1
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Farag MS, van Campenhout MJH, Sonneveld MJ, Fung S, van Erpecum KJ, Wong DK, Verhey E, de Man R, De Knegt RJ, Brouwer JT, Baak HC, Feld JJ, Liem KS, Boonstra A, Hansen BE, Janssen HLA. Addition of PEG-interferon to long-term nucleos(t)ide analogue therapy enhances HBsAg decline and clearance in HBeAg-negative chronic hepatitis B: Multicentre Randomized Trial (PAS Study). J Viral Hepat 2024; 31:197-207. [PMID: 38243144 DOI: 10.1111/jvh.13918] [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: 05/26/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/21/2024]
Abstract
We studied whether 48 weeks of PEG-IFN alfa-2a add-on increases HBsAg-decline and clearance in HBeAg-negative patients on long-term nucleo(s)tide analogue (NA) therapy. In this investigator-initiated, randomized, controlled trial conducted in Europe and Canada, HBeAg-negative patients treated with NA > 12 months, with HBVDNA < 200 IU/mL, were enrolled. Patients were randomized 2:1 to 48 weeks of PEG-IFN alfa-2a add-on (180 μg per week) or continued NA-monotherapy with subsequent follow-up to Week 72. Endpoints were HBsAg decline (≥1 log10 IU/mL) and HBsAg clearance at Week 48. Of the 86 patients in the modified-intention-to-treat analysis, 58 patients received PEG-IFN add-on, and 28 continued NA monotherapy. At Week 48, 16(28%) patients achieved HBsAg decline ≥1 log10 in the add-on arm versus none on NA-monotherapy (p < .001), and HBsAg clearance was observed in 6 (10%) PEG-IFN add-on patients versus 0% NA-monotherapy (p = .01). HBVRNA was only detected in 2% after PEG-IFN treatment versus 19% in NA-monotherapy (p = .002) at Week 48. PEG-IFN add-on therapy was well tolerated in majority of patients. Low baseline HBsAg levels (<10 IU/mL) identified patients most likely to achieve HBsAg loss with PEG-IFN add-on, whereas an HBsAg level > 200 IU/mL at on-treatment Week 12 was highly predictive of non-response (NPV = 100%). Addition of PEG-IFN to long-term NA enhanced HBsAg decline and increased the chance of HBsAg clearance in HBeAg-negative patients on long-term NA. On-treatment HBsAg levels >200 IU/mL identify patients unlikely to benefit from PEG-IFN add-on and could be used as a potential stopping-rule for PEG-IFN therapy. Our findings support further exploration of immune modulation add-on to antiviral therapy, preferably using response-guided strategies, to increase functional cure rates in patients with CHB.
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Affiliation(s)
- Mina S Farag
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Margo J H van Campenhout
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Scott Fung
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Karel J van Erpecum
- Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands
| | - David K Wong
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Elke Verhey
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert de Man
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert J De Knegt
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johannes T Brouwer
- Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, The Netherlands
| | - Hubertus C Baak
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Jordan J Feld
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Kin Seng Liem
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - André Boonstra
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bettina E Hansen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
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van Erpecum KJ, Dalekos GN. New horizons in the diagnosis and management of patients with MASLD. Eur J Intern Med 2024; 122:1-2. [PMID: 38350783 DOI: 10.1016/j.ejim.2024.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Affiliation(s)
- Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Po Box85500, Utrecht, the Netherlands.
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, Expertise Center of Greece in Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
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van Velsen LM, Sonneveld MJ, van Erpecum KJ. Is tenofovir disoproxil fumarate superior to entecavir for prevention of hepatocellular carcinoma in patients with chronic hepatitis B? Hepatobiliary Surg Nutr 2023; 12:919-922. [PMID: 38115936 PMCID: PMC10727831 DOI: 10.21037/hbsn-23-472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/24/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Lisa M. van Velsen
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Milan J. Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Karel J. van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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van Erpecum KJ, van Kleef LA, Beuers U, de Knegt RJ. The new international nomenclature for steatotic liver disease: One step forward towards enhanced awareness for healthier life. Eur J Intern Med 2023; 117:1-2. [PMID: 37714774 DOI: 10.1016/j.ejim.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023]
Affiliation(s)
- Karel J van Erpecum
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands.
| | - Laurens A van Kleef
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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5
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van Dijk AM, Bruins Slot AS, Portincasa P, Siegerink SN, Chargi N, Verstraete CJR, de Bruijne J, Vleggaar FP, van Erpecum KJ. Systematic review with meta-analysis: Branched-chain amino acid supplementation in liver disease. Eur J Clin Invest 2023; 53:e13909. [PMID: 36394355 DOI: 10.1111/eci.13909] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/04/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dietary supplementation with branched-chain amino acids (BCAA) is often used in cirrhotic patients to improve nutritional status. We wanted to explore the evidence for BCAA supplementation in chronic liver disease. METHODS We searched MEDLINE and EMBASE for studies with BCAA supplementation with the presence of a disease-control group (placebo or no intervention) using search terms 'liver cirrhosis', 'hepatocellular carcinoma', 'branched chain amino acids' and relevant synonyms. Risk of bias was assessed using ROBINS-I and RoB 2.0 tools. Meta-analyses were performed with a random-effects model. Results were reported following EQUATOR guidelines. RESULTS Of 3378 studies screened by title and abstract, 54 were included (34 randomized controlled trials, 5 prospective case-control studies, 13 retrospective case-control studies: in total 2308 patients BCAA supplementation, 2876 disease-controls). Risk of bias was high/serious for almost all studies. According to meta-analyses, long-term (at least 6 months) BCAA supplementation in cirrhotic patients significantly improved event-free survival (p = .008; RR .61 95% CI .42-.88) and tended to improve overall survival (p = .05; RR .58 95% CI .34-1.00). Two retrospective studies suggested the beneficial effects during sorafenib for hepatocellular carcinoma. Available studies reported no beneficial effects or contradictory results of BCAA after other specific therapeutic interventions (resection or radiological interventions for hepatocellular carcinoma, liver transplantation, paracentesis or variceal ligation). No convincing beneficial effects of BCAA supplementation on liver function, nutritional status or quality of life were found. No study reported serious side effects of BCAA. CONCLUSIONS Prophylactic BCAA supplementation appears safe and might improve survival in cirrhotic patients.
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Affiliation(s)
- Anne M van Dijk
- Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexandra S Bruins Slot
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Biomedical Sciences and Human Oncology, University of Bari Aldo Moro, Bari, Italy
| | - Sebastiaan N Siegerink
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Najiba Chargi
- Department of Head and Neck Surgical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Carina J R Verstraete
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joep de Bruijne
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank P Vleggaar
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Karel J van Erpecum
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
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van Munster KN, Mol B, Goet JC, van Munster SN, Weersma RK, de Vries AC, van der Meer AJ, Inderson A, Drenth JP, van Erpecum KJ, Boonstra K, Beuers U, Dijkgraaf MGW, Ponsioen CY. Disease burden in primary sclerosing cholangitis in the Netherlands: A long-term follow-up study. Liver Int 2023; 43:639-648. [PMID: 36328957 DOI: 10.1111/liv.15471] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/31/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND & AIMS Primary sclerosing cholangitis (PSC) is a progressive, cholestatic liver disease which greatly impacts the lives of individuals. Burden of disease due to shortened life expectancy and impaired quality of life is ill-described. The aim of this study was to assess long-term disease burden in a large population-based registry with regard to survival, clinical course, quality adjusted life years (QALYs), medical consumption and work productivity loss. METHODS All PSC patients living in a geographically defined area covering ~50% of the Netherlands were included, together with patients from the three liver transplant centres. Survival was estimated by competing risk analysis. Proportional shortfall of QALYs during disease course was measured relative to a matched reference cohort using validated questionnaires. Work productivity loss and medical consumption were evaluated over time. RESULTS A total of 1208 patients were included with a median follow-up of 11.2 year. Median liver transplant-free survival was 21.0 years. Proportional shortfall of QALYs increased to 48% >25 years after diagnosis. Patients had on average 12.4 hospital contact days among which 3.17 admission days per year, annual medical costs were €12 169 and mean work productivity loss was 25%. CONCLUSIONS Our data quantify for the first time disease burden in terms of QALYs lost, clinical events, medical consumption, costs as well as work productivity loss, and show that all these are substantial and increase over time.
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Affiliation(s)
- Kim N van Munster
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Bregje Mol
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Jorn C Goet
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sanne N van Munster
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Adriaan J van der Meer
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Joost P Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kirsten Boonstra
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location VUmc, Amsterdam Gastroenterology & Metabolism, Amsterdam, The Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, location University of Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, The Netherlands
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7
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Mol B, van Munster KN, Bogaards JA, Weersma RK, Inderson A, de Groof EJ, Rossen NGM, Ponsioen W, Turkenburg M, van Erpecum KJ, Poen AC, Spanier BWM, Beuers UHW, Ponsioen CY. Health-related quality of life in patients with primary sclerosing cholangitis: A longitudinal population-based cohort study. Liver Int 2023; 43:1056-1067. [PMID: 36779848 DOI: 10.1111/liv.15542] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND & AIMS Data regarding health-related quality of life (HRQoL) in primary sclerosing cholangitis (PSC) are sparse and have only been studied cross-sectionally in a disease which runs a fluctuating and unpredictable course. We aim to describe HRQoL longitudinally by using repeated measurements in a population-based cohort. METHODS Every 3 months from May 2017 up to August 2020, patients received digital questionnaires at home. These included the EQ-5D, 5-D Itch, patient-based SCCAI and patient-based HBI. The SF-36, measuring HRQoL over eight dimensions as well as a physical component summary (PCS) and mental component summary (MCS) score, was sent annually. Data were compared with Dutch reference data and a matched IBD disease control from the population-based POBASIC cohort. Mixed-effects modelling was performed to identify factors associated with HRQoL. RESULTS Three hundred twenty-eight patients completed 2576 questionnaires. A significant reduction of small clinical relevance in several mean HRQoL scores was found compared with the Dutch reference population: 46.4 versus 48.0, p = .018 for PCS and 47.5 versus 50.5, p = .004 for MCS scores. HRQoL outcomes were significantly negatively associated with coexisting active IBD (PCS -12.2, p < .001 and MCS -12.0, p < .001), which was not the case in case of quiescent IBD. Decreasing HRQoL scores were also negatively associated with increasing age (PCS -0.1 per 10 years, p = .002), female sex (PCS -2.8, p < .001), diagnosis of AIH overlap (PCS -3.7, p = .059), end-stage liver disease (PCS -3.7, p = .015) and presence of itch (PCS -9.2, p < .001 and MCS -3.1, p = .078). The odds of reporting a clinically relevant reduction in EQ-5D scores showed seasonal variation, being lowest in summer (OR = 0.48 relative to spring, p = .037). In patients with liver transplant, HRQoL outcomes were comparable to the Dutch general population. CONCLUSIONS PSC patients report impaired HRQoL of small clinical relevance compared with the general population. After liver transplantation, HRQoL scores are at comparable levels to the general population. HRQoL scores are associated with potentially modifiable factors such as itch and IBD activity.
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Affiliation(s)
- Bregje Mol
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
| | - Kim N van Munster
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
| | - Johannes A Bogaards
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, location AMC, Amsterdam, the Netherlands
| | - Rinse K Weersma
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Akin Inderson
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - E Joline de Groof
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
| | - Noortje G M Rossen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
| | - Willemijn Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
| | - Maud Turkenburg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Alexander C Poen
- Department of Gastroenterology and Hepatology, Isala Hospital, Zwolle, the Netherlands
| | - B W Marcel Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Ulrich H W Beuers
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre, Location AMC, Amsterdam Gastroenterology, Endocrinology & Metabolism, Amsterdam, the Netherlands
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Isfordink CJ, van Erpecum KJ, Fischer K, van der Valk PR, van Vulpen LFD, Schutgens REG, Arends JE, Mauser-Bunschoten EP. Liver-related complications before and after successful treatment of chronic hepatitis C virus infection in people with inherited bleeding disorders. Haemophilia 2023; 29:106-114. [PMID: 36184751 PMCID: PMC10092673 DOI: 10.1111/hae.14668] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 06/02/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION With availability of direct-acting antivirals (DAA), most persons with inherited bleeding disorders are currently cured of hepatitis C virus (HCV) infection. The risk of liver-related complications following HCV cure has not been reported for this population. AIM Reporting liver-related complications during long-term chronic HCV infection and following sustained virological response (SVR) in this population. METHODS Retrospective follow-up of a prospective single-centre cohort of HCV antibody-positive persons with inherited bleeding disorders. Primary endpoint was liver-related complications [hepatocellular carcinoma (HCC), decompensated cirrhosis, bleeding gastroesophageal varices]. Liver-related complications were reported separately during chronic HCV and following SVR, stratified for interferon-based and DAA-based SVR. RESULTS In total 309/381 (81%) HCV antibody-positive individuals developed chronic HCV infection. Median follow-up was 44 years [interquartile range (IQR): 34-50]. Liver-related complications occurred in 36/309 (12%) of individuals with chronic HCV infection after median 31 years of chronic infection. Of 199 individuals with SVR, 97 were cured with interferon-based regimens and 102 with DAA after median infection durations of 29 and 45 years, respectively. At end of follow-up, respectively, 21% and 42% had advanced fibrosis or cirrhosis. Post-SVR, seven (4%) individuals had a liver-related complication, mainly HCC (n = 4). Incidence of liver-related complications per 100 patient-years post-SVR follow-up was .2 for interferon-cured and 1.0 for DAA-cured individuals (p = .01). CONCLUSION Successful HCV treatment does not eliminate the risk of liver-related complications in persons with inherited bleeding disorders. Due to higher baseline risk, incidence was higher after DAA than interferon-based SVR. We advise continuing HCC surveillance post-SVR in all with advanced fibrosis or cirrhosis.
