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Melhaoui I, Oujidi Y, El Heddad IA, Bensaid A, Bkiyar H, Bentata Y, Housni B. Management of post cardiac transplantation immunosuppression and COVID-19: A case report. Ann Med Surg (Lond) 2021; 71:102875. [PMID: 34567547 PMCID: PMC8452461 DOI: 10.1016/j.amsu.2021.102875] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is very limited experience in management of heart transplant (HT) recipients and their immunosuppressive drug therapies while confronted with a SARS-CoV-2 infection. CASE DETAILS We report the case of a 60-year-old male, heart transplant recipient patient, admitted in our ICU for severe COVID-19. His immunosuppressors were discontinued. He presented an ARDS, a multiple organ failure and a refractory septic shock that eventually resulted in his death. DISCUSSION Multiple studies reported a lower incidence of SARS-Cov-2 infection in HT recipients compared to the general population, probably due to their prior knowledge and use of protective and barrier measures; but when infected they tend to have poorer outcomes and higher fatality; on account of their pre-existing comorbidities and immunodeficiency. Therefore, the management of the immunosuppressive therapy raises a challenge, in the absence of trials. Physicians rely on experts' recommendations, to maintain the immunosuppressors in case of mild COVID-19, lower to the bare minimum or even discontinue them in case of critical COVID-19 or systemic complications. CONCLUSION COVID-19 infection is associated with poor outcomes and high mortality in HT recipients, and their immunosuppressive therapy management still raises questions and challenges in the absence of trial-validated data.
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Affiliation(s)
- Imane Melhaoui
- Nephrology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Younes Oujidi
- Anaesthesia and Resuscitation Service – Hospital University Mohammed VI of Oujda. Oujda Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
| | - Inass Arhoun El Heddad
- Anaesthesia and Resuscitation Service – Hospital University Mohammed VI of Oujda. Oujda Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
| | - Amine Bensaid
- Anaesthesia and Resuscitation Service – Hospital University Mohammed VI of Oujda. Oujda Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
| | - Houssam Bkiyar
- Anaesthesia and Resuscitation Service – Hospital University Mohammed VI of Oujda. Oujda Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
| | - Yassamine Bentata
- Nephrology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Brahim Housni
- Anaesthesia and Resuscitation Service – Hospital University Mohammed VI of Oujda. Oujda Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
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Masmejan S, Guex-Crosier Y, Diserens C, Vouga M, Clottu AS, Ribi C, Mathevet P, Jacot-Guillarmod M. When obstetrics-gynecology specialists need to call an ophthalmologist urgently: a case report. J Med Case Rep 2021; 15:517. [PMID: 34670612 PMCID: PMC8529822 DOI: 10.1186/s13256-021-03087-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/31/2021] [Indexed: 12/04/2022] Open
Abstract
Background We report here a case of a healthy 23-year-old female patient who was assessed at the gynecology emergency department for genital ulcers, fever, and blurred vision. After suspicion of herpes simplex virus-2 lesions, the diagnosis of Behçet’s disease was made. We report this case with the aim of including Behçet’s disease in the differential diagnosis of genital ulcers, and emphasize the emergency of the vision loss that can be irreversible. Case presentation A healthy 23-year-old European female patient was assessed by gynecology in the emergency department for genital lesions associated with fever and blurred vision. At first, these lesions were suspected to be primary herpes simplex virus-2 infection One day later, she experienced decreased visual acuity in both eyes. After 4 days of worsening genital ulcers and persistent blurred vision, the patient was referred to the ophthalmology department. Fundoscopic examination showed retinal hemorrhages that were consistent with the first presentation of Behçet’s disease. Conclusions This case demonstrates that genital ulcers can be the very initial symptom of this ophthalmologic emergency. The differential diagnosis of genital ulcers is challenging. Behçet’s disease should be included, especially when associated with systemic or ocular manifestations, and should be considered an emergency for the gynecologist to prevent long-term vision loss.
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Affiliation(s)
- S Masmejan
- Service de Gynécologie et Obstétrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, CHUV, 1011, Lausanne, Switzerland
| | - Y Guex-Crosier
- Jules-Gonin Eye Hospital, Ophthalmogy Department, FAA, University of Lausanne, Lausanne, Switzerland
| | - C Diserens
- Service de Gynécologie et Obstétrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, CHUV, 1011, Lausanne, Switzerland
| | - M Vouga
- Service de Gynécologie et Obstétrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, CHUV, 1011, Lausanne, Switzerland
| | - A S Clottu
- Service d'immunologie et d'allergie, Département de Médecine, Centre Hospitalier Universitaire Vaudois, CHUV, 1011 Lausanne, Switzerland
| | - C Ribi
- Service d'immunologie et d'allergie, Département de Médecine, Centre Hospitalier Universitaire Vaudois, CHUV, 1011 Lausanne, Switzerland
| | - P Mathevet
- Service de Gynécologie et Obstétrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, CHUV, 1011, Lausanne, Switzerland
| | - M Jacot-Guillarmod
- Service de Gynécologie et Obstétrique, Département Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, CHUV, 1011, Lausanne, Switzerland.
