Real-world use of mycophenolate mofetil in inflammatory bowel disease: Results from the ENEIDA registry

BACKGROUND

Studies to evaluate the use of mycophenolate mofetil (MMF) in inflammatory bowel disease (IBD) are limited after the appearance of biological treatments.

AIMS

Our primary objective was to evaluate the effectiveness and safety of MMF in IBD.

METHODS

IBD patients who had received MMF were retrieved from the ENEIDA registry. Clinical activity as per the Harvey-Bradshaw Index (HBI), partial Mayo score (pMS), physician global assessment (PGA) and C-reactive protein (CRP) were reviewed at baseline, at 3 and 6 months, and at final follow-up. Adverse events and causes of treatment discontinuation were documented.

RESULTS

A total of 83 patients were included (66 Crohn's disease, 17 ulcerative colitis), 90% of whom had previously received other immunosuppressants. In 61% of patients systemic steroids were used at initiation of MMF, and in 27.3% biological agents were co-administered with MMF. Overall clinical effectiveness was observed in 64.7% of the population. At the end of treatment, 45.6% and 19.1% of subjects showed remission and clinical response, respectively. MMF treatment was maintained for a median of 28.9 months (IQR: 20.4-37.5).

CONCLUSION

Our study suggests, in the largest cohort to date, that MMF may be an effective alternative to thiopurines and methotrexate in IBD.

Effectiveness and Safety of the Switch from Remicade® to CT-P13 in Patients with Inflammatory Bowel Disease

BACKGROUND AND AIMS

To evaluate the clinical outcomes in patients with IBD after switching from Remicade® to CT-P13 in comparison with patients who maintain Remicade®.

METHODS

Patients under Remicade® who were in clinical remission with standard dosage at study entry were included. The 'switch cohort' [SC] comprised patients who made the switch from Remicade® to CT-P13, and the 'non-switch' cohort [NC] patients remained under Remicade®.

RESULTS

A total of 476 patients were included: 199 [42%] in the SC and 277 [58%] in the NC. The median follow-up was 18 months in the SC and 23 months in the NC [p < 0.01]. Twenty-four out of 277 patients relapsed in the NC; the incidence of relapse was 5% per patient-year. The cumulative incidence of relapse was 2% at 6 months and 10% at 24 months in this group. Thirty-eight out of 199 patients relapsed in the SC; the incidence rate of relapse was 14% per patient-year. The cumulative incidence of relapse was 5% at 6 months and 28% at 24 months. In the multivariate analysis, the switch to CT-P13 was associated with a higher risk of relapse (HR = 3.5, 95% confidence interval [CI] = 2-6). Thirteen percent of patients had adverse events in the NC, compared with 6% in the SC [p < 0.05].

CONCLUSIONS

Switching from Remicade® to CT-P13 might be associated with a higher risk of clinical relapse, although this fact was not supported in our study by an increase in objective markers of inflammation. The nocebo effect might have influenced this result. Switching from Remicade® to CT-P13 was safe.

[Adherence and fidelity in patients treated with intragastric balloon]

A correct treatment of obesity needs a program of habits modification regardless of the selected technique, especially if it is minimally invasive as the intragastric balloon (BIG). The adherence of the obese patients with regard to recommended drugs measures to medium- and long-term is less than 50%. Given that the results obtained using the technique of gastric balloon must be seen influenced by adherence to the modification of habits program and its fulfillment, we reviewed series published in attention to the program proposed with the BIG. The series published to date provide few details about the used Therapeutic Programs as well as the adherence of patients to them, and even less concerning the Monitoring Plan and the loyalty of the patient can be seen. We conclude the convenience to agree on a follow-up strategy, at least the 6 months during which the BIG remain in the stomach.

Stability in a Metapopulation Model with Density-dependent Dispersal

A spatially explicit metapopulation model with positive density-dependent migration is analysed. We obtained conditions under which a previously stable system can be driven to instability caused by a density-dependent migration mechanism. The stability boundary depends on the rate of increase of the number of migrants on each site at local equilibrium, on the intrinsic rate of increase at local level, on the number of patches, and on topological aspects regarding the connectivity between patches. A concrete example is presented illustrating the dynamics on the dispersal-induced unstable regime.

Synchronism in a metapopulation model

We consider a spatially explicit meta-population model with interaction among the two nearest neighbors to relate, with a simple mathematical expression, chaos in the local, uncoupled, populations, the degree of interaction among patches, size of the meta-population, and the stability of the synchronized attractor. Since synchronism is strongly correlated with extinction, our results can provide useful information on factors leading to population extinction.

A prospective trial of self-expanding metal coated stents in the palliation of malignant dysphagia

OBJECTIVE

To analyze the use of self-expanding metal coated esophageal stents a palliative therapy of malignant dysphagia.

METHOD

We performed a one year prospective study placing 12 stents in 10 patients with malignant dysphagia.

RESULTS

The insertion mean time was lower than 25 min, and most of our patients (70%) reported a good tolerance. Dysphagia score improved immediately and it lasted until death with no occlusions. Complications appeared early, 17% at the time of placement, with one patient having a life-threatening complication. The probability for these patients not to develop any complications after the three first weeks will be about 60%.

CONCLUSIONS

Self-expanding metal coated esophageal stents provide a fast and lasting relief in malignant dysphagia, with a good tolerance.