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Affiliation(s)
- Cas J Isfordink
- Van Creveldkliniek, Department of Benign Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kathelijn Fischer
- Van Creveldkliniek, Department of Benign Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul R van der Valk
- Van Creveldkliniek, Department of Benign Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lize F D van Vulpen
- Van Creveldkliniek, Department of Benign Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roger E G Schutgens
- Van Creveldkliniek, Department of Benign Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Evelien P Mauser-Bunschoten
- Van Creveldkliniek, Department of Benign Hematology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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9
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Reinders MT, van Erpecum KJ, Smits ML, Braat AJ, de Bruijne J, Bruijnen R, Sprengers D, de Man RA, Vegt E, IJzermans JN, Moelker A, Lam MG. Safety and Efficacy of 166Ho Radioembolization in Hepatocellular Carcinoma: The HEPAR Primary Study. J Nucl Med 2022; 63:1891-1898. [PMID: 35589409 PMCID: PMC9730925 DOI: 10.2967/jnumed.122.263823] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 01/15/2022] [Revised: 04/18/2022] [Indexed: 01/11/2023] Open
Abstract
The safety and efficacy of 166Ho radioembolization was first determined in the HEPAR and HEPAR II studies, which, however, excluded patients with hepatocellular carcinoma (HCC). The aim of this prospective clinical early phase II study was to establish the toxicity profile of 166Ho radioembolization in patients with measurable, liver-dominant HCC; Barcelona clinic liver cancer stage B or C; a Child-Pugh score of no more than B7; and an Eastern Cooperative Oncology Group performance status of 0-1 without curative treatment options. Methods: The primary endpoint was a rate of unacceptable toxicity defined as grade 3 hyperbilirubinemia (Common Terminology Cancer Adverse Events, version 4.03) in combination with a low albumin or ascites level in the absence of disease progression or treatment-related serious adverse events. Secondary endpoints included overall toxicity, response, survival, change in α-fetoprotein, and quality of life. Thirty-one patients with Barcelona clinic liver cancer stage B (71%) or C (29%) HCC were included, mostly multifocal (87%) or bilobar (55%) disease. Results: Common grade 1 or 2 clinical toxicity included fatigue (71%), back pain (55%), ascites (32%), dyspnea (23%), nausea (23%), and abdominal pain (23%), with no more than 10% grade 3-5 toxicity. Grade 3 laboratory toxicity (>10%) included an aspartate transaminase and γ-glutamyltransferase increase (16%), hyperglycemia (19%), and lymphopenia (29%). Treatment-related unacceptable toxicity occurred in 3 of 31 patients. At 3 mo, 54% of target lesions showed a complete or partial response according to modified RECIST. Median overall survival was 14.9 mo (95% CI, 10.4-24.9 mo). No significant changes in quality of life or pain were observed. Conclusion: The safety of 166Ho radioembolization was confirmed in HCC, with less than 10% unacceptable toxicity. Efficacy data support further evaluation.
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Affiliation(s)
- Margot T.M. Reinders
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Karel J. van Erpecum
- Department of Gastroenterology and Hepatology University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Maarten L.J. Smits
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Arthur J.A.T. Braat
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Joep de Bruijne
- Department of Gastroenterology and Hepatology University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Rutger Bruijnen
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
| | - Dave Sprengers
- Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands
| | - Robert A. de Man
- Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands
| | - Erik Vegt
- Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands; and
| | - Jan N.M. IJzermans
- Department of Surgery, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands
| | - Adriaan Moelker
- Department of Radiology and Nuclear Medicine, Erasmus MC–University Medical Centre, Rotterdam, The Netherlands; and
| | - Marnix G.E.H. Lam
- Department of Radiology and Nuclear Medicine, University Medical Centre, Utrecht University, Utrecht, The Netherlands
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10
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van Dijk AM, Coppens BJP, van Beers MA, Bruins Slot AS, Verstraete CJR, de Bruijne J, Vleggaar FP, van Erpecum KJ. Nutritional status in patients with hepatocellular carcinoma: Potential relevance for clinical outcome. Eur J Intern Med 2022; 104:80-88. [PMID: 35902333 DOI: 10.1016/j.ejim.2022.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/21/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Impaired nutritional status is a risk factor for unfavorable outcome in cirrhosis. METHODS In this prospective cohort study in hepatocellular carcinoma patients referred for tumor-specific therapy, nutritional status was assessed before and 3 months post-treatment using 4 complementary tools: hand-grip strength (HGS), Liver Frailty Index (LFI), Patient-Generated Subjective Global Assessment (PG-SGA) and skeletal muscle index (L3-SMI). Uni- and multivariable analyses were performed using Kaplan Meier curves and Cox's regression analyses with correction for Barcelona Clinic Liver Cancer (BCLC) stage, alpha-fetoprotein and age. RESULTS 56 patients were evaluated at baseline and 38 patients 3 months post-treatment. Baseline BCLC stage was 0 in 14%, A in 27%, B in 36%, C in 21%, and D in 2%. HGS, LFI, PG-SGA and L3-SMI were impaired in 13%, 95%, 21% and 71% respectively. Of all patients, 52% died after (median, range) 373 (32-962) days. Of the nutritional assessment tools, only HGS was independently associated with complication-free survival (HR 0.304, 95%CI 0.10-0.88: p = 0.028) and, approaching significance, with overall survival (HR 0.323, 95%CI 0.103-1.008: p = 0.052). Tumor-specific therapy was administered in 50 patients (20% radiofrequency / microwave ablation, 4% resection, 74% transarterial radio- or chemoembolization, 2% sorafenib). Three months post-treatment, complete response occurred in 44%, partial response in 20%, stable disease in 20% and progressive disease in 16%. Child-Pugh scores deteriorated and such deterioration was independently associated with reduced overall and complication-free survival. CONCLUSIONS reduced baseline HGS and deteriorated post-treatment Child-Pugh score are associated with reduced overall and complication-free survival in HCC.
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Affiliation(s)
- Anne M van Dijk
- Department of Internal Medicine and Dermatology, Dietetics, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart J P Coppens
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Maartje A van Beers
- Department of Head and Neck Surgical Oncology, Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Alexandra S Bruins Slot
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Carina J R Verstraete
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Joep de Bruijne
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Frank P Vleggaar
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Karel J van Erpecum
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands.
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11
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van Erpecum KJ, Didden P, Verdonk RC. High risk of complications and mortality in cirrhotic patients with acute pancreatitis. Eur J Intern Med 2022; 102:45-46. [PMID: 35718647 DOI: 10.1016/j.ejim.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Karel J van Erpecum
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands.
| | - Paul Didden
- Department Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands
| | - Robert C Verdonk
- Department Gastroenterology and Hepatology, St Antonius Hospital, Nieuwegein, the Netherlands
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12
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de Vries M, El-Morabit F, van Erpecum KJ, Westerink J, Bac ST, Kaasjager HAHK, de Valk HW. Non-alcoholic fatty liver disease: identical etiologic factors in patients with type 1 and type 2 diabetes. Eur J Intern Med 2022; 100:77-82. [PMID: 35387749 DOI: 10.1016/j.ejim.2022.03.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 12/17/2021] [Revised: 02/18/2022] [Accepted: 03/18/2022] [Indexed: 01/08/2023]
Abstract
AIMS To compare NAFLD prevalence, distribution and its etiologic determinants in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D). METHODS In this cross-sectional study, NAFLD was evaluated by transient elastography in adult outpatients with T1D and T2D. NAFLD was defined as hepatic steatosis with or without fibrosis. Associations between insulin resistance related factors and NAFLD and advanced fibrosis (≥ F3) were explored in T1D and T2D separately, using multivariate logistic regression models. Interaction analysis was performed to compare the associations in patients with T1D and T2D. RESULTS One hundred and fifty patients with T1D (mean age 47 years, male 55%, mean diabetes duration 25 years, median BMI 25 kg/m2) and 100 patients with T2D (median age 67 years, male 56%, median diabetes duration 17 years, mean BMI 30 kg/m2) were included. NAFLD prevalence was 20% in patients with T1D and 76% in patients with T2D. Advanced fibrosis prevalence was 2.0% in patients with T1D and 22% in patients with T2D. In both patients with T1D and T2D, waist circumference, BMI and metabolic syndrome were positively associated, and estimated insulin sensitivity was negatively associated with the presence of NAFLD, adjusted for age, sex and diabetes duration. There was no effect modification by diabetes type for any of these associations. CONCLUSIONS Despite differences in population characteristics and pathophysiology between T1D and T2D, insulin resistance related factors are similarly associated with NAFLD in both groups.
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Affiliation(s)
- Marieke de Vries
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Fatima El-Morabit
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Westerink
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simon T Bac
- Department of Gastroenterology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - H A H Karin Kaasjager
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Harold W de Valk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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13
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Broekhoven AGC, Fiocco M, Sprengers D, Takkenberg RB, van Meer S, van Erpecum KJ, Ramsoekh D, Verspaget HW, Burgmans MC, Osanto S, Baranski AG, van Hoek B, Coenraad MJ. Real-life data on the impact of successful downstaging in patients with hepatocellular carcinoma: A Dutch Multicenter Study. Eur J Intern Med 2022; 97:56-61. [PMID: 34952770 DOI: 10.1016/j.ejim.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/11/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
Patients with Barcelona Clinic Liver Cancer intermediate stage hepatocellular carcinoma (HCC) theoretically are an excellent group to consider downstaging using locoregional therapy (LRT) since they do not have extrahepatic spread or vascular invasion. Once successful, this can change the treatment strategy from palliative to curative intention. Although downstaging therapy is suggested in guidelines, it is still not widely accepted. Moreover, studies on downstaging are mainly performed in high-incidence HCC countries. Therefore, our aim was to gain insight in therapeutic strategies in patients with intermediate stage HCC and their impact on intention-to-treat survival in a real-life setting in a low-incidence HCC country. We retrospectively analyzed data from the national Dutch HCC registry. From this database, consisting of 1409 patients with a diagnosis of HCC between 2005-2013 in 5 Dutch tertiary referral centers, we identified 165 patients with intermediate stage HCC. Out of these patients, 63 (38%) were not offered LRT, whereas 102 (62%) did receive LRT. Subsequently, 50 (49%) of the 102 patients who received LRT were successfully downstaged. Eleven patients (22% of successfully downstaged patients) eventually underwent liver transplantation. Cox regression analysis showed that a lower MELD score, an AFP value <100 ng/ml, successful downstaging and liver transplantation (all ≤p = 0.01) were positively associated to overall survival. In conclusion, our results demonstrate that LRT is not routinely offered to intermediate stage HCC patients in the Netherlands. Nevertheless, we showed that patients with intermediate stage HCC who are successfully downstaged have a survival benefit compared to those who were not.
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Affiliation(s)
- Annelotte G C Broekhoven
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marta Fiocco
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands; Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - Dave Sprengers
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - R Bart Takkenberg
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location Amsterdam Medical Center, Amsterdam, the Netherlands
| | - Suzanne van Meer
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Dewkoemar Ramsoekh
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Centers, location VU Medical Center, Amsterdam, the Netherlands
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Susanne Osanto
- Department of Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Andrzej G Baranski
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands.
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14
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Isfordink CJ, Maan R, de Man RA, van Erpecum KJ, van der Meer AJ. Should we continue surveillance for hepatocellular carcinoma and gastroesophageal varices in patients with cirrhosis and cured HCV infection? Eur J Intern Med 2021; 94:6-14. [PMID: 34563447 DOI: 10.1016/j.ejim.2021.08.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/02/2021] [Accepted: 08/27/2021] [Indexed: 12/13/2022]
Abstract
Hepatocellular carcinoma (HCC) and variceal bleeding are among the most common causes of liver-related mortality in patients with hepatitis C virus (HCV)-induced cirrhosis. Current guidelines recommend HCC and gastroesophageal varices (GEV) surveillance in patients with HCV infection and cirrhosis. However, since the recent introduction of direct-acting antivirals, most patients with cirrhosis are now cured of their chronic HCV infection. As virological cure is considered to substantially reduce the risk of cirrhosis-related complications, this review discusses the current literature concerning the surveillance of HCC and GEV in patients with HCV-induced cirrhosis with a focus on the setting following sustained virological response.
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Affiliation(s)
- Cas J Isfordink
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands; Division of Infectious Diseases, Amsterdam Infection & Immunity Institute Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Raoel Maan
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Adriaan J van der Meer
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands.
