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Ghosh S, Sensky T, Casellas F, Rioux LC, Ahmad T, Márquez JR, Vanasek T, Gubonina I, Sezgin O, Ardizzone S, Kligys K, Petersson J, Suzuki Y, Peyrin-Biroulet L. A Global, Prospective, Observational Study Measuring Disease Burden and Suffering in Patients with Ulcerative Colitis Using the Pictorial Representation of Illness and Self-Measure Tool. J Crohns Colitis 2020; 15:jjaa159. [PMID: 32722760 PMCID: PMC7904086 DOI: 10.1093/ecco-jcc/jjaa159] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The understanding the Impact of ulcerative COlitis aNd Its assoCiated disease burden on patients study [ICONIC] was a 2-year, global, prospective, observational study evaluating the cumulative burden of ulcerative colitis [UC] using the Pictorial Representation of Illness and Self-Measure [PRISM] tool that is validated to measure suffering, but not previously used in UC. METHODS ICONIC enrolled unselected outpatient clinic attenders with recent-onset UC. Patient- and physician-reported outcomes including PRISM, the Short Inflammatory Bowel Disease Questionnaire [SIBDQ], the Patient Health Questionnaire [PHQ-9], and the Simple Clinical Colitis Activity Indexes [patient: P-SCCAI; physician: SCCAI] were collected at baseline and follow-up visits every 6 months. Correlations between these measures were assessed using Spearman's rank correlation coefficient. RESULTS Overall, 1804 evaluable patients had ≥1 follow-up visit. Over 24 months, mean [SD] disease severity measured by P-SCCAI/SCCAI reduced significantly from 4.2 [3.6]/3.0 [3.0] to 2.4 [2.7]/1.3 [2.1] [p<0.0001]. Patient-/physician-assessed suffering, quantified by PRISM, reduced significantly over 24 months [p<0.0001]. SCCAI/P-SCCAI, and patient-/physician-assessed PRISM, showed strong pairwise correlations [rho ≥0.60, p<0.0001], although physicians consistently underestimated these disease severity and suffering measures compared with patients. Patient-assessed PRISM moderately correlated with other outcome measures, including SIBDQ, PHQ-9, P-SCCAI, and SCCAI (rho = ≤-0.38 [negative correlations] or ≥0.50 [positive correlations], p<0.0001). CONCLUSION Over 2 years, disease burden and suffering, quantified by PRISM, improved in patients with relatively early UC. Physicians underestimated burden and suffering compared with patients. PRISM correlated with other measures of illness perception in patients with UC, supporting its use as an endpoint reflecting patient suffering.
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Affiliation(s)
- Subrata Ghosh
- NIHR Biomedical Research Centre, University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Tom Sensky
- Faculty of Medicine, Department of Brain Sciences, Imperial College London, London, UK
| | - Francesc Casellas
- Crohn-Colitis Care Unit [UACC], Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Louis-Charles Rioux
- Service de Gastro-entérologie, Hôpital Maisonneuve-Rosemont, Montreal, ON, Canada
| | - Tariq Ahmad
- Gastrointestinal and Liver services, Royal Devon and Exeter National Health Service Foundation Trust, Exeter, UK
| | - Juan R Márquez
- Colorectal Surgery Department, Instituto de Coloproctologia ICO Clinica Las Americas, Medellin, Colombia
| | - Tomas Vanasek
- 2nd Department of Internal Medicine-Gastroenterology, Charles University Faculty of Medicine and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Irina Gubonina
- Military Medical Academy n.a. S.M.Kirov, “RIAT”, St Petersburg, Russia
| | - Orhan Sezgin
- Department of Gastroenterology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Sandro Ardizzone
- ASST Fatebenefratelli Sacoo—Department of Biochemical and Clinical Sciences “L. Sacco”, University of Milan, Milan, Italy
| | | | | | - Yasuo Suzuki
- Center of Inflammatory Bowel Disease, Toho University Sakura Medical Center, Sakura, Japan
