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Hagerman C, Kroeker KI, Dieleman L, Peerani F, Baumgart DC, Wong K, Halloran B. A204 COST-EFFECTIVENESS OF THERAPIES AFTER FAILURE OF CONVENTIONAL THERAPY FOR PATIENTS WITH MODERATE-TO-SEVERE ULCERATIVE COLITIS IN THE CANADIAN HEALTHCARE SYSTEM. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991389 DOI: 10.1093/jcag/gwac036.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Ulcerative colitis (UC) is a chronic inflammatory disease of the colon which requires ongoing medical therapy. The therapeutic options for moderate-to-severe UC include biologics and small molecules, which are effective but come with a significant cost. As such, their exact positioning in the therapeutic algorithm remains unclear. Purpose The aim of our study was to assess and compare the cost-effectiveness of infliximab, adalimumab, vedolizumab, golimumab, ustekinumab and tofacitinib for the management of moderate-to-severe UC from the perspective of the Canadian public healthcare system. Method A Markov model was constructed to simulate the disease course of UC patients after initiating each available therapy. Drug costs were obtained from the Alberta Health Drug Benefit List and the remaining costs were determined from the CIHI Patient Cost Estimator. Transition probabilities were obtained from a review of the literature, and loss of response and complication rates were obtained from randomized controlled trials. Our main analysis used a time horizon of 5 years, and time horizons of 1- and 10-years were also assessed in our sensitivity analysis. Probabilistic sensitivity analysis was performed to characterize uncertainty related to all parameters. Result(s) Infliximab costs $26,611 per quality-adjusted life year (QALY) using a 5-year time horizon. Adalimumab costs $20,783 per QALY. Vedolizumab costs $40,553 per QALY. Golimumab costs $34,316 per QALY. Ustekinumab costs $26,366 per QALY. Lastly, tofacitinib costs $25,572 per QALY. At a willingness-to-pay threshold of $50,000 per QALY, sensitivity analysis revealed that infliximab, adalimumab, vedolizumab, golimumab, ustekinumab and tofacitinib had a 36%, 12%, 1%, 1%, 44% and 6% probability of being cost-effective, respectively. Conclusion(s) Our economic model concluded that adalimumab is the most cost-effective first-line therapy for UC patients who have failed conventional therapy. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- C Hagerman
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - K I Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - L Dieleman
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - F Peerani
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - D C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - K Wong
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - B Halloran
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
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2
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Chappell K, Goodman KJ, Le Melledo JM, Meakins D, Marsh-Joyal M, Kroeker KI. A101 VIRTUAL MINDFULNESS-BASED STRESS REDUCTION FOR ADULTS WITH INFLAMMATORY BOWEL DISEASE: FEASIBILITY TRIAL PRELIMINARY RESULTS. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991196 DOI: 10.1093/jcag/gwac036.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Patients with Inflammatory Bowel Disease (IBD) often suffer from high levels of anxiety and depression. Despite high rates of mental health comorbidity, a low proportion of patients receive psychiatric referrals and treatment. In Canada, provincial health care plans cover psychiatric services, making them affordable for patients and making referral efficient for gastroenterologists. Psychiatrist-led virtually-delivered Mindfulness-Based Stress Reduction (MBSR) has been associated with reducing feelings of stress, anxiety, and depression in several high-quality randomized control trials. It also reduces cost and travel requirements for patients, both which have been identified as barriers to accessing mental health treatment. Purpose To assess the feasibility of online-delivered MBSR for IBD patients, with feasibility outcomes defined as recruitment success, and attendance, adherence, and attrition of participating patients. Method Eligible participants were adult IBD patients aged 18-65 attending gastroenterology clinics in Edmonton, Alberta who self-identified as being anxious or depressed and/or were referred by their gastroenterologist. A research coordinator contacted eligible patients who expressed interest in participating after completing an assessment of symptoms and a semi-structured interview with a psychiatrist. The MBSR protocol was an 8-week group-based intervention aimed at giving participants tools to cope with stress effectively. Participants attended 8 weekly sessions lasting 2.5 hours/week and a one-time