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Dahiya DS, Chandan S, Bapaye J, Mohan BP, Ramai D, Kassab LL, Chandan OC, Dulai PS, Kochhar GS. Safety and Effectiveness of Vedolizumab in Elderly Patients with Inflammatory Bowel Disease: A Systematic Review & Meta-Analysis. J Clin Gastroenterol 2024; 58:378-388. [PMID: 37224287 DOI: 10.1097/mcg.0000000000001860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/11/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND There is limited data on Vedolizumab utilization in elderly patients. Our study aims to assess the effectiveness and safety of Vedolizumab in this subset population. MATERIALS AND METHODS Databases including Cochrane Central, Embase, Medline (via Ovid), Scopus, and Web of Science were searched in August 2022 to identify studies that assessed Vedolizumab therapy in elderly patients. Pooled proportion and risk ratios (RR) were calculated. RESULTS Total 11 studies with 3546 IBD patients (1314 elderly and 2232 young) were included in the final analysis. Pooled rate of overall and serious infections in the elderly cohort was 8.45% (95% CI=6.27-11.29; I 2 23%) and 2.59% (95% CI=0.78-8.29; I 2 76%), respectively. However, there was no difference in overall infection rates between elderly and young patients. Pooled rate of endoscopic, clinical, and steroid-free remission for elderly IBD patients was 38.45% (95% CI=20.74-59.56; I 2 93%), 37.95% (95% CI=33.08-43.06; I 2 13%), and 38.8% (95% CI=31.6-46.4; I 2 77%), respectively. Elderly patients had lower steroid-free remission rates [RR 0.85, 95% CI=0.74-0.99; I 2 0%, P =0.03]; however, there was no difference in rates of clinical (RR 0.86, 95% CI=0.72-1.03; I 2 0%, P =0.10) or endoscopic remission (RR 1.06, 95% CI=0.83-1.35; I 2 0%, P =0.63) compared with younger patients. Pooled rate of IBD-related surgery and IBD-related hospitalizations was 9.76% (95% CI=5.81-15.92; I 2 78%) and 10.54% (95% CI=8.37-13.2; I 2 0%), respectively for the elderly cohort. There was no statistical difference in IBD-related surgeries between elderly and young IBD patients, RR 1.20 (95% CI=0.79-1.84; I 2 16%), P =0.4. CONCLUSIONS Vedolizumab is equally safe and effective for clinical and endoscopic remission in elderly and younger populations.
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Affiliation(s)
- Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI
| | - Saurabh Chandan
- Division of Gastroenterology & Hepatology, CHI Creighton University Medical Center, Omaha, NE
| | - Jay Bapaye
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, UT
| | - Lena L Kassab
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ojasvini C Chandan
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, University of Nebraska Medical Center, Omaha, NE
| | - Parambir S Dulai
- Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA
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Chandan S, Dhindsa BS, Khan SR, Deliwala S, Kassab LL, Mohan BP, Chandan OC, Loras C, Shen B, Kochhar GS. Endoscopic Stenting in Crohn's Disease-related Strictures: A Systematic Review and Meta-analysis of Outcomes. Inflamm Bowel Dis 2022:6650011. [PMID: 35880681 DOI: 10.1093/ibd/izac153] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Crohn's disease (CD) is a chronic progressive condition that is complicated by intestinal or colonic stricture in nearly 30% of cases within 10 years of the initial diagnosis. Endoscopic balloon dilation (EBD) is associated with a risk of perforations and recurrence rates of up to 60% at 5 years. Endoscopic stenting has been used as an alternative to EBD, but data on its safety and efficacy are limited. We conducted a systematic review and meta-analysis to assess the outcomes of endoscopic stenting in CD-related strictures. METHODS A systematic and detailed search was run in January 2022 with the assistance of a medical librarian for studies reporting on outcomes of endoscopic stenting in CD-related strictures. Meta-analysis was performed using random-effects model, and results were expressed in terms of pooled proportions along with relevant 95% confidence intervals (CIs). RESULTS Nine studies with 163 patients were included in the final analysis. Self-expanding metal stents (SEMS) including both partial and fully covered were used in 7 studies, whereas biodegradable stents were used in 2 studies. Pooled rate of clinical success and technical success was 60.9% (95% CI, 51.6-69.5; I2 = 13%) and 93% (95% CI, 87.3-96.3; I2 = 0%), respectively. Repeat stenting was needed in 9.6% of patients (95% CI, 5.3-16.7; I2 = 0%), whereas pooled rate of spontaneous stent migration was 43.9% (95% CI, 11.4-82.7; I2 = 88%). Pooled incidence of overall adverse events, proximal stent migration, perforation, and abdominal pain were 15.7%, 6.4%, 2.7%, and 17.9%, respectively. Mean follow-up period ranged from 3 months to 69 months. DISCUSSION Endoscopic stenting in CD-related strictures is a safe technique that can be performed with technical ease, albeit with a limited clinical success. Postprocedure abdominal pain and proximal stent migration are some of the common adverse events reported.