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Panaccione R, Colombel J, Bossuyt P, Baert F, Vanasek T, Danalioglu A, Novacek G, Armuzzi A, Reinisch W, Johnson S, Buessing M, Neimark E, Petersson J, Robinson AM, Thakkar RB, Lee W, Skup M, D’Haens G. A68 COST EFFECTIVENESS OF TIGHT CONTROL FOR CROHN’S DISEASE WITH ADALIMUMAB-BASED TREATMENT: ECONOMIC EVALUATION OF CALM TRIAL FROM CANADIAN PERSPECTIVE. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - J Colombel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - P Bossuyt
- Imelda General Hospital, Bonheiden, Belgium
| | - F Baert
- AZ Delta Roeselare, Menen, Belgium
| | - T Vanasek
- Hepato-Gastroenterologie HK, s.r.o., Hradec Králové , Czechia
| | | | - G Novacek
- Medical University of Vienna, Vienna, Austria
| | - A Armuzzi
- Presidio Columbus Fondazione Policlinico Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - W Reinisch
- Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | | | - W Lee
- AbbVie Inc., North Chicago, IL
| | - M Skup
- AbbVie Inc., North Chicago, IL
| | - G D’Haens
- IBD Unit, Academic Medical Center, Amsterdam, Netherlands
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Vermeire S, Sandborn WJ, Danese S, Hébuterne X, Salzberg BA, Klopocka M, Tarabar D, Vanasek T, Greguš M, Hellstern PA, Kim JS, Sparrow MP, Gorelick KJ, Hinz M, Ahmad A, Pradhan V, Hassan-Zahraee M, Clare R, Cataldi F, Reinisch W. Anti-MAdCAM antibody (PF-00547659) for ulcerative colitis (TURANDOT): a phase 2, randomised, double-blind, placebo-controlled trial. Lancet 2017; 390:135-144. [PMID: 28527704 DOI: 10.1016/s0140-6736(17)30930-3] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [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: 12/07/2016] [Revised: 02/22/2017] [Accepted: 02/28/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND PF-00547659 is a fully human monoclonal antibody that binds to human mucosal addressin cell adhesion molecule-1 (MAdCAM-1) to selectively reduce lymphocyte homing to the intestinal tract. We aimed to assess the efficacy and safety of PF-00547659 in patients with moderate to severe ulcerative colitis. METHODS This phase 2, randomised, double-blind, placebo-controlled clinical trial recruited patients aged 18-65 years from 105 centres in 21 countries, with a history (≥3 months) of active ulcerative colitis extending more than 15 cm beyond the anal verge (with a total Mayo score ≥6 and a Mayo endoscopic subscore ≥2) who had failed or were intolerant to at least one conventional therapy. Patients were stratified by previous anti-TNFα treatment, and randomly assigned by a computer-generated randomisation schedule to receive a subcutaneous injection of 7·5 mg, 22·5 mg, 75 mg, or 225 mg PF-00547659 or placebo at baseline, then every 4 weeks. Patients, investigators, and sponsors were blinded to the treatment. The primary endpoint was the proportion of patients achieving remission (total Mayo score ≤2 with no individual subscore >1 and rectal bleeding subscore ≤1) at week 12. The efficacy analysis included all patients who received at least one dose of the randomised treatment; the safety analysis was done according to treatment received. All p values were one-sided and multiplicity-adjusted. This study is registered with ClinicalTrials.gov, number NCT01620255. FINDINGS Between Nov 2, 2012, and Feb 4, 2016, we screened 587 patients; 357 were eligible and randomly assigned to receive placebo (n=73) or PF-00547659 at doses of 7·5 mg (n=71), 22·5 mg (n=72), 75 mg (n=71), or 225 mg (n=70). Remission rates at week 12 were significantly greater in three of four active-treatment groups than in the placebo group (2·7% [two of 73]): 7·5 mg (11·3% [eight of 71]), 22·5 mg (16·7% [12 of 72]), 75 mg (15·5% [11 of 71]), and 225 mg (5·7% [four of 70]). These rates corresponded to a stratum-adjusted (anti-TNFα-naive and anti-TNFα-experienced) risk difference versus placebo of 8·0% for 7·5 mg (90% CI 1·9 to 14, p=0·0425), 12·8% for 22·5 mg (5·6 to 19·9, p=0·0099), 11·8% for 75 mg (4·8 to 18·8, p=0·0119), and 2·6% for 225 mg (-1·2 to 6·4, p=0·1803). Four of 73 (5·5%) patients had a serious adverse event in the placebo group, ten of 71 (14·1%) in the 7·5 mg group, one of 70 (1·4%) in the 22·5 mg group, three of 73 (4·1%) in the 75 mg group, and three of 70 (4·3%) in the 225 mg group. No safety signal was observed for the study drug. INTERPRETATION PF-00547659 was safe and well tolerated in this patient population, and better than placebo for induction of remission in patients with moderate to severe ulcerative colitis. The greatest clinical effects were observed with the 22·5 mg and 75 mg doses. FUNDING Pfizer.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antibodies, Monoclonal, Humanized/administration & dosage
- Antibodies, Monoclonal, Humanized/adverse effects
- Antibodies, Monoclonal, Humanized/therapeutic use
- Colitis, Ulcerative/drug therapy
- Colitis, Ulcerative/pathology
- Dose-Response Relationship, Drug
- Double-Blind Method
- Drug Administration Schedule
- Female
- Gastrointestinal Agents/administration & dosage
- Gastrointestinal Agents/adverse effects
- Gastrointestinal Agents/therapeutic use
- Humans
- Injections, Subcutaneous
- Male
- Middle Aged
- Remission Induction
- Severity of Illness Index
- Treatment Outcome
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
- Young Adult
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Affiliation(s)
- Séverine Vermeire
- Leuven University Hospital and University of Leuven, Leuven, Belgium.
| | | | - Silvio Danese
- Humanitas University, Clinical and Research Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Xavier Hébuterne
- Centre Hospitalier Universitaire de Nice Sophia Antipolis, Nice, France
| | | | - Maria Klopocka
- Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland
| | - Dino Tarabar
- Military Medical Academy, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia
| | - Tomas Vanasek
- Charles University Hospital, Hradec Kralove, Czech Republic
| | | | | | - Joo Sung Kim
- Seoul National University College of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | - Walter Reinisch
- Medical University of Vienna, Vienna, Austria; McMaster University, Hamilton, ON, Canada
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Drastich P, Lata J, Petrtyl J, Bruha R, Prochazka V, Vanasek T, Zdenek P, Skibova J, Hucl T, Spicak J. Endoscopic variceal band ligation compared with propranolol for prophylaxis of first variceal bleeding. Ann Hepatol 2011; 10:142-9. [PMID: 21502675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Administration of nonselective beta-blockers in prophylaxis of first variceal bleeding is not suitable for all patients. Thus, we evaluated endoscopic variceal band ligation (EVBL) in primary prevention of bleeding in patients with cirrhosis and large esophageal varices. A total of 73 consecutive patients with liver cirrhosis and large esophageal varices without a history of gastrointestinal bleeding were randomized to receive either EVBL or propranolol and were followed for up to 18 months. Forty patients underwent EVBL and 33 patients received propranolol. Variceal bleeding occurred in 2 patients in the EVBL (5%) and in 2 patients in the propranolol group (6%, NS). The 18 month actuarial risk for first variceal bleed was 5% in the EVBL (95% CI, 0-12%) and 20% in the propranolol group (95% CI, 0-49%, NS). The actuarial probability of death at 18 months of follow-up was 5% (95% CI, 0-11%) in the EVBL group and 7% (95% CI, 0-17%, NS) in the propranolol arm. In conclusion, EVBL was an effective and safe alternative to propranolol in primary prophylaxis of bleeding in patients with large esophageal varices.