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Sicilia B, García-López S, González-Lama Y, Zabana Y, Hinojosa J, Gomollón F. GETECCU 2020 guidelines for the treatment of ulcerative colitis. Developed using the GRADE approach. Gastroenterol Hepatol 2021; 43 Suppl 1:1-57. [PMID: 32807301 DOI: 10.1016/j.gastrohep.2020.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Since the first edition of the Guidelines was published in 2013, much information has been generated around the treatment of ulcerative colitis, and new drugs and action protocols have been introduced. Clinical practice has changed substantially, warranting new approaches and a comprehensive review and update of the evidence. MATERIAL AND METHODS Once again, we used the GRADE approach, supported by an electronic tool (https://gradepro.org). The clinical scenarios are the same as in the previous version (induction and maintenance in severe and mild-moderate flare-ups), as are the variables and their evaluation. However, in the updated guidelines, three questions have been deleted, 14 added and 30 maintained, making a total of 44 clinical questions. After an exhaustive review of the evidence, the recommendations are now updated. RESULTS Of the 44 questions analysed, no recommendation could be established in two due to the very low quality of the evidence, while in the other 42, based on different degrees of quality of evidence, recommendations were made according to the GRADE system. In 25 of these questions the final recommendation is strongly in favour, in six strongly against, in seven weakly in favour and in four weakly against. According to the scenarios and recommendations, six algorithms are proposed as a simple guide for practical decision-making. CONCLUSIONS The aim of this update of the 2013 guidelines is to provide answers, based on the GRADE approach, to the different questions we ask ourselves daily when deciding the most appropriate treatment for our patients with ulcerative colitis in the different clinical scenarios.
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Affiliation(s)
- Beatriz Sicilia
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario de Burgos, España
| | - Santiago García-López
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Instituto de Investigaciones Sanitarias de Aragón, Zaragoza, España.
| | - Yago González-Lama
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Yamile Zabana
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo Hospital Universitario Mútua Terrassa Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)
| | - Joaquín Hinojosa
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital de Manises, Valencia, España
| | - Fernando Gomollón
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Instituto de Investigaciones Sanitarias de Aragón, Hospital Clínico Universitario Lozano Blesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Zaragoza, España
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Barroso DH, Brandão JG, Andrade ESN, Correia ACB, Aquino DC, Chen ACR, Vernal S, de Araújo WN, da Mota LMH, Sampaio RNR, Kurizky PS, Gomes CM. Leprosy detection rate in patients under immunosuppression for the treatment of dermatological, rheumatological, and gastroenterological diseases: a systematic review of the literature and meta-analysis. BMC Infect Dis 2021; 21:347. [PMID: 33849463 PMCID: PMC8045377 DOI: 10.1186/s12879-021-06041-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 04/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Recently developed immunosuppressive drugs, especially TNF antagonists, may enhance the risk of granulomatous infections, including leprosy. We aimed to evaluate the leprosy detection rate in patients under immunosuppression due to rheumatological, dermatological and gastroenterological diseases. Methods We performed a systematic review of the literature by searching the PubMed, EMBASE, LILACS, Web of Science and Scielo databases through 2018. No date or language restrictions were applied. We included all articles that reported the occurrence of leprosy in patients under medication-induced immunosuppression. Results The search strategy resulted in 15,103 articles; finally, 20 articles were included, with 4 reporting longitudinal designs. The detection rate of leprosy ranged from 0.13 to 116.18 per 100,000 patients/year in the USA and Brazil, respectively. In the meta-analysis, the detection rate of cases of leprosy per 100,000 immunosuppressed patients with rheumatic diseases was 84 (detection rate = 0.00084; 95% CI = 0.0000–0.00266; I2 = 0%, p = 0.55). Conclusion Our analysis showed that leprosy was relatively frequently detected in medication-induced immunosuppressed patients suffering from rheumatological diseases, and further studies are needed. The lack of an active search for leprosy in the included articles precluded more precise conclusions. Trial registration This review is registered in PROSPERO with the registry number CRD42018116275. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06041-7.