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Affiliation(s)
- Saurabh Chandan
- Department of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, NE, USA
| | - Banreet S Dhindsa
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shahab R Khan
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Smit Deliwala
- Department of Internal Medicine, Michigan State University at Hurley Medical Center, Flint, MI, USA
| | | | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA
| | - Ojasvini C Chandan
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Childrens Hospital of Omaha, Omaha, NE, USA
| | - Carme Loras
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Department of Gastroenterology, Hospital Universitari Mútua Terrassa, Fundació per la Recerca Mútua Terrassa, Terrrassa, Catalonia, Spain
| | - Bo Shen
- Center for Ileal Pouch Disorders, Columbia University Irving Medical Center-New York Presbyterian Hospital, NY, USA
| | - Gursimran S Kochhar
- Division of Gastroenterology, Hepatology & Nutrition, Allegheny Health Network, Pittsburgh, PA, USA
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Chandan S, Khan SR, Deliwala S, Mohan BP, Ramai D, Chandan OC, Facciorusso A. Postvaccination SARS-CoV-2 infection among healthcare workers: A systematic review and meta-analysis. J Med Virol 2022; 94:1428-1441. [PMID: 34783055 PMCID: PMC8661690 DOI: 10.1002/jmv.27457] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/08/2021] [Accepted: 11/14/2021] [Indexed: 01/19/2023]
Abstract
Healthcare workers (HCWs) remain on the front line of the battle against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 2019 (COVID-19) infection and are among the highest groups at risk of infection during this raging pandemic. We conducted a systematic review and meta-analysis to assess the incidence of postvaccination SARS-CoV-2 infection among vaccinated HCWs. We searched multiple databases from inception through August 2021 to identify studies that reported on the incidence of postvaccination SARS-CoV-2 infection among HCWs. Meta-analysis was performed to determine pooled proportions of COVID-19 infection in partially/fully vaccinated as well as unvaccinated individuals. Eighteen studies with 228 873 HCWs were included in the final analysis. The total number of partially vaccinated, fully vaccinated, and unvaccinated HCWs were 132 922, 155 673, and 17 505, respectively. Overall pooled proportion of COVID-19 infections among partially/fully vaccinated and unvaccinated HCWs was 2.1% (95% confidence interval [CI] 1.2-3.5). Among partially vaccinated, fully vaccinated and unvaccinated HCWs, pooled proportion of COVID-19 infections was 2.3% (CI 1.2-4.4), 1.3% (95% CI 0.6-2.9), and 10.1% (95% CI 4.5-19.5), respectively. Our analysis shows the risk of COVID-19 infection in both partially and fully vaccinated HCWs remains exceedingly low when compared to unvaccinated individuals. There remains an urgent need for all frontline HCWs to be vaccinated against SARS-CoV-2 infection.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and HepatologyCHI Creighton University Medical CenterOmahaNebraskaUSA
| | - Shahab R. Khan
- Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Smit Deliwala
- Department of Internal MedicineInternal Medicine, Hurley Medical CenterFlintMichiganUSA
| | - Babu P. Mohan
- Division of Gastroenterology and HepatologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Daryl Ramai
- Division of Gastroenterology and HepatologyUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Ojasvini C. Chandan
- Division of Pediatric GastroenterologyHepatology and Nutrition, Children's Hospital of OmahaOmahaNebraskaUSA
| | - Antonio Facciorusso
- Department of Surgical and Medical SciencesGastroenterology UnitUniversity of FoggiaFoggiaItaly
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Chandan S, Arora S, Mohan BP, Khan SR, Chandan OC, Kassab LL, Murali AR. Multimedia based education on bowel preparation improves adenoma detection rate: Systematic review & meta-analysis of randomized controlled trials. Dig Endosc 2021; 33:730-740. [PMID: 32794240 DOI: 10.1111/den.13809] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/24/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Colorectal cancer (CRC) is the third most common cause of cancer worldwide. Studies have shown a strong association between screening colonoscopy and a reduced risk of death from colorectal cancers. The incidence of poor bowel preparation has been reported in up to 25% cases. We conducted a systematic review and comprehensive meta-analysis to evaluate the effect of patient education using multimedia platforms on adenoma detection rate and adequacy of bowel preparation. METHODS Multiple databases were searched through May 2020 for studies that reported the efficacy of multimedia education (smartphone app and online audio-visual aids) in improving quality of bowel preparation and its effect on adenoma detection rate (ADR). Meta-analysis was performed to determine whether multimedia based patient education (MM) helps improve ADR and bowel preparation quality as compared to controls (CT). RESULTS We included 13 randomized controlled trials with a total of 3754 patients. Eight studies reported outcomes on ADR and 12 reported on adequacy of bowel preparation. Overall ADR was higher in patients receiving multimedia based education as compared to CT (risk ratio (RR) 1.25, confidence interval (CI) 1.01-1.56, P = 0.04). A higher proportion of patients receiving multimedia based education achieved adequate bowel preparation (RR 1.2, CI 1.1-1.3, P = 0.001). In patients with mean age over 50 years, ADR was better in MM cohort as compared to controls (RR 1.3, CI 1.1-1.6, P = 0.001). CONCLUSION Pre-colonoscopy patient education using multimedia based platforms seems to improve ADR and the adequacy of bowel preparation.
