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Miheller P, Kristóf T, Bor R, Farkas K, Golovics P, Harsányi L, Müller KE, Milassin Á, Palatka K, Schäfer E, Szamosi T, Sarlós P, Molnár T. A fekélyes vastagbélgyulladás gyógyszeres és sebészeti kezelése. Orv Hetil 2024; 165:37-64. [PMID: 38470491 DOI: 10.1556/650.2024.33050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Pál Miheller
- 1 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Tünde Kristóf
- 2 Borsod-Abaúj-Zemplén Vármegyei Központi Kórház Miskolc Magyarország
| | - Renáta Bor
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Klaudia Farkas
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Petra Golovics
- 4 Észak-Pesti Centrumkórház - Honvédkórház Budapest Magyarország
| | - László Harsányi
- 1 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | | | - Ágnes Milassin
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Károly Palatka
- 6 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Gasztroenterológiai Klinika Debrecen Magyarország
| | - Eszter Schäfer
- 4 Észak-Pesti Centrumkórház - Honvédkórház Budapest Magyarország
| | - Tamás Szamosi
- 4 Észak-Pesti Centrumkórház - Honvédkórház Budapest Magyarország
| | - Patrícia Sarlós
- 7 Pécsi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika Pécs Magyarország
| | - Tamás Molnár
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
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Farkas K, Székely H, Bacsur P, Bánky B, Élthes ZB, Harsányi L, Müllner KE, Milassin Á, Palatka K, Sarlós P, Szamosi T, Molnár T, Miheller P. A Crohn-betegég terápiás stratégiája. Orv Hetil 2024; 165:1-36. [PMID: 38470481 DOI: 10.1556/650.2024.33020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Affiliation(s)
- Klaudia Farkas
- 1 Szegedi Tudományegyetem, Szent Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Hajnal Székely
- 2 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Péter Bacsur
- 1 Szegedi Tudományegyetem, Szent Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Balázs Bánky
- 2 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Zsuzsa Bianka Élthes
- 3 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Gasztroenterológiai Klinika Debrecen Magyarország
| | - László Harsányi
- 2 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Katalin Edit Müllner
- 2 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
| | - Ágnes Milassin
- 1 Szegedi Tudományegyetem, Szent Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Károly Palatka
- 3 Debreceni Egyetem, Általános Orvostudományi Kar, Klinikai Központ, Gasztroenterológiai Klinika Debrecen Magyarország
| | - Patrícia Sarlós
- 4 Pécsi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika Pécs Magyarország
| | - Tamás Szamosi
- 5 Észak-Pesti Centrumkórház - Honvédkórház Budapest Magyarország
| | - Tamás Molnár
- 1 Szegedi Tudományegyetem, Szent Györgyi Albert Orvostudományi Kar, I. Belgyógyászati Klinika Szeged Magyarország
| | - Pál Miheller
- 2 Semmeweis Egyetem, Általános Orvostudományi Kar, Sebészeti, Transzplantációs és Gasztroenterológiai Klinika Budapest Magyarország
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Bacsur P, Matuz M, Resál T, Miheller P, Szamosi T, Schäfer E, Sarlós P, Iliás Á, Szántó K, Rutka M, Bálint A, Milassin Á, Fábián A, Bor R, Szepes Z, Molnár T, Farkas K. Ustekinumab is associated with superior treatment persistence but not with higher remission rates versus vedolizumab in patients with refractory Crohn's disease: results from a multicentre cohort study. Therap Adv Gastroenterol 2022; 15:17562848221144349. [PMID: 36600684 PMCID: PMC9806440 DOI: 10.1177/17562848221144349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Treatment with antitumor necrosis factor alpha (anti-TNF-α) is safe and effective as first-line therapy; however, its efficacy is limited due to primary nonresponse (PNR) and secondary loss of response (LOR), resulting in treatment discontinuation in approximately 40%-50% of cases. Vedolizumab (VDZ) and ustekinumab (UST) therapies could be good alternatives in patient with anti-TNF failure; however, no head-to-head randomized comparison of these drugs as second- or third-line treatments has been made. OBJECTIVES This study aimed to assess the treatment persistence and comparative effectiveness of UST and VDZ in patients with refractory Crohn's disease (CD). DESIGN In this nationwide retrospective study, patients with CD on UST or VDZ maintenance therapy were enrolled. Clinical data at baseline, after induction, and at week 52 were obtained. METHODS Clinical and biochemical activities as well as corticosteroid-free remission (SFR) rates were assessed, while concomitant medications, comorbidities, hospitalizations, and surgeries were recorded during the follow-up to detect any predictors. RESULTS A total of 161 UST- and 65 VDZ-treated patients completed the follow-up. No significant difference in clinical or biochemical remission rates was observed after induction between the two treatment groups; however, clinical remission rate at week 52 was higher in UST group. UST showed superior drug persistence than VDZ (86.5%, 57.9%, p < 0.0001). The drug type was predictive of clinical SFR at week 52 [p = 0.011, odds ratio (OR) = 2.39 with UST]. Drug failure rates were higher for VDZ than those for UST (PNR rates: 21.54% and 4.97%, respectively, p < 0.001, OR = 8.267, p = 0.001). LOR and escalations were more common during UST treatment (61.5% versus 36.9%, p < 0.001; 64.2% versus 23.1%, p < 0.001). Hospital and surgical admission rates did not differ significantly. Only one adverse event occurred with VDZ at week 20, which led to drug cessation. CONCLUSIONS VDZ and UST were safe and effective for treating patients with CD in whom anti-TNF therapy failed. UST showed superior drug persistence than VDZ, but dose escalation was more frequent. Biologicals used in lower treatment lines resulted in better drug persistence.
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Affiliation(s)
- Péter Bacsur
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of
Pharmacy, University of Szeged, Szeged, Hungary
| | - Tamás Resál
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Pál Miheller
- Department of Surgery and Interventional
Gastroenterology, Faculty of Medicine, Semmelweis University, Budapest,
Hungary
| | - Tamás Szamosi
- Department of Gastroenterology, Military
Hospital – State Health Centre, Budapest, Hungary
| | - Eszter Schäfer
- Department of Gastroenterology, Military
Hospital – State Health Centre, Budapest, Hungary
| | - Patrícia Sarlós
- Division of Gastroenterology, First Department
of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Ákos Iliás
- First Department of Medicine, Faculty of
Medicine, Semmelweis University, Budapest, Hungary
| | - Kata Szántó
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Department of Medicine, Albert Szent-Györgyi
Medical School, University of Szeged, Szeged, Hungary
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Santos RD, Ruzza A, Hovingh GK, Wiegman A, Mach F, Kurtz CE, Hamer A, Bridges I, Bartuli A, Bergeron J, Szamosi T, Santra S, Stefanutti C, Descamps OS, Greber-Platzer S, Luirink I, Kastelein JJP, Gaudet D. Evolocumab in Pediatric Heterozygous Familial Hypercholesterolemia. N Engl J Med 2020; 383:1317-1327. [PMID: 32865373 DOI: 10.1056/nejmoa2019910] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evolocumab, a fully human monoclonal antibody directed against proprotein convertase subtilisin-kexin type 9, is widely used in adult patients to lower low-density lipoprotein (LDL) cholesterol levels. Its effects in pediatric patients with heterozygous familial hypercholesterolemia are not known. METHODS We conducted a 24-week, randomized, double-blind, placebo-controlled trial to evaluate the efficacy and safety of evolocumab in pediatric patients with heterozygous familial hypercholesterolemia. Patients 10 to 17 years of age who had received stable lipid-lowering treatment for at least 4 weeks before screening and who had an LDL cholesterol level of 130 mg per deciliter (3.4 mmol per liter) or more and a triglyceride level of 400 mg per deciliter (4.5 mmol per liter) or less were randomly assigned in a 2:1 ratio to receive monthly subcutaneous injections of evolocumab (420 mg) or placebo. The primary end point was the percent change in LDL cholesterol level from baseline to week 24; key secondary end points were the mean percent change in LDL cholesterol level from baseline to weeks 22 and 24 and the absolute change in LDL cholesterol level from baseline to week 24. RESULTS A total of 157 patients underwent randomization and received evolocumab (104 patients) or placebo (53 patients). At week 24, the mean percent change from baseline in LDL cholesterol level was -44.5% in the evolocumab group and -6.2% in the placebo group, for a difference of -38.3 percentage points (P<0.001). The absolute change in the LDL cholesterol level was -77.5 mg per deciliter (-2.0 mmol per liter) in the evolocumab group and -9.0 mg per deciliter (-0.2 mmol per liter) in the placebo group, for a difference of -68.6 mg per deciliter (-1.8 mmol per liter) (P<0.001). Results for all secondary lipid variables were significantly better with evolocumab than with placebo. The incidence of adverse events that occurred during the treatment period was similar in the evolocumab and placebo groups. CONCLUSIONS In this trial involving pediatric patients with familial hypercholesterolemia, evolocumab reduced the LDL cholesterol level and other lipid variables. (Funded by Amgen; HAUSER-RCT ClinicalTrials.gov number, NCT02392559.).