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Affiliation(s)
- Daniel Holanda Barroso
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília - UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, CEP 70910-900, Brazil.
| | - Jurema Guerrieri Brandão
- Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis - DCCI, Coordenação Geral de Vigilância das Doenças em Eliminação - CGDE, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil
| | - Elaine Silva Nascimento Andrade
- Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis - DCCI, Coordenação Geral de Vigilância das Doenças em Eliminação - CGDE, Secretaria de Vigilância em Saúde, Ministério da Saúde, Brasília, Brazil.,Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade de Brasília - UnB, Brasília, Brazil
| | | | - Danielle Costa Aquino
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília - UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, CEP 70910-900, Brazil
| | | | - Sebastian Vernal
- Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Departamento de Clínica Médica, Divisão de Dermatologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Wildo Navegantes de Araújo
- Programa de Pós-Graduação em Saúde Coletiva, Faculdade de Medicina, Universidade de Brasília - UnB, Brasília, Brazil.,Programa de Pós-Graduação em Medicina Tropical, Núcleo de Medicina Tropical, Universidade de Brasília - UnB, Brasília, Brazil.,National Institute for Science and Technology for Health Technology Assessment (IATS), Porto Alegre, RS, Brazil
| | - Lícia Maria Henrique da Mota
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília - UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, CEP 70910-900, Brazil
| | - Raimunda Nonata Ribeiro Sampaio
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília - UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, CEP 70910-900, Brazil
| | - Patrícia Shu Kurizky
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília - UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, CEP 70910-900, Brazil
| | - Ciro Martins Gomes
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília - UnB, Campus Universitário Darcy Ribeiro, Brasília, DF, CEP 70910-900, Brazil. .,Faculdade de Medicina, Universidade de Brasília - UnB, Brasília, Brazil. .,Programa de Pós-Graduação em Medicina Tropical, Núcleo de Medicina Tropical, Universidade de Brasília - UnB, Brasília, Brazil.
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Lebrun-Frenay C, Berestjuk I, Cohen M, Tartare-Deckert S. Effects on Melanoma Cell Lines Suggest No Significant Risk of Melanoma Under Cladribine Treatment. Neurol Ther 2020; 9:599-604. [PMID: 32712904 DOI: 10.1007/s40120-020-00204-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Indexed: 11/18/2022] Open
Abstract
Cladribine is an oral synthetic purine analog that depletes lymphocytes and induces a dose-dependent reduction of T and B cells. It was approved for the therapy of highly active relapsing-remitting multiple sclerosis. Given cladribine’s mechanism of action, an increased risk of malignancies was suspected from the number of cancers that occurred in the 3.5 mg/kg-treated arm (CLARITY study). We showed that cladribine inhibits cell proliferation on three melanoma cell lines tested, irrespectively of their mutational oncogenic status and invasive/metastatic potential. Aggregated safety data demonstrated that the risk of melanoma is not confirmed.
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van Merendonk LN, Fontova P, Rigo-Bonnin R, Colom H, Vidal-Alabró A, Bestard O, Torras J, Cruzado JM, Grinyó JM, Lloberas N. Validation and evaluation of four sample preparation methods for the quantification of intracellular tacrolimus in peripheral blood mononuclear cells by UHPLC-MS/MS. Clin Chim Acta 2019; 503:210-217. [PMID: 31794770 DOI: 10.1016/j.cca.2019.11.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
Rejection and toxicity occur despite monitoring of tacrolimus blood levels during clinical routine. The intracellular concentration in lymphocytes could be a better reflection of the tacrolimus exposure. Four extraction methods for tacrolimus in peripheral blood mononuclear cells were validated and evaluated with UHPLC-MS/MS. Methods based on protein precipitation (method 1), solid phase extraction (method 2), phospholipids and proteins removal (method 3) and liquid-liquid extraction (method 4) were evaluated on linearity, lower limit of quantification (LLOQ), imprecision and bias. Validation was completed for the methods within these requirements, adding matrix effect and recovery. Linearity was 0.126 (LLOQ)-15 µg/L, 0.504 (LLOQ)-15 µg/L and 0.298 (LLOQ)-15 µg/L with method 1, 2 and 3, respectively. With method 4 non-linearity and a LLOQ higher than 0.504 µg/L were observed. Inter-day imprecision and bias were ≤4.6%, ≤10.9%; ≤6.8%, ≤-11.2%; ≤9.4%, ≤10.3% and ≤44.6%, ≤23.1%, respectively, with methods 1, 2, 3 and 4. Validation was completed for method 1 and 3 adding matrix effect (7.6%; 15.0%) and recovery (8.9%; 10.8%), respectively. The most suitable UHPLC-MS/MS method for quantification of intracellular tacrolimus was protein precipitation due to the best performance characteristics and the least time-consuming rate and complexity.
