101
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Affiliation(s)
- Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, NY
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102
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Hanauer SB, Sandborn WJ, Feagan BG, Gasink C, Jacobstein D, Zou B, Johanns J, Adedokun OJ, Sands BE, Rutgeerts P, de Villiers WJS, Colombel JF, Ghosh S. IM-UNITI: Three-year Efficacy, Safety, and Immunogenicity of Ustekinumab Treatment of Crohn's Disease. J Crohns Colitis 2020; 14:23-32. [PMID: 31158271 DOI: 10.1093/ecco-jcc/jjz110] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [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] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Following induction/maintenance treatment in the UNITI/IM-UNITI studies of ustekinumab for Crohn's disease, patients entered a long-term extension for up to 5 years from induction. Efficacy through 152 and safety through 156 weeks are reported. METHODS At IM-UNITI Week 44, 567 ustekinumab-treated patients entered the long-term extension and continued to receive blinded subcutaneous ustekinumab on their assigned dose interval, without any subsequent dose adjustment. Placebo-treated patients discontinued after study unblinding [after IM-UNITI Week 44 analyses]. Efficacy data in the long-term extension [LTE] were collected every 12 weeks [q12w] before unblinding and then at q12w/q8w dosing visits. RESULTS Through Week 156, 29.6% of ustekinumab-treated patients discontinued. In an intent-to-treat analysis of randomised patients from IM-UNITI Weeks 0-152, 38.0% of ustekinumab induction responders receiving the drug q12w and 43.0% q8w were in remission at Week 152. Among patients entering the long-term extension in their original randomised groups, 61.9% of q12w and 69.5% of q8w patients were in remission at Week 152. Across all ustekinumab-treated patients [randomised and non-randomised] entering the long-term extension, remission rates at Week 152 were 56.3% and 55.1% for q12w and q8w, respectively. Safety events [per 100 patient-years] were similar among all ustekinumab-treated patients entering the long-term extension and placebo [overall adverse events 389.70 vs 444.17; serious adverse events, 18.97 vs 19.54; serious infections, 4.21 vs 3.97]. Rates of antibodies to ustekinumab through Week 156 remained low, 4.6% in all randomised ustekinumab-treated patients; lowest among patients in the original randomised q8w group [2/82, 2.4%]. CONCLUSIONS Continued treatment with subcutaneous ustekinumab maintained clinical response and remission through 3 years in a majority of patients who responded to induction therapy and was well-tolerated. ClinicalTrials.gov number NCT01369355.
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Affiliation(s)
- Stephen B Hanauer
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Brian G Feagan
- Robarts Clinical Trials, Western University, London, ON, Canada
| | | | | | - Bin Zou
- Janssen Research & Development, LLC, Spring House, PA, USA
| | - Jewel Johanns
- Janssen Research & Development, LLC, Spring House, PA, USA
| | | | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Subrata Ghosh
- NIHR Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
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103
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Sands BE, Armuzzi A, Marshall JK, Lindsay JO, Sandborn WJ, Danese S, Panés J, Bressler B, Colombel J, Lawendy N, Maller E, Zhang H, Chan G, Salese L, Tsilkos K, Marren A, Su C. Efficacy and safety of tofacitinib dose de-escalation and dose escalation for patients with ulcerative colitis: results from OCTAVE Open. Aliment Pharmacol Ther 2020; 51:271-280. [PMID: 31660640 PMCID: PMC9328429 DOI: 10.1111/apt.15555] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/15/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND For patients with UC, flexible maintenance dosing therapy may confer advantages for safety, efficacy, costs and patient preference. Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of UC. AIM To assess the efficacy and safety of tofacitinib dose de-escalation and escalation in patients with UC. METHODS We evaluated data (November 2017 data cut-off) from OCTAVE Open, an ongoing, open-label, long-term extension study. The dose de-escalation group comprised 66 tofacitinib induction responders in remission following 52 weeks' tofacitinib 10 mg b.d. maintenance therapy, subsequently de-escalated to 5 mg b.d. in OCTAVE Open. The dose escalation group comprised 57 tofacitinib induction responders who experienced treatment failure while receiving 5 mg b.d. maintenance therapy, subsequently escalated to 10 mg b.d. in OCTAVE Open. RESULTS After tofacitinib de-escalation, 92.4% (61/66) and 84.1% (53/63) of patients maintained clinical response and 80.3% (53/66) and 74.6% (47/63) maintained remission, at months 2 and 12, respectively. After dose escalation, 57.9% (33/57) and 64.9% (37/57) of patients recaptured clinical response and 35.1% (20/57) and 49.1% (28/57) were in remission, at months 2 and 12, respectively. The incidence rate of herpes zoster with dose escalation (7.6 patients with events/100 patient-years) was numerically higher than in the overall tofacitinib UC programme. CONCLUSIONS Following tofacitinib de-escalation in patients already in remission on 10 mg b.d., most maintained remission, although 25.4% lost remission, at month 12. For induction responders who dose-escalated following treatment failure on 5 mg b.d. maintenance therapy, 49.1% achieved remission by month 12. (ClinicalTrials.gov number: NCT01470612).
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Affiliation(s)
| | - Alessandro Armuzzi
- Fondazione Policlinico Universitario A. Gemelli IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
| | - John K. Marshall
- Farncombe Family Digestive Health Research InstituteMcMaster UniversityHamiltonONCanada
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104
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Sands BE. Comparative Effectiveness Research in Inflammatory Bowel Disease: The VARSITY Study and Beyond. Gastroenterol Hepatol (N Y) 2019; 15:682-684. [PMID: 31892915 PMCID: PMC6935026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Bruce E Sands
- Dr Burrill B. Crohn Professor of Medicine The Dr Henry D. Janowitz Division of Gastroenterology Icahn School of Medicine at Mount Sinai New York, New York
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105
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Shmidt E, Saha S, Sands BE. Reply to Letter to the Editor of Dr. Lai and Colleagues. Inflamm Bowel Dis 2019; 25:e166. [PMID: 31622457 DOI: 10.1093/ibd/izz238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Eugenia Shmidt
- University of Minnesota, Division of Gastroenterology, Hepatology and Nutrition, Minneapolis, Minnesota, USA
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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106
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Faleck DM, Winters A, Chablaney S, Shashi P, Meserve J, Weiss A, Aniwan S, Koliani-Pace JL, Kochhar G, Boland BS, Singh S, Hirten R, Shmidt E, Kesar V, Lasch K, Luo M, Bohm M, Varma S, Fischer M, Hudesman D, Chang S, Lukin D, Sultan K, Swaminath A, Gupta N, Siegel CA, Shen B, Sandborn WJ, Kane S, Loftus EV, Sands BE, Colombel JF, Dulai PS, Ungaro R. Shorter Disease Duration Is Associated With Higher Rates of Response to Vedolizumab in Patients With Crohn's Disease But Not Ulcerative Colitis. Clin Gastroenterol Hepatol 2019; 17:2497-2505.e1. [PMID: 30625408 PMCID: PMC7026826 DOI: 10.1016/j.cgh.2018.12.040] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/17/2018] [Accepted: 12/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with Crohn's disease (CD), but not ulcerative colitis (UC), of shorter duration have higher rates of response to tumor necrosis factor (TNF) antagonists than patients with longer disease duration. Little is known about the association between disease duration and response to other biologic agents. We aimed to evaluate response of patients with CD or UC to vedolizumab, stratified by disease duration. METHODS We analyzed data from a retrospective, multicenter, consortium of patients with CD (n = 650) or UC (n = 437) treated with vedolizumab from May 2014 through December 2016. Using time to event analyses, we compared rates of clinical remission, corticosteroid-free remission (CSFR), and endoscopic remission between patients with early-stage (≤2 years duration) and later-stage (>2 years) CD or UC. We used Cox proportional hazards models to identify factors associated with outcomes. RESULTS Within 6 months initiation of treatment with vedolizumab, significantly higher proportions of patients with early-stage CD, vs later-stage CD, achieved clinical remission (38% vs 23%), CSFR (43% vs 14%), and endoscopic remission (29% vs 13%) (P < .05 for all comparisons). After adjusting for disease-related factors including previous exposure to TNF antagonists, patients with early-stage CD were significantly more likely than patients with later-stage CD to achieve clinical remission (adjusted hazard ratio [aHR], 1.59; 95% CI, 1.02-2.49), CSFR (aHR, 3.39; 95% CI, 1.66-6.92), and endoscopic remission (aHR, 1.90; 95% CI, 1.06-3.39). In contrast, disease duration was not a significant predictor of response among patients with UC. CONCLUSIONS Patients with CD for 2 years or less are significantly more likely to achieve a complete response, CSFR, or endoscopic response to vedolizumab than patients with longer disease duration. Disease duration does not associate with response vedolizumab in patients with UC.
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Affiliation(s)
| | - Adam Winters
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Joseph Meserve
- University of California - San Diego, La Jolla, California
| | | | | | | | | | | | | | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Karen Lasch
- Takeda Pharmaceuticals U.S.A., Inc, Deerfield, Illinois
| | - Michelle Luo
- Takeda Pharmaceuticals U.S.A., Inc, Deerfield, Illinois
| | | | | | | | | | | | - Dana Lukin
- Montefiore Medical Center, Bronx, New York
| | - Keith Sultan
- North Shore University Hospital, Manhasset, New York
| | | | - Nitin Gupta
- University of Mississippi, Jackson, Mississippi
| | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | | | - Bruce E. Sands
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Ryan Ungaro
- Icahn School of Medicine at Mount Sinai, New York, New York.
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107
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Sandborn WJ, Panés J, Sands BE, Reinisch W, Su C, Lawendy N, Koram N, Fan H, Jones TV, Modesto I, Quirk D, Danese S. Venous thromboembolic events in the tofacitinib ulcerative colitis clinical development programme. Aliment Pharmacol Ther 2019; 50:1068-1076. [PMID: 31599001 PMCID: PMC6899755 DOI: 10.1111/apt.15514] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/11/2019] [Accepted: 08/30/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis (UC). AIM To report incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in the tofacitinib UC programme. METHODS DVT and PE were evaluated from one phase 2 and two phase 3 induction studies, one phase 3 maintenance study and an ongoing, open-label, long-term extension (OLE) study (September 2018 datacut). Data were analysed in induction, maintenance and overall (patients receiving ≥ 1 dose of tofacitinib 5 or 10 mg b.d. in any phase 2, 3 or OLE study) cohorts. RESULTS 1157 patients (2404 patient-years' exposure; ≤ 6.1 years' tofacitinib treatment) were evaluated in the overall cohort. In induction, one placebo-treated patient had DVT and one had PE; no tofacitinib-treated patients had DVT/PE. In maintenance, one placebo-treated patient had DVT and one had PE; no tofacitinib-treated patients had DVT/PE. In the overall cohort, one patient had DVT (incidence rate [patients with events/100 patient-years; 95% CI]: 0.04 [0.00-0.23]); four had PE (0.16 [0.04-0.41]); all received predominant dose tofacitinib 10 mg b.d.; all had venous thromboembolism risk factors alongside UC. CONCLUSIONS In this post hoc analysis of patients with UC, during tofacitinib exposure, one patient had DVT and four had PE, all during the OLE study, on predominant dose 10 mg b.d. (83% of overall cohort patients received predominant dose 10 mg b.d.) with venous thromboembolism risk factors. This analysis is limited by small sample size and limited drug exposure; further studies are needed. ClinicalTrials.gov: NCT00787202, NCT01465763, NCT01458951, NCT01458574, NCT01470612.
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Affiliation(s)
- William J. Sandborn
- Division of GastroenterologyUniversity of California, San DiegoLa JollaCalifornia
| | - Julian Panés
- Hospital Clínic de BarcelonaIDIBAPS, CIBERehdBarcelonaSpain
| | - Bruce E. Sands
- Dr. Henry D. Janowitz Division of GastroenterologyIcahn School of Medicine at Mount SinaiNew YorkNew York
| | | | | | | | | | | | | | | | | | - Silvio Danese
- Division of GastroenterologyIBD CenterHumanitas UniversityRozzanoMilanItaly
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108
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Koliani-Pace JL, Singh S, Luo M, Hirten R, Aniwan S, Kochhar G, Chang S, Lukin D, Gao Y, Bohm M, Swaminath A, Gupta N, Shmidt E, Meserve J, Winters A, Chablaney S, Faleck DM, Yang J, Huang Z, Boland BS, Shashi P, Weiss A, Hudesman D, Varma S, Fischer M, Sultan K, Shen B, Kane S, Loftus EV, Sands BE, Colombel JF, Sandborn WJ, Lasch K, Siegel CA, Dulai PS. Changes in Vedolizumab Utilization Across US Academic Centers and Community Practice Are Associated With Improved Effectiveness and Disease Outcomes. Inflamm Bowel Dis 2019; 25:1854-1861. [PMID: 31050734 PMCID: PMC6799947 DOI: 10.1093/ibd/izz071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Vedolizumab effectiveness estimates immediately after Food and Drug Administration (FDA) approval for ulcerative colitis (UC) and Crohn's disease (CD) are limited by use in refractory populations. We aimed to compare treatment patterns and outcomes of vedolizumab in 2 time frames after FDA approval. METHODS We used 2 data sets for time trend analysis, an academic multicenter vedolizumab consortium (VICTORY) and the Truven MarketScan database, and 2 time periods, May 2014-June 2015 (Era 1) and July 2015-June 2017 (Era 2). VICTORY cumulative 12-month clinical remission, corticosteroid-free remission, and mucosal healing rates, and Truven 12-month hospitalization and surgery rates, were compared between Eras 1 and 2 using time-to-event analyses. RESULTS A total of 3661 vedolizumab-treated patients were included (n = 1087 VICTORY, n = 2574 Truven). In both cohorts, CD and UC patients treated during Era 2 were more likely to be biologic naïve. Compared with Era 1, Era 2 CD patients in the VICTORY consortium had higher rates of clinical remission (31% vs 40%, P = 0.03) and mucosal healing (42% vs 58%, P < 0.01). These trends were not observed for UC. In the Truven database, UC patients treated during Era 2 had lower rates of inflammatory bowel disease-related hospitalization (22.4% vs 9.6%, P < 0.001) and surgery (17.2% vs 9.4%, P = 0.008), which was not observed for CD. CONCLUSION Since FDA approval, remission and mucosal healing rates have increased for vedolizumab-treated CD patients, and vedolizumab-treated UC patients have had fewer hospitalizations and surgeries. This is likely due to differences between patient populations treated immediately after drug approval and those treated later.