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15
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Stolk MFJ, van den Berg AP, van Erpecum KJ. Maintenance immunosuppressive therapy in autoimmune hepatitis: To stop or not to stop, that is the question. Eur J Intern Med 2021; 90:25-26. [PMID: 34024702 DOI: 10.1016/j.ejim.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/01/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Mark F J Stolk
- Department of Gastroenterology, St Antonius Hospital Nieuwegein, the Netherlands.
| | - Aad P van den Berg
- Department of Gastroenterology and Hepatology and Institute for Organ Transplantation (GIOT). University Medical Center Groningen, Groningen, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology University Medical Center Utrecht, Utrecht, the Netherlands
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16
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van Erpecum KJ, Sonneveld MJ. Antiviral therapy after curative treatment of hepatocellular carcinoma in patients with chronic hepatitis B infection: Is tenofovir or entecavir preferred? Eur J Intern Med 2021; 89:27-29. [PMID: 34023149 DOI: 10.1016/j.ejim.2021.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 01/07/2023]
Affiliation(s)
- Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, the Netherlands..
| | - Milan J Sonneveld
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
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17
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Isfordink CJ, van Erpecum KJ, van der Valk M, Mauser-Bunschoten EP, Makris M. Viral hepatitis in haemophilia: historical perspective and current management. Br J Haematol 2021; 195:174-185. [PMID: 33955555 DOI: 10.1111/bjh.17438] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 02/06/2023]
Abstract
The introduction of clotting factor concentrates has substantially improved the lives of people with clotting factor deficiencies. Unfortunately, the transmission of blood-borne viral infections through these plasma-derived products led to a huge epidemic of human immunodeficiency virus and viral hepatitis in people with haemophilia (PWH). In a significant proportion of PWH exposed to these viruses, the ensuing decades-long chronic infection resulted in excess morbidity and mortality. Fortunately, developments in the safety of blood products, as well as vaccination and highly effective antiviral treatments have improved the prospects of PWH. The present article reviews the background of the viral hepatitis epidemic in PWH, the natural history of hepatitis B and C infections and their long-term management.
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Affiliation(s)
- Cas J Isfordink
- Van Creveldkliniek, Department of Benign Haematology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc van der Valk
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam Institute for Infection and Immunity, University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Evelien P Mauser-Bunschoten
- Van Creveldkliniek, Department of Benign Haematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Michael Makris
- Sheffield Haemophilia and Thrombosis Centre, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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18
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Gorris M, van der Lecq BM, van Erpecum KJ, de Bruijne J. Treatment for chronic hepatitis E virus infection: A systematic review and meta-analysis. J Viral Hepat 2021; 28:454-463. [PMID: 33301609 PMCID: PMC7898834 DOI: 10.1111/jvh.13456] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/09/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022]
Abstract
Hepatitis E virus infection can cause chronic hepatitis in immunocompromised patients with significant chance of progressive fibrosis and possibly cirrhosis. The aim of this systematic review was to summarize the efficacy and safety of the various treatment options for chronic hepatitis E. We performed a systematic literature search. The primary outcome measure was a sustained virological response (SVR). Secondary end points were rapid virological response (RVR), relapse rates, side effects and adverse events. Forty-four articles were included with a total of 582 patients. Reduction of immunosuppressive medication induced viral clearance in 55/174 (32%) of the patients. Meta-analysis of 395 patients showed a pooled SVR rate of 78% (95-CI 72%-84%) after ribavirin treatment. Twenty-five per cent of the patients obtained a RVR, whereas a relapse occurred in 18% of the patients. Anaemia during treatment led to dose reduction, use of erythropoietin and/or blood transfusion in 37% of the patients. A second treatment attempt with ribavirin led to a SVR in 39/51 (76%) of the patients. Pegylated interferon-alpha was administered to 13 patients and SVR was obtained in 85%. Two patients (15%) suffered from acute transplant rejection during treatment with interferon. In conclusion, reduction of immunosuppressive medication and treatment with ribavirin is safe, generally well tolerated and induced viral clearance in 32% and 78% of patients, respectively. Therefore, ribavirin should be considered as first treatment step for chronic hepatitis E. Treatment with pegylated interferon-alpha increases the risk of transplant rejection and should therefore be administered with great caution.
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Affiliation(s)
- Myrte Gorris
- Department of Gastroenterology & HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Bernice M. van der Lecq
- Department of Gastroenterology & HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Karel J. van Erpecum
- Department of Gastroenterology & HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Joep de Bruijne
- Department of Gastroenterology & HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands
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19
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Reinders MTM, van Meer S, Burgmans MC, de Jong KP, Klümpen HJ, de Man RA, Ramsoekh DS, Sprengers D, Tjwa ETTL, de Vos-Geelen J, van Erpecum KJ, van der Geest LGM. Trends in incidence, diagnosis, treatment and survival of hepatocellular carcinoma in a low-incidence country: Data from the Netherlands in the period 2009-2016. Eur J Cancer 2020; 137:214-223. [PMID: 32799035 DOI: 10.1016/j.ejca.2020.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/27/2020] [Revised: 07/01/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluation of the trends in incidence, diagnostics, treatment and survival of patients with hepatocellular carcinoma (HCC) in the Netherlands. METHOD Data regarding incidence, diagnostics, primary treatment and survival of patients with HCC in the period 2009-2016 were obtained from the Netherlands Cancer Registry. Trends in incidence, diagnostics, various treatment modalities (except liver transplantation, due to inaccurate data) and regional treatment preferences were analysed. Survival was evaluated using Kaplan-Meier curves and multivariable Cox proportional hazard regression modelling. RESULTS In the period of 2009-2016, 3838 patients were diagnosed with HCC. A distinct decrease in the percentage of patients who underwent tumour biopsy was observed (from 51% in 2009-2010 to 42% in 2015-2016). Percentage of patients who underwent cancer treatment increased markedly (from 49% in 2009-2010 to 57% in 2015-2016), mainly because of an increasing use of resection and ablation. The number of hospitals where resections were performed or sorafenib treatment prescribed decreased slightly. The number of hospitals sporadically (<1 ablation per year) performing ablations increased. There were significant differences between regions in the application of resection, ablation and transarterial chemoembolisation /radioembolisation (p < 0.05 after 'case mix'-correction). One-, 3- and 5-year survival of patients with HCC significantly improved in the studied period. Receiving cancer treatment was associated with increased survival, whereas increasing age and an advanced tumour stage were both associated with decreased survival. CONCLUSION From 2009 to 2016, patients with hepatocellular carcinoma more often received cancer treatment and their survival improved. There were significant differences in types of treatment between various regions.
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Affiliation(s)
- Margot T M Reinders
- Department of Radiology & Nuclear Medicine, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands; Department of Gastroenterology & Hepatology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Suzanne van Meer
- Department of Gastroenterology & Hepatology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Mark C Burgmans
- Department of Radiology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC Leiden, the Netherlands.
| | - Koert P de Jong
- Department of Surgery, University Medical Centre Groningen, P.O. Box 30001, 9700 RB Groningen, the Netherlands.
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Amsterdam University Medical Centres, P.O. Box 22660, 1100 DD Amsterdam Zuidoost, the Netherlands.
| | - Robert A de Man
- Department of Gastroenterology & Hepatology, Erasmus Medisch Centrum Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - D Sandjai Ramsoekh
- Department of Gastroenterology & Hepatology, Amsterdam University Medical Centres, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands.
| | - Dave Sprengers
- Department of Gastroenterology & Hepatology, Erasmus Medisch Centrum Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Eric T T L Tjwa
- Department of Gastroenterology & Hepatology, Radboud University Medical Centre Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
| | - Judith de Vos-Geelen
- Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ Maastricht, the Netherlands.
| | - Karel J van Erpecum
- Department of Gastroenterology & Hepatology, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Lydia G M van der Geest
- The Netherlands Comprehensive Cancer Organisation, P.O. Box 19079, 3501 DB Utrecht, the Netherlands.
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20
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van den Brand FF, van der Veen KS, de Boer YS, van Gerven NM, Lissenberg-Witte BI, Beuers U, van Erpecum KJ, van Buuren HR, den Ouden JW, Brouwer JT, Vrolijk JM, Verdonk RC, van Hoek B, Koek GH, Drenth JPH, Guichelaar MMJ, Mulder CJJ, Bloemena E, van Nieuwkerk CMJ, Bouma G. Increased Mortality Among Patients With vs Without Cirrhosis and Autoimmune Hepatitis. Clin Gastroenterol Hepatol 2019; 17:940-947.e2. [PMID: 30291909 DOI: 10.1016/j.cgh.2018.09.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/14/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS There have been few reproducible studies of mortality in patients with autoimmune hepatitis (AIH) and its variants. We calculated mortality in a large national cohort of patients with AIH, with vs without cirrhosis, in the Netherlands. METHODS We collected data from 449 patients with established AIH (77% female), from 6 academic and 10 non-academic hospitals in the Netherlands. We identified 29 patients with AIH and primary biliary cholangitis and 35 patients with AIH and primary sclerosing cholangitis (AIH-PSC). Mortality and liver transplantation data were assessed from August 1, 2006 through July 31, 2016. Standardized mortality ratios (SMR) were calculated using age-, sex-, and calendar year-matched mortality for the general Dutch population. RESULTS During the 10-year follow-up period, 60 patients (13%) died (mean age, 71 years; range, 33-94 years). Twenty-six causes of death were liver related (43%), whereas the others could not be attributed to liver disease. Patients with AIH and cirrhosis had significantly higher mortality than the general population (SMR, 1.9; 95% CI, 1.2-3.4), whereas patients without cirrhosis did not (SMR, 1.2; 95% CI, 0.8-1.8). Patients with AIH-PSC had the largest increase in mortality, compared to the general population (SMR, 4.7; 95% CI, 1.5-14.6), of all groups analyzed. Mortality in patients with AIH and primary biliary cholangitis was not greater than the general population. Four or more relapses per decade or not achieving remission was associated with an increase in liver-related death or liver transplantation. Nine patients underwent liver transplantation; 2 died from non-liver related causes. Four of 9 patients on the waitlist for transplantation died before receiving a donated liver. CONCLUSION In an analysis of data from a large national cohort of patients with AIH, we found increased mortality of patients with cirrhosis, but not of patients without cirrhosis, compared to the general Dutch population. Survival was significantly reduced in patients with AIH and features of concurrent PSC.
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Affiliation(s)
- Floris F van den Brand
- Amsterdam Gastroenterology and Metabolism, Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Koen S van der Veen
- Amsterdam Gastroenterology and Metabolism, Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ynto S de Boer
- Amsterdam Gastroenterology and Metabolism, Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Nicole M van Gerven
- Amsterdam Gastroenterology and Metabolism, Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, the Netherlands
| | - Henk R van Buuren
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jannie W den Ouden
- Department of Gastroenterology and Hepatology, Haga Hospital, The Hague, the Netherlands
| | - Johannus T Brouwer
- Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, the Netherlands
| | - Jan M Vrolijk
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Robert C Verdonk
- Department of Gastroenterology and Hepatology, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ger H Koek
- Department of Internal Medicine, division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marleen M J Guichelaar
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Chris J J Mulder
- Amsterdam Gastroenterology and Metabolism, Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Elisabeth Bloemena
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Carin M J van Nieuwkerk
- Amsterdam Gastroenterology and Metabolism, Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Gerd Bouma
- Amsterdam Gastroenterology and Metabolism, Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
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Lieveld FI, Smit C, Richter C, van Erpecum KJ, Spanier BWM, Gisolf EH, Vrolijk JM, Siersema PD, Hoepelman AIM, Reiss P, Arends JE. Liver decompensation in HIV/Hepatitis B coinfection in the combination antiretroviral therapy era does not seem increased compared to hepatitis B mono-infection. Liver Int 2019; 39:470-483. [PMID: 30411848 DOI: 10.1111/liv.14000] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 08/17/2017] [Revised: 09/28/2018] [Accepted: 10/24/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS HIV/hepatitis B virus (HBV) coinfected subjects are thought to have faster progression to end-stage liver disease (ESLD) than HBV mono-infected subjects. We assessed whether this remains in the current cART-era. METHODS Data from subjects with follow-up completion post-2003 were compared between HIV/HBV coinfected subjects in the Dutch HIV Monitoring database and HBV mono-infected subjects from two centres. The primary outcomes of composite ESLD included portal hypertension, decompensated cirrhosis, hepatocellular carcinoma, liver transplantation and liver-related mortality. Outcomes were analysed using time-dependent cause-specific Cox regression models adjusted for follow-up time and relevant covariates. Subset-analyses were done in subjects with follow-up pre-2003. RESULTS In the 1336 co- vs 742 mono-infected subjects, coinfected subjects had no increased probability for ESLD compared to mono-infected subjects (cHR 0.7 (95% CI 0.4-1.1), but had increased probabilities for all-cause (cHR 7.4 [4.9-11.1]) and liver-related mortality (cHR 3.4 [1.6-7.5]). In the current combined cohort, treatment with tenofovir or entecavir was inversely associated with ESLD, all-cause and liver-related mortality (cHR 0.4 [95% CI 0.3-0.7], cHR 0.003 [0.001-0.01]), cHR 0.007 [0.001-0.05]). Other predictors for ESLD were older age, being of Sub-Sahara African descent, increased alanine aminotransferase levels and hepatitis C virus coinfection. While the probability for all-cause mortality was increased in coinfected subjects, this rate decreased compared to pre-2003 (HR 40.2 (95% CI: 8.7-186.2). CONCLUSIONS HIV/HBV coinfected patients no longer seem to be at increased risk for progression to ESLD compared to HBV mono-infected patients, likely due to widespread use of highly effective cART with dual HBV and HIV activity.
