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Fortuny M, Sarrias MR, Torner M, Iborra I, Clos A, Ardèvol A, Bartolí R, Morillas RM, Domènech E, Masnou H. Systematic review of the role of calprotectin in cirrhosis. Eur J Clin Invest 2024; 54:e14111. [PMID: 37849372 DOI: 10.1111/eci.14111] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/16/2023] [Accepted: 09/23/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Calprotectin is a calcium-binding-S100-protein synthetized mainly in neutrophils which has been demonstrated to be an accurate biomarker of the presence of these cells. Gut barrier dysfunction in patients with advanced chronic liver disease (ACLD), in addition to the lack of noninvasive tools for diagnosis and prognosis of cirrhosis decompensations, has raised interest in this biomarker. AIMS Our aim is to summarize the current evidence regarding the role of calprotectin in terms of its diagnostic and prognostic utility in ACLD. METHODS We performed a systematic search (PROSPERO registration no. CRD42023389069) of original articles published without any restrictions on the publication date until January 2023 providing information about calprotectin for the prognosis or diagnosis of ACLD and its decompensations in adult patients. RESULTS A total 227 articles were identified, and 26 observational studies finally met the inclusion criteria. In 14 studies, calprotectin was measured in ascitic fluid, all of which reported higher calprotectin values in spontaneous bacterial peritonitis, while cut-off points for its diagnosis were proposed in nine studies. Three studies reported higher faecal calprotectin levels in patients with hepatic encephalopathy and portal hypertension. Four studies evaluated faecal calprotectin and one plasma calprotectin as biomarkers for gut barrier integrity and bacterial translocation. CONCLUSIONS Calprotectin is emerging as a promising biomarker in ACLD, particularly for the management of bacterial infections and alcohol-related liver disease. Further research with better study designs should help to determine the feasibility of calprotectin measurement in routine clinical practice.
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Affiliation(s)
- Marta Fortuny
- Hepatology Unit, Hospital Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria-Rosa Sarrias
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Maria Torner
- Hepatology Unit, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Ignacio Iborra
- Hepatology Unit, Hospital Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ariadna Clos
- Hepatology Unit, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Alba Ardèvol
- Hepatology Unit, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Ramon Bartolí
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- Germans Trias i Pujol Research Institute (IGTP), Badalona, Spain
| | - Rosa M Morillas
- Hepatology Unit, Hospital Germans Trias i Pujol, Badalona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Eugeni Domènech
- Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
- IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Helena Masnou
- Hepatology Unit, Hospital Germans Trias i Pujol, Badalona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Soria A, Calvo M, Casas M, Vidales Z, Muñoz-Martínez S, Sapena V, Puigvehi M, Canillas L, Guardeño R, Gallego A, Mínguez B, Horta D, Clos A, Montoliu S, Roget M, Reig M, Vergara M. Survival and adverse events of elderly patients treated with sorafenib for hepatocellular carcinoma. Front Oncol 2022; 12:829483. [PMID: 35982971 PMCID: PMC9380437 DOI: 10.3389/fonc.2022.829483] [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] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction The first-line treatment for advanced hepatocellular carcinoma (HCC) is atezolizumab plus bevacizumab, but its availability is not universal and elderly patients are underrepresented in clinical trials. There is little evidence of efficacy and tolerability in elderly patients under systemic treatment. The aims of this study were to characterize the profile of elderly patients treated with sorafenib, assess their survival and safety profile in order to extrapolate their eligibility for systemic treatment. Methods Retrospective multicentre study of HCC patients aged ≥75 years old treated with sorafenib from January 2008 to December 2019. Demographic data, baseline characteristics, and variables related to HCC and sorafenib were recorded. Overall survival (OS) and safety were analyzed. Results The study included 206 patients from 11 hospitals, median age 77.9 years; 71.4% men and 62.6% stage Barcelona Clinic Liver Cancer- C (BCLC-C). The main causes of cirrhosis were hepatitis C (60.7%) and alcohol (14.7%). Most patients (84.5%) started with sorafenib 800mg and 15.5% at lower dosage. Arterial hypertension (AHT) (74.2 vs 62.2%; standardized mean differences (STD): 26) and baseline ECOG-PS>0 (45.3 vs 34.7%; STD: 38.2) differed significantly between patients receiving low and full doses. Median OS was 15.4 months (18.2 in BCLC-B vs 13.6 in BCLC-C). OS was not modified by comorbidities, age or period with more expertise. Conclusions Sorafenib appears to be safe in elderly patients with HCC. This is the first study to characterize the profile of elderly patients to be considered for systemic treatment. These findings could be used as the reference profile for elderly candidates for atezolizumab-bevacizumab.