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Affiliation(s)
| | - Siddharth Singh
- University of California, San Diego, La Jolla, California, USA
| | - Michelle Luo
- Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois, USA
| | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Satimai Aniwan
- Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Dana Lukin
- Montefiore Medical Center, New York, New York, USA
| | - Youran Gao
- North Shore University Hospital, Manhasset, New York, USA
| | | | | | - Nitin Gupta
- University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Joseph Meserve
- University of California, San Diego, La Jolla, California, USA
| | - Adam Winters
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shreya Chablaney
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David M Faleck
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jiao Yang
- Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois, USA
| | - Zhongwen Huang
- Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois, USA
| | - Brigid S Boland
- University of California, San Diego, La Jolla, California, USA
| | | | - Aaron Weiss
- New York University, New York, New York, USA
| | - David Hudesman
- University of California, San Diego, La Jolla, California, USA
| | | | | | - Keith Sultan
- North Shore University Hospital, Manhasset, New York, USA
| | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | | | | | | | | | - Karen Lasch
- Takeda Pharmaceuticals U.S.A., Inc., Deerfield, Illinois, USA
| | - Corey A Siegel
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Parambir S Dulai
- University of California, San Diego, La Jolla, California, USA
- Address correspondence to: Parambir S. Dulai, MD, Division of Gastroenterology University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093 ()
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109
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Dulai PS, Peyrin-Biroulet L, Danese S, Sands BE, Dignass A, Turner D, Mantzaris G, Schölmerich J, Mary JY, Reinisch W, Sandborn WJ. Approaches to Integrating Biomarkers Into Clinical Trials and Care Pathways as Targets for the Treatment of Inflammatory Bowel Diseases. Gastroenterology 2019; 157:1032-1043.e1. [PMID: 31228441 DOI: 10.1053/j.gastro.2019.06.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [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: 02/28/2019] [Revised: 06/06/2019] [Accepted: 06/13/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There is no consensus on the best way to integrate biomarkers into inflammatory bowel disease (IBD) research and clinical practice. The International Organization for the Study of Inflammatory Bowel Disease aimed to outline biomarker definitions, categories, and operating properties required for their use in registration trials and clinical practice. Using fecal calprotectin as an example, we provide a framework for biomarker development and validation in patients with IBD. METHODS We reviewed international society guidelines, regulatory agency guidance documents, and standardized reporting guidelines for biomarkers, in combination with publications on fecal calprotectin levels in patients with IBD. We assessed the validity of fecal calprotectin to serve as a surrogate biomarker of IBD activity and outlined a framework for further validation and development of biomarkers. RESULTS No endpoints have been fully validated as surrogates of risk of disease complications; mucosal healing is the most valid endpoint used to determine risk of disease complications. Fecal level of calprotectin has not been validated as a biomarker for IBD activity because of lack of technical and clinical reliability, assessment of performance when used as a replacement for endoscopy, and assessment of responsiveness to changes in disease states. The level of fecal calprotectin can be used only as a prognostic factor for disease recurrence in patients in remission after medical or surgical treatment. CONCLUSIONS We reviewed guidelines, regulatory documents, and publications to identify properties required for the development of biomarkers of IBD activity and areas in need of clarification from regulatory agencies and societies. We propose a path forward for research of biomarkers for IBD.
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Affiliation(s)
- Parambir S Dulai
- Division of Gastroenterology, University of California San Diego, La Jolla, California.
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Lorraine University, Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Humanitas Clinical and Research Centre, Milan, Italy
| | - Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital and Crohn Colitis Clinical Research Center Rhein-Main, Frankfurt/Main, Germany
| | - Dan Turner
- Institute of Paediatric Gastroenterology, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gerassimos Mantzaris
- Department of Gastroenterology, Evaggelismos-Ophthalmiatreion Athinon-Polycliniki, Athens, Greece
| | | | - Jean-Yves Mary
- INSERM UMR, Paris Diderot University, Saint Louis Hospital, Paris, France
| | | | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
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110
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Sands BE, Peyrin-Biroulet L, Loftus EV, Danese S, Colombel JF, Törüner M, Jonaitis L, Abhyankar B, Chen J, Rogers R, Lirio RA, Bornstein JD, Schreiber S. Vedolizumab versus Adalimumab for Moderate-to-Severe Ulcerative Colitis. N Engl J Med 2019; 381:1215-1226. [PMID: 31553834 DOI: 10.1056/nejmoa1905725] [Citation(s) in RCA: 382] [Impact Index Per Article: 76.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Biologic therapies are widely used in patients with ulcerative colitis. Head-to-head trials of these therapies in patients with inflammatory bowel disease are lacking. METHODS In a phase 3b, double-blind, double-dummy, randomized trial conducted at 245 centers in 34 countries, we compared vedolizumab with adalimumab in adults with moderately to severely active ulcerative colitis to determine whether vedolizumab was superior. Previous exposure to a tumor necrosis factor inhibitor other than adalimumab was allowed in up to 25% of patients. The patients were assigned to receive infusions of 300 mg of vedolizumab on day 1 and at weeks 2, 6, 14, 22, 30, 38, and 46 (plus injections of placebo) or subcutaneous injections of 40 mg of adalimumab, with a total dose of 160 mg at week 1, 80 mg at week 2, and 40 mg every 2 weeks thereafter until week 50 (plus infusions of placebo). Dose escalation was not permitted in either group. The primary outcome was clinical remission at week 52 (defined as a total score of ≤2 on the Mayo scale [range, 0 to 12, with higher scores indicating more severe disease] and no subscore >1 [range, 0 to 3] on any of the four Mayo scale components). To control for type I error, efficacy outcomes were analyzed with a hierarchical testing procedure, with the variables in the following order: clinical remission, endoscopic improvement (subscore of 0 to 1 on the Mayo endoscopic component), and corticosteroid-free remission at week 52. RESULTS A total of 769 patients underwent randomization and received at least one dose of vedolizumab (383 patients) or adalimumab (386 patients). At week 52, clinical remission was observed in a higher percentage of patients in the vedolizumab group than in the adalimumab group (31.3% vs. 22.5%; difference, 8.8 percentage points; 95% confidence interval [CI], 2.5 to 15.0; P = 0.006), as was endoscopic improvement (39.7% vs. 27.7%; difference, 11.9 percentage points; 95% CI, 5.3 to 18.5; P<0.001). Corticosteroid-free clinical remission occurred in 12.6% of the patients in the vedolizumab group and in 21.8% in the adalimumab group (difference, -9.3 percentage points; 95% CI, -18.9 to 0.4). Exposure-adjusted incidence rates of infection were 23.4 and 34.6 events per 100 patient-years with vedolizumab and adalimumab, respectively, and the corresponding rates for serious infection were 1.6 and 2.2 events per 100 patient-years. CONCLUSIONS In this trial involving patients with moderately to severely active ulcerative colitis, vedolizumab was superior to adalimumab with respect to achievement of clinical remission and endoscopic improvement, but not corticosteroid-free clinical remission. (Funded by Takeda; VARSITY ClinicalTrials.gov number, NCT02497469; EudraCT number, 2015-000939-33.).
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Affiliation(s)
- Bruce E Sands
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Laurent Peyrin-Biroulet
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Edward V Loftus
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Silvio Danese
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Jean-Frédéric Colombel
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Murat Törüner
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Laimas Jonaitis
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Brihad Abhyankar
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Jingjing Chen
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Raquel Rogers
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Richard A Lirio
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Jeffrey D Bornstein
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
| | - Stefan Schreiber
- From the Icahn School of Medicine at Mount Sinai, New York (B.E.S., J.-F.C.); Nancy University Hospital, Nancy, France (L.P.-B.); Mayo Clinic College of Medicine, Rochester, MN (E.V.L.); Humanitas University, Milan (S.D.); Ankara University School of Medicine, Ankara, Turkey (M.T.); Lithuanian University of Health Sciences, Kaunas, Lithuania (L.J.); Takeda Development Centre Europe, London (B.A.); Takeda Development Center Americas, Cambridge, MA (J.C., R.R., R.A.L., J.D.B.); and the University Hospital Schleswig-Holstein, Kiel, Germany (S.S.)
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Sands BE, Sandborn WJ, Panaccione R, O'Brien CD, Zhang H, Johanns J, Adedokun OJ, Li K, Peyrin-Biroulet L, Van Assche G, Danese S, Targan S, Abreu MT, Hisamatsu T, Szapary P, Marano C. Ustekinumab as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med 2019; 381:1201-1214. [PMID: 31553833 DOI: 10.1056/nejmoa1900750] [Citation(s) in RCA: 600] [Impact Index Per Article: 120.0] [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] [Indexed: 12/30/2022]
Abstract
BACKGROUND The efficacy of ustekinumab, an antagonist of the p40 subunit of interleukin-12 and interleukin-23, as induction and maintenance therapy in patients with ulcerative colitis is unknown. METHODS We evaluated ustekinumab as 8-week induction therapy and 44-week maintenance therapy in patients with moderate-to-severe ulcerative colitis. A total of 961 patients were randomly assigned to receive an intravenous induction dose of ustekinumab (either 130 mg [320 patients] or a weight-range-based dose that approximated 6 mg per kilogram of body weight [322]) or placebo (319). Patients who had a response to induction therapy 8 weeks after administration of intravenous ustekinumab were randomly assigned again to receive subcutaneous maintenance injections of 90 mg of ustekinumab (either every 12 weeks [172 patients] or every 8 weeks [176]) or placebo (175). The primary end point in the induction trial (week 8) and the maintenance trial (week 44) was clinical remission (defined as a total score of ≤2 on the Mayo scale [range, 0 to 12, with higher scores indicating more severe disease] and no subscore >1 [range, 0 to 3] on any of the four Mayo scale components). RESULTS The percentage of patients who had clinical remission at week 8 among patients who received intravenous ustekinumab at a dose of 130 mg (15.6%) or 6 mg per kilogram (15.5%) was significantly higher than that among patients who received placebo (5.3%) (P<0.001 for both comparisons). Among patients who had a response to induction therapy with ustekinumab and underwent a second randomization, the percentage of patients who had clinical remission at week 44 was significantly higher among patients assigned to 90 mg of subcutaneous ustekinumab every 12 weeks (38.4%) or every 8 weeks (43.8%) than among those assigned to placebo (24.0%) (P = 0.002 and P<0.001, respectively). The incidence of serious adverse events with ustekinumab was similar to that with placebo. Through 52 weeks of exposure, there were two deaths (one each from acute respiratory distress syndrome and hemorrhage from esophageal varices) and seven cases of cancer (one each of prostate, colon, renal papillary, and rectal cancer and three nonmelanoma skin cancers) among 825 patients who received ustekinumab and no deaths and one case of cancer (testicular cancer) among 319 patients who received placebo. CONCLUSIONS Ustekinumab was more effective than placebo for inducing and maintaining remission in patients with moderate-to-severe ulcerative colitis. (Funded by Janssen Research and Development; UNIFI ClinicalTrials.gov number, NCT02407236.).
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Affiliation(s)
- Bruce E Sands
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - William J Sandborn
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Remo Panaccione
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Christopher D O'Brien
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Hongyan Zhang
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Jewel Johanns
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Omoniyi J Adedokun
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Katherine Li
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Laurent Peyrin-Biroulet
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Gert Van Assche
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Silvio Danese
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Stephan Targan
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Maria T Abreu
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Tadakazu Hisamatsu
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Philippe Szapary
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
| | - Colleen Marano
- From the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Division of Gastroenterology, University of California, San Diego, La Jolla (W.J.S.), and the F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; the Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada (R.P.); Janssen Research and Development, Spring House, PA (C.D.O., H.Z., J.J., O.J.A., K.L., P.S., C.M.); the Gastroenterology Department and INSERM 1256, Nutrition, Genetics, and Environmental Risk Exposure, Nancy University Hospital, Université de Lorraine, Nancy, France (L.P.-B.); the Division of Gastroenterology and Hepatology, University Hospitals Leuven and Translational Research Center for Gastrointestinal Disorders, University of Leuven, Leuven, Belgium (G.V.A.); the IBD Center, Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan (S.D.); the Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine, Miami (M.T.A.); and the Division of Gastroenterology, Third Department of Internal Medicine, Kyorin University School of Medicine, Tokyo (T.H.)