weekend session lasting 5 hours. They were also asked to practice every night for 45-60 minutes. Completion of the program required attendance of at least 6 of 8 weekly sessions and the weekend session. Two groups, led by the same team of qualified psychiatrists, started MBSR, with sessions occurring in the evening via Zoom. Result(s) Of the 64 patients referred to the study, 16 (25%) agreed to participate. Reasons for declining to participate are shown in Table 1, with 80% indicating they were too busy. Of the 16 patients enrolled, the median age was 36 (range: 18-55), 10 identified as female (62.5%) and 8 had Crohn’s Disease (50%). Attendance, adherence, and attrition data from the first group of 7 participants were recorded. Only 3 (42.8%) successfully completed the program. The participants that completed the program had an attendance rate of 100% and practiced 6 nights a week for an average of 25 minutes a night. A second group with 9 participants is currently ongoing. Image ![]()
Conclusion(s) Although interest in a cost-free, virtual stress management resource was relatively high, willingness to enroll in MBSR specifically, was low, largely due to the time commitment. Follow-up interviews with those who enrolled and did not enroll in the intervention are underway to highlight the benefits and barriers to MBSR. Disclosure of Interest None Declared
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Affiliation(s)
| | | | | | - D Meakins
- University of Alberta, Edmonton, Canada
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Keshteli AH, Hoevers T, Madsen K, Hotte N, Nickurak C, Kroeker KI, van Den Brand F, Valcheva RS, Fedorak R, Dieleman LA. A84 HIGH FECAL CALPROTECTIN LEVELS IN ULCERATIVE COLITIS PATIENTS IN CLINICAL REMISSION ARE ASSOCIATED WITH SPECIFIC CLINICAL AND DIETARY INTAKE PARAMETERS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A H Keshteli
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - T Hoevers
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Madsen
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - N Hotte
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - C Nickurak
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - K I Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - R S Valcheva
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
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Cookson TA, Klostermann NR, Wine E, Kroeker KI. A150 IBD PATIENTS TRANSITIONING FROM PEDIATRIC TO ADULT CARE LACK THE NECESSARY TRANSITION SKILLS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T A Cookson
- Department of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - N R Klostermann
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - E Wine
- Pediatrics, University of Alberta, Edmonton, AB, Canada
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Nguyen VV, Ambrosio L, Dunsmore G, Agrawal A, Hotte N, Dieleman LA, Halloran BP, Kroeker KI, Fedorak R, elahi S, Madsen K, Huang V. A145 BREASTFEEDING INCREASES COLONIC INFLAMMATION IN INFANTS BORN FROM HEALTHY MOMS, WHICH EFFECT IS LACKING IN INFANTS BORN FROM MOMS WITH IBD. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V V Nguyen
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - L Ambrosio
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - G Dunsmore
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - A Agrawal
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - N Hotte
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - K I Kroeker
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - S elahi
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Madsen
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - V Huang
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
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Ma C, Fedorak R, Kaplan GG, Dieleman LA, Devlin S, Stern N, Kroeker KI, Seow C, Leung Y, Novak KL, Halloran BP, Huang V, Wong K, Ghosh S, Panaccione R. A108 USTEKINUMAB IS EFFECTIVE FOR INDUCING CLINICAL, ENDOSCOPIC, AND RADIOGRAPHIC RESPONSE IN REFRACTORY MODERATE-TO-SEVERE CROHN’S DISEASE: A MULTICENTRE COHORT STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Ma
- University of Calgary, Calgary, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - G G Kaplan
- University of Calgary, Calgary, AB, Canada
| | | | - S Devlin
- University of Calgary, Calgary, AB, Canada
| | - N Stern
- University of Alberta, Edmonton, AB, Canada
| | | | - C Seow
- University of Calgary, Calgary, AB, Canada
| | - Y Leung
- University of Calgary, Calgary, AB, Canada
| | - K L Novak
- University of Calgary, Calgary, AB, Canada
| | | | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - S Ghosh
- University of Birmingham, Birmingham, United Kingdom
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7