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Affiliation(s)
- Faydra I Lieveld
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Colette Smit
- Stichting HIV Monitoring, Amsterdam, The Netherlands
| | - Clemens Richter
- Department of Internal Medicine and Infectious Diseases, Rijnstate Hospital, Arnhem, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bernhard W M Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Elisabeth H Gisolf
- Department of Internal Medicine and Infectious Diseases, Rijnstate Hospital, Arnhem, The Netherlands
| | - Jan M Vrolijk
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter Reiss
- Stichting HIV Monitoring, Amsterdam, The Netherlands.,Department of Global Health, Academic Medical Center and Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
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22
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Kracht PAM, Arends JE, van Erpecum KJ, Thijsen SFT, Vlaminckx BJM, Weersink AJL, Wensing AMJ, Deege MPH, Dimmendaal M, Stadhouders PHGM, Friederich PW, Verhagen MAMT, Boland GJ, Hoepelman AIM. REtrieval And cure of Chronic Hepatitis C (REACH): Results of micro-elimination in the Utrecht province. Liver Int 2019; 39:455-462. [PMID: 30204289 DOI: 10.1111/liv.13959] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/13/2018] [Accepted: 09/03/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Netherlands is one of the six European countries considered on track to eliminate hepatitis C virus by 2030. To achieve this goal, continuous efforts have to be put into designing efficient case-finding strategies, including the retrieval of previously diagnosed hepatitis C virus-infected who are lost to follow-up. AIMS To trace and treat all lost to follow-up hepatitis C virus patients in the Utrecht region and create an efficient retrieval strategy that can be used in future (national) retrieval initiatives. METHODS Positive hepatitis C virus diagnostic tests (anti-hepatitis C virus IgG or hepatitis C virus-RNA) from the laboratory of all four hospitals and one central laboratory for primary care diagnostics in the province of Utrecht from 2001 to 2015 were linked to clinical records. Untreated patients with available contact information were deemed eligible for retrieval and invited for reevaluation with (virology) blood tests, fibroscan measurement and possible direct-acting antiviral therapy. MAIN RESULTS After screening all hepatitis C virus diagnostics, 1913 chronic hepatitis C virus-infected were identified of which 14.1% (n = 269) were invited back into care. Overall, 17.4% was traced with the highest yield (28.3%) in those who lived in the Utrecht province. Through renewed patient assessments, 42 chronic hepatitis C virus infections were re-identified (76% with a history of intravenous drug use, 24% with Metavir F3-F4). Until now, 59% has either scheduled or initiated direct-acting antiviral therapy. CONCLUSION The retrieval of previously diagnosed hepatitis C virus patients through screening of laboratory diagnostics from the past is feasible and should be pursued for further control and reduction of hepatitis C virus infection. Retrieval is most successful when performed regionally. LAY SUMMARY To completely eliminate chronic hepatitis C virus (HCV) infection and prevent complications, undiagnosed and also previously diagnosed but lost to follow-up (LFU) HCV patients have to be brought (back) into care for therapy. Retrieval of LFU HCV patients through screening of laboratory diagnostics from the past is feasible and most successful when performed regionally.
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Affiliation(s)
- Patricia A M Kracht
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joop E Arends
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karel J van Erpecum
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | - Anne M J Wensing
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | | | | | | | | | - Greet J Boland
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Andy I M Hoepelman
- University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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23
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Leoni MC, Amelung L, Lieveld FI, van den Brink J, de Bruijne J, Arends JE, van Erpecum CP, van Erpecum KJ. Adherence to ursodeoxycholic acid therapy in patients with cholestatic and autoimmune liver disease. Clin Res Hepatol Gastroenterol 2019; 43:37-44. [PMID: 30219692 DOI: 10.1016/j.clinre.2018.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/08/2018] [Accepted: 08/21/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Ursodeoxycholic acid (UDCA) is used for treatment of cholestatic liver diseases and may improve long-term outcome. Although treatment with this hydrophilic bile acid is virtually without side effects, medication adherence might be suboptimal due to patient misconceptions, compromising clinical outcome. Our aim was to evaluate adherence to UDCA in relation to patient beliefs about medicine and to identify potential predictors of poor adherence. METHODS Prospective open-label study recruiting patients in treatment with UDCA from April 2016 to March 2017. Adherence was assessed both by the Sensemedic dispenser and by patient-reported adherence, during 12 weeks. Good adherence was defined as ≥ 80% intake. Quality of life (by SF-36) and beliefs about medicine (by BMQ) were also assessed. RESULTS A total of 75 patients were enrolled (32% primary biliary cholangitis, 31% autoimmune hepatitis, 29% primary sclerosing cholangitis and 8% other conditions). Average adherence according to the medication dispenser was 92 ± 16% (range: 17-100). Eighty-nine percent of the patients exhibited good adherence and 11% poor adherence. According to the BMQ, 42% of all patients were accepting, 50% ambivalent, 8% indifferent and 0% skeptical to UDCA treatment. Poor adherence was associated with young age (P = 0.029) and male gender (P = 0.021). CONCLUSIONS Despite the excellent safety profile of UDCA, still a significant number of patients are poorly adherent. Young age and male sex are associated with poor adherence. Efforts should be made to identify patients with poor adherence and to improve their compliance to therapy.
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Affiliation(s)
- Maria Cristina Leoni
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, University of Pavia, p.le Golgi 19, 27100 Pavia, Italy
| | - Linde Amelung
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands; Department of Internal medicine and Infectious diseases, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Faydra I Lieveld
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Janneke van den Brink
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Joep de Bruijne
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Joop E Arends
- Department of Internal medicine and Infectious diseases, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Carel-Peter van Erpecum
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht Affiliated to Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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24
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Portincasa P, van Erpecum KJ, Di Ciaula A, Wang DQH. The physical presence of gallstone modulates ex vivo cholesterol crystallization pathways of human bile. Gastroenterol Rep (Oxf) 2019; 7:32-41. [PMID: 30792864 PMCID: PMC6375352 DOI: 10.1093/gastro/goy044] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/15/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cholesterol crystallization is an essential step toward gallstone formation. Although model bile studies showed that competition occurs between the gallstone surface and the surrounding aqueous phase for cholesterol molecules available for crystallization, this has not been investigated in human bile. METHODS Fresh gallbladder bile was obtained during laparoscopic cholecystectomy from 13 patients with cholesterol (n = 10) or pigment (n = 3) stones. Small cholesterol gallstones were collected from another two patients. Both native and ultrafiltered bile with or without added gallstones was analysed by polarized light microscopy for the presence of arc-like and needle-like anhydrous cholesterol crystals and classic cholesterol monohydrate crystals. Weight of the added stones was evaluated before and after 21 days of bile incubation. RESULTS In unfiltered bile, the presence of stones was associated with a trend towards less anhydrous cholesterol crystals, but significantly more aggregated cholesterol monohydrate crystals. In ultrafiltered bile, the presence of stones tended to inhibit the formation of arc-like or needle-like crystals and was associated with significantly greater amounts of both plate-like and aggregated cholesterol monohydrate crystals. After 21 days of the incubation, stone weight was decreased in both unfiltered (-4.5 ± 1.6%, P = 0.046) and ultrafiltered bile (-6.5 ± 1.5%, P = 0.002). Bile from pigment-stone patients was clear in the absence of stones, but showed early appearance of plate-like and aggregated cholesterol monohydrate crystals in all samples to which cholesterol gallstones were added. CONCLUSIONS The physical presence of cholesterol gallstones in both native and filtered bile greatly influences cholesterol crystallization pathways. Whereas cholesterol monohydrate crystals increase, anhydrous cholesterol crystals tend to be inhibited. Detachment of solid cholesterol crystals from the gallstone surface may explain these findings.
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Affiliation(s)
- Piero Portincasa
- Division of Internal Medicine, Department of Biomedical Sciences and Human Oncology, University Medical School, Bari, Italy
- Corresponding author. Division of Internal Medicine, Clinica Medica ‘A. Murri’, Department of Biomedical Sciences and Human Oncology, University Medical School, Policlinico, Piazza Giulio Cesare 11, Bari, 70124, Italy. Tel: +39-80-5478892; Fax: +39-80-5478232;
| | - Karel J van Erpecum
- Department of Gastroenterology, University Medical Center, Utrecht, The Netherlands
| | - Agostino Di Ciaula
- Division of Internal Medicine, Hospital of Bisceglie, ASL BAT, Bisceglie, Italy
| | - David Q -H Wang
- Department of Medicine, Division of Gastroenterology and Liver Diseases, Marion Bessin Liver Research Center, Albert Einstein College of Medicine, Bronx, NY, USA
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25
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Furnari M, Ahmed I, Erpecum KJV, Savarino V, Giannini EG. Breath Tests to Assess Alcoholic Liver Disease. Rev Recent Clin Trials 2018; 11:185-90. [PMID: 27515960 DOI: 10.2174/1574887111666160810094724] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 02/11/2016] [Accepted: 02/16/2016] [Indexed: 11/22/2022]
Abstract
The prevalence of Alcohol related Liver Disease (ALD) continues to rise all over the world due to changing drinking behaviour of the population. Liver disease due to excessive alcohol consumption causes significant morbidity and mortality, and poses a substantial economic burden to the health care resources. Early diagnosis and treatment of ALD may help prevent progression to cirrhosis and hepatocellular carcinoma. The last decade has seen a rising interest in potential use of non-invasive tests in clinical practice, including diagnosis and monitoring of chronic liver diseases. Over the past few decades, breath testing has been investigated extensively in the diagnosis of ALD, and has shown promising results in predicting the early stages of ALD. A variety of breath tests have been utilised in this regard including the13Clabelled breath tests, aminopyrine breath test , galactose breath test , methacetin breath test, and keto-isocaproic acid breath test. These tests have demonstrated good results in identification of both significant and severe liver disease among patients with ALD. Volatile Organic Compounds (VOC) are chemicals, which can be quantified in breath and other biological fluids, and represent physio-pathological activities within an individual. Alteration in the pattern of breath VOCs can be correlated with a number of diseases including ALD. Early stages of ALD can be detected using these breath tests, which can lead to adoption of preventive measures to reduce the progression of liver disease. This review focuses on the clinical utility of current and future breath tests, including breath VOC, as a non-invasive means of predicting early stages of ALD.
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Affiliation(s)
| | | | | | | | - Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, no.6, 16132, Genoa, Italy
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26
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Lieveld FI, Swaans N, Newsum AM, Ho CKY, Schinkel J, Molenkamp R, van der Meer JTM, Arends JE, Hoepelman AIM, Wensing AMJ, Siersema PD, van Erpecum KJ, Boland GJ. Resistance-associated polymorphisms in Dutch hepatitis C genotype 1a patients with and without HIV infection. Ann Hepatol 2017; 15:696-704. [PMID: 27493108 DOI: 10.5604/16652681.1212426] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED Background and aim. Resistance-associated variants (RAVs) on the NS3 region of the hepatitis C virus (HCV) may be relevant for antiviral therapy, but data in human immunodeficiency virus (HIV) coinfected patients are scarce. We assessed frequencies of NS3 RAVs in patients infected with HCV genotype 1a with or without HIV coinfection. MATERIAL AND METHODS HCV NS3 amino acids 1-181 were sequenced by the Sanger method and analyzed for RAVs. RAVs and their distribution between HCV genotype 1a clade I and II viruses were compared between HIV-infected versus HIV-uninfected patients. RESULTS 148 samples were available (n = 68 HIV and n = 80 non-HIV). Relative frequency of clade I and clade II was significantly different between HIV (85% and 15%) and non-HIV groups (49% and 51%). Overall, HIV infected patients exhibited significantly lower prevalence of RAVs than HIV-uninfected patients (62% vs. 79%, p = 0.03). However, Q80K prevalence was significantly higher in HIV-infected subjects (50% vs. 24%, p = 0.001), whereas prevalence of S122D/G/N/S (2% vs. 16%, p = 0.002) and N174G/N/S (10% vs. 55%, p < 0.0001) polymorphisms were significantly lower. Q80K was found exclusively in clade I viruses. S122 (3% vs. 22%, p=0.001) and N174 (13% vs. 75%, p<0.0001) polymorphisms had significantly lower prevalence in clade I than clade II viruses. CONCLUSIONS In the Netherlands, prevalence of clade I viruses and Q80K was significantly higher in HCV genotype 1a infected patients with HIV coinfection than in those without HIV coinfection. Prevalence of N174 and S122 polymorphisms was significantly higher in clade II than clade I viruses.