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Abstract
In order to identify the practical implications for both health care practitioners and patients in understanding differences between the results of trials assessing therapies for ulcerative colitis [UC], we reviewed clinical trials of therapies for moderate to severe UC, with a focus on trial design. Over time, patient populations in UC trials have become more refractory, reflecting that patients are failing treatment with additional and different classes of drug, including conventional therapies, immunosuppressant drugs, and anti-tumour necrosis factor therapies. Outcomes used to measure efficacy have become increasingly stringent in order to meet the expectations of patients and physicians, and the requirements of regulatory bodies. Trial design has also evolved to integrate induction and maintenance therapy phases, so as to facilitate patient recruitment and to answer clinically important questions such as how efficacious therapies are in specific subpopulations of patients and during long-term use. As UC clinical trial design continues to evolve, and with limited head-to-head trials and real-world comparative effectiveness studies evaluating UC therapies, careful judgment is required to appreciate the differences and similarities in trial designs, and to understand how these variances may affect the observed efficacy and safety outcomes.
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Affiliation(s)
- Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Corresponding author: Bruce E. Sands, MD, Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY 10029, USA. Tel.: 212-241-6744; fax: 646-537-8647;
| | - Adam S Cheifetz
- Department of Medicine and Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Sands BE, Van Assche G, Tudor D, Akhundova-Unadkat G, Curtis RI, Tan T. Vedolizumab in Combination With Corticosteroids for Induction Therapy in Crohn's Disease: A Post Hoc Analysis of GEMINI 2 and 3. Inflamm Bowel Dis 2019; 25:1375-1382. [PMID: 30615117 PMCID: PMC6635819 DOI: 10.1093/ibd/izy384] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Combined therapy with vedolizumab and corticosteroids may improve clinical response or remission in Crohn's disease. The aim of this study is to assess efficacy and safety/tolerability of vedolizumab plus stable doses of corticosteroids at baseline during induction therapy in moderately to severely active Crohn's disease. METHODS A post hoc exploratory analysis was performed on data from GEMINI 2 (NCT00783692) and GEMINI 3 (NCT01224171), which assessed outcomes following induction therapy over 6- and 10-week periods, respectively. Patients receiving vedolizumab or placebo were stratified by corticosteroid use at baseline. Efficacy endpoints were clinical remission (CR; Crohn's Disease Activity Index [CDAI] score ≤150 points) and enhanced clinical response (ECR; decrease of ≥100 points in CDAI score from baseline), assessed at week 6 (GEMINI 2 and GEMINI 3) and week 10 (GEMINI 3). Safety endpoints included the incidence of adverse events. RESULTS Vedolizumab plus corticosteroids resulted in higher CR rates than placebo plus corticosteroids at week 6 in GEMINI 2 and at week 6 and week 10 in GEMINI 3. More patients receiving vedolizumab plus corticosteroids achieved CR at week 6 in GEMINI 2 and at week 10 in GEMINI 3 than patients receiving vedolizumab alone. Vedolizumab plus corticosteroids also resulted in significantly higher ECR rates than placebo plus corticosteroids at all timepoints in both studies. More patients receiving vedolizumab plus corticosteroids achieved higher ECR rates at week 6 in GEMINI 2 and at week 10 in GEMINI 3 than patients receiving vedolizumab alone. Adverse event incidence was similar across groups. CONCLUSIONS Vedolizumab in combination with stable doses of corticosteroids at baseline may improve induction of clinical response or remission in moderately to severely active Crohn's disease. TRIAL REGISTRATION NUMBERS NCT00783692, NCT01224171.
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Affiliation(s)
- Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA,Address correspondence to: Bruce E. Sands, MD, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Annenberg Building, Floor 5, 1468 Madison Avenue, New York, NY, 10029, USA. E-mail:
| | - Gert Van Assche
- University of Leuven and University Hospitals Leuven, Leuven, Belgium
| | - David Tudor
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | | | - Tjoeke Tan
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
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114
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Reinisch W, Gottlieb K, Colombel JF, Danese S, Panaccione R, Panes J, Peyrin-Biroulet L, Rubin D, Sands BE, Schreiber S, Vermeire S, Mulberg A, Sandborn B. Comparison of the EMA and FDA Guidelines on Ulcerative Colitis Drug Development. Clin Gastroenterol Hepatol 2019; 17:1673-1679.e1. [PMID: 31352970 DOI: 10.1016/j.cgh.2018.10.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 06/15/2018] [Revised: 10/09/2018] [Accepted: 10/21/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In 2016, the European Medicines Agency (EMA) and the US Food and Drug Administration (FDA) released revised EMA and new FDA draft guidelines related to the development of drugs intended for the treatment of ulcerative colitis. We sought to compare and contrast the EMA draft guideline with the FDA draft guidance to facilitate further discussion and perhaps harmonization between the 2 guidelines when they are finalized. METHODS A concordance document was created by arranging like or similar topics addressed by the guidelines side by side in a tabular format. This concordance table served as a source for writing the narrative. The first draft was subjected to repeated rounds of reviews and revisions by the authors and outside reviewers, all of them familiar with the subject matter from a regulatory science and/or academic perspective. RESULTS The FDA guidance focuses on end points, whereas the EMA guideline additionally supplies much useful information for trial design. FDA guidance appears more aspirational, suggesting the development of entirely new patient-reported outcome instruments and the incorporation of a not-yet-validated histology instrument into the definition of mucosal healing. CONCLUSIONS The guidelines by the FDA and the EMA complement each other and together are aimed to further practical drug development toward more clinically relevant end points in ulcerative colitis. Efforts are needed to harmonize the documents.
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Affiliation(s)
- Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
| | | | - Jean-Frederic Colombel
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Silvio Danese
- Inflammatory Bowel Disease Center, Humanitas University, Milano, Italy
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada
| | - Julian Panes
- Department of Gastroenterology, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Laurent Peyrin-Biroulet
- Inserm U954, Department of Gastroenterology, Nancy University Hospital, Lorraine University, Nancy, France
| | - David Rubin
- Department of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, Illinois
| | - Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stefan Schreiber
- Klinik für Innere Medizin I, Christian-Albrechts-Universität Kiel, Kiel, Germany
| | - Severine Vermeire
- Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | | | - Bill Sandborn
- University of California San Diego, La Jolla, California
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115
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Shmidt E, Suárez-Fariñas M, Mallette M, Moniz H, Bright R, Shah SA, Merrick M, Shapiro J, Xu F, Saha S, Sands BE. Erectile Dysfunction Is Highly Prevalent in Men With Newly Diagnosed Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:1408-1416. [PMID: 30861068 PMCID: PMC10424100 DOI: 10.1093/ibd/izy401] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/16/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Cross-sectional studies on sexual function in men with inflammatory bowel disease (IBD) yield mixed results. Using a prospective incidence cohort, we aimed to describe sexual function at baseline and over time and to identify factors associated with impaired sexual function in men with IBD. METHODS Men 18 years and older enrolled between April 2008 and January 2013 in the Ocean State Crohn's and Colitis Area Registry (OSCCAR) with a minimum of 2 years of follow-up were eligible for study. Male sexual function was assessed using the International Index of Erectile Function (IIEF), a self-administered questionnaire that assesses 5 dimensions of sexual function over the most recent 4 weeks. To assess changes in the IIEF per various demographic and clinical factors, linear mixed effects models were used. RESULTS Sixty-nine of 82 eligible men (84%) completed the questionnaire (41 Crohn's disease, 28 ulcerative colitis). The mean age (SD) of the cohort at diagnosis was 43.4 (19.2) years. At baseline, 39% of men had global sexual dysfunction, and 94% had erectile dysfunction. Independent factors associated with erectile dysfunction are older age and lower physical and mental component summary scores on the Short Form Health Survey (SF-36). CONCLUSION In an incident cohort of IBD patients, most men had erectile dysfunction. Physicians should be aware of the high prevalence of erectile dysfunction and its associated risk factors among men with newly diagnosed IBD to direct multidisciplinary treatment planning.
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Affiliation(s)
- E Shmidt
- University of Minnesota, Division of Gastroenterology, Hepatology and Nutrition, Minneapolis, Minnesota, USA
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Suárez-Fariñas
- Department of Population Health Science and Policy, Department of Genetics and Genomics Science, Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - M Mallette
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - H Moniz
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - R Bright
- Rhode Island Hospital, Providence, Rhode Island, USA
| | - S A Shah
- The Warren Alpert Medical School at Brown University, Providence, Rhode Island, USA
| | - M Merrick
- Crohn's & Colitis Foundation of America, New York, New York, USA
| | - J Shapiro
- Division of Pediatric Gastroenterology, Nutrition, and Liver Diseases, Hasbro Children's Hospital, Providence, Rhode Island, USA
| | - F Xu
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S Saha
- Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - B E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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116
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Meserve J, Aniwan S, Koliani-Pace JL, Shashi P, Weiss A, Faleck D, Winters A, Chablaney S, Kochhar G, Boland BS, Singh S, Hirten R, Shmidt E, Hartke JG, Chilukuri P, Bohm M, Sagi SV, Fischer M, Lukin D, Hudesman D, Chang S, Gao Y, Sultan K, Swaminath A, Gupta N, Kane S, Loftus EV, Shen B, Sands BE, Colombel JF, Siegel CA, Sandborn WJ, Dulai PS. Retrospective Analysis of Safety of Vedolizumab in Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2019; 17:1533-1540.e2. [PMID: 30268561 PMCID: PMC6594363 DOI: 10.1016/j.cgh.2018.09.035] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [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: 05/01/2018] [Revised: 08/30/2018] [Accepted: 09/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS There are few real-world data on the safety of vedolizumab for treatment of Crohn's disease (CD) or ulcerative colitis (UC). We quantified rates and identified factors significantly associated with infectious and non-infectious adverse events in clinical practice. METHODS We performed a retrospective review of data from a multicenter consortium database (from May 2014 through June 2017). Infectious and non-infectious adverse events were defined as those requiring antibiotics, hospitalization, vedolizumab discontinuation, or resulting in death. Rates were quantified as proportions and events per 100 patient years of exposure (PYE) or follow up (PYF). We performed multivariable logistic regression analyses to identify factors significantly associated with events and reported as odds ratios (OR) with 95% CIs. RESULTS Our analysis comprised 1087 patients (650 with CD and 437 with UC; 55% female; median age, 37 years) with 861 PYE and 955 PYF. Infections were observed in 68 patients (6.3%; 7.9 per 100 PYE, 7.1 per 100 PYF); gastrointestinal infections (n = 31, 2.4 per 100 PYE, 2.2 per 100 PYF) and respiratory infections (n = 14, 1.6 per 100 PYE, 1.5 per 100 PYF) were the most common. Arthralgias were the most common non-infectious adverse events (n = 31, 2.9%; 3.6 per 100 PYE). Two patients developed malignancies (squamous cell skin cancer and colorectal cancer; 0.23 per 100 PYE, 0.21 per 100 PYF). Active smoker status (OR, 3.39) and number of concomitant immunosuppressive agents (corticosteroids or immunomodulators; OR, 1.72 per agent) used were independently associated with infections. CONCLUSION In a retrospective cohort study of patients with IBD, we found vedolizumab to be well tolerated with an overall favorable safety profile. Active smoking and concomitant use of immunosuppressive agents were independently associated with infections.
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Affiliation(s)
- Joseph Meserve
- Department of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Satimai Aniwan
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota; Department of Gastroenterology, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Jenna L Koliani-Pace
- Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Preeti Shashi
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Aaron Weiss
- Department of Gastroenterology, Montefiore Medical Center, New York, New York
| | - David Faleck
- Department of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Adam Winters
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shreva Chablaney
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gursimran Kochhar
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Brigid S Boland
- Department of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Siddharth Singh
- Department of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Robert Hirten
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eugenia Shmidt
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Gastroenterology, University of Minnesota, Minneapolis, Minnesota
| | - Justin G Hartke
- Department of Gastroenterology, Indiana University, Indianapolis, Indiana
| | - Prianka Chilukuri
- Department of Gastroenterology, Indiana University, Indianapolis, Indiana
| | - Matthew Bohm
- Department of Gastroenterology, Indiana University, Indianapolis, Indiana
| | | | - Monika Fischer
- Department of Gastroenterology, Indiana University, Indianapolis, Indiana
| | - Dana Lukin
- Department of Gastroenterology, Montefiore Medical Center, New York, New York
| | - David Hudesman
- Department of Gastroenterology, New York University, New York, New York
| | - Shannon Chang
- Department of Gastroenterology, New York University, New York, New York
| | - Youran Gao
- Department of Gastroenterology, North Shore University Hospital, Manhasset, New York
| | - Keith Sultan
- Department of Gastroenterology, North Shore University Hospital, Manhasset, New York
| | - Arun Swaminath
- Department of Gastroenterology, Lenox Hill Hospital, New York, New York
| | - Nitin Gupta
- Department of Gastroenterology, University of Mississippi, Jackson, Mississippi
| | - Sunanda Kane
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Edward V Loftus
- Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota
| | - Bo Shen
- Department of Gastroenterology, Thai Red Cross Society, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Bruce E Sands
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- Department of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Corey A Siegel
- Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - William J Sandborn
- Department of Gastroenterology, University of California, San Diego, La Jolla, California
| | - Parambir S Dulai
- Department of Gastroenterology, University of California, San Diego, La Jolla, California.