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Laffin M, Perry T, Park H, Gillevet P, Sikaroodi M, Kaplan GG, Fedorak R, Kroeker KI, Dieleman LA, Dicken B, Madsen K. A83 THE MUCOSA-ASSOCIATED-MICROBIOTA IS ASSOCIATED WITH RELAPSE IN CROHN’S DISEASE PATIENTS UNDERGOING ILEOCECAL RESECTION. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Laffin
- University of Alberta, Edmonton, AB, Canada
| | - T Perry
- University of Alberta, Edmonton, AB, Canada
| | - H Park
- University of Alberta, Edmonton, AB, Canada
| | | | | | - G G Kaplan
- Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | | | | | - B Dicken
- University of Alberta, Edmonton, AB, Canada
| | - K Madsen
- University of Alberta, Edmonton, AB, Canada
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8
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Reeson M, Ambrosio L, Lam GY, Fedorak R, Dieleman LA, Kroeker KI, Huang V, Peters A, Halloran BP. A148 EBV STATUS AND IMMUNOSUPPRESSANT USE IN IBD PATIENTS WHO SUBSEQUENTLY DEVELOP LYMPHOMA: A RETROSPECTIVE AND PROSPECTIVE STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Reeson
- Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - L Ambrosio
- University of Alberta, Edmonton, AB, Canada
| | - G Y Lam
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- University Of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - A Peters
- University Of Alberta, Edmonton, AB, Canada
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9
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Shim H, Ma C, Al-Farhan H, Aldarmaki AK, Pang J, Seow C, Fedorak R, Devlin S, Dieleman LA, Kaplan GG, Novak KL, Kroeker KI, Halloran BP, Panaccione R. A107 POSTOPERATIVE OUTCOMES AMONG USTEKINUMAB TREATED CROHN’S DISEASE PATIENTS: A MULTICENTRE CANADIAN PROVINCIAL EXPERIENCE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Shim
- Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - C Ma
- University of Calgary, Calgary, AB, Canada
| | - H Al-Farhan
- Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - A K Aldarmaki
- Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - J Pang
- University of Calgary, Calgary, AB, Canada
| | - C Seow
- Medicine, University of Calgary, Calgary, AB, Canada
| | - R Fedorak
- Los Alamos National Laboratory, Edmonton, AB, Canada
| | - S Devlin
- University of Calgary, Calgary, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - G G Kaplan
- Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - K L Novak
- Gastroenterology, University of Calgary, Calgary AB, Canada
| | - K I Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
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10
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Rodriguez N, Nguyen VV, Ambrosio L, Dieleman LA, Halloran BP, Kroeker KI, Peerani F, Wong K, Fedorak R, Huang V. A221 IMPACT OF A SPECIALIZED CLINIC IN IMPROVING IBD-RELATED PREGNANCY KNOWLEDGE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Rodriguez
- Science, University of Alberta, Edmonton, AB, Canada
| | - V V Nguyen
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - L Ambrosio
- University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - K I Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
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11
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Amin A, Prosser C, Kroeker KI, Wang H, Shalapay C, Dhami N, Fedorak DK, Halloran BP, Dieleman LA, Goodman K, Fedorak R, Huang V. A147 COMBINING INFLIXIMAB TROUGH LEVELS AND FECAL CALPROTECTIN LEVELS WITH CLINICAL DATA HAS THE POTENTIAL TO GUIDE CLINICAL DECISION-MAKING IN IMPROVING OUTCOMES FOR INFLAMMATORY BOWEL DISEASE PATIENTS ON MAINTENANCE INFLIXIMAB. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Amin
- (Core) Internal Medicine Program, University of Alberta, Edmonton, AB, Canada
| | - C Prosser
- University of Alberta, Edmonton, AB, Canada
| | | | - H Wang
- Surgery, University of Alberta, Edmonton, AB, Canada
| | - C Shalapay
- University of Alberta, Edmonton, AB, Canada
| | - N Dhami
- University of Alberta, Edmonton, AB, Canada
| | - D K Fedorak
- Divison of Gastroenterolgy, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Goodman
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Los Alamos National Laboratory, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
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Lytvyak E, Dieleman LA, Halloran BP, Huang V, Kroeker KI, Peerani F, Wong K, Fedorak R. A130 TABLEAU DASHBOARD AS A QUALITY IMPROVEMENT AND STRATEGIC DRIVING TOOL IN THE IBD OUTPATIENT SETTING: EARLY EXPERIENCE FROM THE IBD CENTRE OF EXCELLENCE AT THE UNIVERSITY OF ALBERTA HOSPITAL. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Lytvyak
- University of Alberta, Edmonton, AB, Canada
| | | | | | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | | | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