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Affiliation(s)
- Pavel Drastich
- Department of Hepatogastroenterology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Jirkovsky V, Fejfar T, Safka V, Hulek P, Krajina A, Chovanec V, Raupach J, Lojik M, Vanasek T, Renc O, Ali SM. Influence of the secondary deployment of expanded polytetrafluoroethylene-covered stent grafts on maintenance of transjugular intrahepatic portosystemic shunt patency. J Vasc Interv Radiol 2010; 22:55-60. [PMID: 21106389 DOI: 10.1016/j.jvir.2010.09.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 04/14/2010] [Accepted: 09/02/2010] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To evaluate the effects of secondary deployment of expanded polytetrafluoroethylene (ePTFE)-covered stent grafts in the treatment of dysfunctional transjugular intrahepatic portosystemic shunts (TIPSs) in comparison with other common approaches (conventional angioplasty or implantation of bare metal stents). MATERIALS AND METHODS A retrospective review of 121 dysfunctional bare metal TIPS presenting between 2000 and 2004 was conducted. The group was divided into four subgroups according to the type of intervention: conventional angioplasty (52 cases; 43%), bare metal stent deployment (35 cases; 28.9%), nondedicated ePTFE-covered stent-graft deployment (15 cases; 12.4%), and dedicated ePTFE-covered stent-graft deployment (19 cases; 15.7%). In all four groups, the primary patency after the specific intervention was calculated and mutually compared. RESULTS Primary patency rates after 12 and 24 months were 49.7% and 25.3%, respectively, in conventional angioplasty; 74.9% and 64.9%, respectively, with bare metal stents; 75.2% and 64.5%, respectively, with nondedicated ePTFE-covered stent grafts; and 88.1% and 80.8%, respectively, with dedicated ePTFE-covered stent grafts. CONCLUSIONS In the treatment of dysfunctional TIPS, better patency after the intervention was obtained by deploying dedicated ePTFE-covered stent grafts in comparison with conventional angioplasty, bare metal stents, and nondedicated ePTFE-covered stents.
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Affiliation(s)
- Vaclav Jirkovsky
- Second Department of Internal Medicine, Teaching Hospital of Charles University, Sokolska, Hradec Králové, Czech Republic.
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Jirkovsky V, Fejfar T, Hulek P, Krajina A, Tycova V, Safka V, Chovanec V, Vanasek T, Lojik M, Raupach J, Skodova M, Renc O. Abstract No. 304: TIPS for Treatment of Portal Hypertension Due to Extramedullary Hematopoiesis in Patients with Myelofibrosis Secondary to Myeloproliferative Diseases. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.299] [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: 10/21/2022] Open
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Abstract
Portal hypertension as a consequence of liver cirrhosis is responsible for its most common complications: ascites, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatic encephalopathy and the most important one--variceal hemorrhage. Variceal bleeding results in considerable morbidity and mortality. This review covers all areas of importance in the therapy of acute variceal hemorrhage--endoscopic and pharmacological treatment, transjugular intrahepatic portosystemic shunt, surgery and balloon tamponade. Indications and limitations of these therapeutic modalities are widely discussed.
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Affiliation(s)
- Jan Lata
- Department of Internal Medicine and Gastroentrology, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
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Lata J, Fejfar T, Krechler T, Musil T, Husová L, Senkyrík M, Dolina J, Vanasek T. Spontaneous bacterial peritonitis in the Czech Republic: prevalence and aetiology. Eur J Gastroenterol Hepatol 2003; 15:739-43. [PMID: 12811304 DOI: 10.1097/01.meg.0000059160.46867.62] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [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: 01/16/2023]
Abstract
The aim of the study was to determine the prevalence and detailed data concerning the incidence of spontaneous bacterial peritonitis in the Czech Republic. Ninety-nine patients with liver cirrhosis and ascites were examined. Spontaneous bacterial peritonitis was diagnosed in 35 patients (35.4%). It was revealed more often in patients with alcoholic aetiology of cirrhosis whose anamnesis involved sub-febrile or febrile states and the deterioration of ascites. Elevated serum leucocyte counts and increased levels of C-reactive protein can contribute to the diagnosis. A low level of total protein and albumin in ascites predisposes to the increase of this infection. The reduction of the platelet count in a set of patients with spontaneous bacterial peritonitis indicates the influence of portal hypertension in the aetiology of the disease.
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Affiliation(s)
- Jan Lata
- Department of Internal Medicine and Gastroenterology, University Hospital, Brno, Czech Republic.
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