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Affiliation(s)
- Lisanne N van Merendonk
- Nephrology Department, IDIBELL, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Pere Fontova
- Nephrology Department, IDIBELL, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Raül Rigo-Bonnin
- Biochemistry Department, IDIBELL, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Helena Colom
- Biopharmaceutics and Pharmacokinetics Unit, Department of Pharmacy and Pharmaceutical Technology Department, School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Anna Vidal-Alabró
- Nephrology Department, IDIBELL, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Oriol Bestard
- Nephrology Department, IDIBELL, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Juan Torras
- Nephrology Department, IDIBELL, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Josep M Cruzado
- Nephrology Department, IDIBELL, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Josep M Grinyó
- Nephrology Department, IDIBELL, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Núria Lloberas
- Nephrology Department, IDIBELL, Hospital Universitari de Bellvitge, University of Barcelona, Barcelona, Spain.
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Abstract
IgA nephropathy, identified 50 years ago in France, is the most frequent glomerular disease worldwide. The course is variable, but in most of the cases there is a relentless decline in renal function, reaching end-stage renal failure in 10-60% of the cases after 10 years and in 40% after 20 years. These data justify the interest for finding a suitable therapeutic approach particularly in progressive cases. A supportive care, including renin-angiotensin system inhibitors is the priority in cases with slowly declining renal function, particularly when developing proteinuria. The recent supportive versus immunosuppressive therapy for the treatment of progressive IgA nephropathy (STOP-IgAN) randomized and controlled trial has further stressed the benefit of a strict supportive care including also life-style changes, protein and salt restriction. However, there is clear evidence from observational studies (including the European Validation Study of the Oxford Classification of IgA nephropathy [VALIGA]) and a new randomized and controlled trial (Therapeutic Evaluation of Steroids in IgA Nephropathy Global [TESTING]) of additional benefits of corticosteroid treatment in patients with proteinuric IgA nephropathy. However, the present treatment schedules carry severe side effects, mostly infectious complications, which indicate the need for less toxic interventions. The recent focus on the role of gut-kidney axis in IgA nephropathy has led to the search of corticosteroid formulations targeting the intestinal mucosal immune system (gut-associated lymphoid tissue). The NEFIGAN trial obtained interesting results in terms of reduction of proteinuria and stabilization of renal function using a budesonide formulation allowing a selective drug delivery at intestinal gut-associated lymphoid tissue sites. The adverse events, particularly infections, were found to be not clinically relevant. The possibility of a personalized approach to the treatment according to the renal biopsy lesions (Oxford MEST score) is supported by several uncontrolled studies and deserves great attention in the next future. New treatments options for IgA nephropathy include drugs targeting BAFF, a B-cell factor crucial for IgA synthesis or targeting the complement system, and also the possibility of acting directly on the deposited IgA by selective protease digestion.
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Affiliation(s)
- Rosanna Coppo
- Fondazione Ricerca Molinette, Regina Margherita Hospital, 94, Piazza Polonia, 10126 Torino, TO, Italy.
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Diwo E, Sève P, Trad S, Bielefeld P, Sène D, Abad S, Brézin A, Quartier P, Koné Paut I, Weber M, Chiquet C, Errera MH, Sellam J, Cacoub P, Kaplanski G, Kodjikian L, Bodaghi B, Saadoun D. [Therapeutic strategy for the treatment of non-infectious uveitis proposed by an expert panel]. Rev Med Interne 2018; 39:687-698. [PMID: 29610003 DOI: 10.1016/j.revmed.2018.03.001] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/01/2018] [Indexed: 02/07/2023]
Abstract
Conventional immunosuppressive drugs, anti-TNF alpha and other biotherapies used in clinical practice are capable of controlling non-infectious anterior uveitis, posterior uveitis and panuveitis. The present work has been led by a multidisciplinary panel of experts, internists, rheumatologists and ophthalmologists and is based on a review of the literature. In case of corticodependency or sight-threatening disease, conventional immunosuppressive drugs (methotrexate, azathioprine and mycophenolate mofetil) and/or anti-TNF alpha (adalimumab, infliximab) are used to achieve and maintain remission. Interferon is an efficient immunomodulatory treatment, as a second-line therapy, for some therapeutic indications (refractory macular edema, Behçet's vascularitis). Other biologics, especially tocilizumab, are showing promising results. Local treatments (corticosteroids, sirolimus etc.) are adjuvant therapies in case of unilateral inflammatory relapse. Therapeutic response must be evaluated precisely by clinical examination and repeated complementary investigations (laser flare photometry, multimodal imaging, perimetry, electroretinography measures).