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Sutton RT, Wierstra K, Ambrosio L, Dieleman LA, Halloran BP, Kroeker KI, Fedorak R, Wong K, Berga K, Huang V. A105 AN ONLINE EDUCATIONAL PORTAL IMPROVES CONCERNS OF INFLAMMATORY BOWEL DISEASE PATIENTS REGARDING PREGNANCY AND MEDICATION. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R T Sutton
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K Wierstra
- MacEwan University, Edmonton, AB, Canada
| | - L Ambrosio
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K I Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K Wong
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - K Berga
- MacEwan University, Edmonton, AB, Canada
| | - V Huang
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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14
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Ma C, Fedorak R, Kaplan GG, Dieleman LA, Devlin S, Stern N, Kroeker KI, Seow C, Leung Y, Novak KL, Halloran BP, Huang V, Wong K, Ghosh S, Panaccione R. A106 USTEKINUMAB IS EFFECTIVE FOR MAINTAINING CLINICAL RESPONSE IN REFRACTORY MODERATE-TO-SEVERE CROHN’S DISEASE: A MULTICENTRE COHORT STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Ma
- University of Calgary, Calgary, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - G G Kaplan
- University of Calgary, Calgary, AB, Canada
| | | | - S Devlin
- University of Calgary, Calgary, AB, Canada
| | - N Stern
- University of Alberta, Edmonton, AB, Canada
| | | | - C Seow
- University of Calgary, Calgary, AB, Canada
| | - Y Leung
- University of Calgary, Calgary, AB, Canada
| | - K L Novak
- University of Calgary, Calgary, AB, Canada
| | | | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - S Ghosh
- University of Calgary, Calgary, AB, Canada
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15
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Andrishak SR, Huang V, Kroeker KI, Dieleman LA, Halloran BP, Fedorak R, Manocha A. A283 THE IMPACT INFLAMMATORY BOWEL DISEASE HAS ON BREASTFEEDING PATTERNS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S R Andrishak
- medicine and dentistry, University of Albetra, Rocky Mountain House, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | | | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Los Alamos National Laboratory, Edmonton, AB, Canada
| | - A Manocha
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
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Cookson TA, Fedorak R, Halloran BP, Dieleman LA, Wong K, Huang V, Peerani F, Kroeker KI. A157 THE THRESHOLD FOR INFLIXIMAB TROUGH LEVELS LEADING TO DOSE ESCALATION DIFFERS BETWEEN CROHN’S DISEASE AND ULCERATIVE COLITIS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- T A Cookson
- Department of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Wong
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - K I Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
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Stern N, Wong K, Dieleman LA, Halloran BP, Huang V, Kroeker KI, Peerani F, van Zanten S, Fedorak R. A132 THREE QUARTERS OF INFLAMMATORY BOWEL DISEASE PATIENTS ON MAINTENANCE INFLIXIMAB THERAPY IN CLINICAL REMISSION SHOW EVIDENCE OF MUCOSAL INFLAMMATION WITH ELEVATED FECAL CALPROTECTIN. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Stern
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - K I Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - S van Zanten
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
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Rodriguez N, Ambrosio L, Sutton RT, Dieleman LA, Halloran BP, Kroeker KI, Peerani F, Wong K, Fedorak R, Huang V. A33 DOES PREGNANCY ADVERSELY IMPACT THE HEALTH-RELATED QUALITY OF LIFE AMONG WOMEN WITH IBD? J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- N Rodriguez
- Science, University of Alberta, Edmonton, AB, Canada
| | - L Ambrosio
- University of Alberta, Edmonton, AB, Canada
| | - R T Sutton
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - K I Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
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Hassanzadeh Keshteli A, Madsen K, Nickurak C, Kroeker KI, Mandal R, Valcheva RS, Wishart DS, Veldhuyzen van Zanten S, Halloran BP, Fedorak R, Dieleman LA. A16 FOLLOWING AN ANTI-INFLAMMATORY DIET PREVENTS INCREASES OF FECAL CALPROTECTIN AND ALTERS METABOLOMIC PROFILE OF ULCERATIVE COLITIS PATIENTS, A RANDOMIZED CONTROLLED TRIAL. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Hassanzadeh Keshteli
- Centre of Excellence for Gastrointestinal Inflammation and Immunity Research, University of Alberta, Edmonton, AB, Canada
| | - K Madsen
- University of Alberta, Edmonton, AB, Canada
| | - C Nickurak
- University of Alberta, Edmonton, AB, Canada
| | | | - R Mandal
- University of Alberta, Edmonton, AB, Canada
| | - R S Valcheva
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - D S Wishart