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Affiliation(s)
- Faydra I Lieveld
- † Department of Gastroenterology and Hepatology University Medical Center Utrecht, Utrecht, the Netherlands; Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Niels Swaans
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Astrid M Newsum
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Cynthia K Y Ho
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Janke Schinkel
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Richard Molenkamp
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Jan T M van der Meer
- ¶ Department of Internal Medicine and Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne M J Wensing
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Greet J Boland
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
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27
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Lieveld FI, Arends JE, Amelung L, Dijk E, Gisolf EH, Vrolijk JM, van Erpecum KJ, Siersema PD, Spanier BWM, Hoepelman AIM, Richter C. Overcoming Outpatient Loss to Follow-up as a Barrier to Efficiently Instituting Hepatitis B Liver-related Care. Clin Infect Dis 2016; 64:233-235. [DOI: 10.1093/cid/ciw746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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28
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van Vlerken LG, Lieveld FI, van Meer S, Koek GH, van Nieuwkerk KMJ, Friederich P, Arends JE, Siersema PD, Burger DM, van Erpecum KJ. Adherence to ribavirin in chronic hepatitis C patients on antiviral treatment: Results from a randomized controlled trial using real-time medication monitoring. Clin Res Hepatol Gastroenterol 2016; 40:622-630. [PMID: 26867863 DOI: 10.1016/j.clinre.2015.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 12/17/2015] [Accepted: 12/25/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Adherence is essential in antiviral therapy for chronic hepatitis C. We investigated the effect of real-time medication monitoring on adherence to ribavirin. METHODS In this randomized controlled trial, patients in the intervention group received a medication dispenser that monitored ribavirin intake real-time during 24 weeks PEG-interferon/ribavirin±boceprevir or telaprevir. Patients in the control group received standard-of-care. Adherence was also measured by pill count. RESULTS Seventy-two patients were assigned to either intervention (n=35) or control groups (n=37). Median adherence by pill count was 96% (range: 43%-100%) with 30 (94%) of patients exhibiting≥80% adherence. Perfect adherence (i.e. 100%) was similar in intervention and control groups: 22 (85%) vs. 15 (75%) (P=0.47). Adherences by real-time medication monitoring and by pill count did not correlate (R=0.19, P=0.36). No predictors of poor adherence could be identified. Ribavirin trough levels after 8 weeks (median: 2.4 vs. 2.7mg/L, P=0.30) and 24 weeks (median: 3.0 vs. 3.0mg/L, P=0.69), and virological responses did not differ between intervention and control groups. CONCLUSIONS Adherence to ribavirin during PEG-interferon containing therapy in chronic hepatitis C is high. Real-time medication monitoring did not influence adherence to ribavirin, plasma ribavirin levels or virological responses.
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Affiliation(s)
- Lotte G van Vlerken
- Department of Gastroenterology and Hepatology, University Medical Center of Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Faydra I Lieveld
- Department of Gastroenterology and Hepatology, University Medical Center of Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; Department of Internal Medicine and Infectious Diseases, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - Suzanne van Meer
- Department of Gastroenterology and Hepatology, University Medical Center of Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
| | - Ger H Koek
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karin M J van Nieuwkerk
- Department of Gastroenterology and Hepatology, Free University Medical Center, Amsterdam, The Netherlands
| | - Pieter Friederich
- Department of Gastroenterology and Hepatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center of Utrecht, Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center of Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center of Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
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29
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Coenen S, van Meer S, Vrolijk JM, Richter C, van Erpecum KJ, Mostert MC, Veldhuijzen IK, Reijnders JGP, van Soest H, Dirksen K, Drenth JPH, Koene RPM, Bosschart M, Friederich P, Ter Borg MJ, Daemen RHPJ, Arends JE, Verhagen MAMT, Schout C, Spanier BWM. Clinical impact of five large-scale screening projects for chronic hepatitis B in Chinese migrants in the Netherlands. Liver Int 2016; 36:1425-32. [PMID: 27001619 DOI: 10.1111/liv.13125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In low-endemic countries it is debated whether first-generation migrants should be screened for chronic hepatitis B infection. We describe the clinical impact of five large-scale Dutch screening projects for hepatitis B in first-generation Chinese migrants. METHODS Between 2009 and 2013 five independent outreach screening projects for hepatitis B targeting first-generation Chinese migrants were conducted in five main Dutch regions. To explore the relevance of our screening we defined clinical impact as the presence of an indication for: (i) antiviral therapy, (ii) strict follow-up because of high hepatitis B DNA levels and/or (iii) surveillance for hepatocellular carcinoma. RESULTS In total, 4423 persons participated in the projects of whom 6.0% (n = 264) were HBsAg positive. One hundred and twenty-nine newly diagnosed HBsAg-positive patients were analysed in specialist care. Among these patients prevalence of cirrhosis was 6.9% and antiviral therapy for hepatitis B was started in 32 patients (25%). In patients without a treatment indication, strict follow-up because of high hepatitis B DNA levels and/or surveillance for hepatocellular carcinoma was considered indicated in 64 patients (50%). CONCLUSIONS In our screening project in first-generation Chinese migrants, antiviral treatment, strict follow-up because of high hepatitis B DNA levels and/or surveillance for hepatocellular carcinoma were considered indicated in three of four analysed HBsAg-positive patients. These data show that detection of hepatitis B in Chinese migrants can have considerable impact on patient care.
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Affiliation(s)
- Sandra Coenen
- Department of Gastroenterology and Hepatology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands.
| | - Suzanne van Meer
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan M Vrolijk
- Department of Gastroenterology and Hepatology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands
| | - Clemens Richter
- Department of Internal Medicine and Infectious diseases, Rijnstate Hospital Arnhem, Arnhem, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marijke C Mostert
- Department of Infectious Disease Control, Municipal Health Services, Rotterdam, the Netherlands
| | - Irene K Veldhuijzen
- Department of Infectious Disease Control, Municipal Health Services, Rotterdam, the Netherlands
| | - Jurriën G P Reijnders
- Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Hanneke van Soest
- Department of Gastroenterology and Hepatology, Medical Center Haaglanden The Hague, The Hague, the Netherlands
| | - Kees Dirksen
- Department of Infectious Disease Control, Municipal Health Services, The Hague, the Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboudumc Nijmegen, Nijmegen, the Netherlands
| | - René P M Koene
- Department of Infectious Disease Control, Municipal Health Services, Gelderland Zuid, the Netherlands
| | - Maaike Bosschart
- Department of Infectious Disease Control, Municipal Health Services, Gelderland Midden, the Netherlands
| | - Pieter Friederich
- Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Martijn J Ter Borg
- Department of Gastroenterology and Hepatology, Maxima Medical Center Eindhoven, Eindhoven, the Netherlands
| | - Rick H P J Daemen
- Departments of Infectious Disease Control, Municipal Health Services, Eindhoven, the Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious diseases, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc A M T Verhagen
- Department of Gastroenterology and Hepatology, Diakonessen Hospital Utrecht, Utrecht, the Netherlands
| | - Christine Schout
- Departments of Infectious Disease Control, Municipal Health Services, Utrecht, the Netherlands
| | - B W Marcel Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital Arnhem, Arnhem, the Netherlands
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30
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Nevens F, Andreone P, Mazzella G, Strasser SI, Bowlus C, Invernizzi P, Drenth JPH, Pockros PJ, Regula J, Beuers U, Trauner M, Jones DE, Floreani A, Hohenester S, Luketic V, Shiffman M, van Erpecum KJ, Vargas V, Vincent C, Hirschfield GM, Shah H, Hansen B, Lindor KD, Marschall HU, Kowdley KV, Hooshmand-Rad R, Marmon T, Sheeron S, Pencek R, MacConell L, Pruzanski M, Shapiro D. A Placebo-Controlled Trial of Obeticholic Acid in Primary Biliary Cholangitis. N Engl J Med 2016; 375:631-43. [PMID: 27532829 DOI: 10.1056/nejmoa1509840] [Citation(s) in RCA: 678] [Impact Index Per Article: 84.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary biliary cholangitis (formerly called primary biliary cirrhosis) can progress to cirrhosis and death despite ursodiol therapy. Alkaline phosphatase and bilirubin levels correlate with the risk of liver transplantation or death. Obeticholic acid, a farnesoid X receptor agonist, has shown potential benefit in patients with this disease. METHODS In this 12-month, double-blind, placebo-controlled, phase 3 trial, we randomly assigned 217 patients who had an inadequate response to ursodiol or who found the side effects of ursodiol unacceptable to receive obeticholic acid at a dose of 10 mg (the 10-mg group), obeticholic acid at a dose of 5 mg with adjustment to 10 mg if applicable (the 5-10-mg group), or placebo. The primary end point was an alkaline phosphatase level of less than 1.67 times the upper limit of the normal range, with a reduction of at least 15% from baseline, and a normal total bilirubin level. RESULTS Of 216 patients who underwent randomization and received at least one dose of obeticholic acid or placebo, 93% received ursodiol as background therapy. The primary end point occurred in more patients in the 5-10-mg group (46%) and the 10-mg group (47%) than in the placebo group (10%; P<0.001 for both comparisons). Patients in the 5-10-mg group and those in the 10-mg group had greater decreases than those in the placebo group in the alkaline phosphatase level (least-squares mean, -113 and -130 U per liter, respectively, vs. -14 U per liter; P<0.001 for both comparisons) and total bilirubin level (-0.02 and -0.05 mg per deciliter [-0.3 and -0.9 μmol per liter], respectively, vs. 0.12 mg per deciliter [2.0 μmol per liter]; P<0.001 for both comparisons). Changes in noninvasive measures of liver fibrosis did not differ significantly between either treatment group and the placebo group at 12 months. Pruritus was more common with obeticholic acid than with placebo (56% of patients in the 5-10-mg group and 68% of those in the 10-mg group vs. 38% in the placebo group). The rate of serious adverse events was 16% in the 5-10-mg group, 11% in the 10-mg group, and 4% in the placebo group. CONCLUSIONS Obeticholic acid administered with ursodiol or as monotherapy for 12 months in patients with primary biliary cholangitis resulted in decreases from baseline in alkaline phosphatase and total bilirubin levels that differed significantly from the changes observed with placebo. There were more serious adverse events with obeticholic acid. (Funded by Intercept Pharmaceuticals; POISE ClinicalTrials.gov number, NCT01473524; Current Controlled Trials number, ISRCTN89514817.).
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Affiliation(s)
- Frederik Nevens
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Pietro Andreone
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Giuseppe Mazzella
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Simone I Strasser
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Christopher Bowlus
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Pietro Invernizzi
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Joost P H Drenth
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Paul J Pockros
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Jaroslaw Regula
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Ulrich Beuers
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Michael Trauner
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - David E Jones
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Annarosa Floreani
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Simon Hohenester
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Velimir Luketic
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Mitchell Shiffman
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Karel J van Erpecum
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Victor Vargas
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Catherine Vincent
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Gideon M Hirschfield
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Hemant Shah
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Bettina Hansen
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Keith D Lindor
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Hanns-Ulrich Marschall
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Kris V Kowdley
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Roya Hooshmand-Rad
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Tonya Marmon
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Shawn Sheeron
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Richard Pencek
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Leigh MacConell
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - Mark Pruzanski
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
| | - David Shapiro
- From University Hospitals KU Leuven, Leuven, Belgium (F.N.); University of Bologna, Bologna (P.A., G.M.), Program for Autoimmune Liver Disease, International Center for Digestive Health, Department of Medicine and Surgery, University of Milan-Bicocca, Milan (P.I.), Humanitas Clinical and Research Center, Rozzano (P.I.), and University of Padua, Padua (A.F.) - all in Italy; Royal Prince Alfred Hospital, Camperdown, NSW, Australia (S.I.S.); University of California Davis Medical Center, Sacramento (C.B.), Scripps Clinic, La Jolla (P.J.P.), and Intercept Pharmaceuticals, San Diego (R.H.-R., T.M., S.S., R.P., L.M., M.P., D.S.) - all in California; Radboud University Nijmegen Medical Center, Nijmegen (J.P.H.D.), University of Amsterdam, Amsterdam (U.B.), University Medical Center Utrecht, Utrecht (K.J.E.), and University Medical Center Rotterdam, Rotterdam (B.H.) - all in the Netherlands; Maria Sklodowska-Curie Memorial Cancer Center, Warsaw, Poland (J.R.); Medical University of Vienna, Vienna (M.T.); Newcastle University Medical School, Newcastle upon Tyne (D.E.J.), and the Centre for Liver Research, NIHR Biomedical Research Unit, University of Birmingham, Birmingham (G.M.H.) - both in the United Kingdom; Liver Center Munich, Department of Medicine II, University of Munich, Munich, Germany (S.H.); Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University and Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond (V.L.), and the Liver Institute of Virginia, Newport News (M.S.) - all in Virginia; the Liver Unit, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto de Salud Carlos III, Barcelona (V.V.); Centre Hospitalier de l'Université de Montréal-St. Luc, Montreal (C.V.); University Health Network Toronto Western Hospital, Toronto (H.S.); Arizona State University, Tempe (K.D.L.); Sahlgrenska Academy, University of Gothenburg
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Abstract
Gallstones grow inside the gallbladder or biliary tract. These stones can be asymptomatic or symptomatic; only gallstones with symptoms or complications are defined as gallstone disease. Based on their composition, gallstones are classified into cholesterol gallstones, which represent the predominant entity, and bilirubin ('pigment') stones. Black pigment stones can be caused by chronic haemolysis; brown pigment stones typically develop in obstructed and infected bile ducts. For treatment, localization of the gallstones in the biliary tract is more relevant than composition. Overall, up to 20% of adults develop gallstones and >20% of those develop symptoms or complications. Risk factors for gallstones are female sex, age, pregnancy, physical inactivity, obesity and overnutrition. Factors involved in metabolic syndrome increase the risk of developing gallstones and form the basis of primary prevention by lifestyle changes. Common mutations in the hepatic cholesterol transporter ABCG8 confer most of the genetic risk of developing gallstones, which accounts for ∼25% of the total risk. Diagnosis is mainly based on clinical symptoms, abdominal ultrasonography and liver biochemistry tests. Symptoms often precede the onset of the three common and potentially life-threatening complications of gallstones (acute cholecystitis, acute cholangitis and biliary pancreatitis). Although our knowledge on the genetics and pathophysiology of gallstones has expanded recently, current treatment algorithms remain predominantly invasive and are based on surgery. Hence, our future efforts should focus on novel preventive strategies to overcome the onset of gallstones in at-risk patients in particular, but also in the population in general.
