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Collen LV, Mitsialis V, Kim DY, Bresnahan M, Yang J, Tuthill M, Combs A, Barends J, Field M, Liu E, Bearup R, Okoroafor I, Klein C, Muise AM, Bousvaros A, Ouahed J, Snapper SB. Efficacy and Safety of Anti-Tumor Necrosis Factor Alpha in Very Early Onset Inflammatory Bowel Disease. Inflamm Bowel Dis 2023:izad196. [PMID: 37847820 DOI: 10.1093/ibd/izad196] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Very early onset inflammatory bowel disease (VEOIBD) is defined as disease onset in patients younger than 6 years. Challenges in treatment of VEOIBD include lack of approved therapies and increased incidence of monogenic immunodeficiencies. We report on patterns of anti-TNF use, efficacy, and safety in a large cohort of patients with VEOIBD. METHODS Very early onset inflammatory bowel disease patients receiving care at a single center were prospectively enrolled in a data registry and biorepository starting in 2012. Whole exome sequencing was available to all patients. Clinical data including IBD medication use and response were extracted from the medical record. We examined antitumor necrosis factor (anti-TNF) cumulative exposure and time to failure and evaluated the effect of covariates on anti-TNF failure using Cox proportional hazard regression. RESULTS In this cohort of 216 VEOIBD patients with median 5.8-year follow-up, 116 (53.7%) were TNF-exposed. Sixty-two TNF-exposed patients (53.4%) received their first dose at younger than 6 years. Cumulative exposure to anti-TNF was 23.6% at 1 year, 38.4% at 3 years, and 43.4% at 5 years after diagnosis. Cumulative exposure was greater in patients with Crohn's disease (P = .0004) and in those diagnosed in 2012 or later (P < .0001). Tumor necrosis factor failure occurred in 50.9% of those exposed. Features predictive of anti-TNF failure included ulcerative colitis/IBD-unclassified (hazard ratio, 1.94; P = .03), stricturing (hazard ratio, 2.20; P = .04), and younger age at diagnosis (hazard ratio, 1.25; P = .01). Adverse events occurred in 22.6% of infliximab-exposed and 14.3% of adalimumab-exposed. CONCLUSIONS Efficacy and safety of anti-TNFs in VEOIBD is comparable to what has previously been reported in older patients.
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Affiliation(s)
- Lauren V Collen
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Vanessa Mitsialis
- Division of Gastroenterology, Department of Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - David Y Kim
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Mairead Bresnahan
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Jessica Yang
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Margaret Tuthill
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Abigail Combs
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Jared Barends
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Michael Field
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Enju Liu
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Richelle Bearup
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Ibeawuchi Okoroafor
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Christoph Klein
- Department of Pediatrics, Dr. von Hauner Children's Hospital, LMU Klinikum, and Gene Center, Ludwig Maximilians Universität München, Germany
| | - Aleixo M Muise
- SickKids Inflammatory Bowel Disease Center, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Athos Bousvaros
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Jodie Ouahed
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
| | - Scott B Snapper
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, 02115, USA