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Sandborn WJ, Panés J, D'Haens GR, Sands BE, Su C, Moscariello M, Jones T, Pedersen R, Friedman GS, Lawendy N, Chan G. Safety of Tofacitinib for Treatment of Ulcerative Colitis, Based on 4.4 Years of Data From Global Clinical Trials. Clin Gastroenterol Hepatol 2019; 17:1541-1550. [PMID: 30476584 DOI: 10.1016/j.cgh.2018.11.035] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 10/26/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Tofacitinib is an oral, small-molecule inhibitor of JAK approved in several countries for the treatment of ulcerative colitis (UC). We report integrated safety analyses of tofacitinib-treated patients with moderate to severe UC. METHODS Patients receiving placebo or tofacitinib (5 or 10 mg) twice daily were analyzed as 3 cohorts: induction (phase 2 and 3 induction studies, n = 1220), maintenance (phase 3 maintenance study, n = 592), and overall (patients receiving tofacitinib 5 or 10 mg twice daily in phase 2, phase 3, or open-label, long-term extension studies, n = 1157; 1613 patient-years' exposure). Incidence rates (IRs; patients with events per 100 patient-years of exposure) were evaluated for select adverse events. RESULTS In the maintenance cohort, IRs for select adverse events were similar among treatment groups, except for a numerically higher IR of herpes zoster infection among patients who received tofacitinib 5 mg twice daily (2.1; 95% CI, 0.4-6.0) and statistically higher IR among patients who received tofacitinib 10 mg twice daily (IR, 6.6; 95% CI, 3.2-12.2) vs placebo (IR, 1.0, 95% CI, 0.0-5.4). For the overall cohort (84% received average dose of tofacitinib 10 mg twice daily), IRs were: death, 0.2 (95% CI, 0.1-0.6); serious infections, 2.0 (95% CI, 1.4-2.8); opportunistic infections, 1.3 (95% CI, 0.8-2.0); herpes zoster infection, 4.1 (95% CI, 3.1-5.2); malignancy (excluding non-melanoma skin cancer), 0.7 (95% CI, 0.3-1.2); non-melanoma skin cancer, 0.7 (95% CI, 0.3-1.2); major adverse cardiovascular events, 0.2 (95% CI, 0.1-0.6); and gastrointestinal perforations, 0.2 (95% CI, 0.0-0.5). CONCLUSIONS In safety analyses of patients with moderate to severe UC treated with tofacitinib, we observed a dose relationship with herpes zoster infection. Although follow-up time was relatively short, the safety profile of tofacitinib for patients with UC appeared similar to that reported for patients with rheumatoid arthritis and for patients with UC treated with biologic agents, except for the higher IR of herpes zoster infection. ClinicalTrials.gov, no: NCT00787202, NCT01465763, NCT01458951, NCT01458574, and NCT01470612.
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, University of California, San Diego, La Jolla, California.
| | - Julián Panés
- Inflammatory Bowel Diseases Unit, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Geert R D'Haens
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Bruce E Sands
- Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chinyu Su
- Pfizer Inc, Collegeville, Pennsylvania
| | | | | | | | | | | | - Gary Chan
- Pfizer Inc, Collegeville, Pennsylvania
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Hirten RP, Grinspan A, Fu SC, Luo Y, Suarez-Farinas M, Rowland J, Contijoch EJ, Mogno I, Yang N, Luong T, Labrias PR, Peter I, Cho JH, Sands BE, Colombel JF, Faith JJ, Clemente JC. Microbial Engraftment and Efficacy of Fecal Microbiota Transplant for Clostridium Difficile in Patients With and Without Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:969-979. [PMID: 30852592 PMCID: PMC6499938 DOI: 10.1093/ibd/izy398] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 08/27/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Recurrent and severe Clostridium difficile infections (CDI) are treated with fecal microbiota transplant (FMT). Uncertainty exists regarding FMT effectiveness for CDI with underlying inflammatory bowel disease (IBD) and regarding its effects on disease activity and effectiveness in transferring the donor microbiota to patients with and without IBD. METHODS Subjects with and without IBD who underwent FMT for recurrent or severe CDI between 2013 and 2016 at The Mount Sinai Hospital were followed for up to 6 months. The primary outcome was CDI recurrence 6 months after FMT. Secondary outcomes were (1) CDI recurrence 2 months after FMT; (2) frequency of IBD flare after FMT; (3) microbiota engraftment after FMT; (and 4) predictors of CDI recurrence. RESULTS One hundred thirty-four patients, 46 with IBD, were treated with FMT. Follow-up was available in 83 and 118 patients at 6 and 2 months, respectively. There was no difference in recurrence in patients with and without IBD at 6 months (38.7% vs 36.5%; P > 0.99) and 2 months (22.5% vs 17.9%; P = 0.63). Proton pump inhibitor use, severe CDI, and comorbid conditions were predictors of recurrence. Pre-FMT microbiota was not predictive of CDI recurrence. Subjects with active disease requiring medication escalation had reduced engraftment, with no difference in engraftment based on CDI recurrence or IBD endoscopic severity at FMT. CONCLUSIONS Inflammatory bowel disease did not affect CDI recurrence rates 6 months after FMT. Pre-FMT microbiota was not predictive of recurrence, and microbial engraftment was impacted in those requiring IBD treatment escalation, though not by CDI recurrence or IBD disease severity.
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Affiliation(s)
- Robert P Hirten
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ari Grinspan
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shih-Chen Fu
- Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Yuying Luo
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mayte Suarez-Farinas
- Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Rowland
- Center for Biostatistics, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eduardo J Contijoch
- Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Ilaria Mogno
- Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Nancy Yang
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tramy Luong
- Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Philippe R Labrias
- Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Inga Peter
- Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Judy H Cho
- Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Bruce E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean Frederic Colombel
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeremiah J Faith
- Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York NY, USA
| | - Jose C Clemente
- Icahn Institute for Genomics & Multiscale Biology, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York NY, USA
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York NY, USA
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Abstract
PURPOSE OF REVIEW The biologic era revolutionized the medical management of inflammatory bowel disease (IBD) and allowed for a paradigm shift away from a therapeutic strategy that traditionally relied on corticosteroids and immunomodulators. IBD treatment has now further evolved to encompass novel non-biologic agents. RECENT FINDINGS An electronic database search, spanning up to September 2018, was conducted using PubMed, Web of Science, Google Scholar, and Scopus. Abstracts were also reviewed from Digestive Diseases Week, European Crohn's and Colitis Organization congress, Canadian Digestive Diseases Week, and United European Gastroenterology Week. The JAK1/3 inhibitor, tofacitinib, was shown to both induce and maintain clinical remission and mucosal healing in ulcerative colitis (UC). Also, the sphingosine-1-phosphate (SIP) S1P1/S1P5 receptor agonist ozanimod showed benefit with clinical remission and mucosal healing in UC. Anti-trafficking non-biologic therapies such as AJM300 and a phosphodiesterase (PDE) PDE4 inhibitor, apremilast, have shown benefit in terms of clinical response, clinical remission, and mucosal healing in UC. Upadacitinib and filgotinib have shown initial favorable outcomes in CD patients, with further ongoing trials. Non-biologic agents comprise a growing number of mechanisms of action with the promise of safe and effective oral therapy for patients with IBD.
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Affiliation(s)
- Tushar Shukla
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY, 10029, USA
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1069, New York, NY, 10029, USA.
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Perler BK, Ungaro R, Baird G, Mallette M, Bright R, Shah S, Shapiro J, Sands BE. Presenting symptoms in inflammatory bowel disease: descriptive analysis of a community-based inception cohort. BMC Gastroenterol 2019; 19:47. [PMID: 30940072 PMCID: PMC6446285 DOI: 10.1186/s12876-019-0963-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [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: 01/11/2019] [Accepted: 03/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background Few data are currently available on the initial presenting symptoms of patients with inflammatory bowel disease (IBD). Methods We evaluated the initial symptom presentation of patients with IBD in the Ocean State Crohn’s and Colitis Area Registry (OSCCAR), a community-based inception cohort that enrolled Rhode Island IBD patients at time of diagnosis with longitudinal follow up. A 41-question symptom inventory was administered at time of enrollment to capture symptoms experienced during the 4 weeks preceding diagnosis of IBD. Frequencies of presenting symptoms were calculated. Principal component analysis (PCA) with promax rotation was used to examine possible symptom profiles among Crohn’s disease (CD) and ulcerative colitis (UC) patients, respectively. Using the Scree plot, the 4-component solution was found to be optimal for both CD and UC. Results A total of 233 CD and 150 UC patients were included. The most common presenting symptoms in CD were tiredness/fatigue (80.6%) and abdominal pain (80.4%) while passage of blood with bowel movements (BM) (86.6%) and loose/watery BMs (86.5%) were most common in UC. The 5 symptoms with greatest differences between UC and CD were passage of blood with BM (UC 86.6%/CD 45.3%), urgent BM (UC 82.5%/CD 63.9%), passage of mucus with BM (UC 67.7%/CD 36.9%), passage of blood from the anus (UC 59.7%/CD 32.1%), and anxiety about distance from bathroom (UC 59%/CD 38.7%). The PCA analysis yielded a 4 symptom components solution for CD and UC. Conclusion The most common presenting symptoms in CD are fatigue and abdominal pain while in UC bloody BM and diarrhea are most common. Distinct symptom phenotypes are seen with PCA analysis. Our study demonstrates symptomatic similarities and differences between CD and UC and suggests that patients may also be classified by symptom phenotype at time of diagnosis. Electronic supplementary material The online version of this article (10.1186/s12876-019-0963-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bryce K Perler
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, USA.
| | - Ryan Ungaro
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Grayson Baird
- Lifespan Biostatistics Core, Rhode Island Hospital, Providence, USA
| | - Meaghan Mallette
- Department of Gastroenterology, Warren Alpert Medical School of Brown University, Providence, USA
| | - Renee Bright
- Department of Gastroenterology, Warren Alpert Medical School of Brown University, Providence, USA
| | - Samir Shah
- Department of Gastroenterology, Warren Alpert Medical School of Brown University, Providence, USA
| | - Jason Shapiro
- Department of Pediatric Gastroenterology, Warren Alpert Medical School of Brown University, Providence, USA
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, USA
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121
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Reinisch W, Bressler B, Curtis R, Parikh A, Yang H, Rosario M, Røseth A, Danese S, Feagan B, Sands BE, Ginsburg P, Dassopoulos T, Lewis J, Xu J, Wyant T. Fecal Calprotectin Responses Following Induction Therapy With Vedolizumab in Moderate to Severe Ulcerative Colitis: A Post Hoc Analysis of GEMINI 1. Inflamm Bowel Dis 2019; 25:803-810. [PMID: 30295811 PMCID: PMC6416826 DOI: 10.1093/ibd/izy304] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 08/21/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND In patients with ulcerative colitis (UC), fecal calprotectin (FC) concentrations correlate with endoscopic inflammation evidence. This study investigated the effect of vedolizumab induction on FC concentrations and whether FC concentrations could be a reliable surrogate measure of disease status. METHODS Data from the placebo-controlled, phase 3 trial GEMINI 1 were used to evaluate week-6 relationships between outcomes (including clinical remission, mucosal healing [MH], and endoscopic remission) and both absolute FC concentration values and relative FC concentration changes from baseline (%FC0-6). Sensitivity and specificity were calculated by cross-tabulation; the value of week-6 FC concentration as surrogate biomarker was measured with Youden J statistic computed for various cut points. RESULTS GEMINI 1 induction phase enrolled 895 patients. Fecal calprotectin concentration decreases were deeper in patients with clinical remission, MH, and/or endoscopic remission than in patients without. The best week-6 indicator of clinical or endoscopic remission in this data set was absolute FC concentration ≤150 µg/g. The surrogate biomarker values (based on areas under the curve) for the best-performing cut points (FC0-6 reduction >90%, FC ≤150 µg/g) were fair (range, 0.70-0.77, total population). More patients met the ≤150 µg/g cut point with vedolizumab than with placebo. Baseline FC concentrations were not correlated with clinical outcomes. CONCLUSIONS Fecal calprotectin concentration reductions were greater with vedolizumab induction than with placebo. Week-6 FC concentrations had only fair surrogate biomarker value for endoscopic status. Our data suggest that, while FC may reflect inflammatory burden, FC concentration after vedolizumab induction may not be a robust biomarker of mucosal inflammation.