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Affiliation(s)
- E Diwo
- Ophthalmology department, DHU ViewRestore, Pitié Salpêtrière hospital, Paris, France
| | - P Sève
- Service de médecine interne, hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103, grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France; Faculté de médecine Lyon-Sud, université Claude Bernard-Lyon 1, France
| | - S Trad
- Service de médecine interne, hôpital Ambroise Paré, 92100 Boulogne-Billancourt, France
| | - P Bielefeld
- Internal medicine and systemic diseases department, médecine interne 2, university hospital Dijon Bourgogne, France; Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), Bobigny, France; Faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Bobigny, France; UMR1125, LI2P, université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - D Sène
- Internal medicine department, Lariboisière hospital, AP-HP, Paris, France; Inserm UMR 1149, Paris Diderot university, Paris, France
| | - S Abad
- Service de médecine interne, hôpital Avicenne, Assistance publique-Hôpitaux de Paris (AP-HP), Bobigny, France; Faculté de médecine SMBH, université Paris 13, Sorbonne Paris Cité, Bobigny, France; UMR1125, LI2P, université Paris 13, Sorbonne Paris Cité, Bobigny, France
| | - A Brézin
- Service d'ophtalmologie, hôpital Cochin, université Paris Descartes, Paris, France
| | - P Quartier
- Unité d'immunologie-hématologie et rhumatologie pédiatriques, institut IMAGINE, centre de référence des maladies rhumatologiques inflammatoires et autoimmunes systémiques rares de l'enfant (RAISE), université Paris-Descartes university, hôpital Necker-Enfants-Malades, Assistance publique Hôpitaux de Paris, Paris, France
| | - I Koné Paut
- Paediatric rheumatology department, centre de références des maladies autoinflammatoires et de l'amylose inflammatoire, CEREMAIA, university of Paris Sud, Bicêtre hospital, AP-HP, Paris, France
| | - M Weber
- Department of ophthalmology, Nantes university, Nantes university hospital, Nantes, France
| | - C Chiquet
- Department of ophthalmology, Grenoble-Alpes university, Grenoble Alpes university hospital, Grenoble, France
| | - M H Errera
- Department of ophthalmology at Quinze-Vingts National Eye Hospital and DHU Sight Restore, Paris, France; Sorbonne universities, UPMC université Paris 06, Paris, France
| | - J Sellam
- Service de rhumatologie, CRSA Inserm UMRS_938, DHU i2B, hôpital Saint-Antoine, Sorbonne Université, AP-HP, France
| | - P Cacoub
- Inflammation-immunopathology-biotherapy department (DHU i2B), Sorbonne universités, UPMC université Paris 06, UMR 7211, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of internal medicine and clinical immunology, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Centre national de référence des maladies autoimmunes systémiques rares, centre National de référence des maladies autoinflammatoires et de l'amylose, France
| | - G Kaplanski
- Service de médecine interne et immunologie clinique, Aix-Marseille université, hôpital de la conception, 147, boulevard Baille, 1305 Marseille, France
| | - L Kodjikian
- Department of ophthalmology, Croix-Rousse university hospital, Hospices Civils de Lyon, university of Lyon I, 69004 Lyon, France; CNRS UMR 5510 Mateis, 69621 Villeurbanne, France
| | - B Bodaghi
- Ophthalmology department, DHU ViewRestore, Pitié Salpêtrière hospital, Paris, France.
| | - D Saadoun
- Inflammation-immunopathology-biotherapy department (DHU i2B), Sorbonne universités, UPMC université Paris 06, UMR 7211, 75005 Paris, France; Inserm, UMR_S 959, 75013 Paris, France; CNRS, FRE3632, 75005 Paris, France; Department of internal medicine and clinical immunology, groupe hospitalier Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Centre national de référence des maladies autoimmunes systémiques rares, centre National de référence des maladies autoinflammatoires et de l'amylose, France.
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Espinosa G, Muñoz-Fernández S, García Ruiz de Morales JM, Herreras JM, Cordero-Coma M. Treatment recommendations for non-infectious anterior uveitis. Med Clin (Barc) 2017; 149:552.e1-552.e12. [PMID: 28911893 DOI: 10.1016/j.medcli.2017.06.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 06/28/2017] [Accepted: 06/29/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND OBJECTIVE To develop recommendations on the use of immunodepressors in patients with non-infectious, non-neoplastic anterior uveitis (AU) based on best evidence and experience. MATERIAL AND METHODS A multidisciplinary panel of five experts was established, who, in the first nominal group meeting defined the scope, users, and chapters of the document. A systematic literature review was performed to assess the efficacy and safety of immunosuppressors in patients with non-infectious, non-neoplastic AU. All the above was discussed in a second nominal group meeting and 33 recommendations were generated. Through the Delphi methodology, the degree of agreement with the recommendations was tested also by 25 more experts. Recommendations were voted on from one (total disagreement) to 10 (total agreement). We defined agreement if at least 70% voted ≥7. The level of evidence and degree of recommendation was assessed using the Oxford Centre for Evidence-based Medicine's Levels of Evidence. RESULTS The 33 recommendations were accepted. They include specific recommendations on patients with non-infectious, non-neoplastic AU, as well as different treatment lines. CONCLUSIONS In patients with non-infectious, non-neoplastic AU, these recommendations on the use of immunosuppressors might be a guide in order to help in the treatment decision making, due to the lack of robust evidence or other globally accepted algorithms.
