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Kablawi D, Aljohani F, Palumbo CS, Restellini S, Bitton A, Wild G, Afif W, Latakos PL, Bessissow T, Sebastiani G. A34 NONALCOHOLIC FATTY LIVER DISEASE AND LIVER FIBROSIS INCREASE CARDIOVASCULAR RISK IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991260 DOI: 10.1093/jcag/gwac036.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both NAFLD and cardiovascular diseases seem more frequent in patients with inflammatory bowel disease (IBD). Purpose We aimed to assess the effect of NAFLD and associated liver fibrosis on the cardiovascular risk in people with IBD. Method We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP >275 dB/m and liver stiffness measurement (LSM) by TE ≥8 kPa, respectively. Nonalcoholic steatohepatitis (NASH) with liver fibrosis was defined as Fibroscan-aspartate aminotransferase (AST) score (FAST) >0.35. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator proposed by the American Heart Association and computed from age, sex, race, lipid pattern, blood pressure, diabetes treatment and smoking. Based on the American Heart Association guidelines, the 10-year cardiovascular risk by ASCVD was categorized as low if <5%, borderline if 5%–7.4%, intermediate if 7.5%–19.9% and high if ≥20% or if previous cardiovascular event.Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis. Result(s) We included 405 patients with IBD (54% female; mean age 45+15 years; mean BMI 26+5 Kg/m2; 31% with ulcerative colitis; 7% with diabetes; 14% with hypertension). Overall, 278 (68%), 23 (6%), 47 (12%) and 57 (14%) were categorized as at low, borderline, intermediate and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (32%) and 35 (9%) patients, respectively. NASH with fibrosis was found in 11 (3%) patients. Patients with NAFLD and with significant liver fibrosis diagnosed by TE with CAP had higher proportion of intermediate-high ASCVD risk category (see Figure). These findings were confirmed also in young IBD patients <55 years old with NAFLD. No difference in ASCVD risk was detected for FAST score. After adjusting for IBD disease activity, significant liver fibrosis and BMI, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% confidence interval [CI] 1.56–5.68), IBD duration (aOR 1.55 per 10 years, 95% CI 1.22–1.97), and ulcerative colitis (aOR 2.32, 95% CI 1.35–3.98). Only 30% of IBD patients classified as intermediate-high ASCVD risk were on statin treatment, with no difference between patients with and without NAFLD. Image ![]()
Conclusion(s) NAFLD increases cardiovascular risk, independently of age, IBD-related factors and BMI. A potential deliverable of our finding is the targeted cardiovascular assessment in IBD patients with NAFLD and appropriate initiation of statin, particularly if they have longer IBD duration and ulcerative colitis. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared
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Affiliation(s)
- D Kablawi
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - F Aljohani
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - C S Palumbo
- Division of Gastroenterology, Jewish General Hospital, Montreal, Canada
| | - S Restellini
- University Hospital of Geneva, Geneva, Switzerland
| | - A Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - G Wild
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - W Afif
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - P L Latakos
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - T Bessissow
- Division of Gastroenterology and Hepatology, McGill University Health Centre
| | - G Sebastiani
- Division of Gastroenterology and Hepatology, McGill University Health Centre
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Kablawi D, Aljohani F, Palumbo CS, Restellini S, Bitton A, Wild G, Afif W, Lakatos PL, Bessissow T, Sebastiani G. A191 NONALCOHOLIC FATTY LIVER DISEASE AND LIVER FIBROSIS INCREASE CARDIOVASCULAR RISK IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES. J Can Assoc Gastroenterol 2023. [PMCID: PMC9991199 DOI: 10.1093/jcag/gwac036.191] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Background Non-alcoholic fatty liver disease (NAFLD) is strongly associated with cardiovascular disease in the general population. Both NAFLD and cardiovascular diseases seem more frequent in patients with inflammatory bowel disease (IBD). Purpose We aimed to assess the effect of NAFLD and associated liver fibrosis on the cardiovascular risk in people with IBD. Method We prospectively included IBD patients undergoing a routine screening program for NAFLD by transient elastography (TE) with associated controlled attenuation parameter (CAP). NAFLD and significant liver fibrosis were defined as CAP >275 dB/m and liver stiffness measurement (LSM) by TE ≥8 kPa, respectively. Nonalcoholic steatohepatitis (NASH) with liver fibrosis was defined as Fibroscan-aspartate aminotransferase (AST) score (FAST) >0.35. Cardiovascular risk was assessed with the atherosclerotic cardiovascular disease (ASCVD) risk estimator proposed by the American Heart Association and computed from age, sex, race, lipid pattern, blood pressure, diabetes treatment and smoking. Based on the American Heart Association guidelines, the 10-year cardiovascular risk by ASCVD was categorized as low if <5%, borderline if 5%–7.4%, intermediate if 7.5%–19.9% and high if ≥20% or if previous cardiovascular event.Predictors of intermediate-high cardiovascular risk were investigated by multivariable logistic regression analysis. Result(s) We included 405 patients with IBD (54% female; mean age 45+15 years; mean BMI 26+5 Kg/m; 31% with ulcerative colitis; 7% with diabetes; 14% with hypertension). Overall, 278 (68%), 23 (6%), 47 (12%) and 57 (14%) were categorized as at low, borderline, intermediate and high ASCVD risk, respectively. NAFLD and significant liver fibrosis were found in 129 (32%) and 35 (9%) patients, respectively. NASH with fibrosis was found in 11 (3%) patients. Patients with NAFLD and with significant liver fibrosis diagnosed by TE with CAP had higher proportion of intermediate-high ASCVD risk category (see Figure). These findings were confirmed also in young IBD patients <55 years old with NAFLD. No difference in ASCVD risk was detected for FAST score. After adjusting for IBD disease activity, significant liver fibrosis and BMI, predictors of intermediate-high ASCVD risk were NAFLD (adjusted odds ratio [aOR] 2.97, 95% confidence interval [CI] 1.56–5.68), IBD duration (aOR 1.55 per 10 years, 95% CI 1.22–1.97), and ulcerative colitis (aOR 2.32, 95% CI 1.35–3.98). Only 30% of IBD patients classified as intermediate-high ASCVD risk were on statin treatment, with no difference between patients with and without NAFLD. Image ![]()
Conclusion(s) NAFLD increases cardiovascular risk, independently of age, IBD-related factors and BMI. A potential implication of our finding is the targeted cardiovascular assessment in IBD patients with NAFLD and appropriate initiation of statin, particularly if they have longer IBD duration and ulcerative colitis. Please acknowledge all funding agencies by checking the applicable boxes below CAG Disclosure of Interest None Declared
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Affiliation(s)
- D Kablawi
- Division of Gastroenterology and Hepatology
| | - F Aljohani
- Department of Gastroenterology and Hepatology, McGill University Health Centre
| | - C S Palumbo
- Division of Gastroenterology, Jewish General Hospital, Montreal, Canada
| | - S Restellini
- Department of Gastroenterology, University Hospital of Geneva , Genève, Switzerland
| | - A Bitton
- Division of Gastroenterology and Hepatology
| | - G Wild
- Division of Gastroenterology and Hepatology
| | - W Afif
- Division of Gastroenterology and Hepatology
| | - P L Lakatos
- Division of Gastroenterology and Hepatology,1st Department of Medicine, Semmelweis University, Budapest, Hungary
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Golovics P, Drügg Hahn G, Wetwittayakhlang P, Wild G, Afif W, Bitton A, Bessissow T, Lakatos PL. A143 SAFETY OF BIOLOGICAL THERAPIES IN ELDERLY IBD: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859392 DOI: 10.1093/jcag/gwab049.142] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background There was a significant progress in the medical therapy of inflammatory bowel disease(IBD) with the advent of biological compounds, yet patients may experience adverse events(AE): infusion reactions, serious infections and malignancies, understudied in vulnerable patient populations (e.g. elderly). Aims Our aim was to perform a systematic review to assess the safety of the biologic therapies in the elderly IBD population. Methods Medline databases and conferences proceedings were searched between January 1, 2010, and June 1, 2021. Two reviewers independently evaluated the collected studies based on inclusion and exclusion criteria. Search was focused on IBD/CD/UC, any biological therapy, and adverse events in the elderly. The methodological quality of the included studies was assessed using the Newcastle– Ottawa Scale (NOS). This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Results Our search identified 2885 articles and 12 congress abstracts trough the data base search, finally 14 peer reviewed papers and 3 abstracts met the inclusion criteria. The majority of the studies were retrospective, merging IBD patients, with an age limit of 60 or 65 years for elderly, from Europe or North America. The gender ratio was equal except in the USA veteran database. The identified studies collected safety data on anti-TNF therapy, vedolizumab and ustekinumab. We selected studies with at least 1 year follow-up period. Ranges of AE rates(infliximab/adalimumab 6–39/100patient-years (PY), vedolizumab 6–26/100 PY and ustekinumab 6–18.2/100 PY), infection rates (anti TNF 2.5–31/100PY, vedolizumab 2.6–77/100 PY and ustekinumab 5.2–35.7/100 PY) or infusion/injection reactions (anti TNF 0–14/100PY, vedolizumab 0.9–5/100 PY and ustekinumab 0–2.6/100 PY), were not different among the biological medication. Conclusions We report for the first time the comparative safety of biological therapies in elderly IBD patients. Ranges of adverse events or infections were wide but not different among the medications. Current data are insufficient to suggest prioritizing among biologicals in the elderly based on the safety, larger studies in elderly IBD patients are warranted. Funding Agencies None
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Affiliation(s)
- P Golovics
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - G Drügg Hahn
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | | | - G Wild