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Affiliation(s)
- Walter Reinisch
- Medical University of Vienna, Vienna, Austria,Address correspondence to: Walter Reinisch, MD, Department of Gastroenterology and Hepatology, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria. E-mail:
| | | | | | - Asit Parikh
- Takeda Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Huyuan Yang
- Takeda Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Maria Rosario
- Takeda Pharmaceuticals, Cambridge, Massachusetts, USA
| | | | | | - Brian Feagan
- Robarts Clinical Trials, Robarts Research Institute, and the University of Western Ontario, London, Ontario, Canada
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Philip Ginsburg
- Frank H Netter MD School of Medicine, Quinnipiac University, Hamden, Connecticut, USA
| | | | - James Lewis
- Center for Clinical Epidemiology and Biostatistics Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Xu
- Takeda Pharmaceuticals, Cambridge, Massachusetts, USA
| | - Tim Wyant
- Curis, Inc., Lexington, Massachusetts, USA
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Sandborn WJ, Panés J, Panaccione R, D’Haens G, Sands BE, Su C, Moscariello M, Jones TV, Pedersen RD, Friedman GS, Lawendy N, Chan G. A202 TOFACITINIB FOR THE TREATMENT OF ULCERATIVE COLITIS: UP TO 5.4 YEARS OF SAFETY DATA FROM GLOBAL CLINICAL TRIALS. J Can Assoc Gastroenterol 2019. [DOI: 10.1093/jcag/gwz006.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- W J Sandborn
- Division of Gastroenterology, University of California, San Diego, La Jolla, CA
| | - J Panés
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | | | - G D’Haens
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, Netherlands
| | - B E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - C Su
- Pfizer Inc, Collegeville, PA
| | | | | | | | | | | | - G Chan
- Pfizer Inc, Collegeville, PA
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123
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Britton GJ, Contijoch EJ, Mogno I, Vennaro OH, Llewellyn SR, Ng R, Li Z, Mortha A, Merad M, Das A, Gevers D, McGovern DPB, Singh N, Braun J, Jacobs JP, Clemente JC, Grinspan A, Sands BE, Colombel JF, Dubinsky MC, Faith JJ. Microbiotas from Humans with Inflammatory Bowel Disease Alter the Balance of Gut Th17 and RORγt + Regulatory T Cells and Exacerbate Colitis in Mice. Immunity 2019; 50:212-224.e4. [PMID: 30650377 PMCID: PMC6512335 DOI: 10.1016/j.immuni.2018.12.015] [Citation(s) in RCA: 296] [Impact Index Per Article: 59.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 10/03/2018] [Accepted: 12/13/2018] [Indexed: 12/13/2022]
Abstract
Microbiota are thought to influence the development and progression of inflammatory bowel disease (IBD), but determining generalizable effects of microbiota on IBD etiology requires larger-scale functional analyses. We colonized germ-free mice with intestinal microbiotas from 30 healthy and IBD donors and determined the homeostatic intestinal T cell response to each microbiota. Compared to microbiotas from healthy donors, transfer of IBD microbiotas into germ-free mice increased numbers of intestinal Th17 cells and Th2 cells and decreased numbers of RORγt+ Treg cells. Colonization with IBD microbiotas exacerbated disease in a model where colitis is induced upon transfer of naive T cells into Rag1-/- mice. The proportions of Th17 and RORγt+ Treg cells induced by each microbiota were predictive of human disease status and accounted for disease severity in the Rag1-/- colitis model. Thus, an impact on intestinal Th17 and RORγt+ Treg cell compartments emerges as a unifying feature of IBD microbiotas, suggesting a general mechanism for microbial contribution to IBD pathogenesis.
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Affiliation(s)
- Graham J Britton
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eduardo J Contijoch
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ilaria Mogno
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Olivia H Vennaro
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sean R Llewellyn
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ruby Ng
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zhihua Li
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Arthur Mortha
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Miriam Merad
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anuk Das
- Janssen Human Microbiome Institute, Janssen Research and Development, LLC, Spring House, PA, USA
| | - Dirk Gevers
- Janssen Human Microbiome Institute, Janssen Research and Development, LLC, Spring House, PA, USA
| | - Dermot P B McGovern
- Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Namita Singh
- Pediatric Gastroenterology and Inflammatory Bowel Disease, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jonathan Braun
- UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Jonathan P Jacobs
- Division of Digestive Diseases, Department of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Jose C Clemente
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ari Grinspan
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce E Sands
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marla C Dubinsky
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Pediatric Gastroenterology and Hepatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeremiah J Faith
- Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Zhao YQ, Laber EB, Ning Y, Saha S, Sands BE. Efficient augmentation and relaxation learning for individualized treatment rules using observational data. J Mach Learn Res 2019; 20:48. [PMID: 31440118 PMCID: PMC6705615] [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] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Individualized treatment rules aim to identify if, when, which, and to whom treatment should be applied. A globally aging population, rising healthcare costs, and increased access to patient-level data have created an urgent need for high-quality estimators of individualized treatment rules that can be applied to observational data. A recent and promising line of research for estimating individualized treatment rules recasts the problem of estimating an optimal treatment rule as a weighted classification problem. We consider a class of estimators for optimal treatment rules that are analogous to convex large-margin classifiers. The proposed class applies to observational data and is doubly-robust in the sense that correct specification of either a propensity or outcome model leads to consistent estimation of the optimal individualized treatment rule. Using techniques from semiparametric efficiency theory, we derive rates of convergence for the proposed estimators and use these rates to characterize the bias-variance trade-off for estimating individualized treatment rules with classification-based methods. Simulation experiments informed by these results demonstrate that it is possible to construct new estimators within the proposed framework that significantly outperform existing ones. We illustrate the proposed methods using data from a labor training program and a study of inflammatory bowel syndrome.
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Affiliation(s)
- Ying-Qi Zhao
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, 98109, USA
| | - Eric B Laber
- Department of Statistics, North Carolina State University, Raleigh, NC, 27695, USA
| | - Yang Ning
- Department of Statistical Science, Cornell University, Ithaca, NY, 14853, USA
| | - Sumona Saha
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Bruce E Sands
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
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125
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Panés J, Vermeire S, Lindsay JO, Sands BE, Su C, Friedman G, Zhang H, Yarlas A, Bayliss M, Maher S, Cappelleri JC, Bushmakin AG, Rubin DT. Tofacitinib in Patients with Ulcerative Colitis: Health-Related Quality of Life in Phase 3 Randomised Controlled Induction and Maintenance Studies. J Crohns Colitis 2019; 13:139-140. [PMID: 30412228 PMCID: PMC6302951 DOI: 10.1093/ecco-jcc/jjy135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Julian Panés
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - James O Lindsay
- Centre for Immunobiology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | | | | | - David T Rubin
- The University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL, USA
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126
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Sands BE, Sandborn WJ, Feagan BG, Lichtenstein GR, Zhang H, Strauss R, Szapary P, Johanns J, Panes J, Vermeire S, O'Brien CD, Yang Z, Bertelsen K, Marano C. Peficitinib, an Oral Janus Kinase Inhibitor, in Moderate-to-severe Ulcerative Colitis: Results From a Randomised, Phase 2 Study. J Crohns Colitis 2018; 12:1158-1169. [PMID: 29917064 DOI: 10.1093/ecco-jcc/jjy085] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Janus kinase [JAK] inhibitors have shown efficacy in ulcerative colitis [UC]. We studied the dose-response, efficacy, and safety of peficitinib, an oral JAK inhibitor, in patients with moderate-to-severe UC. METHODS In this Phase 2b, dose-ranging trial, we evaluated peficitinib at 25 mg once daily [o.d.], 75 mg o.d., 150 mg o.d., and 75 mg twice daily versus placebo for efficacy and safety in 219 patients with moderate-to-severe UC. The primary outcome was peficitinib dose-response at Week 8, with response assessed using Mayo score change from baseline. Secondary endpoints were clinical response, clinical remission, mucosal healing, change from baseline in Inflammatory Bowel Disease Questionnaire [IBDQ], and normalisation of inflammatory biomarkers at Week 8; other secondary endpoints were treatment response through Week 16 and through Week 32 for patients in clinical response at Week 8. Safety was assessed through Week 36 or 4 weeks after the last dose. RESULTS A statistically significant peficitinib dose-response was not demonstrated at Week 8, although a numerically greater proportion of patients receiving peficitinib ≥75 mg o.d. achieved clinical response, remission, and mucosal healing at Week 8, supported by IBDQ improvement and inflammatory biomarker normalisation. Treatment-emergent adverse event [TEAE] rates reported through Week 8 and the final safety visit were higher in the combined peficitinib group than in the placebo group; patients receiving doses of ≥75 mg o.d. peficitinib reported TEAEs more frequently. CONCLUSIONS No dose-response in patients with moderate-to-severe UC was demonstrated with peficitinib, but evidence of efficacy was suggested at doses ≥75 mg o.d. The safety profile of peficitinib was consistent with current information. ClinicalTrials.gov NCT01959282.
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Affiliation(s)
- Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William J Sandborn
- Department of Medicine, Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Brian G Feagan
- Robarts Clinical Trials Inc., Western University, London, ON, Canada
| | - Gary R Lichtenstein
- Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, USA
| | - Hongyan Zhang
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Richard Strauss
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Philippe Szapary
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Jewel Johanns
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Julian Panes
- Department of Gastroenterology, Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Severine Vermeire
- Departments of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Zijiang Yang
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Kirk Bertelsen
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Colleen Marano
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
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Shmidt E, Kochhar G, Hartke J, Chilukuri P, Meserve J, Chaudrey K, Koliani-Pace JL, Hirten R, Faleck D, Barocas M, Luo M, Lasch K, Boland BS, Singh S, Vande Casteele N, Sagi SV, Fischer M, Chang S, Bohm M, Lukin D, Sultan K, Swaminath A, Hudesman D, Gupta N, Kane S, Loftus EV, Sandborn WJ, Siegel CA, Sands BE, Colombel JF, Shen B, Dulai PS. Predictors and Management of Loss of Response to Vedolizumab in Inflammatory Bowel Disease. Inflamm Bowel Dis 2018; 24:2461-2467. [PMID: 29788240 PMCID: PMC6693035 DOI: 10.1093/ibd/izy171] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 12/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND We quantified loss of response (LOR) to vedolizumab (VDZ) in clinical practice and assessed the effectiveness of VDZ dose intensification for managing LOR. METHODS Retrospective review (May 2014-December 2016) of a prospectively maintained inflammatory bowel disease (IBD) registry. Kaplan-Meier estimates were used to determine rates of LOR to VDZ . Independent predictors of LOR were identified using univariate and multivariable Cox proportional hazard regression. Success of recapturing response (>50% reduction in symptoms from baseline) and remission (complete resolution of symptoms) after dose intensification was quantified. RESULTS Cumulative rates for VDZ LOR were 20% at 6 months and 35% at 12 months, with slightly lower rates in Crohn's disease than in ulcerative colitis (6 months 15% vs 18% and 12 months 30% vs 39%, P = 0.03). On multivariable analysis, LOR to a tumor necrosis factor (TNF) antagonist before VDZ use was associated with an increased risk for LOR to VDZ [hazard ratio (HR) 1.93; 95% confidence interval (CI) 1.25-2.97] in all patients. For Crohn's disease patients specifically, higher baseline C-reactive protein concentration was associated with increased risk for LOR to VDZ (HR 1.01 per mg/dL increase, 95% CI 1.01-1.02). Shortening of VDZ infusion interval from 8 to every 4 or 6 weeks recaptured response in 49% and remission in 18% of patients. CONCLUSIONS LOR to a TNF antagonist before VDZ use and higher baseline C-reactive protein are important predictors of VDZ LOR. Treatment response can be recaptured in almost half of these patients with VDZ infusion interval shortening.
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Affiliation(s)
- Eugenia Shmidt
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,University of Minnesota, Minneapolis, MN, USA
| | | | | | | | | | | | | | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - David Faleck
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Michelle Luo
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | - Karen Lasch
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | | | | | | | | | | | | | | | - Dana Lukin
- Montefiore Medical Center, New York, NY, USA
| | - Keith Sultan
- North Shore University Hospital, Manhasset, NY, USA
| | | | | | | | | | | | | | | | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Parambir S Dulai
- University of California, San Diego, La Jolla, CA, USA,Address correspondence to: Parambir S. Dulai, MD, University of California, San Diego, Division of Gastroenterology, 9500 Gilman Dr, La Jolla, CA 92093. E-mail:
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Herfarth H, Barnes EL, Valentine JF, Hanson J, Higgins PDR, Isaacs KL, Jackson S, Osterman MT, Anton K, Ivanova A, Long MD, Martin C, Sandler RS, Abraham B, Cross RK, Dryden G, Fischer M, Harlan W, Levy C, McCabe R, Polyak S, Saha S, Williams E, Yajnik V, Serrano J, Sands BE, Lewis JD. Methotrexate Is Not Superior to Placebo in Maintaining Steroid-Free Response or Remission in Ulcerative Colitis. Gastroenterology 2018; 155:1098-1108.e9. [PMID: 29964043 PMCID: PMC6174092 DOI: 10.1053/j.gastro.2018.06.046] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [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: 03/28/2018] [Revised: 06/16/2018] [Accepted: 06/22/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Parenteral methotrexate induces clinical remission but not endoscopic improvement of mucosal inflammation in patients with ulcerative colitis (UC). We performed a randomized, placebo-controlled trial to assess the efficacy of parenteral methotrexate in maintaining steroid-free response or remission in patients with UC after induction therapy with methotrexate and steroids. METHODS We performed a 48-week trial, from February 2012 through May 2016, of 179 patients with active UC (Mayo score of 6-12 with endoscopy subscore ≥ 2) despite previous conventional or biological therapy. The study comprised a 16-week open label methotrexate induction period followed by a 32-week double-blind, placebo-controlled maintenance period. Patients were given subcutaneous methotrexate (25 mg/wk) and a 12-week steroid taper. At week 16, steroid-free responders were randomly assigned to groups that either continued methotrexate (25 mg/wk, n = 44) or were given placebo (n = 40) until week 48. We compared the efficacy of treatment by analyzing the proportion of patients who remained relapse free and were in remission at week 48 without use of steroids or other medications to control disease activity. RESULTS Ninety-one patients (51%) achieved response at week 16, and 84 patients were included in the maintenance period study. During this period, 60% of patients in the placebo group (24/40) and 66% in the methotrexate group (29/44) had a relapse of UC (P = .75). At week 48, 30% of patients in the placebo group (12/40) and 27% of patients in the methotrexate group (12/44) were in steroid-free clinical remission without need for additional therapies (P = .86). No new safety signals for methotrexate were detected. CONCLUSIONS Parenteral methotrexate (25 mg/wk) was not superior to placebo in preventing relapses of UC in patients who achieved steroid-free response during induction therapy. ClinicalTrials.gov, Number: NCT01393405.