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Affiliation(s)
- Raul D Santos
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Andrea Ruzza
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - G Kees Hovingh
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Albert Wiegman
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - François Mach
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Christopher E Kurtz
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Andrew Hamer
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Ian Bridges
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Andrea Bartuli
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Jean Bergeron
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Tamás Szamosi
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Saikat Santra
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Claudia Stefanutti
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Olivier S Descamps
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Susanne Greber-Platzer
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Ilse Luirink
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - John J P Kastelein
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
| | - Daniel Gaudet
- From the Lipid Clinic Heart Institute, University of São Paulo Medical School Hospital and Hospital Israelita Albert Einstein, São Paulo (R.D.S.); Amgen, Thousand Oaks, CA (A.R., C.E.K, A.H.); the Departments of Vascular Medicine (G.K.H., J.J.P.K.) and Pediatrics (A.W., I.L.), Amsterdam UMC, Amsterdam; the Cardiology Department, Geneva University Hospital, Geneva (F.M.); the Biostatistics Department, Amgen, Cambridge (I.B.), and the Department of Clinical Inherited Metabolic Disorders, Birmingham Children's Hospital, Birmingham (S.S.) - both in the United Kingdom; the Rare Diseases and Clinical Genetics Unit, Academic Pediatric Department, Bambino Gesù Children's Hospital (A.B.), and the Department of Molecular Medicine, Umberto I Hospital, Sapienza University of Rome (C.S.), Rome; the Lipid Clinic, Department of Medicine, Centre Hospitalier Universitaire de Québec-Université Laval, Quebec (J.B.), and the Clinical Lipidology and Rare Lipid Disorders Unit, Community Genomic Medicine Centre and ECOGENE-21, Department of Medicine, Université de Montréal, Chicoutimi, QC (D.G.) - both in Canada; the 2nd Department of Pediatrics, Semmelweis University, Budapest, Hungary (T.S.); the Department of Internal Medicine, Centres Hospitaliers Jolimont, La Louvière, Belgium (O.S.D.); and the Division of Pediatric Pulmonology, Allergology, and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna (S.G.-P.)
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Kunovszki P, Milassin Á, Gimesi-Országh J, Takács P, Szántó K, Bálint A, Farkas K, Borsi A, Lakatos PL, Szamosi T, Molnár T. Epidemiology, mortality and prevalence of colorectal cancer in ulcerative colitis patients between 2010-2016 in Hungary - a population-based study. PLoS One 2020; 15:e0233238. [PMID: 32407408 PMCID: PMC7224530 DOI: 10.1371/journal.pone.0233238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 11/25/2019] [Accepted: 04/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background The incidence and prevalence of ulcerative colitis (UC) varies geographically. The risk of colorectal cancer (CRC) and possibly some other malignancies is increased among patients with UC. It is still debated if patients with UC are at a greater risk of dying compared with the general population. Our aim was to describe the epidemiology and mortality of the Hungarian UC population from 2010 to 2016 and to analyze the associated malignancies with a special focus on CRC. Methods This is an observational, descriptive, epidemiological study based on the National Health Insurance Fund social security databases from 2010 to 2016. All adult patients who had at least two events in outpatient care or at least two medication prescriptions, or at least one inpatient event with UC diagnosis were analyzed. Malignancies and CRC were defined using ICD-10 codes. We also evaluated the survival of patients suffering from UC compared with the general population using a 3 to 1 matched random sample (age, gender, geography) from the full population of Hungary. Results We found the annual prevalence of UC 0.24–0.34%. The incidence in 2015 was 21.7/100 000 inhabitants. Annual mortality rate was 0.019–0.023%. In this subpopulation, CRC was the most common cancer, followed by non-melanotic skin and prostate cancer. 8.5% of the UC incident subpopulation was diagnosed with CRC. 470 (33%) of the CRC patients died during the course of the study (25% of all deaths were due to CRC), the median survival was 9.6 years. UC patients had significantly worse survival than their matched controls (HR = 1.65, 95% CI: 1.56–1.75). Summary This is the first population-based study from Eastern Europe to estimate the different malignancies and mortality data amongst Hungarian ulcerative colitis patients. Our results revealed a significantly worse survival of patients suffering from UC compared to the general population.
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Affiliation(s)
- Péter Kunovszki
- Janssen Global Commercial Strategy Organization, Budapest, Hungary
| | - Ágnes Milassin
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | | | - Péter Takács
- Janssen Global Commercial Strategy Organization, Budapest, Hungary
| | - Kata Szántó
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - András Borsi
- Janssen-Cilag Limited, High Wycombe, England, United Kingdom
| | - Péter L Lakatos
- Semmelweis University, Budapest, Hungary.,Division of Gastroenterology, McGill University, Montreal, Canada
| | - Tamás Szamosi
- Military Hospital-State Health Centre, Budapest, Hungary
| | - Tamás Molnár
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
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Kósa F, Kunovszki P, Borsi A, Iliás Á, Palatka K, Szamosi T, Vincze Á, Molnár T, Lakatos PL. Anti-TNF dose escalation and drug sustainability in Crohn's disease: Data from the nationwide administrative database in Hungary. Dig Liver Dis 2020; 52:274-280. [PMID: 31669077 DOI: 10.1016/j.dld.2019.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND A significant percentage of patients receiving anti-tumor necrosis factor alpha (anti-TNFα) agents lose clinical response over time. This study aims to provide representative real-world data on anti-TNFα drug sustainability, prevalence and predictors of anti-TNFα dose escalation. METHODS In this nationwide, retrospective study, patients receiving infliximab or adalimumab therapy between 2013 and 2016 were included using the administrative claims database of the Hungarian National Health Insurance Fund. Demographic characteristics, drug sustainability, dose escalation, use of parallel medications were analyzed. RESULTS 476 infliximab and 397 adalimumab patients were included. Dose escalation was observed in 7%, 9% and 22% of patients receiving originator/biosimilar infliximab and adalimumab during the complete follow-up, respectively. Dose escalation was associated with shorter disease duration (OR = 1.75, p = 0.026) and corticosteroid use. Drug retention rates were 62.7%, 72.3%, 75.4% after 1 year follow-up for Remicade®, Inflectra® and Humira®, which decreased to 38.3% and 52.1% for Remicade® and Humira® at 3 years. Drug sustainability was affected by steroid use prior biologic initiation in adalimumab treated patients (HR = 2.04, p < 0.001), while in infliximab treated patients dose escalation (HR = 0.51, p = 0.02) and gender (HR = 1.39, p = 0.033) were predictors of treatment discontinuation. CONCLUSION Dose escalation rates were lower in this real-world administrative database study for both adalimumab and infliximab compared to published data. Drug retention rates were overall satisfactory, with no apparent difference between the legacy and biosimilar infliximab.
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Affiliation(s)
- Fruzsina Kósa
- Janssen Global Commercial Strategy Organization, Budapest, Hungary
| | - Péter Kunovszki
- Janssen Global Commercial Strategy Organization, Budapest, Hungary
| | | | - Ákos Iliás
- Semmelweis University, Budapest, Hungary
| | | | | | | | | | - Peter L Lakatos
- Semmelweis University, Budapest, Hungary; McGill University Health Center, Montreal, Canada.