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Affiliation(s)
- Gerard Espinosa
- Servicio de Enfermedades Autoinmunes, Institut Clinic de Medicina i Dermatologia, Hospital Clínic, Barcelona, España
| | - Santiago Muñoz-Fernández
- Servicio de Reumatología, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, España; Universidad Europea, San Sebastián de los Reyes, Madrid, España
| | - José M García Ruiz de Morales
- Unidad de Uveítis, Servicio de Inmunología, Complejo Asistencial Universitario de León, León, España; Instituto de Biomedicina, Universidad de León (IBIOMED), León, España
| | - José M Herreras
- IOBA (Instituto Universitario de Oftalmobiología), Universidad de Valladolid, Valladolid, España; Servicio de Oftalmología, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Miguel Cordero-Coma
- Instituto de Biomedicina, Universidad de León (IBIOMED), León, España; Unidad de uveítis, Servicio de Oftalmología, Complejo Asistencial Universitario de León, León, España.
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10
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Gionchetti P, Rizzello F, Annese V, Armuzzi A, Biancone L, Castiglione F, Comberlato M, Cottone M, Danese S, Daperno M, D'Incà R, Fries W, Kohn A, Orlando A, Papi C, Vecchi M, Ardizzone S. Use of corticosteroids and immunosuppressive drugs in inflammatory bowel disease: Clinical practice guidelines of the Italian Group for the Study of Inflammatory Bowel Disease. Dig Liver Dis 2017; 49:604-617. [PMID: 28254463 DOI: 10.1016/j.dld.2017.01.161] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 09/26/2016] [Revised: 01/15/2017] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
Abstract
The two main forms of intestinal bowel disease, namely ulcerative colitis and Crohn's disease, are not curable but can be controlled by various medical therapies. The Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) has prepared clinical practice guidelines to help physicians prescribe corticosteroids and immunosuppressive drugs for these patients. The guidelines consider therapies that induce remission in patients with active disease as well as treatment regimens that maintain remission. These guidelines complement already existing guidelines from IG-IBD on the use of biological drugs in patients with inflammatory bowel diseases.
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Affiliation(s)
- Paolo Gionchetti
- Department of Medical and Surgical Sciences, IBD Unit, University of Bologna, Bologna, Italy.
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, IBD Unit, University of Bologna, Bologna, Italy
| | - Vito Annese
- AOU Gastroenterology, Careggi University Hospital, Florence, Italy
| | - Alessandro Armuzzi
- IBD Unit Complesso Integrato Columbus-Gemelli Hospital Catholic University Foundation, Rome, Italy
| | - Livia Biancone
- University "Tor Vergata", Department of Systems Medicine, Rome, Italy
| | | | | | - Mario Cottone
- Department of Medicine, Pneumology and Nutrition Clinic, V. Cervello Hospital, Ospedali Riuniti Villa Sofia-Cervello University of Palermo, Palermo, Italy
| | - Silvio Danese
- IBD Center, Humanitas Clinical and Research Centre, Milan, Italy
| | - Marco Daperno
- Gastroenterology Unit, A.O. Ordine Mauriziano Hospital, Turin, Italy
| | - Renata D'Incà
- Department of Surgical and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Walter Fries
- Clinical Unit for Chronic Bowel Disorders, Department of Internal Medicine, IBD Unit Messina, University of Messina, Messina, Italy
| | - Anna Kohn
- Department of Gastroenterology, San Camillo-Forlanini Hospital, Rome, Italy
| | - Ambrogio Orlando
- Department of Medicine, Pneumology and Nutrition Clinic, V. Cervello Hospital, Ospedali Riuniti Villa Sofia-Cervello University of Palermo, Palermo, Italy
| | - Claudio Papi
- Gastroenterology Unit, San Filippo Neri Hospital, Rome, Italy
| | - Maurizio Vecchi
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS San Donato Hospital, San Donato Milanese, Italy
| | - Sandro Ardizzone
- Gastroenterology and Digestive Endoscopy, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
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11
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Vieira AP, Trindade MAB, de Paula FJ, Sakai-Valente NY, Duarte AJDS, Lemos FBC, Benard G. Severe type 1 upgrading leprosy reaction in a renal transplant recipient: a paradoxical manifestation associated with deficiency of antigen-specific regulatory T-cells? BMC Infect Dis 2017; 17:305. [PMID: 28438129 PMCID: PMC5404339 DOI: 10.1186/s12879-017-2406-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/13/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Due to its chronic subclinical course and large spectrum of manifestations, leprosy often represents a diagnostic challenge. Even with proper anti-mycobacteria treatment, leprosy follow up remains challenging: almost half of leprosy patients may develop reaction episodes. Leprosy is an infrequent complication of solid organ transplant recipients. This case report illustrates the challenges in diagnosing and managing leprosy and its reactional states in a