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Affiliation(s)
- Hans Herfarth
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina; University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, North Carolina.
| | - Edward L Barnes
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC,University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, NC
| | - John F Valentine
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, UT
| | | | - Peter DR Higgins
- Division of Gastroenterology University of Michigan Ann Arbor, MI
| | - Kim L Isaacs
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC,University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, NC
| | - Susan Jackson
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC,University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, NC
| | - Mark T Osterman
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Kristen Anton
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Anastasia Ivanova
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Millie D Long
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC,University of North Carolina Multidisciplinary Center for Inflammatory Bowel Diseases, Chapel Hill, NC
| | - Chris Martin
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC
| | - Robert S Sandler
- Division of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC
| | - Bincy Abraham
- Division of Gastroenterology and Hepatology, Houston Methodist – Weill Cornell, Houston, TX
| | - Raymond K Cross
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD
| | - Gerald Dryden
- Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, KY
| | - Monika Fischer
- Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN
| | | | - Campbell Levy
- Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Steven Polyak
- Division of Gastroenterology, Hepatology and Nutrition, University of Iowa, Iowa City, IA
| | - Sumona Saha
- Division of Gastroenterology and Hepatology, University of Wisconsin, Madison, WI
| | - Emmanuelle Williams
- Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, PA
| | - Vijay Yajnik
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jose Serrano
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James D Lewis
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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- see sites and investigators in Supplementary Material
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Shah SC, Khalili H, Gower-Rousseau C, Olen O, Benchimol EI, Lynge E, Nielsen KR, Brassard P, Vutcovici M, Bitton A, Bernstein CN, Leddin D, Tamim H, Stefansson T, Loftus EV, Moum B, Tang W, Ng SC, Gearry R, Sincic B, Bell S, Sands BE, Lakatos PL, Végh Z, Ott C, Kaplan GG, Burisch J, Colombel JF. Sex-Based Differences in Incidence of Inflammatory Bowel Diseases-Pooled Analysis of Population-Based Studies From Western Countries. Gastroenterology 2018; 155:1079-1089.e3. [PMID: 29958857 DOI: 10.1053/j.gastro.2018.06.043] [Citation(s) in RCA: 127] [Impact Index Per Article: 21.2] [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: 03/28/2018] [Revised: 06/12/2018] [Accepted: 06/21/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Although the incidence of inflammatory bowel diseases (IBDs) varies with age, few studies have examined variations between the sexes. We therefore used population data from established cohorts to analyze sex differences in IBD incidence according to age at diagnosis. METHODS We identified population-based cohorts of patients with IBD for which incidence and age data were available (17 distinct cohorts from 16 regions of Europe, North America, Australia, and New Zealand). We collected data through December 2016 on 95,605 incident cases of Crohn's disease (CD) (42,831 male and 52,774 female) and 112,004 incident cases of ulcerative colitis (UC) (61,672 male and 50,332 female). We pooled incidence rate ratios of CD and UC for the combined cohort and compared differences according to sex using random effects meta-analysis. RESULTS Female patients had a lower risk of CD during childhood, until the age range of 10-14 years (incidence rate ratio, 0.70; 95% CI, 0.53-0.93), but they had a higher risk of CD thereafter, which was statistically significant for the age groups of 25-29 years and older than 35 years. The incidence of UC did not differ significantly for female vs male patients (except for the age group of 5-9 years) until age 45 years; thereafter, men had a significantly higher incidence of ulcerative colitis than women. CONCLUSIONS In a pooled analysis of population-based studies, we found age at IBD onset to vary with sex. Further studies are needed to investigate mechanisms of sex differences in IBD incidence.
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Affiliation(s)
- Shailja C Shah
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York; Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Corinne Gower-Rousseau
- Public Health Unit, Epimad Registre, Lille University Hospital, France; INSERM LIRIC, UMR 995, Lille University, France
| | - Ola Olen
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Eric I Benchimol
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Department of Pediatrics and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Elsebeth Lynge
- Division of Gastroenterology, University of Copenhagen, Copenhagen, Denmark
| | - Kári R Nielsen
- Division of Gastroenterology, National Hospital, Tórshavn, Faroe Islands
| | - Paul Brassard
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Maria Vutcovici
- Department of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Alain Bitton
- Department of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Charles N Bernstein
- Division of Gastroenterology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Desmond Leddin
- Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hala Tamim
- Division of Gastroenterology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tryggvi Stefansson
- Division of Gastroenterology, National University Hospital of Iceland, Reykjavík, Iceland
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, New York
| | - Bjørn Moum
- Department of Gastroenterology, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Whitney Tang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Siew C Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, LKS Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong
| | - Richard Gearry
- Division of Gastroenterology, University of Otago, Christchurch, New Zealand
| | - Brankica Sincic
- Division of Gastroenterology, University of Rijeka, Rijeka, Croatia
| | - Sally Bell
- Division of Gastroenterology, St. Vincent's Hospital, Melbourne, Australia
| | - Bruce E Sands
- Division of Gastroenterology, Mount Sinai Hospital, New York, New York
| | - Peter L Lakatos
- Division of Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Zsuzsanna Végh
- Division of Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Claudia Ott
- Division of Gastroenterology, University of Regensburg, Regensburg, Germany
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital, Frederikssund, Denmark
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Zhang X, Ko HM, Torres J, Panchal HJ, Cai Z, Wagner M, Sands BE, Colombel JF, Cho J, Taouli B, Harpaz N. Luminally polarized mural and vascular remodeling in ileal strictures of Crohn's disease. Hum Pathol 2018; 79:42-49. [DOI: 10.1016/j.humpath.2018.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 02/25/2018] [Accepted: 03/07/2018] [Indexed: 12/13/2022]
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131
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Narula N, Peerani F, Meserve J, Kochhar G, Chaudrey K, Hartke J, Chilukuri P, Koliani-Pace J, Winters A, Katta L, Shmidt E, Hirten R, Faleck D, Parikh MP, Whitehead D, Boland BS, Singh S, Sagi SV, Fischer M, Chang S, Barocas M, Luo M, Lasch K, Bohm M, Lukin D, Sultan K, Swaminath A, Hudesman D, Gupta N, Shen B, Kane S, Loftus EV, Siegel CA, Sands BE, Colombel JF, Sandborn WJ, Dulai PS. Vedolizumab for Ulcerative Colitis: Treatment Outcomes from the VICTORY Consortium. Am J Gastroenterol 2018; 113:1345. [PMID: 29946178 PMCID: PMC6445254 DOI: 10.1038/s41395-018-0162-0] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/22/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We aimed to quantify the safety and effectiveness of vedolizumab (VDZ) when used for UC, and to identify predictors of response to treatment. METHODS Retrospective review (May 2014-December 2016) of VICTORY Consortium data. Adults with follow-up after starting VDZ for clinically active UC were included. Primary effectiveness outcomes were cumulative rates of clinical remission (resolution of all UC-related symptoms) and endoscopic remission (Mayo endoscopic sub-score 0). Key secondary effectiveness outcomes included cumulative rates of corticosteroid-free remission and deep remission (clinical remission and endoscopic remission). Cox proportional hazard analyses were used to identify independent predictors of treatment effectiveness. Non-response imputation (NRI) sensitivity analyses were performed for effectiveness outcomes. Key safety outcomes were rates of serious infection, serious adverse events, and colectomy. RESULTS We included 321 UC patients (71% prior TNFα antagonist exposure, median follow-up 10 months). The 12-month cumulative rates of clinical remission and endoscopic remission were 51% and 41%, respectively. Corresponding rates for corticosteroid-free remission and deep remission were 37% and 30%, respectively. Using NRI, 12-month rates were 20% (n = 64/321) for clinical remission, 17% (n = 35/203) for endoscopic remission, 15% (n = 30/195) for corticosteroid-free remission, and 14% (n = 28/203) for deep remission. A majority of the patients without adequate follow-up at 12 months who were deemed non-responders using NRI had already achieved clinical remission (n = 70) or a significant clinical response (n = 36) prior to 12 months. VDZ discontinuation prior to 12 months was observed in 91 patients, for lack of response (n = 56), need for surgery (n = 29), or adverse event (n = 6). On multivariable analyses, prior exposure to a TNFα antagonist was associated with a reduced probability of achieving clinical remission (HR 0.53, 95% CI 0.38-0.75) and endoscopic remission (HR 0.51, 95% CI 0.29-0.88). Serious adverse events and serious infections were reported in 6% and 4% of patients, respectively. Overall cumulative rates of colectomy over 12 months were 13%, with lower rates observed in patients naive to TNFα antagonist therapy (2%) than those who had been exposed to TNFα antagonists (19%). CONCLUSION In this large real-world cohort we observed that VDZ was well tolerated and effective in achieving key clinical outcomes.
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Affiliation(s)
- Neeraj Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,McMaster University Medical Centre, Hamilton, ON, Canada
| | - Farhad Peerani
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,University of Alberta, Edmonton, AB, Canada
| | | | | | | | | | | | | | - Adam Winters
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leah Katta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eugenia Shmidt
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Hirten
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,North Shore University Hospital, Manhasset, NY, USA
| | - David Faleck
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | | | | | - Michelle Luo
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | - Karen Lasch
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | | | - Dana Lukin
- Montefiore Medical Center, New York, NY, USA
| | - Keith Sultan
- North Shore University Hospital, Manhasset, NY, USA
| | | | | | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | - Bruce E. Sands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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132
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Dulai PS, Boland BS, Singh S, Chaudrey K, Koliani-Pace JL, Kochhar G, Parikh MP, Shmidt E, Hartke J, Chilukuri P, Meserve J, Whitehead D, Hirten R, Winters AC, Katta LG, Peerani F, Narula N, Sultan K, Swaminath A, Bohm M, Lukin D, Hudesman D, Chang JT, Rivera-Nieves J, Jairath V, Zou GY, Feagan BG, Shen B, Siegel CA, Loftus EV, Kane S, Sands BE, Colombel JF, Sandborn WJ, Lasch K, Cao C. Development and Validation of a Scoring System to Predict Outcomes of Vedolizumab Treatment in Patients With Crohn's Disease. Gastroenterology 2018; 155:687-695.e10. [PMID: 29857091 PMCID: PMC6419724 DOI: 10.1053/j.gastro.2018.05.039] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [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: 08/25/2017] [Revised: 04/30/2018] [Accepted: 01/02/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS As more treatment options for inflammatory bowel diseases become available, it is important to identify patients most likely to respond to different therapies. We created and validated a scoring system to identify patients with Crohn's disease (CD) who respond to vedolizumab. METHODS We collected data from the GEMINI 2 phase 3 trial of patients with active CD treated with vedolizumab for 26 weeks (n = 814) and performed logistic regression analysis to identify factors associated with clinical, steroid-free, and durable remission (derivation set). We used these data to develop a clinical decision support tool, which we validated using data from 366 participants in a separate clinical practice observational cohort of patients with active CD treated with vedolizumab for 26 weeks (the VICTORY cohort). We evaluated the ability of this tool to identify patients in clinical remission or corticosteroid-free remission, or those with mucosal healing (MH), clinical remission with MH, or corticosteroid-free remission with MH after vedolizumab therapy using receiver operating characteristic area under the curve (AUC) analyses. The primary outcome was to develop and validate a list of factors associated with achieving remission by vedolizumab in patients with active CD. RESULTS In the derivation analysis, we identified absence of previous treatment with a tumor necrosis factor antagonist (+3 points), absence of prior bowel surgery (+2 points), absence of prior fistulizing disease (+2 points), baseline level of albumin (+0.4 points per g/L), and baseline concentration of C-reactive protein (reduction of 0.5 points for values between 3.0 and 10.0 mg/L and 3.0 points for values >10.0 mg/L) as factors associated with remission. In the validation set, our model identified patients in clinical remission with an AUC of 0.67, patients in corticosteroid-free remission with an AUC of 0.66, patients with MH with an AUC of 0.72, patients in clinical remission with MH with an AUC of 0.73, and patients in corticosteroid-free clinical remission with MH with an AUC of 0.75. A cutoff value of 13 points identified patients in clinical remission after vedolizumab therapy with 92% sensitivity, patients in corticosteroid-free remission with 94% sensitivity, patients with MH with 98% sensitivity, patients with clinical remission and MH with 100% sensitivity, and patients with corticosteroid-free clinical remission with MH with 100% sensitivity. CONCLUSIONS We developed and validated a scoring system to identify patients with CD most likely to respond to 26 weeks of vedolizumab therapy. Further studies are needed to optimize its accuracy in select populations and determine its cost-effectiveness.