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Kunovszki P, Judit Szántó K, Gimesi-Országh J, Takács P, Borsi A, Bálint A, Farkas K, Milassin Á, Lakatos PL, Szamosi T, Molnár T. Epidemiological data and utilization patterns of anti-TNF alpha therapy in the Hungarian ulcerative colitis population between 2012-2016. Expert Opin Biol Ther 2020; 20:443-449. [DOI: 10.1080/14712598.2020.1718097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | | | | | | | | | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter L. Lakatos
- Department of Medicine, Semmelweis University, Budapest, Hungary
- Division of Gastroenterology, McGill University, Montreal, Canada
| | - Tamás Szamosi
- Department of Gastroenterology, Military Hospital-State Health Centre, Budapest, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
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Bor R, Fábián A, Matuz M, Szepes Z, Farkas K, Miheller P, Szamosi T, Vincze Á, Rutka M, Szántó K, Bálint A, Nagy F, Milassin Á, Tóth T, Zsigmond F, Bajor J, Müllner K, Lakner L, Papp M, Salamon Á, Horváth G, Sarang K, Schäfer E, Sarlós P, Palatka K, Molnár T. Real-life efficacy of vedolizumab on endoscopic healing in inflammatory bowel disease – A nationwide Hungarian cohort study. Expert Opin Biol Ther 2019; 20:205-213. [PMID: 31782939 DOI: 10.1080/14712598.2020.1699529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Pál Miheller
- First Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Tamás Szamosi
- Department of Gastroenterology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Áron Vincze
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tibor Tóth
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Zsigmond
- Department of Gastroenterology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Judit Bajor
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Katalin Müllner
- Second Department of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Mária Papp
- Second Department of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Gábor Horváth
- Central Hospital of Borsod-Abaúj-Zemplén County, Miskolc, Hungary
| | | | - Eszter Schäfer
- Department of Gastroenterology, Hungarian Defence Forces Military Hospital, Budapest, Hungary
| | - Patrícia Sarlós
- First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Károly Palatka
- Second Department of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
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Szamosi T. Treatment of pediatric patients with homozygote familial hypercholesterolemia (HEFH). Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.436] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gonczi L, Vegh Z, Golovics PA, Rutka M, Gecse KB, Bor R, Farkas K, Szamosi T, Bene L, Gasztonyi B, Kristóf T, Lakatos L, Miheller P, Palatka K, Papp M, Patai Á, Salamon Á, Tóth GT, Vincze Á, Biro E, Lovasz BD, Kurti Z, Szepes Z, Molnár T, Lakatos PL. Prediction of Short- and Medium-term Efficacy of Biosimilar Infliximab Therapy. Do Trough Levels and Antidrug Antibody Levels or Clinical And Biochemical Markers Play the More Important Role? J Crohns Colitis 2017; 11:697-705. [PMID: 27838610 DOI: 10.1093/ecco-jcc/jjw203] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/09/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Biosimilar infliximab CT-P13 received European Medicines Agency [EMA] approval in June 2013 for all indications of the originator product. In the present study, we aimed to evaluate the predictors of short- and medium-term clinical outcome in patients treated with the biosimilar infliximab at the participating inflammatory bowel disease [IBD] centres in Hungary. METHODS Demographic data were collected and a harmonised monitoring strategy was applied. Clinical and biochemical activities were evaluated at Weeks 14, 30, and 54. Trough level [TL] and anti-drug antibody [ADA] concentrations were measured by enzyme-linked immunosorbent assay [ELISA] [LT-005, Theradiag, France] at baseline at 14, 30 and 54 weeks and in two centres at Weeks 2 and 6. RESULTS A total of 291 consecutive IBD patients (184 Crohn's disease [CD] and 107 ulcerative colitis [UC]) were included. In UC, TLs at Week 2 predicted both clinical response and remission at Weeks 14 and 30 (clinical response/remission at Week 14: area under the curve [AUC] = 0.81, p < 0.001, cut-off: 11.5 μg/ml/AUC = 0.79, p < 0.001, cut-off: 15.3μg/ml; clinical response/remission at Week 30: AUC = 0.79, p = 0.002, cut-off: 11.5 μg/ml/AUC = 0.74, p = 0.006, cut-off: 14.5 μg/ml), whereas ADA positivity at Week 14 was inversely associated with clinical response at Week 30 [58.3% vs 84.8% ,p = 0.04]. Previous anti-tumour necrosis factor [TNF] exposure was inversely associated with short-term clinical remission [Week 2: 18.8% vs 47.8%, p = 0.03, at Week 6: 38.9% vs 69.7%, p = 0.013, at Week 14: 37.5% vs 2.5%, p = 0.06]. In CD, TLs at Week 2 predicted short-term [Week 14 response/remission, AUCTLweek2 = 0.715-0.721, p = 0.05/0.005] but not medium-term clinical efficacy. In addition, early ADA status by Week 14 [p = 0.04-0.05 for Weeks 14 and 30], early clinical response [p < 0.001 for Weeks 30/54] and normal C-reactive protein [CRP] at Week 14 [p = 0.005-0.0001] and previous anti-TNF exposure [p = 0.03-0.0001 for Weeks 14, 30, and 54] were associated with short-and medium-term clinical response and remission. CONCLUSIONS In UC, early TLs were predictive for short- and medium-term clinical efficacy, whereas in CD, Week 2 TLs were associated only with short-term clinical outcomes.
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Affiliation(s)
- Lorant Gonczi
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Vegh
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Petra Anna Golovics
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | | | - Renata Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Szamosi
- Military Hospital - State Health Centre, Budapest, Hungary
| | - László Bene
- First Department of Medicine, Peterfy Hospital, Budapest, Hungary
| | - Beáta Gasztonyi
- Second Department of Medicine, Zala County Hospital, Zalaegerszeg, Hungary
| | - Tünde Kristóf
- Second Department of Medicine, B-A-Z County and University Teaching Hospital, Miskolc, Hungary
| | - László Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprém, Hungary
| | - Pál Miheller
- Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Károly Palatka
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Mária Papp
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Árpád Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Ágnes Salamon
- Department of Gastroenterology, Tolna County Teaching Hospital, Szekszárd, Hungary
| | - Gábor Tamás Tóth
- Department of Gastroenterology, Janos Hospital, Budapest, Hungary
| | - Áron Vincze
- First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Edina Biro
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | | | - Zsuzsanna Kurti
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltan Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Péter L Lakatos
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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11
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Bálint A, Rutka M, Végh Z, Kürti Z, Gecse KB, Banai J, Bene L, Gasztonyi B, Kristóf T, Lakatos L, Miheller P, Palatka K, Patai Á, Salamon Á, Szamosi T, Szepes Z, Tóth GT, Vincze Á, Bor R, Milassin Á, Fábián A, Nagy F, Kolar M, Bortlik M, Duricova D, Hruba V, Lukas M, Mitrova K, Malickova K, Lukas M, Lakatos PL, Molnár T, Farkas K. Frequency and characteristics of infusion reactions during biosimilar infliximab treatment in inflammatory bowel diseases: results from Central European nationwide cohort. Expert Opin Drug Saf 2017; 16:885-890. [PMID: 28504555 DOI: 10.1080/14740338.2017.1323330] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Anita Bálint
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Mariann Rutka
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Végh
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Kürti
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Krisztina B. Gecse
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - János Banai
- Military Hospital – State Health Centre, Budapest, Hungary
| | - László Bene
- 1st Department of Medicine, Peterfy Hospital, Budapest, Hungary
| | - Beáta Gasztonyi
- 2nd Department of Medicine, Zala County Hospital, Zalaegerszeg, Hungary
| | - Tünde Kristóf
- 2nd Department of Medicine, B-A-Z County and University Teaching Hospital, Miskolc, Hungary
| | - László Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprém, Hungary
| | - Pál Miheller
- Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Károly Palatka
- Institute of Medicine, Department of Gastroenterology, University of Debrecen, Clinical Center, Debrecen, Hungary
| | - Árpád Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Ágnes Salamon
- Department of Gastroenterology, Tolna County Teaching Hospital, Szekszárd, Hungary
| | - Tamás Szamosi
- Military Hospital – State Health Centre, Budapest, Hungary
| | - Zoltán Szepes
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Tamás Tóth
- Department of Gastroenterology, Janos Hospital, Budapest, Hungary
| | - Áron Vincze
- 1st Department of Medicine, University of Pécs, Pécs, Hungary
| | - Renáta Bor
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ágnes Milassin
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Martin Kolar
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Martin Bortlik
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Department of Internal Medicine, Military Hospital, Charles University, Prague, Czech Republic
| | - Dana Duricova
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Institute of Pharmacology, 1st Medical Faculty, Charles University, Prague, Czech Republic