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Affiliation(s)
- Anna Soria
- Department of Digestive Diseases, Liver Unit, Parc Taulí University Hospital, Investigation and Innovation Institute Parc Taulí I3PT, Universitat Autònoma of Barcelona, Sabadell, Spain
| | - Mariona Calvo
- Medical Oncology Department, Catalan Institute of Oncology, Hospitalet, Barcelona, Spain
| | - Meritxell Casas
- Department of Digestive Diseases, Liver Unit, Parc Taulí University Hospital, Investigation and Innovation Institute Parc Taulí I3PT, Universitat Autònoma of Barcelona, Sabadell, Spain
| | - Zara Vidales
- Medical Oncology Department, Catalan Institute of Oncology, Hospitalet, Barcelona, Spain
| | - Sergio Muñoz-Martínez
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Clinical Insitute of Digestive and Metabolic Diseases (ICMDiM), Clinic Hospital, Barcelona University, Barcelona, Spain
- Biomedical Research Center in Digestive and Liver Diseases Network (CIBERehd), Instituto Carlos III, Madrid, Spain
| | - Victor Sapena
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Clinical Insitute of Digestive and Metabolic Diseases (ICMDiM), Clinic Hospital, Barcelona University, Barcelona, Spain
- Medical Statistics Core Facility, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Barcelona, Spain
- Liver Unit, University Hospital Vall d’Hebron, Liver Diseases Research Group, Vall d’Hebron Institut of Research (VHIR), Universitat Autònoma of Barcelona, Barcelona, Spain
| | - Marc Puigvehi
- Department of Digestive Diseases, Liver Unit, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Lidia Canillas
- Department of Digestive Diseases, Liver Unit, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Raquel Guardeño
- Medical Oncology Department, Josep Trueta University Hospital, Catalan Institute of Oncology, Girona, Spain
| | - Adolfo Gallego
- Department of Digestive Diseases, Sant Pau i Santa Creu University Hospital, Barcelona, Spain
| | - Beatriz Mínguez
- Biomedical Research Center in Digestive and Liver Diseases Network (CIBERehd), Instituto Carlos III, Madrid, Spain
- Liver Unit, University Hospital Vall d’Hebron, Liver Diseases Research Group, Vall d’Hebron Institut of Research (VHIR), Universitat Autònoma of Barcelona, Barcelona, Spain
| | - Diana Horta
- Biomedical Research Center in Digestive and Liver Diseases Network (CIBERehd), Instituto Carlos III, Madrid, Spain
- Department of Gastroenterology, University Hospital Mútua Terrassa, Barcelona University, Terrassa, Spain
| | - Ariadna Clos
- Department of Digestive Diseases, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Silvia Montoliu
- Department of Digestive Diseases, Joan XXIII University Hospital, Tarragona, Spain
| | - Mercè Roget
- Department of Digestive Diseases, Liver Unit, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Maria Reig
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Clinical Insitute of Digestive and Metabolic Diseases (ICMDiM), Clinic Hospital, Barcelona University, Barcelona, Spain
- Biomedical Research Center in Digestive and Liver Diseases Network (CIBERehd), Instituto Carlos III, Madrid, Spain
| | - Mercedes Vergara
- Department of Digestive Diseases, Liver Unit, Parc Taulí University Hospital, Investigation and Innovation Institute Parc Taulí I3PT, Universitat Autònoma of Barcelona, Sabadell, Spain
- Biomedical Research Center in Digestive and Liver Diseases Network (CIBERehd), Instituto Carlos III, Madrid, Spain
- *Correspondence: Mercedes Vergara,
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Masnou H, Luna D, Castillo E, Galindo M, Ardèvol A, Clos A, Sarrias MR, Armengol C, Bargalló A, Morillas RM, Domènech E. Prevalence and outcomes of acute-on-chronic liver failure among cirrhotic patients admitted for an acute decompensation. Gastroenterol Hepatol 2021; 45:424-431. [PMID: 34118317 DOI: 10.1016/j.gastrohep.2021.05.007] [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] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 05/14/2021] [Accepted: 05/27/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Acute-on-chronic liver failure (ACLF) is a common syndrome that occurs in patients with advanced chronic liver disease. It consists of the rapid failure of various organs and is associated with high short-term mortality. We aim to describe the main features and outcomes of inpatients who developed ACLF and to identify the factors associated with