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - W Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - A Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - T Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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Yanofsky R, Abduallah Y, Golovics P, Lakatos PL, Bitton A, Wild G, Afif W, Bessissow T. A150 ASSOCIATION BETWEEN SERUM USTEKINUMAB CONCENTRATIONS AND ENDOSCOPIC DISEASE ACTIVITY IN CROHN’S DISEASE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859224 DOI: 10.1093/jcag/gwab049.149] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Therapeutic drug monitoring, the measurement of serum biologic concentrations and immunogenicity, has become an important method in guiding the management of biologic therapy in patients with Crohn’s disease (CD). Ustekinumab, an inhibitor of the p40 subunit of interleukins 12 and 23, is an approved therapy for patients with CD. However, few studies have explored the relationship between serum ustekinumab drug levels and outcomes in CD. Thus, the utility of serum ustekinumab drug levels in the management of CD remains unknown. Aims The primary objective of the study was to evaluate the association between serum ustekinumab drug levels and endoscopic remission (ER) in CD. Secondary outcomes included evaluating the association between serum ustekinumab drug levels and clinical (CR), biochemical, and histological remission (HR). Methods Adult patients with CD maintained on ustekinumab were prospectively recruited at the time of routine colonoscopy from 2018 to 2021 at the Montreal University Health Centre, Montreal, Quebec. Clinical and demographic information was obtained from chart and patient review. CD symptom severity was assessed by the Harvey-Bradshaw Index (HBI), with clinical remission defined as an HBI score less than 5. Blood samples were drawn for measurement of serum ustekinumab drug level and C-reactive protein. Stool samples for fecal calprotectin were also collected. Elevated C-reactive protein and fecal calprotectin were defined as a value greater than 5 mg/L and 200 ug/g, respectively. Endoscopic remission was evaluated by the Simplified Endoscopic Score for Crohn’s Disease (SES-CD), with ER defined by an SES-CD score less than 3. If biopsies were taken, histological outcomes were recorded. HR was defined as inactive colitis. Results 53 patients were included in the study, of which 22 (41.5%) were in ER. Median [interquartile range] ustekinumab drug levels were not associated with ER (ER = 5.4 mg/L [2.6–9.4 mg/L], no ER = 4.3 mg/L [2.3–9.4 mg/L]; P=0.843). There was also no association between quartiles of ustekinumab drug levels and ER (P=0.772). In addition, there was no association observed between median ustekinumab drug level and CR (CR = 4.7 mg/L [2.7–8.3 mg/L], no CR = 3.8 mg/L [2.1–9.6 mg/L]; P=0.993) or HR (HR = 6.4 mg/L [3.5–9.5 mg/L], no HR = 3.7 mg/L [2.2–8.0 mg/L]); P=0.168). There was no association observed between median ustekinumab drug level and C-reactive protein or fecal calprotectin as well (P=0.158 and 0.923, respectively). Conclusions There was no association observed between serum ustekinumab drug levels and endoscopic remission. Further studies are required to validate our findings. Funding Agencies None
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Affiliation(s)
- R Yanofsky
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - Y Abduallah
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P Golovics
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P L Lakatos
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - A Bitton
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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Wetwittayakhlang P, Albader F, Golovics P, Drügg Hahn G, Bessissow T, Bitton A, Afif W, Wild G, Lakatos PL. A180 CLINICAL OUTCOMES OF COVID-19 AND IMPACT ON DISEASE COURSE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859145 DOI: 10.1093/jcag/gwab049.179] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The impact of COVID-19 has been of great concern in patients with IBD worldwide, including an increased risk of severe outcomes and/or flare of IBD.
Aims
This study aims to evaluate prevalence, outcomes, the impact of COVID-19 in patients with IBD, and risk factors associated with severe COVID-19 or flare of IBD.
Methods
A consecutive cohort of IBD patients diagnosed with COVID was obtained between March 2020 - April 2021.
Results
A total of 3,516 IBD cohort patients were included. 82 patients (2.3%) were diagnosed with COVID infection (median age 39.0, 77% with Crohn’s disease). The prevalence of COVID-19 in IBD was significantly lower compared to the general population in Canada and Quebec (3.5% vs. 4.3%, p<0.001). Severe COVID occurred in 6 patients (7.3%); 2 patients (2.4%) died. A flare of IBD post-COVID infection was reported in 8 patients (9.8%) within 3 months. Age ≥55 years (OR 11.1, 95%CI:1.8–68.0), systemic corticosteroid use (OR:4.6, 95%CI:0.7–30.1), active IBD (OR:3.8, 95%CI:0.7–20.8) and comorbidity (OR:4.9, 95%CI:0.8–28.6) were associated with severe COVID. After initial infection, 61% received vaccinations.
Conclusions
The prevalence of COVID-19 among patients with IBD was lower than the general population. Severe COVID and flare of IBD were relatively rare. Older age, comorbidities, active IBD, and corticosteroid, but not biological therapy were associated with severe COVID.