| | - Veronika Hruba
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
| | - Martin Lukas
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
| | - Katarina Mitrova
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Department of Paediatrics, Faculty Hospital Motol, 2nd Medical Faculty, Charles University, Prague, Czech Republic
| | - Karin Malickova
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Milan Lukas
- IBD Clinical and Research Centre, Iscarea.s., Prague, Czech Republic
- Institute of Medical Biochemistry and Laboratory Diagnostics, 1st Medical Faculty and General Teaching Hospital, Charles University, Prague, Czech Republic
| | - Péter L. Lakatos
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
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12
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Gecse KB, Lovász BD, Farkas K, Banai J, Bene L, Gasztonyi B, Golovics PA, Kristóf T, Lakatos L, Csontos ÁA, Juhász M, Nagy F, Palatka K, Papp M, Patai Á, Lakner L, Salamon Á, Szamosi T, Szepes Z, Tóth GT, Vincze Á, Szalay B, Molnár T, Lakatos PL. Efficacy and Safety of the Biosimilar Infliximab CT-P13 Treatment in Inflammatory Bowel Diseases: A Prospective, Multicentre, Nationwide Cohort. J Crohns Colitis 2016; 10:133-40. [PMID: 26661272 DOI: 10.1093/ecco-jcc/jjv220] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 10/19/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Biosimilar infliximab CT-P13 is approved for all indications of the originator product in Europe. Prospective data on its efficacy, safety, and immunogenicity in inflammatory bowel diseases are lacking. METHODS A prospective, nationwide, multicentre, observational cohort was designed to examine the efficacy, safety, and immunogenicity of CT-P13 infliximab biosimilar in the induction treatment of Crohn's disease [CD] and ulcerative colitis [UC]. Demographic data were collected and a harmonised monitoring strategy was applied. Early clinical remission, response, and early biochemical response were evaluated at Week 14, steroid-free clinical remission was evaluated at Week 30. Therapeutic drug level was monitored using a conventional enzyme-linked immunosorbent assay. RESULTS In all, 210 consecutive inflammatory bowel disease [126 CD and 84 UC] patients were included in the present cohort. At Week 14, 81.4% of CD and 77.6% of UC patients showed clinical response and 53.6% of CD and 58.6% of UC patients were in clinical remission. Clinical remission rates at Week 14 were significantly higher in CD and UC patients who were infliximab naïve, compared with those with previous exposure to the originator compound [p < 0.05]. Until Week 30, adverse events were experienced in 17.1% of all patients. Infusion reactions and infectious adverse events occurred in 6.6% and 5.7% of all patients, respectively. CONCLUSIONS This prospective multicentre cohort shows that CT-P13 is safe and effective in the induction of clinical remission and response in both CD and UC. Patients with previous infliximab exposure exhibited decreased response rates and were more likely to develop allergic reactions.
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Affiliation(s)
- Krisztina B Gecse
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Barbara D Lovász
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Klaudia Farkas
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - János Banai
- Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - László Bene
- First Department of Medicine, Peterfy Hospital, Budapest, Hungary
| | - Beáta Gasztonyi
- Second Department of Medicine, Zala County Hospital, Zalaegerszeg, Hungary
| | - Petra Anna Golovics
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Tünde Kristóf
- Second Department of Medicine, B-A-Z County and University Teaching Hospital, Miskolc, Hungary
| | - László Lakatos
- Department of Internal Medicine, Csolnoky Ferenc Regional Hospital, Veszprém, Hungary
| | - Ágnes Anna Csontos
- Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Márk Juhász
- Second Department of Internal Medicine, Semmelweis University, Budapest, Hungary
| | - Ferenc Nagy
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Károly Palatka
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Mária Papp
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Hungary
| | - Árpád Patai
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Lilla Lakner
- Department of Medicine and Gastroenterology, Markusovszky Hospital, Szombathely, Hungary
| | - Ágnes Salamon
- Department of Gastroenterology, Tolna County Teaching Hospital, Szekszárd, Hungary
| | - Tamás Szamosi
- Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Zoltán Szepes
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Gábor T Tóth
- Department of Gastroenterology, Janos Hospital, Budapest, Hungary
| | - Áron Vincze
- First Department of Medicine, University of Pécs, Pécs, Hungary
| | - Balázs Szalay
- Department of Laboratory Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Molnár
- First Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Péter L Lakatos
- First Department of Internal Medicine, Semmelweis University, Budapest, Hungary
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13
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Horváth G, Farkas K, Hollósi R, Nagy F, Szepes Z, Papp M, Palatka K, Miheller P, Lakatos L, Szamosi T, Nyári T, Wittmann T, Molnár T. Is there any association between impaired health-related quality of life and non-adherence to medical therapy in inflammatory bowel disease? Scand J Gastroenterol 2012; 47:1298-303. [PMID: 22935014 DOI: 10.3109/00365521.2012.703233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Inflammatory bowel diseases (IBD) have a huge impact on the patients' lives and require continuous medication and long-term medical follow-up. The Short Form Health Survey (SF-36) is a commonly used questionnaire measuring health-related quality of life (HRQOL). Our aim was to evaluate whether HRQOL influences medication adherence and vice versa in IBD patients, and to find relationships between demographic parameters, therapeutic modalities and non-adherence or HRQOL. PATIENTS AND METHODS Five hundred ninety-two IBD patients treated at six Hungarian tertiary centers were enrolled. Patients completed the SF-36 questionnaire and a medication adherence report scale during their visits. The associations between demographic parameters, HRQOL, different kinds of therapies and non-adherence were analyzed. RESULTS The most affected dimension was physical functioning and least affected were the social functions. About 42.7% of the patients revealed their HRQOL to be acceptable. About 74.6% of the patients believed that the prescribed medications actually improved their HRQOL. Diarrhea was the most common and most severe symptom during the course of the disease. Non-adherence was reported in 13.4% of the patients. 'Forgetting to take the medication' was the main reason for non-adherence in 67.6% of the cases. Medication adherence was significantly higher among nonsmoker patients, and also in the case of immunomodulator therapy. There was no association between the sum of HRQOL and different subscores and non-adherence. CONCLUSION Inflammatory bowel disease is associated with low HRQOL, which is not affected by drug therapy. The impaired quality of life in IBD is mainly influenced by the disease itself.
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Affiliation(s)
- Gábor Horváth
- Department of Gastroenterology, Semmelweis Health Centre of Miskolc, Miskolc, Hungary
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14
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Gyökeres T, Rusznyák K, Visnyei Z, Schäfer E, Szamosi T, Banai J. [Introduction of a quality index in a Hungarian endoscopy unit]. Orv Hetil 2012; 153:1142-52. [PMID: 22805040 DOI: 10.1556/oh.2012.29408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED The quality of endoscopic examinations substantially determines their value. In developed countries, Continuous Quality Management is used to improve it permanently. In Hungary there is no example for measuring quality in the field of gastrointestinal endoscopy. AIM The measurement and improvement of quality of endoscopy applying completeness index (cecum intubation rate) during colonoscopy. PATIENTS AND METHODS The authors defined base values retrospectively from 841 colonoscopy reports, performed in the last quarter of the year, before starting the project. The next two years (3160 colonoscopy in 2009 and 3167 in 2010) every three months they calculated the cecum intubation rate for each endoscopist. RESULTS The cecum intubation rate was 81.6% in the base period. When the authors excluded examinations with poor preparations and those with a previously unknown stenosis that prevented the total colonoscopy, the adjusted cecal intubation rate was 90.9%. In the next 2 years, the cecum intubation rate was 84.2% and 85.7% (p = 0.0394), while adjusted cecum intubation rate proved to be 92.3% and 92.6% (p = 0.381 NS) for the whole endoscopy unit. Of the 14 endoscopists only 6 reached an adjusted cecum intubation rate of 90%, but in the second year of the project 10 of them reached this rate and only one endoscopist remained below 87%. The endoscopists performing more than 100 colonoscopies per year had better adjusted cecum intubation rate (base 91.2%; 92.7% and 93.1% during the 2 project years) compared to those with less than 100 colonoscopies per year (base, 86.7%; project period, 85.5 and 89%). CONCLUSIONS The evaluation and publicity of the cecal intubation rate resulted in an improvement of the quality of colonoscopy. The authors also presented that endoscopists performing more than 100 colonoscopies per year have better endoscopic quality.