- Biological Science, University of Alberta, Edmonton, AB, Canada
| | | | - B P Halloran
- Biological Science, University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Biological Science, University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
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20
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Winczura N, Kao DH, McSweeney B, Huang V, Dieleman LA, Halloran BP, Kroeker KI, Peerani F, Fedorak R, Wong K. A219 A RETROSPECTIVE ANALYSIS COMPARING THE OUTCOMES OF INFLAMMATORY BOWEL DISEASE PATIENTS WHO ARE POSITIVE FOR C DIFFICILE TOXIN BY EIA VERSUS C DIFFICILE PCR. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N Winczura
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - D H Kao
- University of Alberta, Edmonton, AB, Canada
| | | | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - K I Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- Medicine, University of Alberta, Edmonton, AB, Canada
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21
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Nguyen VV, Baker C, Andrishak SR, Ambrosio L, Berga K, Dieleman LA, Halloran BP, Kroeker KI, Peerani F, Wong K, Fedorak R, Huang V. A144 AN EXPLORATORY PROSPECTIVE LONGITUDINAL STUDY INTO THE BREASTFEEDING PRACTICES OF WOMEN WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- V V Nguyen
- University of Alberta, Edmonton, AB, Canada
| | - C Baker
- Grant Macewan University, Edmonton, AB, Canada
| | | | - L Ambrosio
- University of Alberta, Edmonton, AB, Canada
| | - K Berga
- University of Alberta, Edmonton, AB, Canada
| | | | | | | | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
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22
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Stern NC, Fedorak R, Wong K, Halloran BP, Dieleman LA, Huang V, Peerani F, Kroeker KI. A137 THERAPEUTIC DRUG MONITORING WITH INFLIXIMAB TROUGH LEVELS LEAD TO INCREASED INTERVENTION. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N C Stern
- University of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- University of Alberta, Edmonton, AB, Canada
| | - K Wong
- University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Medicine, Divison of Gastroenterology, University Of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Medicine, University of Alberta, Edmonton, AB, Canada
| | - V Huang
- University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- University of Alberta, Edmonton, AB, Canada
| | - K I Kroeker
- Medicine, University of Alberta, Edmonton, AB, Canada
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Zhu J, Abraldes J, Dieleman LA, Huang V, Kroeker KI, Peerani F, Wong K, LeGatt D, Fedorak R, Halloran BP. A102 THIOPURINE METABOLITE LEVEL MONITORING LEADS TO INDIVIDUALIZED AND OPTIMIZED THIOPURINE THERAPY IN ADULT INFLAMMATORY BOWEL DISEASE (IBD). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Zhu
- Division of Gastroenterology, Medicine, University of Alberta, Edmonton, AB, Canada
| | - J Abraldes
- Division of Gastroenterology, Medicine, University of Alberta, Edmonton, AB, Canada
| | - L A Dieleman
- Division of Gastroenterology, Medicine, University of Alberta, Edmonton, AB, Canada
| | - V Huang
- Division of Gastroenterology, Medicine, University of Alberta, Edmonton, AB, Canada
| | - K I Kroeker
- Division of Gastroenterology, Medicine, University of Alberta, Edmonton, AB, Canada
| | - F Peerani
- Division of Gastroenterology, Medicine, University of Alberta, Edmonton, AB, Canada
| | - K Wong
- Division of Gastroenterology, Medicine, University of Alberta, Edmonton, AB, Canada
| | - D LeGatt
- Department of Laboratory Medicine and Pathology, University Of Alberta, Edmonton, AB, Canada
| | - R Fedorak
- Division of Gastroenterology, Medicine, University of Alberta, Edmonton, AB, Canada
| | - B P Halloran
- Division of Gastroenterology, Medicine, University of Alberta, Edmonton, AB, Canada
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Ma C, Fedorak RN, Kaplan GG, Dieleman LA, Devlin SM, Stern N, Kroeker KI, Seow CH, Leung Y, Novak KL, Halloran BP, Huang VW, Wong K, Blustein PK, Ghosh S, Panaccione R. Clinical, endoscopic and radiographic outcomes with ustekinumab in medically-refractory Crohn's disease: real world experience from a multicentre cohort. Aliment Pharmacol Ther 2017; 45:1232-1243. [PMID: 28252210 DOI: 10.1111/apt.14016] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 12/22/2016] [Accepted: 02/07/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ustekinumab is a monoclonal antibody targeting interleukins-12 and -23, with efficacy in Crohn's disease (CD) demonstrated in clinical trials. AIM To assess the real-world clinical, endoscopic and radiographic response and remission outcomes achieved with ustekinumab in medically-refractory CD. METHODS A retrospective multicentre cohort study was performed on CD patients receiving ustekinumab between 2011 and 2016. The primary outcome was achievement of clinical and objective steroid-free response and remission at 3, 6 and 12 months. Clinical response and remission were defined by reduction in Harvey Bradshaw Index (HBI) of ≥3 points and an HBI ≤4 points respectively. Objective response was defined by improvement in endoscopic or radiographic CD, as assessed by ileocolonoscopy, contrast-enhanced ultrasound or CT/MR enterography. Objective remission was defined by endoscopic mucosal healing or complete resolution of inflammatory parameters on radiographic assessment. RESULTS A total of 167 CD patients were treated with ustekinumab. 