Outcome of COVID-19 in IBD patients, disease course of IBD, and vaccination after COVID infection
Funding Agencies
None
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Affiliation(s)
| | - F Albader
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - P Golovics
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - G Drügg Hahn
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - A Bitton
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - G Wild
- Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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Gorodensky J, Bernatsky S, Afif W, St-Pierre Y, Filion K, Vinet E. POS1420 RISK OF SERIOUS INFECTIONS IN OFFSPRING EXPOSED IN UTERO TO USTEKINUMAB OR VEDOLIZUMAB. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Ustekinumab, an IL-12/23 inhibitor, is indicated in adult patients with inflammatory bowel disease (IBD), psoriasis (PsO), and psoriatic arthritis (PsA) and vedolizumab, an α4β7 receptor antagonist is indicated in IBD only. Both are monoclonal antibodies harbouring an Fc portion, which are actively transported across the placenta, often reaching higher fetal than maternal levels. As fetuses could be exposed to therapeutic or supra-therapeutic levels of these drugs, there are concerns that these agents could cause immunosuppression after birth. However, evidence is lacking.Objectives:We compared the risk of serious infections in offspring exposed to ustekinumab, vedolizumab, tumour necrosis factor inhibitors (TNFi), and non-biologic immunosupressives versus offspring unexposed during pregnancy among women with IBD, PsO and/or PsA.Methods:We conducted a retrospective cohort study using the US MarketScan database, an employment insurance database. We included live births (01/2011-12/2018) among women with PsO, PsA, and/or IBD. Drug exposure was defined as ≥1 filled prescrip tion or infusion procedure code during pregnancy. In offspring, we evaluated serious infections within the first year of life as any single inpatient infection code. We performed multivariate analyses using logistic regression, adjusting for maternal age, co-morbidities, corticosteroid use, concomitant drug use, and preterm birth.Results:We included 16,115 offspring born to 7,612 women with PsO/PsA, 8,315 with IBD, and 188 with PsO/PsA and IBD. A total of 52 offspring were exposed to ustekinumab, 43 to vedolizumab (including 7 to both TNFi and vedolizumab),1,578 to TNFi, 1,857 to non-biologic immunosuppressives alone, and 12,585 unexposed to any drug. The percentage of serious infections in offspring exposed to ustekinumab was 3.9% (95% CI 0.5-13.9), versus 2.7% (95% CI 1.9-3.6) for TNFi, 2.3% (95% CI 0.06-13.0) for vedolizumab and 2.6 (95% CI 2.3-2.8) for those unexposed to any drug, though all estimates had wide, overlapping confidence intervals. Compared to children unexposed to any drug, there was a potential trend for increased risk with ustekinumab (OR 1.54, 0.37-6.45), but CIs were wide and included the null. For those exposed to vedolizumab (OR 0.82, 0.15-5.91) or TNFi (OR 0.98, 0.68-1.40) there was no clear excess risk.Conclusion:In a large cohort, we did not detect a clear excess risk for offspring exposed in-utero to, vedolizumab or anti-TNF’s, compared to unexposed patients; there was a signal for more events with ustekinumab, but confidence intervals were wide. Ongoing caution, as well as more research on short and long-term effects, is warranted for biologics actively transported across the placentaDisclosure of Interests:Jonah Gorodensky: None declared, Sasha Bernatsky: None declared, Waqqas Afif Consultant of: Abbvie, Amgen, Arena Pharmaceuticals, Dynacare, Janssen, Merck, Novartis, Pfizer, Sandoz, Takeda, Yvan St-Pierre: None declared, Kristian Filion: None declared, Evelyne Vinet: None declared
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Xiao Y, Al Khoury A, Golovics P, Kohen R, Afif W, Wild G, Friedman G, Galiatsatos P, Hilzenrat N, Szilagyi A, Wyse J, Cohen A, Bitton A, Bessissow T, Lakatos PL. A157 REAL-WORLD TIGHT OBJECTIVE MONITORING WITH ADALIMUMAB LEADS TO EARLIER DOSE OPTIMIZATION AND HIGHER CLINICAL REMISSION RATES AT 12 MONTHS. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.155] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Data suggests that tight objective monitoring of inflammatory bowel diseases (IBD) may improve one-year clinical outcomes.
Aims
The goal of this study is to assess the adherence to serial tight objective monitoring, via clinical symptoms and biomarkers, and the effect of such tight monitoring on one year outcome in IBD patients at an academic and an university-affiliated center.
Methods
We retrospectively reviewed the chart of 428 consecutive IBD patients who started adalimumaby at the McGill University Health Center and Jewish General Hospital (Montreal, Canada) between January 1, 2015 and January 1, 2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index and partial Mayo), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) were captured at treatment initiation and at 3, 6, 9, and 12 months. Combined adherence was defined as the evaluation of ≥2 of 3 parameters(clinical, CRP, FCAL). Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method.
Results
Clinical symptoms were assessed in nearly all patients at 3 (CD-UC:95-94%), 6 (90-83%), 9 (86-85%) and 12 (96-89%) months. CRP was also available for most patients but the frequency of assessment decreased in CD patients over the study period. In comparison, compliance to serial FCAL testing was low throughout the follow-up period. Clinical remission at one-year was significantly higher in patients who were adherent to early assessment visit at 3 months (p=0.001 both for CD and UC). Adherence to early follow-up also resulted in earlier dose optimisation in both CD and UC patients(pLogrank=0.026 for UC and p=0.09 for CD). However, the overall drug sustainability did not differ.
Conclusions
Clinical assessment and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization and improved one-year clinical outcomes but did not change drug sustainability rates.
Funding Agencies
None
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Affiliation(s)
- Y Xiao
- Internal Medicine, McGill University, Montreal, QC, Canada
| | | | | | - R Kohen
- McGill University Health Centre, Montreal, QC, Canada
| | - W Afif
- McGill University Health Centre, Montreal, QC, Canada
| | - G Wild
- McGill University Health Centre, Montreal, QC, Canada
| | - G Friedman
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - P Galiatsatos
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - N Hilzenrat
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - A Szilagyi
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - J Wyse
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - A Cohen
- Sir Mortimer B Davis Jewish General Hospital, Montreal, QC, Canada
| | - A Bitton
- McGill University Health Centre, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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Benchimol EI, Afif W, Plamondon S, Newhook D, Nicholls SG, Lévesque D. A192 A MEDICAL SUMMARY TEMPLATE FOR THE TRANSFER OF PATIENTS WITH INFLAMMATORY BOWEL DISEASE TRANSITIONING FROM PEDIATRIC TO ADULT CARE. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The transfer of information in a medical summary letter is a key aspect of the transition of adolescent patients with IBD from pediatric to adult care. The existing template from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) is nearly 20 years old, and the many intervening changes to the care of children with IBD necessitate a new template to reflect modern care.