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Affiliation(s)
- Tibor Gyökeres
- MH Honvédkórház Gasztroenterológia Budapest Podmaniczky.
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15
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Kiss LS, Szamosi T, Molnar T, Miheller P, Lakatos L, Vincze A, Palatka K, Barta Z, Gasztonyi B, Salamon A, Horvath G, Tóth GT, Farkas K, Banai J, Tulassay Z, Nagy F, Szenes M, Veres G, Lovasz BD, Vegh Z, Golovics PA, Szathmari M, Papp M, Lakatos PL. Early clinical remission and normalisation of CRP are the strongest predictors of efficacy, mucosal healing and dose escalation during the first year of adalimumab therapy in Crohn's disease. Aliment Pharmacol Ther 2011; 34:911-22. [PMID: 21883326 DOI: 10.1111/j.1365-2036.2011.04827.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adalimumab is a fully human monoclonal antibody targeting tumour necrosis factor with proven efficacy in the treatment of Crohn's disease (CD). AIM To investigate the predictors of medium-term clinical efficacy and mucosal healing during adalimumab therapy, in patients with CD, in specialised centres approved for biological therapy in Hungary. METHODS Data capture of the 201 CD patients was standardised and prospective (male/female: 112/89, median age: 33.0 years, duration: 8 years). Previous infliximab therapy had been administered in 48% of patients, concomitant steroids in 41%, azathioprine in 69% and combined therapy in 27% of patients. RESULTS Overall clinical response and remission rates at 24 weeks were 78% and 52%, respectively; at 52 weeks were 69% and 44%, respectively. Endoscopic improvement and healing were achieved in 43% and 24% of patients. In a logistic regression model, clinical efficacy and CRP at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, whereas CRP at week 12, clinical remission at week 24, inflammatory parameters and nonsmoking were associated to endoscopic improvement/healing. Intensification to weekly dosing was needed in 16% of patients. Parallel azathioprine therapy and clinical remission at week 12 were inversely associated with dose escalation. CONCLUSIONS Clinical efficacy and normalised CRP at week 12 (early deep clinical remission) are associated with medium-term clinical efficacy and mucosal healing during adalimumab therapy, whereas need for combined immunosuppression at induction and smoking status are predictors for non-response. Parallel azathioprine therapy may decrease the probability for dose escalation.
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Affiliation(s)
- L S Kiss
- Semmelweis University, Budapest, Hungary
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16
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Kiss LS, Szamosi T, Molnár T, Miheller P, Lakatos L, Vincze A, Palatka K, Bartha Z, Gasztonyi B, Salamon A, Horváth G, Tóth GT, Farkas K, Banai J, Tulassay Z, Nagy F, Szenes M, Veres G, Lovász BD, Végh Z, Golovics PA, Szathmári M, Papp M, Lakatos PL. [Predictors of efficacy, mucosal healing and dose intensification during the first year of adalimumab therapy in patients with luminal and fistulizing Crohn's disease. National data from Hungary]. Orv Hetil 2011; 152:1433-42. [PMID: 21865144 DOI: 10.1556/oh.2011.29200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
UNLABELLED Adalimumab is a fully human monoclonal antibody targeting tumor necrosis factor with proven efficacy in the treatment of Crohn's disease in clinical trials. The aim of the present study was to investigate the predictors of medium term clinical efficacy and mucosal healing during adalimumab therapy in patients with Crohn's disease in specialized centers approved for biological therapy in Hungary. METHODS Data of 201 Crohn's disease patients were prospectively captured (male/female: 112/89, median age: 24 years, duration: 8 years). Previous infliximab therapy was given in 97 (48.3%) patients, concomitant steroids in 41.3% and azathioprine in 69.2% (combined: 26.4%) of patients. RESULTS Overall clinical response and remission rates at 24 and 52 weeks were 78% and 52%, and 69.4% and 44.4%, respectively. Endoscopic improvement and healing was achieved in 43.1% and 23.6%, respectively. In a logistic regression model, clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression at induction, shorter disease duration and smoking were identified as independent predictors for 12-month clinical outcome, while normalized C-reactive protein at week 12, clinical remission at week 24, frequency of previous relapses and smoking were associated to endoscopic improvement/healing. Dose intensification to weekly dosing was needed in 16.4%. Parallel azathioprine therapy and clinical remission at week 12 was inversely associated to dose escalation to weekly dosing. CONCLUSION Clinical efficacy and normalized C-reactive protein at week 12, need for combined immunosuppression, luminal disease and smoking are predictors for medium term clinical efficacy/mucosal healing during adalimumab therapy, while parallel azathioprine therapy may decrease the probability for dose escalation.
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Affiliation(s)
- Lajos Sándor Kiss
- Semmelweis Egyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika Budapest
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Szamosi A, Martos E, Angyal J, Beli T, Soos K, Szamosi T. Fundus of the eye in adolescents with essential hypertension after long term lifestyle modification. J Am Coll Nutr 2010. [DOI: 10.1080/07315724.2010.10719867] [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: 10/26/2022]
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18
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Lakatos L, Czeglédi Z, Dávid G, Kispál Z, Kiss LS, Palatka K, Kristóf T, Molnár T, Salamon A, Demeter P, Miheller P, Szamosi T, Banai J, Papp M, Bene L, Kovács A, Rácz I, Lakatos PL. [Treatment adherence and use of complementary and alternative medicine in patients with inflammatory bowel disease]. Orv Hetil 2010; 151:250-8. [PMID: 20133244 DOI: 10.1556/oh.2010.28805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
UNLABELLED Previous studies have suggested an increasing use of complementary and alternative medicine (CAM) in patients with inflammatory bowel disease (IBD). Furthermore, a significant number of IBD patients fail to comply with treatment. The aim of our study was to evaluate the prevalence of non-adherence the use of CAM in Hungarian patients with IBD. METHODS A total of 655 consecutive IBD patients (Crohn's disease [CD]: 344, age: 38.2 + or - 12.9 years; ulcerative colitis [UC]: 311, age: 44.9 + or - 15.3 years) were interviewed during the visit at specialists by self-administered questionnaire including demographic and disease-related data, as well as items analyzing the extent of non-adherence and CAM use. Patients taking more then 80% of each prescribed medicine were classified as adherent. RESULTS The overall rate of self reported non-adherence (CD: 20.9%, UC: 20.6%) and CAM (CD: 31.7%, UC: 30.9%) use was not different between CD and UC. The most common causes of non-adherence were: forgetfulness (47.8%), too many/unnecessary pills (39.7%), being afraid of side effects (27.9%) and too frequent dosing. Most common forms of CAM were herbal tee (47.3%), homeopathy (14.6%), special diet (12.2%), and acupuncture (5.8%). In CD, disease duration, date of last follow-up visit, educational level and previous surgeries were predicting factors for non-adherence. Alternative medicine use was associated in both diseases with younger age, higher educational level and immunosuppressant use. In addition, CAM use in UC was more common in females and in patients with supportive psychiatric/psychological therapy. CONCLUSIONS Non-adherence and CAM use is common in patients with IBD. Special attention should be paid to explore the identified predictive factors during follow-up visits to improve adherence to therapy and improving patient-doctor relationship.