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Challapalli A, Ratnayake G, McGrane J, Frazer R, Gupta S, Parslow D, Kingdon S, Lydon A, Sharma A, Tuthill M, McCusker C, Ford V, Ferrera A, Malik J, Boh Z, Jones E, T.R. Geldart, Nelmes S, Brown J, Bahl A. 1463P Patterns of care and outcomes of metastatic renal cell carcinoma (mRCC) patients (pts) with bone metastases (BM): A UK multicenter review. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Ratnayake G, Challapalli A, McGrane J, Frazer R, Gupta S, Parslow D, Kingdon S, Lydon A, Sharma A, Tuthill M, McCartney T, Jabbar R, Charnley N, Malik J, Abhi D, Chau C, Geldart T, Halstead A, Anuforom U, Bahl A. 1457P A UK multicentre retrospective review of metastatic renal cell carcinoma (mRCC) patients (pts) outcomes with brain metastases (BM) in the modern era. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Castellano Gauna D, Morales-Barrera R, Duran I, Oh DY, Chung I, Arkenau T, Vaishampayan U, Tuthill M, Borau PG, Shin S, Dang S, Ju CH, Chong E, Lal I, Cole G, Reig Torras O. 754P Ibrutinib (Ibr) in combination with paclitaxel (Pac) has activity in patients (Pts) with advanced urothelial carcinoma (aUC): Final analysis of a phase Ib/II study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Tuthill M, Cappuccini F, Carter L, Pollock E, Poulton I, Verrill C, Evans T, Gillessen S, Attard G, Protheroe A, Hamdy F, Hill A, Redchenko I. 682P Results from ADVANCE: A phase I/II open-label non-randomised safety and efficacy study of the viral vectored ChAdOx1-MVA 5T4 (VTP-800) vaccine in combination with PD-1 checkpoint blockade in metastatic prostate cancer. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.2076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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De La Pena H, Sharma A, Glicksman C, Joseph J, Subesinghe M, Traill Z, Verrill C, Sullivan M, Redgwell J, Bataillard E, Pintus E, Dallas N, Gogbashian A, Tuthill M, Protheroe A, Hall M. No longer any role for routine follow-up chest x-rays in men with stage I germ cell cancer. Eur J Cancer 2017; 84:354-359. [DOI: 10.1016/j.ejca.2017.07.005] [Citation(s) in RCA: 11] [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: 04/20/2017] [Revised: 06/19/2017] [Accepted: 07/03/2017] [Indexed: 10/18/2022]
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Stokoe I, Tuthill M, Balakrishnan L, Brock J. 75 Palliative second-line systemic treatment of non-small cell lung cancer within a UK cancer centre. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lees C, Tuthill M, Croxford W, Sharkey R, Newsom-Davis T. 42 Lung cancer diagnosis in the acute setting. Lung Cancer 2014. [DOI: 10.1016/s0169-5002(14)70043-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Harding V, Fenu E, Medani H, Shaboodien R, Ngan S, Li HK, Burt R, Diamantis N, Tuthill M, Blagden S, Gabra H, Urch CE, Moser S, Agarwal R. Safety, cost-effectiveness and feasibility of daycase paracentesis in the management of malignant ascites with a focus on ovarian cancer. Br J Cancer 2012; 107:925-30. [PMID: 22878372 PMCID: PMC3464770 DOI: 10.1038/bjc.2012.343] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/24/2012] [Accepted: 06/26/2012] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Paracentesis for malignant ascites is usually performed as an in-patient procedure, with a median length of stay (LoS) of 3-5 days, with intermittent clamping of the drain due to a perceived risk of hypotension. In this study, we assessed the safety of free drainage and the feasibility and cost-effectiveness of daycase paracentesis. METHOD Ovarian cancer admissions at Hammersmith Hospital between July and October 2009 were audited (Stage 1). A total of 21 patients (Stage 2) subsequently underwent paracentesis with free drainage of ascites without intermittent clamping (October 2010-January 2011). Finally, 13 patients (19 paracenteses, Stage 3), were drained as a daycase (May-December 2011). RESULTS Of 67 patients (Stage 1), 22% of admissions and 18% of bed-days were for paracentesis, with a median LoS of 4 days. In all, 81% of patients (Stage 2) drained completely without hypotension. Of four patients with hypotension, none was tachycardic or symptomatic. Daycase paracentesis achieved complete ascites drainage without complications, or the need for in-patient admission in 94.7% of cases (Stage 3), and cost £954 compared with £1473 for in-patient drainage. CONCLUSIONS Free drainage of malignant ascites is safe. Daycase paracentesis is feasible, cost-effective and reduces hospital admissions, and potentially represents the standard of care for patients with malignant ascites.