Aims
We developed a standardized medical summary template based on the feedback of adult and pediatric IBD health care providers.
Methods
We purposively sampled gastroenterologists (GIs) or nurse practitioners (NPs) caring for patients with IBD in Montreal, Ottawa, Toronto or Vancouver and invited them to take part in focus group discussions. Gastroenterologists caring for <50 IBD patients in the past 2 years were excluded. We invited 30 local academic or community-based physicians and nurse-practitioners, of whom 17 (56.7%) agreed to participate. Four focus groups were conducted, consisting of: 1) adult GIs practicing in Ottawa; 2) adult GIs practicing in Montreal and Sherbrooke; 3) paediatric GIs and NPs practicing in Ottawa, Montreal, Toronto or Vancouver; 4) a mixed group consisting of most participants from the preceding three groups. Focus groups employed a semi-structured approach and were recorded with consent. Informed by conventional content analysis, we inductively coded the focus group transcripts to identify all areas of priority for inclusion in the template. The final mixed focus group finalized the template content based information from the preceding groups.
Results
Content areas of importance (see Table) were: patient/disease characteristics, therapeutics history, clinical history and current status, noteworthy investigations, history of complications, family history, immunization history, and psychosocial history. In addition, the template addressed health system process factors (i.e., urgency of transfer, mode of delivery, confidentiality) to ensure a seamless transfer to adult care.
Conclusions
The standardized medical summary template should be used by pediatric providers to ensure that essential information is sent to the receiving adult provider.
Funding Agencies
Transition des patients avec Crohn et colite (TRACC) program
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Affiliation(s)
- E I Benchimol
- SickKids IBD Centre, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - S Plamondon
- Gastroenterology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - D Newhook
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - S G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - D Lévesque
- Gastroenterology, McGill University, Montreal, QC, Canada
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Balram B, Al Khoury A, Bessissow T, Afif W, gonczi L, abreu M, Lakatos PL. A174 PATIENT PERSPECTIVES AND EXPECTATIONS IN INFLAMMATORY BOWEL DISEASE: A SYSTEMATIC REVIEW. J Can Assoc Gastroenterol 2021. [DOI: 10.1093/jcag/gwab002.172] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Shared decision making is gaining favour in clinical practice and increasingly patients want to be involved in their disease process.
Aims
In this systematic review, our objective was to assess inflammatory bowel disease (IBD) patient preferences and perspectives relating to their disease diagnosis, treatment, knowledge needs and telemedicine.
Methods
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Four databases and conference proceedings were searched between January 1, 1980, and May 1, 2020. The methodological quality of the included studies was assessed using the Standards for reporting qualitative research (SRQR) checklist.
Results
Our search identified 240 citations and 51 studies met the inclusion criteria. The major expectations of the patients are symptomatic and pain control, quality of life and normal endoscopy. Patients’ main concerns are access to information and healthcare, and shared decision making. At the time of diagnosis, patients expressed a greater need for knowledge about their IBD, preferentially by their treating gastroenterologist. The main treatment expectations in active disease are efficacy, safety and convenience. Patients are willing to accept relatively high risks of complications from medical therapy to avoid a permanent ostomy and to achieve durable remission. Patients are more interested in disease monitoring, research and development during the time of remission. Telemedicine and self-management with supervised e-health tools are feasible and acceptable amongst IBD patients.
Conclusions
This systematic review demonstrates that IBD patients expect more information about their disease process, shared decision making and symptom control. Further research is needed to help align patient and physician expectations in order to improve the quality of care provided to IBD patients.
Funding Agencies
None
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Affiliation(s)
- B Balram
- Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - A Al Khoury
- University of Miami School of Medicine, Miami, FL
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - l gonczi
- Semmelweis Egyetem, Budapest, Hungary
| | - m abreu
- University of Miami School of Medicine, Miami, FL
| | - P L Lakatos
- IBD Centre, McGill University Health Center, Montreal, QC, Canada
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10
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Xiao Y, Lakatos PL, Bourdages R, Bitton A, Afif W, Kohen R, Berberi M, Bessissow T. A232 EFFICACY OF TOFACITINIB FOR THE TREATMENT OF MODERATE-TO-SEVERE ULCERATIVE COLITIS: REAL-WORLD DATA. J Can Assoc Gastroenterol 2020. [DOI: 10.1093/jcag/gwz047.231] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A significant proportion of patients with moderate to severe ulcerative colitis (UC) do not respond to therapy, which includes thiopurines, glucocorticoids, and antagonists to tumour necrosis factor-α and integrin. Tofacitinib, a Janus Kinase inhibitor, has emerged as an efficacious and safe treatment for moderate to severe ulcerative colitis. However, it is not known if this efficacy translates into real-life effectiveness in a regular clinical practice.
Aims
We aimed to assess the rate of clinical response and clinical remission at 3 and 6 months after tofacitinib initiation. Secondary endpoints included rate of biomarker normalization, corticosteroids-free clinical remission and severe infections.