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Affiliation(s)
- László Lakatos
- Csolnoky Ferenc Megyei Kórház Belgyógyászati Centrum, Veszprém, Kórház u, 1, 8200
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19
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Miheller P, Lakatos PL, Horváth G, Molnár T, Szamosi T, Czeglédi Z, Salamon A, Czimmer J, Rumi G, Palatka K, Papp M, Jakab Z, Szabó A, Gelley A, Lakatos L, Barta Z, Balázs C, Rácz I, Zeher M, Döbrönte Z, Altorjay I, Hunyady B, Simon L, Papp J, Banai J, Nagy F, Lonovics J, Ujszászy L, Muzes G, Herszényi L, Tulassay Z. Efficacy and safety of infliximab induction therapy in Crohn's Disease in Central Europe--a Hungarian nationwide observational study. BMC Gastroenterol 2009; 9:66. [PMID: 19740450 PMCID: PMC2755473 DOI: 10.1186/1471-230x-9-66] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 09/10/2009] [Indexed: 02/08/2023] Open
Abstract
Background Infliximab (IFX) has proven to be an effective addition to the therapeutic arsenal for refractory, fistulizing, and steroid dependent Crohn's disease (CD), with efficacy in the induction and maintenance of clinical remission of CD. Our objective in this study is to report the nationwide, multicenter experience with IFX induction therapy for CD in Hungary. Methods During a 6-year-period, beginning in 2000, a total of 363 CD patients were treated with IFX as induction therapy (5 mg/kg IFX infusions given at week 0, 2 and 6) at eleven centers in Hungary in this observational study. Data analysis included patient demographics, important disease parameters and the outcome of IFX induction therapy. Results Three hundred and sixty three patients (183 women and 180 men) were treated with IFX since 2000. Mean age was 33.5 ± 11.2 years and the mean duration of disease was 6.7 ± 6.1 years. The population included 114 patients (31.4%) with therapy-refractory CD, 195 patients (53.7%) with fistulas, 16 patients (4.4%) with both therapy-refractory CD and fistulas, and 26 patients (7.2%) with steroid dependent CD. Overall response rate was 86.2% (313/363). A higher response rate was observed in patients with shorter disease duration (p = 0.05, OR:0.54, 95%CI:0.29-0.99) and concomitant immunosuppressant therapy (p = 0.05, OR: 2.03, 95%CI:0.165-0.596). Concomitant steroid treatment did not enhance the efficacy of IFX induction therapy. Adverse events included 34 allergic reactions (9.4%), 17 delayed type hypersensitivity (4.7%), 16 infections (4.4%), and 3 malignancies (0.8%). Conclusion IFX was safe and effective treatment in this cohort of Hungarian CD patients. Based on our experience co-administration of immunosuppressant therapy is suggested in patients receiving IFX induction therapy. However, concomitant steroid treatment did not enhanced the efficacy of IFX induction therapy.
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Affiliation(s)
- Pál Miheller
- 2nd Department of Medicine, Semmelweis University, Budapest, Hungary.
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Tolmácsi B, Rábai K, Szamosi T, Czeglédi Z, Gyökeres T, Zsigmond F, Banai J. [Self-expanding metal stents for palliation of malignant oesophageal obstruction]. Magy Seb 2009; 62:59-66. [PMID: 19386565 DOI: 10.1556/maseb.62.2009.2.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Malignant oesophageal stenosis can be caused by cancer of the oesophagus, gastric cardia, lungs, mediastinum or, rarely, breast. Most of these cases are inoperable due to advanced stage of the disease, comorbidities or age of the patients; and palliative treatment can be applied only. The quality of life is mostly determined by the extent of dysphagia. Several methods are available to palliate dysphagia. Hereby, the authors review their results with palliation of malignant oesophageal obstruction applying self-expanding metal stents. PATIENTS AND METHODS 68 endoscopic stent implantations were performed in 64 patients (15 female and 49 male) with malignant dysphagia between 2003 and 2008. After radiological investigations, distally deployed covered stents with or without an antireflux valve were placed, depending on the localization of the tumour. In one patient with a stenosis localized in the upper third of the oesophagus a proximally deployed covered stent was used. The aim was to re-establish oral nutrition and cover possible fistulas. RESULTS Significant improvement of swallowing was detected in every patient. Average dysphagia score has improved from 3.2 to 1.7. Technical difficulties during stenting occurred in a relatively low percentage of patients only (2 in 68; i.e. 2.94%). Fistulas were covered in every case. Early stent migration (<7 days) happened in one case. One patient suffered non-fatal myocardial infarction two days after stent placement. In 5 cases tumour in- and overgrowth, in 4 cases bleeding was seen as late complications. Oesophago-tracheal fistula was noted in three patients after stent implantation. Late stent migration (>7 days) occurred in two patients. Re-stenting was necessary in four cases, while three patients needed an upper GI endoscopy for cleansing the stent caused by food obstruction. CONCLUSIONS According to our data self-expanding metal stents are highly effective and safe for improving dysphagia. Stent-related complications are relatively rare. This method is highly recommended for palliation of malignant dysphagia.
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Affiliation(s)
- Balázs Tolmácsi
- HM Allami Egészségügyi Központ Gasztroenterológiai Osztály, Budapest, Hungary.
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Fajcsák Z, Kovács V, Gábor A, Szamosi T, Martos É. Twelve weeks low glycemic load diet reduced body weight, fat mass and hunger in overweight/obese children. Acta Alimentaria 2008. [DOI: 10.1556/aalim.2008.0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lakatos PL, Szamosi T, Szilvasi A, Molnar E, Lakatos L, Kovacs A, Molnar T, Altorjay I, Papp M, Tulassay Z, Miheller P, Papp J, Tordai A, Andrikovics H. ATG16L1 and IL23 receptor (IL23R) genes are associated with disease susceptibility in Hungarian CD patients. Dig Liver Dis 2008; 40:867-73. [PMID: 18499543 DOI: 10.1016/j.dld.2008.03.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Revised: 03/28/2008] [Accepted: 03/31/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND North American and European genome-wide association scans have identified ATG16L1 and IL23R as novel inflammatory bowel disease (IBD) susceptibility genes and subsequent reports confirmed these findings in large independent populations. The aims of this study were to investigate the association and examine genotype-phenotype relationships in a Hungarian IBD cohort. METHODS 415 unrelated IBD patients (CD: 266, age: 35.2+/-12.1 years, duration: 8.7+/-7.5 years and UC: 149, age: 44.4+/-15.4 years, duration: 10.7+/-8.9 years) and 149 healthy subjects were investigated. IL23R Arg381Gln (R381Q, rs11209026) and ATG16L1 Thr300Ala (T300A, rs2241880) polymorphisms were tested using LightCycler allele discrimination method. Detailed clinical phenotypes were determined by reviewing the medical charts. RESULTS The association between IL23R rs11209026, ATG16L1 rs2241880 and CD was confirmed (OR(IL23R381Q): 0.38, 95% CI: 0.16-0.87; OR(ATG16L1300AA): 1.86, 95% CI: 1.04-3.40). No difference was found between patients with UC and either controls or CD. In CD, IL23R 381Gln heterozygosity was associated with inflammatory disease (70% vs. 34%, p=0.037), while disease restricted to the colon was more prevalent in patients with the ATG16L1 300Ala/Ala homozygosity (33.3% vs. 21.1%, p=0.036). In addition, carriage of the variant alleles did not predict response to steroids, infliximab or need for surgery. CONCLUSIONS We confirmed that ATG16L1 and IL23R are susceptibility loci for CD in Hungarian CD patients. Further studies are needed to confirm the reported phenotype-genotype associations found in this study.
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Affiliation(s)
- P L Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
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Lakatos PL, Altorjay I, Mándi Y, Lakatos L, Tumpek J, Kovacs A, Molnar T, Tulassay Z, Miheller P, Palatka K, Szamosi T, Fischer S, Papp J, Papp M. Interaction between seroreactivity to microbial antigens and genetics in Crohn’s disease: is there a role for defensins? ACTA ACUST UNITED AC 2008; 71:552-9. [PMID: 18397186 DOI: 10.1111/j.1399-0039.2008.01049.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Kocsis AK, Lakatos PL, Somogyvári F, Fuszek P, Papp J, Fischer S, Szamosi T, Lakatos L, Kovacs A, Hofner P, Mándi Y. Association of beta-defensin 1 single nucleotide polymorphisms with Crohn's disease. Scand J Gastroenterol 2008; 43:299-307. [PMID: 18938660 DOI: 10.1080/00365520701682615] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE It has been suggested that deficient defensin expression is associated with the chronic inflammation of Crohn's disease. The regional localization of Crohn's disease, ileal or colonic disease can be linked to different defensin profiles. As constitutive beta-defensin 1 has a colonic expression, we considered it of interest to investigate single nucleotide polymorphisms (SNPs) of the beta-defensin 1 gene (DEFB1) in Crohn's disease. MATERIAL AND METHODS Three SNPs of the DEFB1 gene, DEFB1 G-20A (rs11362), DEFB1 C-44G (rs1800972) and DEFB1 G-52A (rs1799946), were genotyped either by Custom TaqMan SNP genotyping assays or by restriction fragment length polymorphisms (RFLP) in 190 patients with Crohn's disease and 95 Hungarian controls. RESULTS It was found that the G-20A and C-44G SNPs had a strong association with the colonic and ileocolonic localizations of the disease, respectively, but no association was detected for the ileal localization. A significantly higher frequency of the GA genotype of G-20A was observed among patients with colonic localization (60%) as compared with healthy controls (39%), with an odds ratio (OR) of 2.39. The GG genotype of C-44G SNP, which is regarded as a protective genotype, was much less frequent (4%) among patients than among controls (12%), OR 3.367. CONCLUSIONS These results indicate that genetic variations in the DEFB1 gene encoding constitutive human beta-defensin 1 may be associated with the risk for Crohn's disease and may determine disease phenotype, e.g. colonic localization.