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Affiliation(s)
- Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Saarland University, Kirrberger Str. 100, 66424 Hamburg, Germany
| | - Kurinchi Gurusamy
- Royal Free Campus, University College London Medical School, 9th Floor, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK
| | - Cynthia W Ko
- Department of Medicine, Division of Gastroenterology, University of Washington, Seattle, Washington, USA
| | - Juan-Francisco Miquel
- Department of Gastroenterology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Piero Portincasa
- Department of Biomedical Sciences and Human Oncology, Clinica Medica "A. Murri", University of Bari Medical School, Bari, Italy
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
| | - Cees J van Laarhoven
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Q-H Wang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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Huisman EJ, van Meer S, van Hoek B, van Soest H, van Nieuwkerk KMJ, Arends JE, Siersema PD, van Erpecum KJ. Effects of preventive versus "on-demand" nutritional support on paid labour productivity, physical exercise and performance status during PEG-interferon-containing treatment for hepatitis C. Clin Res Hepatol Gastroenterol 2016; 40:221-9. [PMID: 26188490 DOI: 10.1016/j.clinre.2015.06.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/31/2015] [Accepted: 06/08/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Deterioration of nutritional status during PEG-interferon containing therapy for chronic hepatitis C can be ameliorated by preventive nutritional support. We aimed to explore whether such support also affects paid labour productivity, physical exercise and performance status. METHODS In this prospective randomized controlled trial (J Hepatol 2012;57:1069-75), 53 patients with chronic hepatitis C had been allocated to "on demand" support (n=26: nutritional intervention if weight loss>5%) or preventive support (n=27: regular dietary advice plus energy- and protein-rich evening snack) during PEG-interferon-containing therapy. Paid labour productivity, physical exercise and performance status were evaluated at baseline, after 24 and (if applicable) after 48 weeks of treatment. RESULTS At baseline, 46% of patients performed paid labour and 62% performed some kind of physical exercise. Furthermore, most patients were able to carry out normal activity with only minor symptoms of disease (mean Karnofsky performance score: 94). Decreases of paid labour productivity (-21% vs. -70%, P=0.003), physical exercise activity (-43% vs. -87%, P=0.005) and Karnofsky performance scores (-12% vs. -24%, P<0.001) were less in the preventive than in "on demand" group after 24 weeks of treatment. Effects of preventive nutritional support were even more pronounced after 48 weeks. CONCLUSIONS Preventive nutritional support markedly ameliorates decreases of paid labour productivity, physical exercise and performance status during PEG-interferon-containing treatment for chronic hepatitis C.
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Affiliation(s)
- Ellen J Huisman
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
| | - Suzanne van Meer
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, University Medical Center, Leiden, The Netherlands
| | - Hanneke van Soest
- Department of Gastroenterology and Hepatology, Medical Center Haaglanden, The Hague, The Netherlands
| | - Karin M J van Nieuwkerk
- Department of Gastroenterology and Hepatology, VU Medical Center, Amsterdam, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center, Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
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van Meer S, de Man RA, van Erpecum KJ. Reply to "Surveillance for hepatocellular carcinoma: A tale of two countries". J Hepatol 2016; 64:755-6. [PMID: 26721605 DOI: 10.1016/j.jhep.2015.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 12/04/2022]
Affiliation(s)
- Suzanne van Meer
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
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van Meer S, van Erpecum KJ, Sprengers D, Coenraad MJ, Klümpen HJ, Jansen PLM, IJzermans JNM, Verheij J, van Nieuwkerk CMJ, Siersema PD, de Man RA. Hepatocellular carcinoma in cirrhotic versus noncirrhotic livers: results from a large cohort in the Netherlands. Eur J Gastroenterol Hepatol 2016; 28:352-9. [PMID: 26629867 DOI: 10.1097/meg.0000000000000527] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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: 12/13/2022]
Abstract
OBJECTIVES Hepatocellular carcinoma (HCC) usually occurs in patients with cirrhosis, but can also develop in noncirrhotic livers. In the present study we explored associated risk factors for HCC without cirrhosis and compared patient and tumor characteristics and outcomes in HCC patients with and without underlying cirrhosis. METHODS Patients with HCC diagnosed in the period 2005-2012 in five Dutch academic centers were evaluated. Patients were categorized according to the presence of cirrhosis on the basis of histology or combined radiological and laboratory features. RESULTS In total, 19% of the 1221 HCC patients had no underlying cirrhosis. Noncirrhotic HCC patients were more likely to be female and to have nonalcoholic fatty liver disease or no risk factors for underlying liver disease, and less likely to have hepatitis C virus or alcohol-related liver disease than did cirrhotic HCC patients. HCCs in noncirrhotic livers were more often unifocal (67 vs. 48%), but tumor size was significantly larger (8 vs. 4 cm). Despite the larger tumors, more patients underwent resection (50 vs. 10%) and overall survival was significantly better than in cirrhotics. In multivariate analyses, absence of cirrhosis [hazard ratio (HR) 0.49, 95% confidence interval (CI) 0.38-0.63] and presence of hepatitis B (HR 0.68, 95% CI 0.51-0.91) were independent predictors for lower mortality, whereas hepatitis C virus was associated with higher mortality (HR 1.32, 95% CI 1.01-1.65). CONCLUSION HCC without cirrhosis was strongly associated with female sex and presence of nonalcoholic fatty liver disease or no risk factors for underlying liver disease. In absence of cirrhosis, resections were more often performed, with better survival despite larger tumor size.
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Affiliation(s)
- Suzanne van Meer
- aDepartment of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht Departments of bGastroenterology and Hepatology cSurgery, Erasmus Medical Center, Rotterdam dDepartment of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden Departments of eMedical Oncology fGastroenterology and Hepatology gPathology, Academic Medical Center Amsterdam hDepartment of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
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Boonstra K, de Vries EMG, van Geloven N, van Erpecum KJ, Spanier M, Poen AC, van Nieuwkerk CM, Witteman BJ, Tuynman HA, Naber AH, Kingma PJ, Beuers U, Ponsioen CY. Risk factors for primary sclerosing cholangitis. Liver Int 2016; 36:84-91. [PMID: 26077553 DOI: 10.1111/liv.12894] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 01/22/2015] [Accepted: 06/09/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease of unknown cause, but strongly associated with inflammatory bowel disease (IBD). Potential risk factors triggering PSC have never been studied on a population level. The aim of this study was to evaluate smoking, appendectomy, family history and geographical distribution in a population-based cohort of PSC patients, as compared to IBD control patients and healthy controls (HC). METHODS For this case-control study 343 PSC patients, 370 IBD controls and 232 HC's living in a geographically defined area in the Netherlands filled-out a questionnaire concerning smoking, appendectomy and family history of IBD and autoimmune liver diseases. RESULTS Smoking was associated with a lower risk of developing PSC in PSC-ulcerative colitis (UC) patients (adjusted OR 0.21; 95% CI 0.12-0.34; P < 0.001). Comparable results were found for PSC-Crohn's disease (CD) patients (16% former smokers) compared to CD patients (55% former smokers) (adjusted OR 0.17; 95% CI 0.08-0.39; P < 0.001). Frequency of appendectomy did not differ between PSC and HC, but PSC-UC patients had undergone appendectomy more often than UC patients (13% vs. 6%) (adjusted OR 2.51; 95%CI 1.04-6.07; P = 0.041). We found no association between family history of IBD or autoimmune liver disease and risk of PSC. Degree of urbanization was not associated with PSC incidence. CONCLUSION In this large population-based case-control study we confirm that smoking is associated with a lower risk of developing PSC, independent of its protective effect for developing UC. Appendectomy is not associated with the risk of developing PSC.
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Affiliation(s)
- Kirsten Boonstra
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Elisabeth M G de Vries
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Nan van Geloven
- Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marcel Spanier
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Alexander C Poen
- Department of Gastroenterology and Hepatology, Isala Clinics, Zwolle, the Netherlands
| | - Carin M van Nieuwkerk
- Department of Gastroenterology and Hepatology, VU Medical Center, Amsterdam, the Netherlands
| | - Ben J Witteman
- Department of Gastroenterology and Hepatology, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Hans A Tuynman
- Department of Gastroenterology and Hepatology, Medical Center Alkmaar, Alkmaar, the Netherlands
| | - Anton H Naber
- Department of Gastroenterology and Hepatology, Tergooiziekenhuizen, Hilversum/Blaricum, the Netherlands
| | - Paul J Kingma
- Department of Gastroenterology and Hepatology, Tergooiziekenhuizen, Hilversum/Blaricum, the Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands
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van Meer S, de Man RA, Coenraad MJ, Sprengers D, van Nieuwkerk KMJ, Klümpen HJ, Jansen PLM, IJzermans JNM, van Oijen MGH, Siersema PD, van Erpecum KJ. Surveillance for hepatocellular carcinoma is associated with increased survival: Results from a large cohort in the Netherlands. J Hepatol 2015; 63:1156-63. [PMID: 26100498 DOI: 10.1016/j.jhep.2015.06.012] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [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: 09/10/2014] [Revised: 06/07/2015] [Accepted: 06/10/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Effectiveness of surveillance for hepatocellular carcinoma is controversial. We here explore its effects in "real life" clinical practice. METHODS Patients with hepatocellular carcinoma diagnosed in the period 2005-2012 in five Dutch academic centers were evaluated. Surveillance was defined as ⩾2 screening tests during three preceding years and at least one radiologic imaging test within 18 months before diagnosis. RESULTS 295 (27%) of 1074 cases underwent surveillance. Median time interval between last negative radiologic imaging and hepatocellular carcinoma diagnosis was 7.5 months. In the surveillance group, cirrhosis (97% vs. 60%, p<0.001) and viral hepatitis were more frequent, and non-alcoholic fatty liver disease or absence of risk factors less frequent. In case of surveillance, tumor size was significantly smaller (2.7 vs. 6.0 cm), with lower alpha-fetoprotein levels (16 vs. 44 μg/L), earlier tumor stage (BCLC 0 and A combined: 61% vs. 21%) and resection/transplantation (34% vs. 25%) or radiofrequency ablation (23% vs. 7%) more often applied, with significantly higher 1-, 3-, and 5-year survival rates. Survival benefit by surveillance remained significant after adjustment for lead-time bias based on assumed tumor doubling time of 90 days, but not with doubling time of ⩾120 days. In multivariate analysis, surveillance was an independent predictor for mortality (for interval ⩽9 respectively >9 months: adjusted HRs 0.51 and 0.50, 95% confidence intervals: 0.39-0.67 and 0.37-0.69). CONCLUSIONS Surveillance for hepatocellular carcinoma was associated with smaller tumor size, earlier tumor stage, with an impact on therapeutic strategy and was an independent predictor of survival.
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Affiliation(s)
- Suzanne van Meer
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Robert A de Man
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Minneke J Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dave Sprengers
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Karin M J van Nieuwkerk
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Heinz-Josef Klümpen
- Department of Medical Oncology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Peter L M Jansen
- Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Jan N M IJzermans
- Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Martijn G H van Oijen
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Arends JE, Lieveld FI, Boeijen LL, de Kanter CTMM, van Erpecum KJ, Salmon D, Hoepelman AIM, Asselah T, Ustianowski A. Natural history and treatment of HCV/HIV coinfection: Is it time to change paradigms? J Hepatol 2015; 63:1254-62. [PMID: 26186987 DOI: 10.1016/j.jhep.2015.06.034] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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] [Received: 06/08/2015] [Revised: 06/28/2015] [Accepted: 06/30/2015] [Indexed: 12/12/2022]
Abstract
Evidence over the past decades have shown that HIV/HCV coinfected patients did not respond as well to HCV therapy as HCV mono-infected patients. However, these paradigms are being recently reassessed with the improvements of care for HIV and HCV patients. This article reviews these original paradigms and how the new data is impacting upon them. Treatment efficacy now appears comparable for HIV/HCV coinfected and HCV mono-infected patients, while liver fibrosis progression is increasingly similar in optimally managed patients. Additional importance of therapy is directed to drug-drug interactions and the impact of HCV reinfection, as well as the possibility of transmitted drug resistance.