Methods
We conducted a multi-center retrospective observational study of adult patients with active UC started on tofacitinib from January 1, 2015 to October 1, 2019 at the McGill University Health Center and Hotel-Dieu de Lévis. A positive clinical response was defined as a decrease of ≥3 in the partial Mayo score. Clinical remission was defined as partial Mayo score of ≤2. Biomarker normalization was defined as fecal calprotectin ≤250ug/g. Severe infection was defined as an infection requiring hospitalization.
Results
During the study period, 40 patients with UC were started on tofacitinib. Amongst the patients, 85% (n=34) had failed ≥1 biologic and 50% (n=20) had failed ≥3 biologics. At the time of this preliminary analysis, 38 patients had undergone 3 months of treatment and 30 patients had undergone 6 months of treatment. At 3 months, a clinical response was seen in 89.5% of patients (n=34) and clinical remission occurred in 63.2% (n=24). At 6 months, clinical response occurred in 73.3% of patients (n=22) and clinical remission was sustained in 53.33% (n=16). Biochemical normalization occurred in 29.0% (n=11) and 30.0% (n=9) at 3 and 6 months, respectively. Additionally, 63.2% (n=24) and 43.3% of patients (n=13) achieved steroid-free clinical remission at 3 and 6 months, respectively. In the interim, one patient developed a serious infection requiring discontinuation of drug.
Conclusions
Our preliminary analysis demonstrates that in a real-life setting, tofacitinib is an effective treatment for inducing clinical remission in refractory UC patients. Further data will be complied to better assess the efficacy over a longer follow up.
Funding Agencies
None
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Affiliation(s)
- Y Xiao
- Internal Medicine, McGill University, Montreal, QC, Canada
| | - P L Lakatos
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - R Bourdages
- Hotel Dieu Hospital of Lévis, Quebec City, QC, Canada
| | - A Bitton
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - R Kohen
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - M Berberi
- Hotel Dieu Hospital of Lévis, Quebec City, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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Singh K, Al Khoury A, Kurti Z, Gonczi L, Reinglas J, Verdon C, Kohen R, Bessissow T, Afif W, Wild G, Seidman EG, Bitton A, Lakatos P. A134 HIGH ADHERENCE TO SURVEILLANCE GUIDELINES IN IBD RESULTS IN LOW CRC AND DYSPLASIA RATES, WHILE RATES OF DYSPLASIA AND CANCER ARE LOW BEFORE THE SUGGESTED START OF SURVEILLANCE. RESULTS FROM A TERTIARY IBD CENTER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.133] [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: 11/14/2022] Open
Affiliation(s)
- K Singh
- McGill University Health Center, Montreal, QC, Canada
| | - A Al Khoury
- McGill University Health Center, Montreal, QC, Canada
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | - J Reinglas
- McGill University Health Center, Montreal, QC, Canada
| | - C Verdon
- McGill University Health Center, Montreal, QC, Canada
| | - R Kohen
- McGill University Health Center, Montreal, QC, Canada
| | - T Bessissow
- McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- McGill University Health Center, Montreal, QC, Canada
| | - E G Seidman
- McGill University Health Center, Montreal, QC, Canada
| | - A Bitton
- Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - P Lakatos
- McGill University Health Center, Montreal, QC, Canada
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12
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Reinglas J, Restellini S, Gonczi L, Kurti Z, Nene S, Kohen R, Afif W, Bessissow T, Wild G, Seidman EG, Lakatos P. A112 HARMONIZATION OF QUALITY OF CARE IN AN IBD CENTER IMPACTS DISEASE OUTCOMES: IMPORTANCE OF STRUCTURE AND PROCESS INDICATORS. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.111] [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: 11/14/2022] Open
Affiliation(s)
- J Reinglas
- McGill University Health Center, Montreal, QC, Canada
| | - S Restellini
- Geneva’s University Hospitals and University of Geneva, Geneva, Switzerland
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - S Nene
- McGill University Health Center, Montreal, QC, Canada
| | - R Kohen
- McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- McGill University Health Center, Montreal, QC, Canada
| | - E G Seidman
- McGill University Health Center, Montreal, QC, Canada
| | - P Lakatos
- McGill University Health Center, Montreal, QC, Canada
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13
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Singh K, Al Khoury A, Kurti Z, Gonczi L, Reinglas J, Verdon C, Kohen R, Bessissow T, Afif W, Wild G, Seidman EG, Bitton A, Lakatos P. A76 HIGH ADHERENCE TO SURVEILLANCE GUIDELINES IN IBD RESULTS IN LOW CRC AND DYSPLASIA RATES, WHILE RATES OF DYSPLASIA AND CANCER ARE LOW BEFORE THE SUGGESTED START OF SURVEILLANCE. RESULTS FROM A TERTIARY IBD CENTER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.075] [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: 11/14/2022] Open
Affiliation(s)
- K Singh
- McGill University, Montreal, QC, Canada
| | | | - Z Kurti
- Semmelweis University , Budapest, Hungary
| | - L Gonczi
- Semmelweis University , Budapest, Hungary
| | | | - C Verdon
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - R Kohen
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - G Wild
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - E G Seidman
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - A Bitton
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - P Lakatos
- Gastroenterology, McGill University, Montreal, QC, Canada
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14
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Nene S, Reinglas J, Gonczi L, Kurti Z, Restellini S, Kohen R, Afif W, Bessissow T, Wild G, Seidman EG, Bitton A, Lakatos P. A78 IMPACT OF IMPLEMENTING A RAPID ACCESS CLINIC IN A HIGH-VOLUME INFLAMMATORY BOWEL DISEASE CENTER: ACCESSIBILITY, REASOURCE UTILISATION AND OUTCOMES. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.077] [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)
- S Nene
- McGill University Health Center, Montreal, QC, Canada
| | - J Reinglas
- McGill University Health Center, Montreal, QC, Canada
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - S Restellini
- Geneva’s University Hospitals and University of Geneva, Geneva, Switzerland
| | - R Kohen
- McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- McGill University Health Center, Montreal, QC, Canada
| | - T Bessissow
- McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- McGill University Health Center, Montreal, QC, Canada
| | - E G Seidman
- McGill University Health Center, Montreal, QC, Canada
| | - A Bitton
- McGill University Health Center, Montreal, QC, Canada
| | - P Lakatos
- McGill University Health Center, Montreal, QC, Canada
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15