transplant recipient. CASE PRESENTATION A 53-year-old man presented 34 months after a successful renal transplantation a borderline-tuberculoid leprosy with signs of mild type 1 upgrading reaction (T1R). Cutaneous manifestations were atypical, and diagnosis was only made when granulomatous neuritis was found in a cutaneous biopsy. He was successfully treated with the WHO recommended multidrug therapy (MDT: rifampicin, dapsone and clofazimine). However he developed a severe T1R immediately after completion of the MDT but no signs of allograft rejection. T1R results from flare-ups of the host T-helper-1 cell-mediated immune response against Mycobacterium leprae antigens in patients with immunologically unstable, borderline forms of leprosy and has been considered an inflammatory syndrome in many aspects similar to the immune reconstitution inflammatory syndromes (IRS). The T1R was successfully treated by increasing the prednisone dose without modifying the other immunosuppressive drugs used for preventing allograft rejection. Immunological study revealed that the patient had a profound depletion of both in situ and circulating regulatory T-cells and lack of expansion of the Tregs upon M. leprae stimulation compared to T1R leprosy patients without iatrogenic immunosuppression. CONCLUSIONS Our case report highlights that leprosy, especially in the transplant setting, requires a high degree of clinical suspicion and the contribution of histopathology. It also suggests that the development of upgrading inflammatory syndromes such as T1R can occur despite the sustained immunosuppressors regimen for preventing graft rejection. Our hypothesis is that the well-known deleterious effects of these immunosuppressors on pathogen-induced regulatory T-cells contributed to the immunedysregulation and development T1R.
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Affiliation(s)
- Ana Paula Vieira
- Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Flávio Jota de Paula
- Renal Transplantation Service, Clinics Hospital, Medical School, University of São Paulo, São Paulo, Brazil
| | - Neusa Yurico Sakai-Valente
- Laboratory of Medical Investigation Unit 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil
| | - Alberto José da Silva Duarte
- Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Gil Benard
- Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of São Paulo, São Paulo, Brazil. .,Laboratory of Medical Investigation Unit 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil.
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12
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Delmont E. Review of the literature: Articles published in the last five years that have changed my daily practice. Rev Neurol (Paris) 2016; 172:785-7. [PMID: 27866733 DOI: 10.1016/j.neurol.2016.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/01/2016] [Indexed: 11/23/2022]
Abstract
Over the last five years, the management of peripheral neuropathies has become structured by the publication of recognized diagnostic criteria for inflammatory neuropathies and the elaboration of a function score, the R-ODS, used to evaluate the progression of these neuropathies. The concept of nodo-paranodopathy has enriched the concept of peripheral neuropathies, over-riding the classical mechanisms of axonal and demyelinating mechanisms. The structures of the nodes of Ranvier, gangliosides, contractin and neurofascin are preferential targets for auto-antibodies responsible for dysimmune neuropathies. Concerning treatments, immunosuppressors have demonstrated their efficacy for the treatment of anti-MAG neuropathies. Corticosteroid treatments are also in the limelight, demonstrating a different response profile than intravenous immunoglobulins for CIDP. But the most remarkable therapeutic progress has been made in the domain of hereditary neuropathies. The first trial versus placebo produced positive results in CMT1a. Finally, the era of genetic therapy appears to have come to fruition with the interfering RNA trial for familial amyloid neuropathies.
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13
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Holguin F, Rubió-Casadevall J, Saigi M, Marruecos J, Taberna M, Tobed M, Maños M, Mesía R. Cetuximab as treatment for head and neck cancer patients with a previous liver transplant: report of two cases. J Chemother 2016; 29:310-313. [PMID: 27380218 DOI: 10.1080/1120009x.2016.1187360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Cetuximab is a monoclonal antibody against epidermal growth factor receptor useful in the treatment of patients with Head and Neck Squamous Cell Carcinoma combined with radiotherapy or chemotherapy. Its pharmacokinetics are not influenced by hepatic status and there are no specific warnings concerning its indication in patients with impaired hepatic function. Patients with a previous liver transplant are at risk for hepatic toxicity and use immunosupressants to avoid rejection that can interact with other drugs. We present two cases of patients with a previous liver transplant in which cetuximab was administered to treat head and neck cancer.