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Affiliation(s)
- Agnes Katalin Kocsis
- Department of Medical Microbiology and Immunobiology, University of Szeged, Szeged, Hungary
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de Jongh S, Ose L, Szamosi T, Gagné C, Lambert M, Scott R, Perron P, Dobbelaere D, Saborio M, Tuohy MB, Stepanavage M, Sapre A, Gumbiner B, Mercuri M, van Trotsenburg ASP, Bakker HD, Kastelein JJP. Efficacy and safety of statin therapy in children with familial hypercholesterolemia: a randomized, double-blind, placebo-controlled trial with simvastatin. Circulation 2002; 106:2231-7. [PMID: 12390953 DOI: 10.1161/01.cir.0000035247.42888.82] [Citation(s) in RCA: 179] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND A multicenter, randomized, double-blind, placebo-controlled study was conducted to evaluate LDL cholesterol-lowering efficacy, overall safety, and tolerability and the influence on growth and pubertal development of simvastatin in a large cohort of boys and girls with heterozygous familial hypercholesterolemia (heFH). METHODS AND RESULTS A total of 173 heFH children (98 boys and 75 girls) were included in this study. After a 4-week diet/placebo run-in period, children with heFH were randomized to either simvastatin or placebo in a ratio of 3:2. Simvastatin was started at 10 mg/d and titrated at 8-week intervals to 20 and then 40 mg/d. During a 24-week extension period, the patients continued to receive simvastatin (40 mg) or placebo according to their assignment. After 48 weeks of simvastatin therapy, there were significant reductions of LDL cholesterol (-41%), total cholesterol (-31%), apolipoprotein B (-34%), VLDL cholesterol (-21%), and triglyceride (-9%) levels. HDL cholesterol and apolipoprotein A-I levels were increased by 3.3% and 10.4%, respectively (not significant). No safety issues became evident. Except for small decreases in dehydroepiandrosterone sulfate compared with placebo, there were no significant changes from baseline in adrenal, gonadal, and pituitary hormones in either treatment group. CONCLUSIONS Simvastatin significantly reduced LDL cholesterol, total cholesterol, triglyceride, VLDL cholesterol, and apolipoprotein B levels and was well tolerated in children with heFH. There was no evidence of any adverse effect of simvastatin on growth and pubertal development. Therefore, simvastatin at doses up to 40 mg is a well-tolerated and effective therapy for heFH children.
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Affiliation(s)
- Saskia de Jongh
- Department of Vascular Medicine, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Veres A, Szamosi T, Ablonczy M, Szamosi T, Singh M, Karádi I, Romics L, Füst G, Prohászka Z. Complement activating antibodies against the human 60 kDa heat shock protein as a new independent family risk factor of coronary heart disease. Eur J Clin Invest 2002; 32:405-10. [PMID: 12059985 DOI: 10.1046/j.1365-2362.2002.01007.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several groups have reported high levels of antibodies against 60 kDa heat shock proteins (hsp) associated with coronary heart disease. METHODS AND RESULTS Complement activating (CA) antihsp60 autoantibodies were measured by the AtheroRisk kit (CardioPath Ltd, Alloa, UK), in parallel with IgG antibodies to human hsp60 and mycobacterial hsp65 by ELISA in 32 healthy children (18 boys, 14 girls, 11.8 +/- 4.0 years). At least one of the parents of these children had a history of myocardial infarction before 55 years of age (high family risk (HFR) group). The control group consisted of 63 healthy children (31 boys, 32 girls, 9.0 +/- 3.6 years) without known family history of coronary heart disease (CHD), hypertension, and diabetes mellitus. Concentrations of CA antihsp60 antibodies were significantly (P = 0.021) higher in the HFR group than in the control group. Also in the HFR group, significantly (P = 0.004) lower high-density lipoprotein cholesterol (HDL-C)-cholesterol (measured enzymatically) and significantly (P = 0.020) higher low-density lipoprotein cholesterol (LDL-C)-cholesterol levels (calculated by the Friedewald formula) were observed when compared with the controls. The difference in the CA antihsp60 antibody levels between the HFR and control groups remained significant even after adjustments for age, smoking, HDL-cholesterol, LDL-cholesterol levels, and white blood cell count. Children with high (in the highest quartile) CA antihsp60 antibody levels compared with those with normal levels of these antibodies also had adjusted odds ratios (OR) of 9.80 (2.15-44.58, P = 0.003), indicating high family risk. No significant difference in the IgG antihsp antibody levels was observed. CONCLUSIONS These findings indicate that high levels of CA autoantibodies against hsp60 can be considered to be a novel family risk factor of CHD, independent of HDL- and LDL-cholesterol levels.
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Affiliation(s)
- A Veres
- 3rd Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Prohászka Z, Veres A, Szamosi T, Ablonczy M, Singh M, Romics L, Füst G. Complement activating antibodies against the 60 kD heat shock proteins as a new and independent family risk factor of coronary heart disease. ATHEROSCLEROSIS SUPP 2001. [DOI: 10.1016/s1567-5688(01)80185-9] [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: 10/18/2022]
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Szamosi T, Murber A, Szamosi T, Tory V, Kosztolicz A, Sztankits K. Atherosclerosis risk factors in children of high risk families. Acta Physiol Hung 2000; 86:185-90. [PMID: 10943646] [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: 02/17/2023]
Abstract
UNLABELLED The Objective of this study was to determine the frequency of care reactive atherosclerosis risk factors in children of parents with premature coronary heart disease observed before their 45 years of age for the promotion of the effectivity of the preventive work started in childhood and adolescent ages. METHODS Height and weight was measured. Body mass index (BMI) was calculated. Fat analysis was performed in children with overweight. Blood pressure was measured and both 24 hour monitoring and fundoscopy were performed in cases with a blood pressure higher than 90 centile values. Fasting blood sugar (BS) level was measured. Oral glucose tolerance test was made in cases with a fasting BS level higher than 5 mmol/l. Serum total cholesterol (TC), HDL-cholesterol (HDLC) and total triglyceride (TT) levels were measured and LDL-cholesterol (LDLC) level was calculated. The plasma thiobarbituric acid reactive system (TBARS) was investigated. Statistical analyses were performed by chi2 and Student t-probes. Data of 1140 offsprings and 457 referents without any high atherosclerotic risk family history were analyzed. RESULTS BMI of 87 offsprings was higher than the 90 centile value. The fat percent of the body of these children was higher than 40. The blood pressure of 311 children and adolescents was higher than the 90 centile value. Fasting BS level was higher than 5 mmol/l in 47 cases 17 of them showed a pathologic oral glucose tolerance test. High serum TC level was observed in 67 cases, high serum TT level was found in 8 cases. 245 offsprings had a low serum HDLC level. The plasma TBARS level was high in 241 cases. Data of referents differed significantly from those of offsprings. Their serum TC, LDLC levels and plasma TBARS level were lower, serum HDLC level was higher than that of children and adolescents with high risk atherosclerotic family history. CONCLUSION Risk factors of atherosclerosis are detectable in children and adolescents of high risk families. The measurement of these factors may help the efficacy of the preventive work.