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Affiliation(s)
| | | | | | | | | | | | | | - Eugenia Shmidt
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | - Leah G. Katta
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Farhad Peerani
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,University of Alberta, Edmonton, AB, Canada
| | - Neeraj Narula
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,McMaster University Medical Centre, Hamilton, ON, Canada
| | - Keith Sultan
- North Shore University Hospital, Manhasset, NY, USA
| | | | | | - Dana Lukin
- Montefiore Medical Center, New York, NY, USA
| | | | - John T. Chang
- University of California - San Diego, La Jolla, CA, USA
| | | | | | - GY Zou
- University of Western Ontario, London, ON, Canada
| | | | - Bo Shen
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | | | | | - Bruce E. Sands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Karen Lasch
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
| | - Charlie Cao
- Takeda Pharmaceuticals USA Inc., Deerfield, IL, USA
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133
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Sands BE, Han C, Gasink C, Jacobstein D, Szapary P, Gao LL, Lang Y, Targan S, Sandborn WJ, Feagan BG. The Effects of Ustekinumab on Health-related Quality of Life in Patients With Moderate to Severe Crohn's Disease. J Crohns Colitis 2018; 12:883-895. [PMID: 29726939 DOI: 10.1093/ecco-jcc/jjy055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 12/13/2017] [Accepted: 05/01/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS We assessed the effect of ustekinumab on health-related quality of life [HRQOL] in adults with Crohn's disease [CD]. METHODS Patients with moderately to severely active CD and inadequate response or intolerance to tumour necrosis factor antagonists [UNITI-1, n = 741], or conventional therapy [UNITI-2, n = 627] were randomised to placebo, ustekinumab 130 mg, or 6 mg/kg intravenous induction therapy. At Week 8, ustekinumab-treated responders (Crohn's Disease Activity Index [CDAI] reduction ≥100 or CDAI <150 points) were re-randomised to subcutaneous maintenance therapy [IM-UNITI, n = 388] with placebo, ustekinumab 90 mg every 12 weeks [q12w], or ustekinumab 90 mg every 8 weeks [q8w], for 44 additional weeks. Inflammatory Bowel Disease Questionnaire [IBDQ] and 36-item Short Form Health Survey [SF-36] physical component summary [PCS] and mental component summary [MCS] scores were completed at induction baseline and Week 8, and at maintenance Weeks 20 and 44. Clinically meaningful improvement in IBDQ and PCS and MCS scores were evaluated. For all HRQOL outcomes, each ustekinumab dose and placebo were compared. RESULTS Induction baseline mean values of IBDQ, PCS, and MCS were similar across groups, but impaired relative to general population norms. At Week 8, ustekinumab induced greater improvement than placebo in both HRQOL scores. Significantly greater proportions of patients receiving ustekinumab 6 mg/kg or 130 mg had clinically meaningful IBDQ improvement [UNITI-1: 54.8%, 46.9% versus 36.5%, respectively; UNITI-2: 68.1%, 58.7% versus 41.1%, respectively; p <0.05, all comparisons]. Similarly, greater proportions of ustekinumab-treated patients in both studies had clinically meaningful improvements in PCS and MCS as compared with placebo. At Week 44, improvements in IBDQ, PCS, and MCS scores were maintained with ustekinumab. CONCLUSIONS Ustekinumab improved HRQOL in patients with moderately to severely active CD.
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Affiliation(s)
- Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chenglong Han
- Patient Reported Outcomes, Janssen Research & Development, LLC, Spring House, PA, USA
| | | | | | - Philippe Szapary
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Long-Long Gao
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Yinghua Lang
- Immunology, Janssen Research & Development, LLC, Spring House, PA, USA
| | - Stephan Targan
- Inflammatory Bowel Disease Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON, Canada
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134
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Danese S, Bonovas S, Lopez A, Fiorino G, Sandborn WJ, Rubin DT, Kamm MA, Colombel JF, Sands BE, Vermeire S, Panes J, Rogler G, D'Haens G, Peyrin-Biroulet L. Identification of Endpoints for Development of Antifibrosis Drugs for Treatment of Crohn's Disease. Gastroenterology 2018; 155:76-87. [PMID: 29601825 DOI: 10.1053/j.gastro.2018.03.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 01/03/2018] [Revised: 02/20/2018] [Accepted: 03/19/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Intestinal fibrosis is a challenge to management of patients with Crohn's disease (CD); there is an urgent need to expedite development of antifibrosis drugs for this disease. The International Organization for the Study of Inflammatory Bowel Disease (IOIBD) aimed to identify a set of endpoints that can be used to determine efficacy of antifibrosis agents tested in clinical trials of patients with CD. METHODS We conducted a systematic review to identify clinical, radiologic, biochemical, endoscopic, and composite endpoints used in assessing activity of fibrostenosing CD and response to treatment, and determined their operational properties. A panel of IOIBD experts performed a consensus process to identify the best endpoints for inclusion in clinical trials, through a 2-round, Delphi-style online survey. RESULTS A total of 36 potentially relevant endpoints for intestinal fibrosis were selected and assessed. Forty-eight physicians with expertise in inflammatory bowel disease, from 5 regions (North America, Europe, Middle East, Asia/Pacific, and Latin America), participated in the Delphi consensus process. A core set of 13 endpoints (complete clinical response, long-term efficacy, sustained clinical benefit, treatment failure, radiological remission, normal quality of life, clinical remission without steroids, therapeutic failure, deep remission, complete absence of occlusive symptoms, symptom-free survival, bowel damage progression, and no disability) were rated as critical. Agreement was high among the experts. CONCLUSIONS Members of the IOIBD reached expert consensus on a set of endpoints that can be used to assess antifibrosis agents in trials of patients with CD. Studies are needed to clarify methods for measuring these outcomes and validate measurement instruments.
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Affiliation(s)
- Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Humanitas Clinical and Research Center, Milan, Italy.
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | - Anthony Lopez
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Gionata Fiorino
- IBD Center, Humanitas Clinical and Research Center, Milan, Italy
| | | | | | - Michael A Kamm
- Departments of Gastroenterology and Medicine, St Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | - Jean-Frederic Colombel
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Severine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Julian Panes
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
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Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. Correction: ACG Clinical Guideline: Management of Crohn's Disease in Adults. Am J Gastroenterol 2018; 113:1101. [PMID: 29895986 DOI: 10.1038/s41395-018-0120-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since the publication of these Guidelines, the authors have noticed an error in the text on page 15. The incorrect statement is.
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Rebello D, Anjelly D, Grand DJ, Machan JT, Beland MD, Furman MS, Shapiro J, LeLeiko N, Sands BE, Mallette M, Bright R, Moniz H, Merrick M, Shah SA. Opportunistic screening for bone disease using abdominal CT scans obtained for other reasons in newly diagnosed IBD patients. Osteoporos Int 2018. [PMID: 29520605 DOI: 10.1007/s00198-018-4444-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
UNLABELLED Bone disease is prevalent among patients with inflammatory bowel disease (IBD), though bone density screening remains underutilized. We used CT scans performed for other indications in IBD patients to identify and monitor osteopenia using CT attenuation values at the lumbar spine. Significant rates of bone disease were detected which would have otherwise gone undiagnosed. INTRODUCTION Osteoporosis affects about 14-42% of patients with IBD. Though screening is recommended in IBD patients with risk factors, it remains underutilized. In patients with newly diagnosed IBD, we used CT scans performed for other indications to identify and monitor progression of osteopenia. METHODS Using the Ocean State Crohn's and Colitis Area Registry, we identified adult patients with one or more abdominal CT scans. Each patient had two age- and gender-matched controls. Radiologists measured attenuation through trabecular bone in the L1 vertebral body recorded in Hounsfield units (HU). Generalized estimating equations were used to measure how HU varied as a function of gender, type of IBD, and age. RESULTS One hundred five IBD patients were included, and 72.4% were classified as "normal" bone mineral density (BMD) and 27.6% as potentially osteopenic: 8.6% with ulcerative colitis and 19.0% with Crohn's disease. We found a decrease in bone density over time (p < 0.001) and that BMD decreases more in Crohn's disease than in ulcerative colitis (p < 0.004). Sixty patients had two CT scans, and mean loss of 9.3 HU was noted. There was a non-significant decrease in BMD over time in patients exposed to > 31 days of steroids and BMD was stable with < 30 days of steroid exposure (p < 0.09). CONCLUSION Using CT scans obtained for other indications, we found low rates of osteopenia and osteoporosis that may otherwise have gone undiagnosed. Refinement of opportunistic screening may have advantages in terms of cost-savings and earlier detection of bone loss.
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Affiliation(s)
- D Rebello
- Alpert Medical School, Brown University, Providence, RI, USA.
- Department of Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA.
| | - D Anjelly
- Alpert Medical School, Brown University, Providence, RI, USA
- Division of Gastroenterology, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - D J Grand
- Alpert Medical School, Brown University, Providence, RI, USA
- Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - J T Machan
- Department of Biostatistics and Research, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - M D Beland
- Alpert Medical School, Brown University, Providence, RI, USA
- Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - M S Furman
- Alpert Medical School, Brown University, Providence, RI, USA
- Department of Diagnostic Imaging, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
| | - J Shapiro
- Alpert Medical School, Brown University, Providence, RI, USA
- Hasbro Children's Hospital, Providence, RI, USA
| | - N LeLeiko
- Alpert Medical School, Brown University, Providence, RI, USA
- Hasbro Children's Hospital, Providence, RI, USA
| | - B E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Mallette
- Division of Gastroenterology, Rhode Island Hospital, Providence, RI, USA
| | - R Bright
- Division of Gastroenterology, Rhode Island Hospital, Providence, RI, USA
| | - H Moniz
- Division of Gastroenterology, Rhode Island Hospital, Providence, RI, USA
| | - M Merrick
- Crohn's & Colitis Foundation, New York, NY, USA
| | - S A Shah
- Alpert Medical School, Brown University, Providence, RI, USA
- The Miriam Hospital, Providence, RI, USA
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Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical Guideline: Management of Crohn's Disease in Adults. Am J Gastroenterol 2018; 113:481-517. [PMID: 29610508 DOI: 10.1038/ajg.2018.27] [Citation(s) in RCA: 711] [Impact Index Per Article: 118.5] [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: 06/11/2017] [Accepted: 01/11/2018] [Indexed: 02/06/2023]
Abstract
Crohn's disease is an idiopathic inflammatory disorder of unknown etiology with genetic, immunologic, and environmental influences. The incidence of Crohn's disease has steadily increased over the past several decades. The diagnosis and treatment of patients with Crohn's disease has evolved since the last practice guideline was published. These guidelines represent the official practice recommendations of the American College of Gastroenterology and were developed under the auspices of the Practice Parameters Committee for the management of adult patients with Crohn's disease. These guidelines are established for clinical practice with the intent of suggesting preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When exercising clinical judgment, health-care providers should incorporate this guideline along with patient's needs, desires, and their values in order to fully and appropriately care for patients with Crohn's disease. This guideline is intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. To evaluate the level of evidence and strength of recommendations, we used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.
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Affiliation(s)
- Gary R Lichtenstein
- Department of Medicine, Division of Gastroenterology, Hospital of the University of Pennsylvania, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kim L Isaacs
- Department of Medicine, Division of Gastroenterology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Miguel D Regueiro
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lauren B Gerson
- Department of Medicine, Division of Gastroenterology, California Pacific Medical Center, San Francisco, California, USA
| | - Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Rosario M, French JL, Dirks NL, Sankoh S, Parikh A, Yang H, Danese S, Colombel JF, Smyth M, Sandborn WJ, Feagan BG, Reinisch W, Sands BE, Sans M, Fox I. Corrigendum: Exposure-efficacy Relationships for Vedolizumab Induction Therapy in Patients with Ulcerative Colitis or Crohn's Disease. J Crohns Colitis 2018; 12:510. [PMID: 29385425 DOI: 10.1093/ecco-jcc/jjx168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Maria Rosario
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | | | | | - Serap Sankoh
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Asit Parikh
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Huyuan Yang
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Silvio Danese
- Inflammatory Bowel Disease Clinical and Research Unit, Istituto Clinico Humanitas, Milan, Italy
| | | | | | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Brian G Feagan
- Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria, and Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Miguel Sans
- Digestive Diseases Service, Centro Médico Teknon, Barcelona, Spain
| | - Irving Fox
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
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Kim AH, Roberts C, Feagan BG, Banerjee R, Bemelman W, Bodger K, Derieppe M, Dignass A, Driscoll R, Fitzpatrick R, Gaarentstroom-Lunt J, Higgins PD, Kotze PG, Meissner J, O'Connor M, Ran ZH, Siegel CA, Terry H, van Deen WK, van der Woude CJ, Weaver A, Yang SK, Sands BE, Vermeire S, Travis SP. Developing a Standard Set of Patient-Centred Outcomes for Inflammatory Bowel Disease-an International, Cross-disciplinary Consensus. J Crohns Colitis 2018; 12:408-418. [PMID: 29216349 DOI: 10.1093/ecco-jcc/jjx161] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 11/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Success in delivering value-based healthcare involves measuring outcomes that matter most to patients. Our aim was to develop a minimum Standard Set of patient-centred outcome measures for inflammatory bowel disease [IBD], for use in different healthcare settings. METHODS An international working group [n = 25] representing patients, patient associations, gastroenterologists, surgeons, specialist nurses, IBD registries and patient-reported outcome measure [PROM] methodologists participated in a series of teleconferences incorporating a modified Delphi process. Systematic review of existing literature, registry data, patient focus groups and open review periods were used to reach consensus on a minimum set of standard outcome measures and risk adjustment variables. Similar methodology has been used in 21 other disease areas [www.ichom.org]. RESULTS A minimum Standard Set of outcomes was developed for patients [aged ≥16] with IBD. Outcome domains included survival and disease control [survival, disease activity/remission, colorectal cancer, anaemia], disutility of care [treatment-related complications], healthcare utilization [IBD-related admissions, emergency room visits] and patient-reported outcomes [including quality of life, nutritional status and impact of fistulae] measured at baseline and at 6 or 12 month intervals. A single PROM [IBD-Control questionnaire] was recommended in the Standard Set and minimum risk adjustment data collected at baseline and annually were included: demographics, basic clinical information and treatment factors. CONCLUSIONS A Standard Set of outcome measures for IBD has been developed based on evidence, patient input and specialist consensus. It provides an international template for meaningful, comparable and easy-to-interpret measures as a step towards achieving value-based healthcare in IBD.