95.2% (159/167) previously failed anti-TNF therapy. Median follow-up was 45.6 weeks (IQR: 24.4-88.9). At 3 months, clinical response was achieved in 38.9% (65/167) and remission in 15.0% (25/167) of patients. At 6 months, clinical response was achieved in 60.3% (91/151) and remission in 25.2% (38/151) of patients. At 12 months, clinical response was achieved in 59.5% (66/111) and remission in 27.9% (31/111) of patients. Endoscopic or radiographic response was demonstrated in 54.5% (67/123) at 6 months and 55.8% (48/86) of patients at 12 months. CONCLUSIONS Ustekinumab is an effective therapeutic option for inducing and maintaining clinical, endoscopic and radiographic response in patients with Crohn's disease failing anti-TNF therapy.
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Affiliation(s)
- C Ma
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - R N Fedorak
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - G G Kaplan
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - L A Dieleman
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - S M Devlin
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - N Stern
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - K I Kroeker
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - C H Seow
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - Y Leung
- Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada
| | - K L Novak
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - B P Halloran
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - V W Huang
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - K Wong
- Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
| | - P K Blustein
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
| | - S Ghosh
- University of Birmingham, Birmingham, UK
| | - R Panaccione
- Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada
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25
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Ma C, Huang V, Fedorak DK, Kroeker KI, Dieleman LA, Halloran BP, Fedorak RN. Adalimumab dose escalation is effective for managing secondary loss of response in Crohn's disease. Aliment Pharmacol Ther 2014; 40:1044-55. [PMID: 25185992 DOI: 10.1111/apt.12940] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/14/2014] [Accepted: 08/09/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The efficacy of adalimumab in maintaining remission in Crohn's disease patients may wane over time, leading to secondary loss of response that is often managed with dose escalation. However, the response to adalimumab dose escalation and long-term outcomes after escalation have not been well evaluated. AIMS To characterise the short- and long-term clinical responses to adalimumab dose escalation for secondary loss of response. METHODS A retrospective cohort study evaluating Crohn's disease out-patients requiring adalimumab dose escalation for secondary loss of response from 2003 to 2013 was conducted. The primary outcome was the proportion of patients achieving symptomatic clinical response to dose escalation and subsequent development of tertiary loss of response. Duration of regained response was assessed by Kaplan-Meier analysis. RESULTS Ninety-two CD patients met inclusion criteria with mean duration of follow-up of 170.2 weeks (±129.6 weeks). Disease distribution was predominantly ileal (37/92, 40.2%) or ileocolonic (43/92, 46.7%), with equal distribution of inflammatory (34.8%), stricturing (27.2%), and penetrating (38.0%) disease phenotypes. At 24 weeks post-dose escalation, 74/92 (80.4%) patients had symptomatic clinical response. Among responders, median duration of sustained response was 69.2 weeks (IQR 29.4-107.1) but 42/74 (56.8%) responders experienced subsequent tertiary loss of response at a median time of 47.9 weeks (IQR 24.7-80.3). C-reactive protein >10.0 mg/L at the time of dose escalation predicted tertiary loss of response in univariate analysis (OR 3.32, 95% CI: 1.18-9.37). CONCLUSIONS In patients with Crohn's disease, adalimumab dose escalation is effective for recapturing symptomatic response after secondary loss of response, but more than half will eventually experience a tertiary loss of response.
