recognizable by radiological (ultrasonography, computer tomography and double contrast x-ray) methods. An appropriate diagnosis followed by surgical removal of the tumor might result in a complete healing of the patient.
Collapse
Affiliation(s)
- E Pásztor
- Debreceni Orvostudományi Egyetem, Radiológiai Klinika
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Palatka K, Altorjay I, Szakáll S, Györffy A, Udvardy M. [Detection of Helicobacter pylori in tissue samples of stomach cancer]. Orv Hetil 1999; 140:1985-9. [PMID: 10506822] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
The role of Helicobacter pylori in the carcinogenesis of the stomach has been recognised both in intestinal and diffuse forms. The occurrence of the bacterium was studied in this report, with various methods in biopsy samples from the cancerous stomach, as well as the presence of associated gastritis and metaplasia related to the histological type. Retrospective histological examination were performed on endoscopic biopsy samples from 124 patients with distal stomach cancer using haematoxillin-eosin and Giemsa staining and immunohistochemical tests. Out of the 124 samples 69 (55.64%) was positive: 48 with Giemsa staining and further 21 samples showed immunohistochemical positivity on atrophic gastritis samples despite negative Giemsa staining. In view of the presence of gastritis and metaplasia significant difference (p < 0.001) was found between the positive and negative cases. The ratio of the Helicobacter pylori positive samples was high both for intestinal and diffuse type carcinomas. Our results suggest that the presence of Helicobacter pylori infection is important in the development of both types of carcinoma, nevertheless, the hystological type of the tumor is also decisively influenced by the onset of action of other more direct local eliciting factors.
Collapse
Affiliation(s)
- K Palatka
- II. sz. Belgyógyászati Klinika, Debreceni Orvostudományi Egyetem
| | | | | | | | | |
Collapse
|
49
|
Altorjay I, Palatka K, Vitális Z, Rejtö L, Györffy A, Udvardy M. [Current status of the management of upper gastrointestinal hemorrhage at a specialized hospital unit]. Orv Hetil 1998; 139:2121-6. [PMID: 9757776] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of bleeding of the gastrointestinal tract is around 100/100,000 adults/year. These events need special diagnostic and therapeutic approach, which previously was located mostly to surgical departments. At the beginning of 1996 a specialized ward ("gastrointestinal bleeding unit, GBU") was created at the 2nd Dept. Medicine of the University Medical School of Debrecen. The authors give an account about their experiences with the first 250 cases, try to establish the optimal and necessary conditions and analyse the consequences of their newly developed "risk-score" system. The overall mortality was 9% during this period and surgical intervention proved to be necessary in only 10 cases. On the basis of the collected experiences, they are convinced that the described and elaborated model can well be used for the proper, up-to-date management of gasrointestinal bleeding disorders. As next they suggest an overall, regional organisation of such units, together with the correct determination and provision of the financial background.
Collapse
Affiliation(s)
- I Altorjay
- Debreceni Orvostudományi Egyetem, II. Belgyógyászati Klinika
| | | | | | | | | | | |
Collapse
|
50
|
Abstract
L-arginine ahs received much attention in numerous aspects of the regulation of vascular tone and haemostasis. L-arginine seems to be capable to bind to plasminogen, too. The aim of the present paper is to investigate the action of L-arginine on in vitro plasmin generation and fibrino(geno)lysis by chromogenic, kinetic plasmin generation assay and electrophoretic analysis. The acceleration of tPA-induced plasmin generation in the presence of low concentration of L-arginine, along with augmentation of in vitro fibrinogenolysis have been documented. L-arginine may have a role in the modification of fibrinogenolysis, and this role should be considered if arginine is used as an element of some novel antithrombotic agents.
Collapse
Affiliation(s)
- M Udvardy
- 2nd Department of Medicine and Institute of Clinical Chemistry, University Medical School, Debrecen, Hungary
| | | | | | | | | |
Collapse
|