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Affiliation(s)
- T Szamosi
- Second Department of Pediatrics, Semmelweis University of Medicine, Budapest, Hungary.
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Németh Á, Szamosi T, Horváth E, Szabolcs J, Lozsádi K. A case of familiar hypercholesterinaemia II/A associated with valvular aortic stenosis. Atherosclerosis 2000. [DOI: 10.1016/s0021-9150(00)80997-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Szilágyi G, Szamosi T, Sárai A, Szemerédi P, Nagy Z. [The cumulative risk index in stroke prevention]. Orv Hetil 2000; 141:901-3. [PMID: 10827470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The screening and special management of high risk patient, is possible strategy to reduce the high morbidity and mortality of stroke. In the II. district of Budapest we examined high vascular risk patients cooperating with general practitioners. We let the severity of risk with arithmetic of the cumulative risk index. Significant relation was found between of high cumulative risk index and 50% or higher carotis stenosis, as well as the cumulative risk index and low Se HDL level. Increased blood pressure level has been found in among the treated hypertonic patient. Reduction of high blood pressure was documented in the 6 month control examination. Finally there was very low level of smoking in the high vascular risk patient group.
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Affiliation(s)
- G Szilágyi
- Altalános Orvostudományi Kar, Semmelweis Egyetem, Budapest
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Szamosi T. Recent studies regarding the role of childhood nutrition in the prevention of atherosclerosis. J Am Coll Nutr 1995; 14:406. [PMID: 8568120 DOI: 10.1080/07315724.1995.10718529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
Children whose parents had early coronary heart disease were investigated. In order to assess high-risk parameters serum total cholesterol (TC), total triglyceride (TT), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC), lipid peroxide (LP), prostacyclin (PGI2), thromboxane (TX) levels, and the distribution of the complement 3 (C3), protein phenotypes were measured. Compared to a group of control children, the offspring of high-risk subjects had increased LDLC, LP, TC, and TX levels, a higher incidence of fast-slow heterozygotes, and decreased HDLC and PGI2 levels. The measurement of serum PGI2, TX levels and the distribution of C3 protein phenotypes may give further information about the true risk of atherosclerosis.
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Affiliation(s)
- T Szamosi
- Department of Pediatrics No. 2, Semmelweis University Medical School, Budapest, Hungary
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Horváth K, Horn G, Hassan Bin G, Szamosi T, Nemes Nagy A, Bodánszky H. [Chronic recurrent abdominal pain and lactose malabsorption in childhood]. Orv Hetil 1990; 131:2631-5. [PMID: 2263351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Authors examined 515 children with abdominal pain in the outpatient clinics for a period of two years. The pain was frequently periumbilical or mid epigastric with a history of more than two months. Persistent lactose malabsorption was found in 252 children (48,9%), which justifies the use of Breath Hydrogen Test as a first diagnostic procedure for assessing recurrent abdominal pain. Putative pathogens were identified in the stool specimens of 21 patients. Oesophagitis was diagnosed in 18 children and duodenal ulcer in one. 91 patients (less than 6 years old) improved after successful treatment of the chronic upper respiratory inflammations. The authors did not find any causes in 18.1 per cent of the children examined and they think that the abdominal pain in these children may be psychogenic. The use of high-fiber diet is proposed for the later group.
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Affiliation(s)
- K Horváth
- Semmelweis Orvostudományi Egyetem, Budapest
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Szamosi T, Hacsek G, Szamosi A, Popovits I, Venekei I, Jávor A. Different cholesterol fractions, LCAT activity and lipid peroxides in the serum of children whose parents had early coronary heart disease. Clin Biochem 1988; 21:97-9. [PMID: 3390903 DOI: 10.1016/s0009-9120(88)80095-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Children whose parents had early coronary heart disease were investigated for lipid abnormalities. In order to assess high risk parameters and the efficacy of the applied care, serum total cholesterol (TC), total triglyceride (TT), total free cholesterol (FC) high density lipoprotein cholesterol (HDLC), high density lipoprotein free cholesterol (HDLFC), lipid peroxide (LP) levels, and lecithin: cholesterol acyl transferase (LCAT) activity were measured. Compared to a group of control children, the offspring of high risk subjects had increased TC, FC, and LP levels and decreased HDLC levels. After one year of preventative care all parameters normalized except the high FC level and elevated LCAT activity. The measurement of serum FC and LP levels seems to be a useful method for the determination of true high risk. The LCAT activity may show the efficacy of the dietary treatment.
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Affiliation(s)
- T Szamosi
- Department of Pediatrics No. 2, Semmelweis University Medical School, Budapest, Hungary
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Abstract
Children of parents who had their first acute myocardial infarction (AMI) before the age of 45 years were investigated and divided into 2 groups. Group 1 consisted of 12 children: both their parents or one parent and grandparents suffered from AMI. Group 2 consisted of 55 children, each of whom had one parent with AMI. Serum levels of total cholesterol (TC) and lipid peroxide (LP) were higher in these children and HDL-cholesterol values were lower than those of 39 control children. The extent of serum TC and HDL-C differences was similar in both high risk groups but the serum LP level was significantly higher in group 1 than in group 2. The serum free cholesterol (FC) level was higher in group 1 than in controls. Children were treated according to a program giving advice on diet, physical exercise and health education for 1 year. At the end of this period the serum HDL-C level increased in both groups, while LP and TC levels decreased. The high serum FC level did not change.
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Affiliation(s)
- T Szamosi
- Department of Pediatrics No. 2, Semmelweis University Medical School, Budapest, Hungary
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Szamosi T, Gara I, Venekei I, Jávor A, Ceskel R, Knoll J. [Lipid peroxides and other lipid metabolism parameters in the serum of children of parents with a past history of myocardial infarct]. Orv Hetil 1987; 128:837-40. [PMID: 3587960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Szamosi T, Szollár J, Meggyesi V, Wilhelm O, Bodánszky H, Mátyus J. [Low serum HDL cholesterol levels in progeria]. Orv Hetil 1985; 126:2039-42. [PMID: 4034191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Szamosi T, Szollár J, Meggyesi V, Wilhelm O, Bodánszky H, Mátyus J. Serum cholesterol and triglyceride levels in progeria as a model of ageing. Mech Ageing Dev 1984; 28:243-8. [PMID: 6521505 DOI: 10.1016/0047-6374(84)90024-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Hutchinson-Gilford progeria was observed in two brothers. Their parents, sister and other relatives did not show any signs of this illness. Serum total cholesterol and total triglyceride levels were normal in the whole family. The serum high density lipoprotein cholesterol (HDL-C) level of parents was low and that of boys was extremely low. The serum HDL-C level of the healthy sister and other relatives was normal. These findings in homozygous children and heterozygous parents may explain the development of the very early fatal arteriosclerosis described in this disease. The connection between the disorder of the lipid metabolism and progeria can serve as a useful model in the study of the role of lipid metabolism in normal ageing.
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Szamosi T, Miriszlai E, Schmidt M, Bognár I, Mátyus J. [The significance of local antibiotic therapy of lower respiratory tract diseases in infancy and childhood]. Orv Hetil 1983; 124:631-3. [PMID: 6843985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Szamosi T, Marosvári I, Borus B. [Intestinal parasitosis in children treated for obstructive bronchitis and subglottic laryngitis]. Orv Hetil 1980; 121:1637-9. [PMID: 7454275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Szamosi T, Porjesz T. The penetration of the membrane of mitochondria, obtained from livers of adult or old rats, by different anions. Experientia 1972; 28:394-6. [PMID: 5036548 DOI: 10.1007/bf02008296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Szamosi T. The effect of sound, light and vibratory stimuli on serum lipid levels and liver fatty acid content of old and adult rats. Experientia 1971; 27:628-9. [PMID: 5556433 DOI: 10.1007/bf02136927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Szamosi T, Székely JI, Bálint A, Zombory J. The effect of conflicting uncoditioned reflexes on serum cholesterol level in the rat. Experientia 1968; 24:801-2. [PMID: 4176306 DOI: 10.1007/bf02144878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Szamosi T, Orményi I, Makláry L, Zombory J. The effect of meterological factors on the serum cholesterol level of arteriosclerotic patients. Int J Biometeorol 1965; 9:171-176. [PMID: 5867936 DOI: 10.1007/bf02188473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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