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Affiliation(s)
- Saurabh Chandan
- Division of Gastroenterology and Hepatology, CHI Creighton University Medical Center, Omaha, USA
| | - Sumant Arora
- Gastroenterology & Hepatology, University of Iowa, Iowa City, USA
| | - Babu P Mohan
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, USA
| | - Shahab R Khan
- Section of Gastroenterology, Rush University Medical Center, Chicago, USA
| | - Ojasvini C Chandan
- Department of Pediatric Gastroenterology, Hepatology & Nutrition, University of Nebraska Medical Center, Omaha, USA
| | | | - Arvind R Murali
- Gastroenterology & Hepatology, University of Iowa, Iowa City, USA
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Chandan S, Mohan BP, Chandan OC, Ahmad R, Challa A, Tummala H, Singh S, Dhawan P, Ponnada S, Singh AB, Adler DG. Curcumin use in ulcerative colitis: is it ready for prime time? A systematic review and meta-analysis of clinical trials. Ann Gastroenterol 2019; 33:53-58. [PMID: 31892798 PMCID: PMC6928475 DOI: 10.20524/aog.2019.0439] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Curcumin, an active ingredient of the Indian herb turmeric (Curcuma longa), has shown promising anti-inflammatory properties. Studies of its potential benefits in treating patients with ulcerative colitis (UC) are limited. We performed a systematic review and meta-analysis of human randomized placebo controlled trials to evaluate the efficacy of adjunctive therapy with curcumin in treating patients with UC. Methods: We conducted a search of several databases (from January 2000 to September 2018). A random-effects model was used for analysis. We assessed heterogeneity between study-specific estimates using the Cochran Q statistical test, 95% prediction interval (PI) and I2 statistics. The outcomes assessed were the pooled odds of clinical response and remission as well as the endoscopic response. Results: A total of 7 studies with 380 patients (curcumin n=188; placebo n=190) were included in the final analysis. The pooled odds ratio for clinical remission with curcumin use was 2.9 (95%CI 1.5-5.5, I2=45, P=0.002), clinical response was 2.6 (95%CI 1.5-4.5, I2=74%, P=0.001), and endoscopic response/remission was 2.3 (95%CI 1.2-4.6, I2=35.5%, P=0.01). Conclusions: Based on our study, combined mesalamine and curcumin therapy was associated with roughly threefold better odds of a clinical response compared to placebo, with minimal side effects. This response was statistically significant, albeit with heterogeneity, probably due to the different severity scoring indices, curcumin dosages and routes of drug delivery used.
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Affiliation(s)
- Saurabh Chandan
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska (Saurabh Chandan, Abhishek Challa, Shailender Singh)
| | - Babu P Mohan
- Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona (Babu P. Mohan)
| | - Ojasvini C Chandan
- Pediatric Gastroenterology, Hepatology and Nutrition, University of Nebraska Medical Center, Omaha, Nebraska (Ojasvini C. Chandan)
| | - Rizwan Ahmad
- Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska (Rizwan Ahmad, Punita Dhawan)
| | - Abhishek Challa
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska (Saurabh Chandan, Abhishek Challa, Shailender Singh)
| | - Hemachand Tummala
- College of Pharmacy and Allied Health Professions, South Dakota State University, Brookings, South Dakota (Hemachand Tummala)
| | - Shailender Singh
- Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska (Saurabh Chandan, Abhishek Challa, Shailender Singh)
| | - Punita Dhawan
- Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska (Rizwan Ahmad, Punita Dhawan)
| | - Suresh Ponnada
- Internal Medicine, Carilion Roanoke Memorial Hospital, Roanoke, Virginia (Suresh Ponnada)
| | - Amar B Singh
- Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska (Rizwan Ahmad, Punita Dhawan)
| | - Douglas G Adler
- Division of Gastroenterology and Hepatology, University of Utah School of Medicine, Salt Lake City, Utah (Douglas G. Adler), USA
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