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Al Khoury A, Singh K, Kurti Z, Gonczi L, Reinglas J, Verdon C, Kohen R, Bessissow T, Afif W, Wild G, Seidman EG, Bitton A, Lakatos P. A105 HIGH ADHERENCE TO SURVEILLANCE GUIDELINES IN IBD RESULTS IN LOW CRC AND DYSPLASIA RATES, WHILE RATES OF DYSPLASIA AND CANCER ARE LOW BEFORE THE SUGGESTED START OF SURVEILLANCE. RESULTS FROM A TERTIARY IBD CENTER. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.104] [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: 11/12/2022] Open
Affiliation(s)
| | - K Singh
- McGill University, Montreal, QC, Canada
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | | | - C Verdon
- McGill University, Montreal, QC, Canada
| | - R Kohen
- McGill University, Montreal, QC, Canada
| | - T Bessissow
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - G Wild
- McGill University, Montreal, QC, Canada
| | - E G Seidman
- Gastroenterology, McGill University, Montreal, QC, Canada
| | - A Bitton
- Royal Victoria Hospital, McGill University, Montreal, QC, Canada
| | - P Lakatos
- Gastroenterology, McGill University, Montreal, QC, Canada
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16
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Alrajhi S, Germain P, Martel M, Lakatos PL, Afif W. A141 CONCORDANCE BETWEEN TUBERCULIN SKIN TEST AND INTERFERON GAMMA RELEASE ASSAY FOR LATENT TUBERCULOSIS SCREENING IN INFLAMMATORY BOWEL DISEASE (META-ANALYSIS). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.141] [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: 11/12/2022] Open
Affiliation(s)
- S Alrajhi
- McGill University, Montreal, QC, Canada
| | - P Germain
- McGill University, Montreal, QC, Canada
| | - M Martel
- McGill University, Montreal, QC, Canada
| | | | - W Afif
- Gastroenterology, McGill University, Montreal, QC, Canada
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17
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Restellini S, Gonczi L, Kurti Z, Bessissow T, Afif W, Wild G, Kohen R, Seidman EG, Bitton A, Lakatos PL. A153 QUALITY OF CARE AND OUTCOMES IN A TERTIARY HOSPITAL INFLAMMATORY BOWEL (IBD) CENTER: MONITORING AND TREATMENT ALGORITHMS DURING FOLLOW-UP. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.153] [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)
- S Restellini
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - T Bessissow
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - W Afif
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - R Kohen
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - E G Seidman
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - A Bitton
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P L Lakatos
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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18
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Restellini S, Gonczi L, Kurti Z, Afif W, Bessissow T, Wild G, Seidman EG, Kohen R, Bitton A, Lakatos PL. A155 QUALITY OF CARE IN THE INFLAMMATORY BOWEL DISEASES (IBD) CENTER FROM A TERTIARY REFERRAL HOSPITAL: PATIENT ASSESSMENT STRATEGY AT REFERRAL. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.155] [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: 11/14/2022] Open
Affiliation(s)
- S Restellini
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - L Gonczi
- Semmelweis University, Budapest, Hungary
| | - Z Kurti
- Semmelweis University, Budapest, Hungary
| | - W Afif
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - T Bessissow
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - G Wild
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - E G Seidman
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - R Kohen
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - A Bitton
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - P L Lakatos
- Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
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19
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Vegh Z, Bessissow T, Afif W, Lakatos PL. Editorial: co-existing immune-mediated disease in inflammatory bowel diseases - a new disease severity indicator? Aliment Pharmacol Ther 2017; 45:1167. [PMID: 28326586 DOI: 10.1111/apt.13987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Z Vegh
- Semmelweis University, First Department of Medicine, Budapest, Hungary
| | - T Bessissow
- Department of Gastroenterology, McGill University Health Center, Montreal General Hospital, Montreal, Canada
| | - W Afif
- Department of Gastroenterology, McGill University Health Center, Montreal General Hospital, Montreal, Canada
| | - P L Lakatos
- Semmelweis University, First Department of Medicine, Budapest, Hungary.,Department of Gastroenterology, McGill University Health Center, Montreal General Hospital, Montreal, Canada
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20
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Khanna R, Sattin BD, Afif W, Benchimol EI, Bernard EJ, Bitton A, Bressler B, Fedorak RN, Ghosh S, Greenberg GR, Marshall JK, Panaccione R, Seidman EG, Silverberg MS, Steinhart AH, Sy R, Van Assche G, Walters TD, Sandborn WJ, Feagan BG. Review article: a clinician's guide for therapeutic drug monitoring of infliximab in inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38:447-59. [PMID: 23848220 DOI: 10.1111/apt.12407] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 04/29/2013] [Accepted: 06/21/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Tumour necrosis factor (TNF)-antagonists have an established role in the treatment of inflammatory bowel diseases (IBDs), however, subtherapeutic drug levels and the formation of anti-drug antibodies (ADAs) may decrease their efficacy. AIM The evidence supporting the use of therapeutic drug monitoring (TDM) based clinical algorithms for infliximab (IFX) and their role in clinical practice will be discussed. METHODS The literature was reviewed to identify relevant articles on the measurement of IFX levels and antibodies-to-infliximab. RESULTS Treatment algorithms for IBD have evolved from episodic monotherapy used in patients refractory to all other treatments, to long-term combination therapy initiated early in the disease course. Improved remission rates have been observed with this paradigm shift, nevertheless many patients ultimately lose response to therapy. Although empiric dose optimization or switching agents constitute the current standard of care for secondary failure, these interventions have not been applied in an evidence-based manner and are probably not cost-effective. Multiple TDM-based algorithms have been developed to identify patients that may benefit from measurement of IFX and ADA levels to guide adjustments to therapy. CONCLUSIONS Therapeutic drug monitoring offers a rational approach to the management of secondary failure to IFX. This concept has gained momentum based on evidence from case series, cohort studies and post-hoc analyses of randomised controlled trials.