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Affiliation(s)
- Joop E Arends
- Department of Internal Medicine and Infectious Disease, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands.
| | - Faydra I Lieveld
- Department of Internal Medicine and Infectious Disease, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Lauke L Boeijen
- Department of Internal Medicine and Infectious Disease, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Clara T M M de Kanter
- Department of Clinical Pharmacy, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Dominique Salmon
- Department of Infectious Diseases, Hôpital Cochin, Paris, France
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious Disease, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Tarik Asselah
- Service d'Hépatologie, Hôpital Beaujon, AP-HP, Clichy, and INSERM, UMR1149, Labex INFLAMEX, Université Denis Diderot Paris 7, France
| | - Andrew Ustianowski
- Regional Infectious Diseases Unit, North Manchester General Hospital, Manchester, United Kingdom
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Harkisoen S, Arends JE, Hoepelman AIM, van Erpecum KJ. Renal proximal tubular dysfunction due to tenofovir in a patient with chronic hepatitis B monoinfection. Clin Res Hepatol Gastroenterol 2015; 39:e67-9. [PMID: 25746138 DOI: 10.1016/j.clinre.2015.01.007] [Citation(s) in RCA: 3] [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] [Received: 01/12/2015] [Accepted: 01/22/2015] [Indexed: 02/04/2023]
Affiliation(s)
- Soeradj Harkisoen
- Department of Internal Medicine and Infectious diseases, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Joop E Arends
- Department of Internal Medicine and Infectious diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andy I M Hoepelman
- Department of Internal Medicine and Infectious diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
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Le TM, Sanders CJG, van de Corput L, van Erpecum KJ, Röckmann H. Drug rash with eosinophilia and systemic symptoms caused by the dietary supplement diindolylmethane. J Allergy Clin Immunol Pract 2015; 4:175-6. [PMID: 26298826 DOI: 10.1016/j.jaip.2015.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/05/2015] [Accepted: 07/10/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Thuy-My Le
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Cornelus J G Sanders
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisette van de Corput
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Heike Röckmann
- Department of Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands
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40
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van Vlerken LG, Arends P, Lieveld FI, Arends JE, Brouwer WP, Siersema PD, Janssen HL, van Erpecum KJ. Real life adherence of chronic hepatitis B patients to entecavir treatment. Dig Liver Dis 2015; 47:577-83. [PMID: 25936691 DOI: 10.1016/j.dld.2015.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [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: 11/08/2014] [Revised: 03/24/2015] [Accepted: 03/28/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Real-life prospective data on adherence to nucleos(t)ide analogues in chronic hepatitis B patients are scarce. AIMS We investigated adherence to entecavir in relation to virological response. METHODS In this prospective study, we provided 100 consecutive chronic hepatitis B patients with a medication dispenser that monitored entecavir intake during 16 weeks therapy. Hepatitis B virus (HBV) DNA was measured at baseline and after 16 weeks. Beliefs about medicines were evaluated using a questionnaire. RESULTS Adherence over 16 weeks averaged 85 ± 17%, with 70% of patients exhibiting good (i.e. ≥ 80%) adherence. Patients with poor (i.e. <80%) adherence were significantly younger (p=0.01), with more often indifferent attitudes towards entecavir (p=0.03) Viral breakthrough did not occur during the study. Adherence in patients with HBV DNA after 16 weeks > 20 IU/mL (n=18) and ≤ 20 IU/mL (n=81) averaged 83% and 91% respectively (p=0.19). In multivariate analysis, adherence was not a significant predictor of HBV DNA negativity (adjusted OR 1.02; p=0.34), after adjustment for duration of entecavir treatment (p<0.001) and HBe-status (p=0.001). CONCLUSIONS 70% of chronic hepatitis B patients exhibited good adherence to entecavir, with younger age and an indifferent attitude being risk factors for poor adherence. Poor adherence was not an independent predictor of virological response.
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Affiliation(s)
- Lotte G van Vlerken
- Department of Gastroenterology and Hepatology, University Medical Centrum Utrecht, Utrecht, The Netherlands
| | - Pauline Arends
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Faydra I Lieveld
- Department of Gastroenterology and Hepatology, University Medical Centrum Utrecht, Utrecht, The Netherlands; Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem Pieter Brouwer
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Centrum Utrecht, Utrecht, The Netherlands
| | - Harry L Janssen
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; Liver Clinic, Toronto Western and General Hospital, University Health Network, Toronto, Canada
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Centrum Utrecht, Utrecht, The Netherlands.
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van Erpecum KJ, Schaap FG. Intestinal failure to produce FGF19: A culprit in intestinal failure-associated liver disease? J Hepatol 2015; 62:1231-3. [PMID: 25795585 DOI: 10.1016/j.jhep.2015.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 03/08/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands.
| | - Frank G Schaap
- Department of General Surgery, Maastricht University, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
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42
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van Meer S, de Man RA, van den Berg AP, Houwen RHJ, Linn FHH, van Oijen MGH, Siersema PD, van Erpecum KJ. No increased risk of hepatocellular carcinoma in cirrhosis due to Wilson disease during long-term follow-up. J Gastroenterol Hepatol 2015; 30:535-9. [PMID: 25160780 DOI: 10.1111/jgh.12716] [Citation(s) in RCA: 36] [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] [Accepted: 08/11/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Data on risk of hepatocellular carcinoma (HCC) in patients with Wilson disease are scarce. We determine HCC risk in a well-defined cohort of Wilson patients. METHODS All patients with a confirmed diagnosis of Wilson disease (Leipzig score ≥ 4) in three Dutch university referral hospitals were included in this retrospective cohort study. End of follow-up was defined as date of diagnosis of HCC, liver transplantation, death, or last available hospital visit. Also, a meta-analysis was performed to determine incidence and mortality rate of HCC in Wilson disease based on all published cohorts. RESULTS In total, 130 patients with Wilson disease were followed during a median follow-up of 15 years (range 0.1-51.2). At baseline, cirrhosis was present in 74 patients (57% of total: 64% compensated, and 36% decompensated). At end of follow-up, liver disease severity was improved, stable or deteriorated in 20%, 46%, and 24% of all cases (10% unknown), respectively. Two patients developed HCC (one despite excellent decoppering after 50 years follow-up, the other with newly diagnosed Wilson disease). Estimated annual HCC risk for all patients was 0.09% (95% confidence interval [CI]: 0.01-0.28). Subgroup analysis in cirrhotic patients revealed an annual HCC risk of 0.14% (95% CI: 0.02-0.46). The meta-analysis showed an annual HCC risk of 0.04% (95% CI: 0.01-0.10) and HCC mortality rate of 2.6/10 000 person-years (95% CI: 0.7-7.0). CONCLUSIONS Even in case of cirrhosis, HCC risk is low in Wilson disease. Our data do not support regular HCC surveillance in Wilson disease.
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Affiliation(s)
- Suzanne van Meer
- Department of Gastroenterology and Hepatology, University Medical Center, Utrecht, The Netherlands
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Nijmeijer RM, Schaap FG, Smits AJJ, Kremer AE, Akkermans LMA, Kroese ABA, Rijkers GT, Schipper MEI, Verheem A, Wijmenga C, Gooszen HG, van Erpecum KJ. Impact of global Fxr deficiency on experimental acute pancreatitis and genetic variation in the FXR locus in human acute pancreatitis. PLoS One 2014; 9:e114393. [PMID: 25470824 PMCID: PMC4255038 DOI: 10.1371/journal.pone.0114393] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 11/10/2014] [Indexed: 01/26/2023] Open
Abstract
Background Infectious complications often occur in acute pancreatitis, related to impaired intestinal barrier function, with prolonged disease course and even mortality as a result. The bile salt nuclear receptor farnesoid X receptor (FXR), which is expressed in the ileum, liver and other organs including the pancreas, exhibits anti-inflammatory effects by inhibiting NF-κB activation and is implicated in maintaining intestinal barrier integrity and preventing bacterial overgrowth and translocation. Here we explore, with the aid of complementary animal and human experiments, the potential role of FXR in acute pancreatitis. Methods Experimental acute pancreatitis was induced using the CCK-analogue cerulein in wild-type and Fxr-/- mice. Severity of acute pancreatitis was assessed using histology and a semi-quantitative scoring system. Ileal permeability was analyzed in vitro by Ussing chambers and an in vivo permeability assay. Gene expression of Fxr and Fxr target genes was studied by quantitative RT-PCR. Serum FGF19 levels were determined by ELISA in acute pancreatitis patients and healthy volunteers. A genetic association study in 387 acute pancreatitis patients and 853 controls was performed using 9 tagging single nucleotide polymorphisms (SNPs) covering the complete FXR gene and two additional functional SNPs. Results In wild-type mice with acute pancreatitis, ileal transepithelial resistance was reduced and ileal mRNA expression of Fxr target genes Fgf15, SHP, and IBABP was decreased. Nevertheless, Fxr-/- mice did not exhibit a more severe acute pancreatitis than wild-type mice. In patients with acute pancreatitis, FGF19 levels were lower than in controls. However, there were no associations of FXR SNPs or haplotypes with susceptibility to acute pancreatitis, or its course, outcome or etiology. Conclusion We found no evidence for a major role of FXR in acute human or murine pancreatitis. The observed altered Fxr activity during the course of disease may be a secondary phenomenon.
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Affiliation(s)
- Rian M. Nijmeijer
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank G. Schaap
- Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, the Netherlands
- Department of General Surgery, Maastricht University, Maastricht, The Netherlands
| | - Alexander J. J. Smits
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Andreas E. Kremer
- Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, Amsterdam, the Netherlands
- Department of Medicine 1, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany
| | | | - Alfons B. A. Kroese
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Neurotoxicology Research Group, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
| | - Ger. T. Rijkers
- Department of Operating Rooms, University Medical Center St. Radboud, Nijmegen, the Netherlands
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - André Verheem
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cisca Wijmenga
- Department of Genetics, University Medical Centrum Groningen, University of Groningen, Groningen, the Netherlands
| | - Hein G. Gooszen
- Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Operating Rooms, University Medical Center St. Radboud, Nijmegen, the Netherlands
| | - Karel J. van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail:
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Harkisoen S, Kroon S, van Erpecum KJ, Hoepelman AIM, Baarle DV, Arends JE. The influences of antiviral therapy on T-cell function in adult patients with chronic hepatitis B. Future Virol 2014. [DOI: 10.2217/fvl.14.76] [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: 11/21/2022]
Abstract
ABSTRACT T cells play an important role in the clearance of acute infection and control of hepatitis B virus (HBV) infection during the chronic phase. Chronic HBV is characterized by a weak and limited T-cell response. Several hypotheses, such as presence of Tregs or occurrence of T-cell exhaustion have been proposed to explain these observations. The two registered classes of anti-HBV drugs: pegylated-IFN-α (PEG-IFN-α) and nucleos(t)ide analogs (NUCs) have, next to their antiviral effect, also an immunomodulatory effect. Although NUCs have no direct immunomodulatory effects, they may indirectly positively affect the T-cell response through their viral suppressive action. In this review, effects of both PEG-IFN-α and NUC therapy will be discussed with regard to the cellular immune response against HBV.
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Affiliation(s)
- Soeradj Harkisoen
- Department of Internal Medicine & Infectious diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven Kroon
- Department of Internal Medicine & Infectious diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology & Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andy IM Hoepelman
- Department of Internal Medicine & Infectious diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Debbie van Baarle
- Department of Immunology, Laboratory for Translational Immunology (LTI), University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Infectious Disease Control, National Institute for Public Health & the Environment (RIVM), Bilthoven, The Netherlands
| | - Joop E Arends
- Department of Internal Medicine & Infectious diseases, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Immunology, Laboratory for Translational Immunology (LTI), University Medical Center Utrecht, Utrecht, The Netherlands
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van Gerven NMF, Verwer BJ, Witte BI, van Erpecum KJ, van Buuren HR, Maijers I, Visscher AP, Verschuren EC, van Hoek B, Coenraad MJ, Beuers UHW, de Man RA, Drenth JPH, den Ouden JW, Verdonk RC, Koek GH, Brouwer JT, Guichelaar MMJ, Vrolijk JM, Mulder CJJ, van Nieuwkerk CMJ, Bouma G. Epidemiology and clinical characteristics of autoimmune hepatitis in the Netherlands. Scand J Gastroenterol 2014; 49:1245-54. [PMID: 25123213 DOI: 10.3109/00365521.2014.946083] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [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: 02/06/2023]
Abstract
BACKGROUND AND AIMS Epidemiological data on autoimmune hepatitis (AIH) are scarce. In this study, we determined the clinical and epidemiological characteristics of AIH patients in the Netherlands (16.7 million inhabitants). METHODS Clinical characteristics were collected from 1313 AIH patients (78% females) from 31 centers, including all eight academic centers in the Netherlands. Additional data on ethnicity, family history and symptoms were obtained by the use of a questionnaire. RESULTS The prevalence of AIH was 18.3 (95% confidential interval [CI]: 17.3-19.4) per 100,000 with an annual incidence of 1.1 (95% CI: 0.5-2) in adults. An incidence peak was found in middle-aged women. At diagnosis, 56% of patients had fibrosis and 12% cirrhosis in liver biopsy. Overall, 1% of patients developed HCC and 3% of patients underwent liver transplantation. Overlap with primary biliary cirrhosis and primary sclerosing cholangitis was found in 9% and 6%, respectively. The clinical course did not differ between Caucasian and non-Caucasian patients. Other autoimmune diseases were found in 26% of patients. Half of the patients reported persistent AIH-related symptoms despite treatment with a median treatment period of 8 years (range 1-44 years). Familial occurrence was reported in three cases. CONCLUSION This is the largest epidemiological study of AIH in a geographically defined region and demonstrates that the prevalence of AIH in the Netherlands is uncommon. Although familial occurrence of AIH is extremely rare, our twin data may point towards a genetic predisposition. The high percentage of patients with cirrhosis or fibrosis at diagnosis urges the need of more awareness for AIH.