in-hospital and 28-day mortality. PATIENTS AND METHODS All patients meeting ACLF criteria with advanced chronic liver disease admitted for decompensation from January 2014 to December 2016 were identified. Clinical and biological data were collected at the time of ACLF diagnosis and at 3-7 days thereafter, as well as in-hospital and 28-day mortality. RESULTS Eighty nine out of 354 admission episodes (28%) developed ACLF, which was present at the time of admission in 72% of cases. A precipitating factor was identified in 83% of cases, the most frequent being infection (53%) and gastrointestinal bleeding (19%). In the multivariate regression analysis, the ACLF grade at 3-7 days after diagnosis was predictive of in-hospital mortality and 28-day mortality, and lower creatinine and bilirubin levels at the time of ACLF diagnosis and a precipitating factor other than bacterial infection were associated with ACLF reversion at 3-7 days. CONCLUSIONS ACLF is a frequent complication among patients with chronic liver disease admitted for acute decompensations and is associated with a high mortality rate and is related to the number of organs involved. Bacterial infection is the most frequent precipitating factor of ACLF and probably entails a worse prognosis.
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Affiliation(s)
- Helena Masnou
- Gastroenterology & Hepatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
| | - Daniel Luna
- Gastroenterology & Hepatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Edgar Castillo
- Gastroenterology & Hepatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Marc Galindo
- Gastroenterology & Hepatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Alba Ardèvol
- Gastroenterology & Hepatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Ariadna Clos
- Gastroenterology & Hepatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - María Rosa Sarrias
- Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas, Spain; Institut de Recerca Germans Trias i Pujol, Spain
| | - Carolina Armengol
- Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas, Spain; Institut de Recerca Germans Trias i Pujol, Spain
| | - Ana Bargalló
- Gastroenterology Department, Hospital Moisés Broggi. Sant Joan d'Espí, Spain
| | - Rosa María Morillas
- Gastroenterology & Hepatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas, Spain
| | - Eugeni Domènech
- Gastroenterology & Hepatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas, Spain
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Guasch M, Cañete F, Ordás I, Iglesias-Flores E, Clos A, Gisbert JP, Taxonera C, Vera I, Mínguez M, Guardiola J, Rivero M, Nos P, Gomollón F, Barrio J, de Francisco R, López-Sanromán A, Martín-Arranz MD, Garcia-Planella E, Camargo R, García-López S, de Castro L, Calvet X, Esteve M, Mañosa M, Domènech E. Changes in the requirement for early surgery in inflammatory bowel disease in the era of biological agents. J Gastroenterol Hepatol 2020; 35:2080-2087. [PMID: 32350906 DOI: 10.1111/jgh.15084] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 12/23/2019] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Biological therapies may be changing the natural history of inflammatory bowel diseases (IBDs), reducing the need for surgical intervention. We aimed to assess whether the availability of anti-TNF agents impacts the need for early surgery in Crohn's disease (CD) and ulcerative colitis (UC). METHODS Retrospective, cohort study of patients diagnosed within a 6-year period before and after the licensing of anti-TNFs (1990-1995 and 2007-2012 for CD; 1995-2000 and 2007-2012 for UC) were identified in the ENEIDA Registry. Surgery-free survival curves were compared between cohorts. RESULTS A total of 7370 CD patients (2022 in Cohort 1 and 5348 in Cohort 2) and 8069 UC patients (2938 in Cohort 1 and 5131 in Cohort 2) were included. Immunosuppressants were used significantly earlier and more frequently in both CD and UC post-biological cohorts. The cumulative probability of surgery was lower in CD following anti-TNF approval (16% and 11%, 22% and 16%, and 29% and 19%, at 1, 3, and 5 years, respectively P < 0.0001), although not in UC (3% and 2%, 4% and 4%, and 6% and 5% at 1, 3, and 5 years, respectively; P = 0.2). Ileal involvement, older age at diagnosis and active smoking in CD, and extensive disease in UC, were independent risk factors for surgery, whereas high-volume IBD centers (in both CD and UC) and immunosuppressant use (in CD) were protective factors. CONCLUSIONS Anti-TNF availability was associated with a reduction in early surgery for CD (driven mainly by earlier and more widespread immunosuppressant use) but not in UC.