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Affiliation(s)
- R Khanna
- Robarts Clinical Trials Inc., Robarts Research Institute, Western University, London, ON, Canada
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21
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Abstract
BACKGROUND Inappropriate use of intravenous proton pump inhibitors is prevalent. AIM To assess appropriateness of intravenous proton pump inhibitor prescribing. METHODS Retrospective review of in-patient prescribing of intravenous pantoprazole over a 2-month period in 2004, in an academic centre. Prescribing was deemed appropriate before and after endoscopic haemostasis, and in fasting individuals requiring a proton pump inhibitor. RESULTS Amongst 107 patients, 49 (46%) had upper gastrointestinal bleeding. Overall, 33 (31%, 95% CI: 22-41%) received appropriate therapy (indication, dose and duration), 61 (57%, 95% CI: 47-67%) had an inappropriate indication, and 13 (12%, 95% CI: 7-20%) had an incorrect treatment dose or duration. Therapy was appropriate in 20 (41%, 95% CI: 27-55%) with upper gastrointestinal bleeding, and 13 (22%, 95% CI: 12-33%) in the non-upper gastrointestinal bleeding group. Appropriate prescribing rates decreased (from 41% to 16%, 95% on difference CI: 14-38%) when considering intravenous proton pump inhibitor use while awaiting endoscopy as inappropriate. Significant predictors of inappropriate use were increasing age and decreasing mean daily dose, with a trend for prescriptions written during evening shifts. CONCLUSION Inappropriate intravenous proton pump inhibitor utilization was most frequent in the non-upper gastrointestinal bleeding group, mostly for unrecognized indications. Educational interventions to optimize utilization should target prescribing in older patients, those receiving lower mean daily doses, and, perhaps, prescribing outside regular hours.
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Affiliation(s)
- W Afif
- Division of Gastroenterology, McGill University, Montréal, Québec, Canada
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22
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Maghni K, Taha R, Afif W, Hamid Q, Martin JG. Dichotomy between neurokinin receptor actions in modulating allergic airway responses in an animal model of helper T cell type 2 cytokine-associated inflammation. Am J Respir Crit Care Med 2000; 162:1068-74. [PMID: 10988132 DOI: 10.1164/ajrccm.162.3.9910089] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [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: 11/16/2022] Open
Abstract
Neurokinins (NKs), which include substance P (SP) and neurokinin A (NKA), act through NK-1 and NK-2 receptors. There is considerable evidence of interaction between the neurogenic and the immune systems, and NKs are candidates for mediating such interactions. We hypothesized that selective inhibition of pulmonary NK-1 or NK-2 receptors may modulate immune responses so as to prevent the development of allergic airway responses in the atopic BN rat sensitized to ovalbumin (OA). To address this hypothesis, we have validated our animal model by showing that NK-1 and NK-2 receptors are expressed in the lungs, and that SP is released in the airways after allergen challenge. The selective NK-1 (CP-99,994) or NK-2 (SR-48968) antagonists before allergen challenge failed to reduce the allergic early airway responses. In contrast, both neurokinin antagonists decreased allergen-induced late airway responses in OA-challenged animals. However, only the NK-2 antagonist decreased the eosinophil numbers in the bronchoalveolar lavage (BAL). Likewise, the NK-2, but not NK-1, antagonist decreased both Th1 (INF-gamma) and Th2 (IL-4 and -5) cytokine expression in BAL cells by in situ hybridization. These results provide initial in vivo evidence linking neurokinins to the regulation of cytokine expression in cells without discrimination as to their phenotype. We conclude that there is a dichotomy between NK receptors in the modulation of the allergic airway inflammation, which has important implications for future therapeutic strategies for asthma using the NK antagonists.
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Affiliation(s)
- K Maghni
- Meakins-Christie Laboratories, McGill University, Montreal, Quebec, Canada
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