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Affiliation(s)
- V Harding
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - E Fenu
- National Clinical Guideline Centre, Royal College of Physicians, London NW1 4L, UK
| | - H Medani
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - R Shaboodien
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - S Ngan
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - H K Li
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - R Burt
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - N Diamantis
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - M Tuthill
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - S Blagden
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - H Gabra
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - C E Urch
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - S Moser
- Department of Radiology, Hammersmith Hospital, Imperial College, Du Cane Road, London W12 0HS, UK
| | - R Agarwal
- Department of Oncology, Hammersmith Hospital Campus, Imperial College London, Du Cane Road, London W12 0NN, UK
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Abstract
BACKGROUND Current regulation of drug approvals has caused considerable controversy as entrusted to the National Institute of Clinical Excellence, and has led to a lack of availability of modern medicines on the basis of calculations made of 'value'. AIM We have examined the assessment tool used by National Institute of Clinical Excellence (NICE) to establish the cost of drugs in order to assess whether it is a reasonable and objective evaluation methodology. DESIGN A review of the methods of analysis. METHODS An objective assessment of the value of the Quality Adjusted Life Year (QALY). RESULTS We conclude that current methods used by NICE to assess drug costs are arbitrary, subjective and fail to reflect the true costs for patients, which are grossly overestimated. CONCLUSION NICE needs to look again at the evaluation methods for calculating drug costs, and change their methodology from a subjective to an objective measure of true cost.
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Lee S, Syed N, Taylor J, Smith P, Griffin B, Baens M, Bai M, Bourantas K, Stebbing J, Naresh K, Nelson M, Tuthill M, Bower M, Hatzimichael E, Crook T. DUSP16 is an epigenetically regulated determinant of JNK signalling in Burkitt's lymphoma. Br J Cancer 2010; 103:265-74. [PMID: 20551953 PMCID: PMC2906728 DOI: 10.1038/sj.bjc.6605711] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: The mitogen-activated protein kinase (MAPK) phosphatases or dual specificity phosphatases (DUSPs) are a family of proteins that catalyse the inactivation of MAPK in eukaryotic cells. Little is known of the expression, regulation or function of the DUSPs in human neoplasia. Methods: We used RT–PCR and quantitative PCR (qPCR) to examine the expression of DUSP16 mRNA. The methylation in the DUSP16 CpG island was analysed using bisulphite sequencing and methylation-specific PCR. The activation of MAPK was determined using western blotting with phospho-specific antibodies for extra-cellular signal-related kinase (ERK), p38 and c-Jun N-terminal kinase (JNK). The proliferation of cell lines was assessed using the CellTiter 96 Aqueous One assay. Results: The expression of DUSP16, which inactivates MAPK, is subject to methylation-dependent transcriptional silencing in Burkitt's Lymphoma (BL) cell lines and in primary BL. The silencing is associated with aberrant methylation in the CpG island in the 5′ regulatory sequences of the gene blocking its constitutive expression. In contrast to BL, the CpG island of DUSP16 is unmethylated in other non-Hodgkin's lymphomas (NHLs) and epithelial malignancies. In BL cell lines, neither constitutive nor inducible ERK or p38 activity varied significantly with DUSP16 status. However, activation of JNK was increased in lines with DUSP16 methylation. Furthermore, methylation in the DUSP16 CpG island blocked transcriptional induction of DUSP16, thereby abrogating a normal physiological negative feedback loop that limits JNK activity, and conferred increased cellular sensitivity to agents, such as sorbitol and anthracycline chemotherapeutic agents that activate JNK. Conclusion: DUSP16 is a new epigenetically regulated determinant of JNK activation in BL.
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Affiliation(s)
- S Lee
- Laboratory of Cancer Genetics and Epigenetics, Breakthrough Breast Cancer, Institute of Cancer Research, Fulham Road, London, UK
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Cowman S, Stebbing J, Tuthill M. Large bowel perforation associated with capecitabine treatment for breast cancer. Ann Oncol 2008; 19:1510-1511. [DOI: 10.1093/annonc/mdn397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hulbert F, Ozzard A, Tuthill M, Bower M. HIV-associated renal cell cancer. J HIV Ther 2007; 12:73-74. [PMID: 17962798] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- F Hulbert
- Dept. of Oncology, Chelsea and Westminster Hospital, London, UK
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