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Affiliation(s)
- Montserrat Guasch
- Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Fiorella Cañete
- Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain
| | - Ingrid Ordás
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,Hospital Clínic and IDIBAPS (Barcelona, Catalonia), Madrid, Spain
| | | | - Ariadna Clos
- Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain
| | - Javier P Gisbert
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,Hospital de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (Madrid), Madrid, Spain
| | - Carlos Taxonera
- Hospital Clínico San Carlos, Instituto de Investigación del Hospital Clínico San Carlos (IdISSC) (Madrid), Madrid, Spain
| | - Isabel Vera
- Hospital Universitario Puerta de Hierro (Madrid), Majadahonda, Spain
| | - Miguel Mínguez
- H. Clínico de Valencia i Universitat de València (València), Valencia, Spain
| | - Jordi Guardiola
- Hospital Universitari de Bellvitge IDIBELL and Universitat de Barcelona (L'Hospitalet del Llobregat, Catalonia), Llobregat, Spain
| | - Montserrat Rivero
- Hospital Marqués de Valdecilla and IDIVAL (Santander), Santander, Spain
| | - Pilar Nos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,Hospital Universitari i Politècnic La Fe (Valencia), Valencia, Spain
| | - Fernando Gomollón
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,IIS Aragón, Hospital Clínico Lozano Blesa (Zaragoza), Zaragoza, Spain
| | | | - Ruth de Francisco
- Hospital Universitario Central de Asturias e Instituto de Investigación Sanitaria del Principado de Asturias (ISPA) (Oviedo), Spain
| | | | | | | | | | | | | | - Xavier Calvet
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,Hospital Parc Taulí (Sabadell, Catalonia), Spain
| | - Maria Esteve
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain.,Hospital Mútua Terrassa (Terrassa, Catalonia), Spain
| | - Míriam Mañosa
- Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain
| | - Eugeni Domènech
- Hospital Universitari Germans Trias i Pujol (Badalona, Catalonia), Barcelona, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Madrid), Madrid, Spain
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Cañete F, Mañosa M, Clos A, Cabré E, Domènech E. Review article: the relationship between obesity, bariatric surgery, and inflammatory bowel disease. Aliment Pharmacol Ther 2018; 48:807-816. [PMID: 30178869 DOI: 10.1111/apt.14956] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 05/10/2018] [Revised: 06/07/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND The convoluted relationship between obesity, bariatric surgery and inflammatory bowel disease (IBD) is of increasing interest. AIM To analyse evidence regarding the role of bariatric surgery in the development of de novo IBD and its impact on clinical outcomes and safety in patients with established IBD. METHODS A PubMed/Medline search was performed to identify studies reporting the development of IBD after bariatric surgery and the outcomes of IBD patients after bariatric surgery. RESULTS Eighty patients were reported to have developed de novo IBD after bariatric surgery (21% ulcerative colitis [UC], 75% Crohn's disease [CD]), mostly females. Roux-en-Y gastric bypass was the most frequent bariatric technique (80%). Symptoms related to IBD occurred within 1 month and 16 years after surgery. Regarding patients with known IBD undergoing bariatric surgery, 60 patients (35 CD, 24 UC, and 1 unclassified colitis) have been reported. Sleeve gastrectomy was the most frequent bariatric procedure, particularly in CD patients. Acute flares after surgery were observed in only four UC patients. In addition, two retrospective population-based studies described perioperative outcomes of bariatric surgery on IBD patients, demonstrating only a significant increase in small bowel obstruction in these patients. CONCLUSIONS Bariatric surgery in carefully selected patients with established IBD is technically feasible and probably safe. Development of de novo IBD should be taken into account in individuals with previous bariatric surgery who develop diarrhoea, anaemia or excessive weight loss.