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Affiliation(s)
- C Ma
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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26
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Reich KM, Chang HJ, Rezaie A, Wang H, Goodman KJ, Kaplan GG, Svenson LW, Lees G, Fedorak RN, Kroeker KI. The incidence rate of colectomy for medically refractory ulcerative colitis has declined in parallel with increasing anti-TNF use: a time-trend study. Aliment Pharmacol Ther 2014; 40:629-38. [PMID: 25039715 DOI: 10.1111/apt.12873] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 03/10/2014] [Accepted: 06/21/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND Medical therapy is standard treatment for ulcerative colitis with colectomy reserved for medically refractory disease or malignancy. The introductions of ciclosporin in 1994 and anti-TNF therapy in 2005 have extended medical management options. AIM To determine whether the colectomy incidence rate for medically refractory ulcerative colitis has changed since the introduction of anti-TNF therapy. METHODS Adult patients with a diagnosis of ulcerative colitis and who subsequently underwent an urgent or elective colectomy for medically refractory disease in Edmonton, Canada between 1 January 1998 and 31 December 2011 were identified. Log-linear regression was used to estimate the annual percent change in the total colectomy incidence rate (urgent and elective combined) and the urgent and elective incidence rates individually, before and after 2005, the year infliximab was approved for use in ulcerative colitis. Temporal trends of drug utilisation in this study population were also described. RESULTS During 1998-2011, 481 patients with ulcerative colitis underwent a colectomy for medically refractory disease. There was negligible change in the total colectomy incidence rate from 1998 to 2005, with an annual percent change of 4.4% (95% confidence interval (CI): -1.12% to 10.16%). From 2005-2011, following the approval and increasing use of anti-TNF therapy, the total colectomy incidence rate decreased by 16.1% (95% CI: -21.32% to -10.54%) every year to 0.9 per 100 ulcerative colitis patients in 2011. CONCLUSION The total incidence rate of colectomy for medically refractory ulcerative colitis has declined substantially since 2005, paralleling the increased use of anti-TNF therapy in this patient population.
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Affiliation(s)
- K M Reich
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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27
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Abstract
Aliment Pharmacol Ther 2010; 32: 522-528 Summary Background Randomized, controlled trials have demonstrated that anti-TNF agents are efficacious in inducing remission in cases of Crohn's disease and ulcerative colitis. However, response rates for anti-TNF agents in 'real life' clinical practice are less well-defined. Aims To examine the response rates and long-term outcomes of infliximab and adalimumab treatment for out-patients with ulcerative colitis and to study the variables associated with response rates. Methods In a prospective study, a single-centre out-patient cohort was treated and followed up according to a structured protocol of clinical care. Response to treatment was assessed using a physician's global assessment that focused on normalization of bowel frequency, absence of blood with defecation and tapering of corticosteroids to zero. Results Fifty-three ulcerative colitis patients were included in the study. Responses to induction therapy were 96.4% (27/28) for infliximab and 80% (20/25) for adalimumab (P = 0.0889). Responses to maintenance therapy were similar: infliximab 77.8% (14/18) and adalimumab 70.0% (14/20) (P = 0.7190). Multivariate analyses of the induction and maintenance responses did not reveal confounding elements. No new safety signals were identified. Conclusions This long-term follow-up of a single-centre cohort of ulcerative colitis patients demonstrates that 'real-life' out-patient treatment with infliximab and adalimumab is effective in induction and maintenance of response.
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Affiliation(s)
- N Gies
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
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28
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Affiliation(s)
- K I Kroeker
- Department of Clinical Affairs, Calgary Regional Health Authority, Canada
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29
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Abstract
We evaluated the after-hours support that radiologists could provide from their homes to an urban hospital for reading emergency computerized tomography (CT) scans. During a six-month study period, 36 CT scans were acquired using a video-capture card in a PC and transmitted via an ordinary telephone line. The teleradiology interpretation and the formal report (from the hard copy) were compared with a reference or gold standard interpretation made by a radiologist and an emergency physician for 31 of the 36 cases. In comparison with the gold standard, there were 26 correct diagnoses by teleradiology (84%) and five incorrect (16%). Head CT scans accounted for 74% of the transmitted scans and all five of the cases with discrepant diagnoses. The cause of the single clinically relevant discrepancy was found to be unrelated to the use of teleradiology. In comparison with the formal report, the accuracy of the teleradiologist was not significantly different for all categories combined or for head CT scans alone. Video-capture technology provided a reliable means of transmitting CT scans for after-hours interpretation in emergency cases.
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Affiliation(s)
- K I Kroeker
- Department of Clinical Affairs, Calgary Regional Health Authority, Alberta, Canada
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