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Affiliation(s)
- Francia Holguin
- a Deparment of Medical Oncology, Catalan Institute of Oncology , Hospital JosepTrueta , Girona , Spain
| | - Jordi Rubió-Casadevall
- a Deparment of Medical Oncology, Catalan Institute of Oncology , Hospital JosepTrueta , Girona , Spain.,b Descriptive Epidemiology, Genetics and Cancer Prevention Group , Biomedical Research Institute (IDIBGI) , Girona , Spain
| | - Maria Saigi
- c Deparment of Medical Oncology, Catalan Institute of Oncology , Hospital Duran I Reynalds , L'Hospitalet de LLobregat, Barcelona , Spain
| | - Jordi Marruecos
- d Deparment of Radiotherapy, Catalan Institute of Oncology , Hospital JosepTrueta , Girona , Spain
| | - Miren Taberna
- c Deparment of Medical Oncology, Catalan Institute of Oncology , Hospital Duran I Reynalds , L'Hospitalet de LLobregat, Barcelona , Spain
| | - Marc Tobed
- e Deparment of Otorhinolaringology , Hospital Universitari JosepTrueta , Servei Català de la Salut, Girona , Spain
| | - Manuel Maños
- f Deparment of Otorhinolaringology , Hospital Universitari de Bellvitge, University of Barcelona , Servei Català de la Salut, Barcelona , Spain.,g Medical Oncology Department , Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) , Hospitalet de LLobregat, Barcelona , Spain
| | - Ricard Mesía
- c Deparment of Medical Oncology, Catalan Institute of Oncology , Hospital Duran I Reynalds , L'Hospitalet de LLobregat, Barcelona , Spain.,g Medical Oncology Department , Institut d'Investigació Biomèdica de Bellvitge (IDIBELL) , Hospitalet de LLobregat, Barcelona , Spain
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14
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Del Papa N, Zaccara E. From mechanisms of action to therapeutic application: A review on current therapeutic approaches and future directions in systemic sclerosis. Best Pract Res Clin Rheumatol 2016; 29:756-69. [PMID: 27107511 DOI: 10.1016/j.berh.2016.02.004] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/01/2016] [Indexed: 01/08/2023]
Abstract
Systemic sclerosis (SSc) is one of the most complex connective tissue diseases. Although the pathogenesis of SSc still remains elusive, it is generally accepted that initial vascular injury due to autoimmunity might result in the constitutive activation of fibroblasts and fibrosis. All of these three processes interact and affect one another resulting in a polymorphous spectrum of clinical and pathologic manifestations of SSc. The disease pleomorphism poses numerous difficulties in defining the ideal outcomes to be used in clinical trials. Despite significant progress over the past decades, the clinical management of patients with SSc remains a challenge. Novel therapies are currently being tested in the treatment of SSc and have the potential for modifying the disease process and improving the clinical outcomes. However, the evaluation of the studies is still difficult, due to either the small size of included patients or the different types and phases of the scleroderma disease under scrutiny.
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Affiliation(s)
- Nicoletta Del Papa
- U.O.C. Day Hospital Reumatologia, Dip. Reumatologia, Ospedale G. Pini, Milan, Italy.
| | - Eleonora Zaccara
- U.O.C. Day Hospital Reumatologia, Dip. Reumatologia, Ospedale G. Pini, Milan, Italy
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15
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Cintolo M, Costantino G, Pallio S, Fries W. Mucosal healing in inflammatory bowel disease: Maintain or de-escalate therapy. World J Gastrointest Pathophysiol 2016; 7:1-16. [PMID: 26909224 PMCID: PMC4753175 DOI: 10.4291/wjgp.v7.i1.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 11/16/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
In the past decade, thanks to the introduction of biologic therapies, a new therapeutic goal, mucosal healing (MH), has been introduced. MH is the expression of an arrest of disease progression, resulting in minor hospitalizations, surgeries, and prolonged clinical remission. MH may be achieved with several therapeutic strategies reaching success rates up to 80% for both, ulcerative colitis (UC) and Crohn’s disease (CD). Various scoring systems for UC and for the transmural CD, have been proposed to standardize the definition of MH. Several attempts have been undertaken to de-escalate therapy once MH is achieved, thus, reducing the risk of adverse events. In this review, we analysed the available studies regarding the achievement of MH and the subsequent treatment de-escalation according to disease type and administered therapy, together with non-invasive markers proposed as predictors for relapse. The available data are not encouraging since de-escalation after the achievement of MH is followed by a high number of clinical relapses reaching up to 50% within one year. Unclear is also another question, in case of combination therapies, which drug is more appropriate to stop, in order to guarantee a durable remission. Predictors of unfavourable outcome such as disease extension, perianal disease, or early onset disease appear to be inadequate to foresee behaviour of disease. Further studies are warranted to investigate the role of histologic healing for the further course of disease.
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