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Affiliation(s)
- Nicole M F van Gerven
- Department of Gastroenterology and Hepatology, VU University Medical Center , Amsterdam , The Netherlands
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de Boer YS, van Gerven NMF, Zwiers A, Verwer BJ, van Hoek B, van Erpecum KJ, Beuers U, van Buuren HR, Drenth JPH, den Ouden JW, Verdonk RC, Koek GH, Brouwer JT, Guichelaar MMJ, Vrolijk JM, Kraal G, Mulder CJJ, van Nieuwkerk CMJ, Fischer J, Berg T, Stickel F, Sarrazin C, Schramm C, Lohse AW, Weiler-Normann C, Lerch MM, Nauck M, Völzke H, Homuth G, Bloemena E, Verspaget HW, Kumar V, Zhernakova A, Wijmenga C, Franke L, Bouma G. Genome-wide association study identifies variants associated with autoimmune hepatitis type 1. Gastroenterology 2014; 147:443-52.e5. [PMID: 24768677 DOI: 10.1053/j.gastro.2014.04.022] [Citation(s) in RCA: 202] [Impact Index Per Article: 20.2] [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] [Received: 12/19/2013] [Revised: 03/17/2014] [Accepted: 04/09/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Autoimmune hepatitis (AIH) is an uncommon autoimmune liver disease of unknown etiology. We used a genome-wide approach to identify genetic variants that predispose individuals to AIH. METHODS We performed a genome-wide association study of 649 adults in The Netherlands with AIH type 1 and 13,436 controls. Initial associations were further analyzed in an independent replication panel comprising 451 patients with AIH type 1 in Germany and 4103 controls. We also performed an association analysis in the discovery cohort using imputed genotypes of the major histocompatibility complex region. RESULTS We associated AIH with a variant in the major histocompatibility complex region at rs2187668 (P = 1.5 × 10(-78)). Analysis of this variant in the discovery cohort identified HLA-DRB1*0301 (P = 5.3 × 10(-49)) as a primary susceptibility genotype and HLA-DRB1*0401 (P = 2.8 × 10(-18)) as a secondary susceptibility genotype. We also associated AIH with variants of SH2B3 (rs3184504, 12q24; P = 7.7 × 10(-8)) and CARD10 (rs6000782, 22q13.1; P = 3.0 × 10(-6)). In addition, strong inflation of association signal was found with single-nucleotide polymorphisms associated with other immune-mediated diseases, including primary sclerosing cholangitis and primary biliary cirrhosis, but not with single-nucleotide polymorphisms associated with other genetic traits. CONCLUSIONS In a genome-wide association study, we associated AIH type 1 with variants in the major histocompatibility complex region, and identified variants of SH2B3and CARD10 as likely risk factors. These findings support a complex genetic basis for AIH pathogenesis and indicate that part of the genetic susceptibility overlaps with that for other immune-mediated liver diseases.
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Affiliation(s)
- Ynto S de Boer
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nicole M F van Gerven
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Antonie Zwiers
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands; Department of Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart J Verwer
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - Henk R van Buuren
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Jannie W den Ouden
- Department of Gastroenterology and Hepatology, Haga Hospital, The Hague, The Netherlands
| | - Robert C Verdonk
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands; Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - Ger H Koek
- Department of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands
| | - Johannes T Brouwer
- Department of Gastroenterology and Hepatology, Reinier de Graaf Hospital, Delft, The Netherlands
| | - Maureen M J Guichelaar
- Department of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Jan M Vrolijk
- Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Georg Kraal
- Department of Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, The Netherlands
| | - Chris J J Mulder
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Carin M J van Nieuwkerk
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Janett Fischer
- Department of Internal Medicine, Neurology and Dermatology, Medical Clinic of Gastroenterology and Rheumatology, Section of Hepatology, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Berg
- Department of Internal Medicine, Neurology and Dermatology, Medical Clinic of Gastroenterology and Rheumatology, Section of Hepatology, University Hospital Leipzig, Leipzig, Germany
| | - Felix Stickel
- Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | | | - Christoph Schramm
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar W Lohse
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Markus M Lerch
- Department of Internal Medicine A, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine and Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany
| | - Elisabeth Bloemena
- Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
| | - Hein W Verspaget
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Vinod Kumar
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Alexandra Zhernakova
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Cisca Wijmenga
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Lude Franke
- University of Groningen, University Medical Center Groningen, Department of Genetics, Groningen, The Netherlands
| | - Gerd Bouma
- Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands; Department of Molecular Cell Biology and Immunology, VU University Medical Center, Amsterdam, The Netherlands.
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Schalkx HJ, van Stralen M, Coenegrachts K, van den Bosch MAAJ, van Kessel CS, van Hillegersberg R, van Erpecum KJ, Verkooijen HM, Pluim JPW, Veldhuis WB, van Leeuwen MS. Liver perfusion in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI): comparison of enhancement in Gd-BT-DO3A and Gd-EOB-DTPA in normal liver parenchyma. Eur Radiol 2014; 24:2146-56. [DOI: 10.1007/s00330-014-3275-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 05/26/2014] [Accepted: 06/03/2014] [Indexed: 01/01/2023]
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Boonstra K, Culver EL, de Buy Wenniger LM, van Heerde MJ, van Erpecum KJ, Poen AC, van Nieuwkerk KMJ, Spanier BWM, Witteman BJM, Tuynman HARE, van Geloven N, van Buuren H, Chapman RW, Barnes E, Beuers U, Ponsioen CY. Serum immunoglobulin G4 and immunoglobulin G1 for distinguishing immunoglobulin G4-associated cholangitis from primary sclerosing cholangitis. Hepatology 2014; 59:1954-63. [PMID: 24375491 PMCID: PMC4489327 DOI: 10.1002/hep.26977] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 12/17/2013] [Indexed: 02/06/2023]
Abstract
UNLABELLED The recent addition of immunoglobulin (Ig)G4-associated cholangitis (IAC), also called IgG4-related sclerosing cholangitis (IRSC), to the spectrum of chronic cholangiopathies has created the clinical need for reliable methods to discriminate between IAC and the more common cholestatic entities, primary (PSC) and secondary sclerosing cholangitis. The current American Association for the Study of Liver Diseases practice guidelines for PSC advise on the measurement of specific Ig (sIg)G4 in PSC patients, but interpretation of elevated sIgG4 levels remains unclear. We aimed to provide an algorithm to distinguish IAC from PSC using sIgG analyses. We measured total IgG and IgG subclasses in serum samples of IAC (n = 73) and PSC (n = 310) patients, as well as in serum samples of disease controls (primary biliary cirrhosis; n = 22). sIgG4 levels were elevated above the upper limit of normal (ULN = >1.4 g/L) in 45 PSC patients (15%; 95% confidence interval [CI]: 11-19). The highest specificity and positive predictive value (PPV; 100%) for IAC were reached when applying the 4 × ULN (sIgG4 > 5.6 g/L) cutoff with a sensitivity of 42% (95% CI: 31-55). However, in patients with a sIgG4 between 1 × and 2 × ULN (n = 38/45), the PPV of sIgG4 for IAC was only 28%. In this subgroup, the sIgG4/sIgG1 ratio cutoff of 0.24 yielded a sensitivity of 80% (95% CI: 51-95), a specificity of 74% (95% CI: 57-86), a PPV of 55% (95% CI: 33-75), and a negative predictive value of 90% (95% CI: 73-97). CONCLUSION Elevated sIgG4 (>1.4 g/L) occurred in 15% of patients with PSC. In patients with a sIgG4 >1.4 and <2.8 g/L, incorporating the IgG4/IgG1 ratio with a cutoff at 0.24 in the diagnostic algorithm significantly improved PPV and specificity. We propose a new diagnostic algorithm based on IgG4/IgG1 ratio that may be used in clinical practice to distinguish PSC from IAC.
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Affiliation(s)
- Kirsten Boonstra
- Department of Gastroenterology and Hepatology, Academic Medical CenterAmsterdam, the Netherlands
| | - Emma L Culver
- Translational Gastroenterology Unit, John Radcliffe HospitalOxford, United Kingdom
| | | | - Marianne J van Heerde
- Department of Gastroenterology and Hepatology, Erasmus University Medical CenterRotterdam, the Netherlands
| | - Karel J van Erpecum
- Department of Gastroenterology and Hepatology, University Medical Center UtrechtUtrecht, the Netherlands
| | - Alexander C Poen
- Department of Gastroenterology and Hepatology, Isala ClinicsZwolle, the Netherlands
| | - Karin MJ van Nieuwkerk
- Department of Gastroenterology and Hepatology, VU Medical CenterAmsterdam, the Netherlands
| | - BW Marcel Spanier
- Department of Gastroenterology and Hepatology, Rijnstate HospitalArnhem, the Netherlands
| | - Ben JM Witteman
- Department of Gastroenterology and Hepatology, Gelderse Vallei HospitalEde, the Netherlands
| | - Hans ARE Tuynman
- Department of Gastroenterology and Hepatology, Medical Center AlkmaarAlkmaar, the Netherlands
| | - Nan van Geloven
- Clinical Research Unit, Academic Medical CenterAmsterdam, the Netherlands
| | - Henk van Buuren
- Department of Gastroenterology and Hepatology, Erasmus University Medical CenterRotterdam, the Netherlands
| | - Roger W Chapman
- Translational Gastroenterology Unit, John Radcliffe HospitalOxford, United Kingdom
| | - Eleanor Barnes
- Translational Gastroenterology Unit, John Radcliffe HospitalOxford, United Kingdom,Oxford NIHR Biomedical Research Center, and NDM, University of OxfordOxford, United Kingdom
| | - Ulrich Beuers
- Department of Gastroenterology and Hepatology, Academic Medical CenterAmsterdam, the Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical CenterAmsterdam, the Netherlands
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Feuth T, van Baarle D, van Erpecum KJ, Siersema PD, Hoepelman AIM, Arends JE. CD4/CD8 ratio is a promising candidate for non-invasive measurement of liver fibrosis in chronic HCV-monoinfected patients. Eur J Clin Microbiol Infect Dis 2014; 33:1113-7. [PMID: 24449348 DOI: 10.1007/s10096-014-2053-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/06/2014] [Indexed: 12/27/2022]
Abstract
The extent of liver fibrosis is an important factor in prognosis and clinical decision-making in chronic hepatitis C virus (HCV) infection. We investigated CD4/CD8 ratio in HCV-monoinfected and HIV/HCV-coinfected patients, in order to reveal its relation with liver fibrosis. CD4/CD8 ratio in the peripheral blood was assessed by flow cytometry in a cohort of 19 HCV-monoinfected, 14 HIV/HCV-coinfected, ten HIV-monoinfected patients and 15 healthy controls. Liver fibrosis was assessed by transient elastography (n = 25) or by liver biopsy (n = 8). Coinfection with HIV was associated with decreased CD4/CD8 ratios in chronic HCV-infected patients, despite adequate antiretroviral treatment. Furthermore, HCV-monoinfected patients with F3-F4 liver fibrosis demonstrated much lower CD4/CD8 ratios than patients with F0-F2 fibrosis (1.4 versus 2.5, p = 0.023). Similarly, we observed a strong negative correlation between the CD4/CD8 ratio and liver stiffness measured by transient elastography (R = -0.78, p = 0.0006). ROC analysis revealed that CD4/CD8 ratio as a non-invasive marker for fibrosis is very promising (area under the curve 0.8). Although our study was performed with a relatively small number of patients, our findings suggest that the CD4/CD8 ratio is a promising candidate for non-invasive evaluation of liver fibrosis in HCV-monoinfected patients.
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Affiliation(s)
- Thijs Feuth
- Department of Internal Medicine and Infectious Diseases, University Medical Center Utrecht (UMCU), Huispostnummer F.02.126, P.O. Box 85500, 3508, GA, Utrecht, The Netherlands
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50
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van Meer S, van Erpecum KJ, Schrier GHJ, Verhoef C, Verheij J, de Man RA, van der Geest LGM. [Diagnostics and treatment of hepatocellular carcinoma: trends in the Netherlands in the period 2003-2011]. Ned Tijdschr Geneeskd 2014; 158:A7074. [PMID: 24594129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate trends in the distribution of care for patients with hepatocellular carcinoma (HCC) in the past decade. DESIGN Retrospective study. METHOD We collected data on diagnostic testing and initial treatment of patients with HCC in the period 2003-2011 from the Dutch Cancer Registry. RESULTS In the period 2003-2011, 2915 patients were diagnosed with HCC. The proportion of patients given palliative treatment increased significantly, whereas the proportion of patients treated by resection remained stable (approximately 10%). Tumour biopsies were performed in virtually all hospitals. Despite a significant decrease seen in the period studied, tumour biopsy was still performed in more than 50% of cases. The number of hospitals where any treatment was performed increased significantly (from 33% to 62% of all hospitals) and the contribution of treatments in academic hospitals decreased significantly (from 83% to 75%). Transarterial chemoembolization (TACE), radiofrequency ablation (RFA) and resection were mainly performed in academic hospitals (99%, 95% and 79% respectively), whereas about half of the initial sorafenib treatments were given in non-academic hospitals. Only in a few academic hospitals were a minimum of five resections performed annually and (only during the last three years of the period studied) were a minimum of five patients started on sorafenib annually. Significant differences existed between regions in the use of RFA or TACE - both p < 0.001, after case-mix correction. CONCLUSION In the past decade there was no trend towards centralization of diagnostic testing and treatments for patients with HCC.
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Affiliation(s)
- Suzanne van Meer
- Universitair Medisch Centrum Utrecht, afd. Maag- Darm- en Leverziekten, Utrecht
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