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Affiliation(s)
- Fiorella Cañete
- IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain.,Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Catalonia, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Míriam Mañosa
- IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain.,Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Catalonia, Spain
| | - Ariadna Clos
- IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain
| | - Eduard Cabré
- IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain.,Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Catalonia, Spain
| | - Eugeni Domènech
- IBD Unit, Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain.,Centro de Investigaciones Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Catalonia, Spain
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Torres P, Lobatón T, Cañete F, Clos A, Mañosa M, Cabré E, Domènech E. Cytomegalovirus primoinfection in inflammatory bowel disease. Gastroenterología y Hepatología (English Edition) 2018; 41:453-454. [DOI: 10.1016/j.gastre.2018.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Maier M, Haas K, Feucht N, Fiore B, Winkler von Mohrenfels C, Clos A, Lohmann C. [Photodynamic therapy with verteporfin combined with intravitreal injection of bevacizumab for occult and classic CNV in AMD]. Klin Monbl Augenheilkd 2008; 225:653-9. [PMID: 18642209 DOI: 10.1055/s-2008-1027455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of this study is to discuss the effect and outcome of a combined photodynamic therapy and intravitreal injection of bevacizumab (1.25 mg) in occult and classic choroidal neovascularisation (CNV) due to AMD. Especially cases of occult CNV with pigment epithelium detachment (PED) are not likely to respond positively to standard photodynamic therapy, often ending up in PED enlargement or tearing of the RPE. METHODS In a pilot study involving 23 patients, intravitreal injections of bevacizumab were administered within 12 to 24 hours after standard PDT to reduce the post-PDT increase of proangiogenic and inflammatory factors. Before and at 1, 3 and 6 month after treatment visual acuity and OCT examinations (retinal thickness) were performed. RESULTS Mean visual acuity was significantly improved compared to baseline. (VA baseline 20/125, after 1 month 20/80, after 3 months 20/80, and 20/80 after 6 months) and an enlargement of the PED in occult CNV was prevented. We found no RPE rip. OCT findings in patients with occult and classic choroidal neovascularisation 1, 3 and 6 months after combination therapy showed a reduced retinal thickness compared to baseline. CONCLUSIONS Photodynamic therapy combined with injection of intravitreal bevacizumab tends to be more effective compared to PDT monotherapy by reducing the post-PDT increase of vascular growth and inflammatory factors. Our short-term results are very promising. Further studies are necessary to show the long-term effect of PDT and anti-VEGF combination therapy.
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Affiliation(s)
- M Maier
- Augenklinik, Klinikum rechts der Isar der TU München.
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Maier M, Feucht N, Haas K, Fiore B, Winkler von Mohrenfels C, Clos A, Lohmann C. Bevacizumab intravitreal zur Behandlung okkulter und minimal klassischer choroidaler Neovaskularisation (CNV) bei AMD. Klin Monbl Augenheilkd 2008; 225:818-24. [DOI: 10.1055/s-2008-1027638] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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