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Affiliation(s)
- Andrew H Kim
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | - Charlotte Roberts
- International Consortium for Health Outcomes Measurement, London, UK
| | - Brian G Feagan
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Rupa Banerjee
- Asian Institute of Gastroenterology, Hyderabad, India
| | - Willem Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Keith Bodger
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Digestive Diseases Unit, Aintree University Hospital, Liverpool, UK
| | | | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt am Main, Germany
| | | | | | - Janette Gaarentstroom-Lunt
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter D Higgins
- Department of Internal Medicine, University of Michigan Medical School, Michigan, Ann Arbor, MI, USA
| | | | | | - Marian O'Connor
- St Mark's Hospital, London Northwest Healthcare NHS Trust, UK
| | - Zhi-Hua Ran
- Key Laboratory of Gastroenterology & Hepatology Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Shanghai, China
| | - Corey A Siegel
- Department of Gastroenterology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Helen Terry
- Crohn's and Colitis UK, St Albans, Hertfordshire, UK
| | - Welmoed K van Deen
- UCLA Center for Inflammatory Bowel Diseases, Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,USC Gehr Family Center for Implementation Science, Los Angeles, CA, USA
| | | | | | - Suk-Kyun Yang
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Séverine Vermeire
- Department of Gastroenterology & Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Simon Pl Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
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Sands BE, Gasink C, Jacobstein D, Ott E, Lang Y, Ramachandran P, Ghosh S. A106 SAFETY OF USTEKINUMAB WITH AND WITHOUT CONCOMITANT CORTICOSTEROIDS OR IMMUNOSUPPRESSANTS IN PATIENTS WITH MODERATELY-TO-SEVERELY ACTIVE CROHN’S DISEASE. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy009.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- B E Sands
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - C Gasink
- Janssen Scientific Affairs, LLC, Horsham, PA
| | - D Jacobstein
- Janssen Research & Development, LLC, Spring House, PA
| | - E Ott
- Janssen Research & Development, LLC, Spring House, PA
| | - Y Lang
- Janssen Research & Development, LLC, Spring House, PA
| | | | - S Ghosh
- Gastrointestinal Section, Imperial College london, London, United Kingdom
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Feagan BG, Sands BE, de Villiers W, Ott E, Gasink C, Lang Y, Szapary P, Jacobstein D, Ghosh S. A81 POOLED SAFETY ANALYSIS FROM THE USTEKINUMAB CROHN’S DISEASE AND PSORIATIC DISEASES PHASE 2 AND 3 TRIALS. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B G Feagan
- Robarts Clinical Trials Inc, London, ON, Canada
| | - B E Sands
- Icahn School of Medicine at Mt Sinai, New York, NY
| | | | - E Ott
- Janssen Research & Development, LLC, Spring House, PA
| | - C Gasink
- Janssen Research & Development, LLC, Spring House, PA
| | - Y Lang
- Janssen Research & Development, LLC, Spring House, PA
| | - P Szapary
- Janssen Research & Development, LLC, Spring House, PA
| | - D Jacobstein
- Janssen Research & Development, LLC, Spring House, PA
| | - S Ghosh
- Gastrointestinal Section, Imperial College london, London, United Kingdom
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Sands BE, Gasink C, Jacobstein D, Gao L, Johanns J, Szapary P, Colombel JF, Targan S, Ghosh S, Sandborn W. A85 EFFICACY AND SAFETY OF DOSE ADJUSTMENT AND DELAYED RESPONSE TO USTEKINUMAB IN MODERATE–SEVERE CROHN’S DISEASE: RESULTS FROM THE IM-UNITI MAINTENANCE STUDY. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B E Sands
- Icahn School of Medicine at Mt Sinai, New York, NY
| | - C Gasink
- Janssen Research & Development, LLC, Spring House, PA
| | - D Jacobstein
- Janssen Research & Development, LLC, Spring House, PA
| | - L Gao
- Janssen Research & Development, LLC, Spring House, PA
| | - J Johanns
- Janssen Research & Development, LLC, Spring House, PA
| | - P Szapary
- Janssen Research & Development, LLC, Spring House, PA
| | - J F Colombel
- School Of Medicine, Mount Sinai Medical Center, New York, NY
| | - S Targan
- Cedars-Sinai Medical Center, Los Angeles, CA
| | - S Ghosh
- Gastrointestinal Section, Imperial College london, London, United Kingdom
| | - W Sandborn
- University of California San Diego, La Jolla, CA
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Shah SC, Naymagon S, Panchal HJ, Sands BE, Cohen BL, Dubinsky MC. Accelerated Infliximab Dosing Increases 30-Day Colectomy in Hospitalized Ulcerative Colitis Patients: A Propensity Score Analysis. Inflamm Bowel Dis 2018; 24:651-659. [PMID: 29462380 DOI: 10.1093/ibd/izx039] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 08/04/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Standard outpatient induction dosing of infliximab (IFX) may not be effective in hospitalized ulcerative colitis (UC) patients with higher inflammatory burden and colectomy risk. Our aim was to determine whether initial IFX induction dose affects 30-day colectomy rate and other disease-related outcomes. METHODS IFX-naive hospitalized UC patients receiving at least 1 inpatient 5 mg/kg (SD) or 10 mg/kg (HD) IFX induction dose were included. Baseline demographics and admission-related characteristics were documented. Propensity score based matching was used to control for provider bias introduced due to nonprotocolized choice of IFX dose. The primary outcome was 30-day colectomy; secondary outcomes included the need for an accelerated induction IFX (AD), length of stay (LOS), 90-day and 1-year colectomy, and complications. RESULTS Of 146 (120 SD/26 HD) patients included, 25 (17.1%) underwent colectomy by 30 days, 33 (22.6%) by 90 days, and 41 (28.1%) by 1 year. In 21 propensity score matched dyads (n = 42) treated with SD or HD, colectomy rates and LOS were similar. SD patients more often needed AD (23.8% vs. 0%, P = 0.048) and AD patients progressed to colectomy more rapidly within 30 days compared to non-AD (P = 0.001). Female sex and hypoalbuminemia were associated with significantly increased odds of needing AD on both univariate and multivariate analyses. CONCLUSIONS In our propensity score based analysis, receiving accelerated IFX dosing after an initial SD infusion was associated with significantly higher 30-day colectomy rates in hospitalized acute UC patients. The most effective dosing strategy in this population remains unclear and prospective randomized studies are needed.
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Affiliation(s)
- Shailja C Shah
- Department of Medicine and Pediatrics, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven Naymagon
- Department of Medicine and Pediatrics, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hinaben J Panchal
- Department of Medicine and Pediatrics, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bruce E Sands
- Department of Medicine and Pediatrics, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin L Cohen
- Department of Medicine and Pediatrics, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marla C Dubinsky
- Department of Medicine and Pediatrics, Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Panés J, Vermeire S, Lindsay JO, Sands BE, Su C, Friedman G, Zhang H, Yarlas A, Bayliss M, Maher S, Cappelleri JC, Bushmakin AG, Rubin DT. Tofacitinib in Patients with Ulcerative Colitis: Health-Related Quality of Life in Phase 3 Randomised Controlled Induction and Maintenance Studies. J Crohns Colitis 2018; 12:145-156. [PMID: 29028981 PMCID: PMC5881763 DOI: 10.1093/ecco-jcc/jjx133] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Tofacitinib is an oral, small molecule Janus kinase [JAK] inhibitor that is being investigated for ulcerative colitis [UC]. We evaluated health-related quality of life [HRQoL] in tofacitinib UC Phase 3 studies. METHODS Patients ≥ 18 years old in OCTAVE Induction 1 [N = 598] and 2 [N = 541] with moderately to severely active UC were randomised [1:4] to placebo or tofacitinib 10 mg twice daily [BID] for 8 weeks. Subsequently, OCTAVE Sustain re-randomised [1:1:1] clinical responders [N = 593] from induction studies to placebo, tofacitinib 5 mg BID, or 10 mg BID, for 52 weeks. Inflammatory Bowel Disease Questionnaire [IBDQ] and SF-36v2® Health Survey [SF-36v2] assessed HRQoL. RESULTS In OCTAVE Induction 1 and 2, mean changes from baseline IBDQ were greater with tofacitinib 10 mg BID at Week 8 [28.9 and 31.5] versus placebo [15.4 and 17.2; p < 0.0001]; mean changes from baseline SF-36v2 Physical and Mental Component Summaries [PCS/MCS] were also greater with 10 mg BID [PCS: 6.8 and 6.8; MCS: 6.8 and 7.6] versus placebo [PCS: 2.5 and 4.6; MCS: 3.5 and 4.4; p < 0.01]. In OCTAVE Sustain atWeek 52, changes in IBDQ were maintained with tofacitinib 5 mg [-1.3] and 10 mg BID [0.6], and larger with placebo [-20.2; p < 0.0001]. Changes in SF-36v2 PCS/MCS were also maintained with 5 mg [PCS: 0.0; MCS: -1.0] and 10 mg BID [PCS: 0.3; MCS: 0.1] versus placebo [PCS: -5.2; MCS: -6.7; p < 0.0001] at Week 52 in OCTAVE Sustain. CONCLUSIONS Tofacitinib 10 mg BID induction therapy significantly improved HRQoL versus placebo at Week 8. Improvements were maintained through 52 weeks' maintenance therapy with tofacitinib 5 mg and 10 mg BID. CLINICALTRIALS.GOV REGISTRATION NUMBERS NCT01465763, NCT01458951 and NCT01458574.
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Affiliation(s)
- Julian Panés
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - James O Lindsay
- Centre for Immunobiology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | | | | | - David T Rubin
- The University of Chicago Medicine, Inflammatory Bowel Disease Center, Chicago, IL, USA,Corresponding author: David T. Rubin, MD, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 4076, Chicago, IL 60637, USA. Tel.: +1 773 702 2950; fax: +1 773 702 2182;
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Feagan BG, Sands BE, Rossiter G, Li X, Usiskin K, Zhan X, Colombel JF. Effects of Mongersen (GED-0301) on Endoscopic and Clinical Outcomes in Patients With Active Crohn's Disease. Gastroenterology 2018; 154:61-64.e6. [PMID: 28847751 DOI: 10.1053/j.gastro.2017.08.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [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: 03/23/2017] [Revised: 08/11/2017] [Accepted: 08/18/2017] [Indexed: 12/31/2022]
Abstract
GED-0301 is an antisense oligodeoxynucleotide with a sequence complementary to the Smad7 mRNA transcript. Smad7 is a negative regulator of transforming growth factor-β, which is increased in the intestinal mucosa of patients with active Crohn's disease (CD). We randomly assigned 63 CD patients to 4-, 8-, or 12-week treatment groups receiving oral GED-0301 (160 mg/day). The primary objective was to determine GED-0301's effect on endoscopic CD measures; secondary objectives included effects on clinical activity. Endoscopic improvement was observed in 37% of participants with evaluable endoscopy results at week 12. At week 12, 32% (4 weeks), 35% (8 weeks), and 48% (12 weeks) of patients receiving GED-0301 were in remission (CD activity index score <150); corresponding reductions from baseline in mean CD activity index scores were -124, -112, and -133 points. No new safety signals were observed. These findings support a GED-0301 benefit in active CD. ClinicalTrials.gov no: NCT02367183.
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Affiliation(s)
- Brian G Feagan
- Robarts Clinical Trials and Western University, London, Ontario, Canada.
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, New York
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Rosario M, French JL, Dirks NL, Sankoh S, Parikh A, Yang H, Danese S, Colombel JF, Smyth M, Sandborn WJ, Feagan BG, Reinisch W, Sands BE, Sans M, Fox I. Exposure-efficacy Relationships for Vedolizumab Induction Therapy in Patients with Ulcerative Colitis or Crohn's Disease. J Crohns Colitis 2017; 11:921-929. [PMID: 28333288 DOI: 10.1093/ecco-jcc/jjx021] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [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] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS A positive relationship between vedolizumab trough serum concentrations and clinical outcomes in patients with ulcerative colitis [UC] or Crohn's disease [CD] has been reported. Here we further explore exposure-efficacy relationships for vedolizumab induction therapy in post hoc analyses of GEMINI study data. METHODS Vedolizumab trough concentrations at Week 6 or 10 were grouped in quartiles and clinical outcome rates calculated. Exposure-efficacy relationships at Week 6 and potential baseline covariate effects were explored using logistic regression and individual predicted cumulative average concentration through Week 6 [Caverage] as exposure measure. RESULTS Higher vedolizumab concentrations were associated with higher clinical remission rates; the exposure-efficacy relationship was steeper for UC than CD. Unadjusted analyses overestimated the relationship, more so for CD. From covariate-adjusted models, average probability of remission at Week 6 increased by approximately 15% for UC and 10% for CD between Caverage values of 35 and 84 µg/ml [5th and 95th percentiles, respectively]. On average, patients with higher albumin, lower faecal calprotectin [UC only], lower C-reactive protein [CD only], and no previous tumour necrosis factor-α [TNFα] antagonist use had a higher remission probability. Previous TNFα antagonist use had the greatest impact; remission probability was approximately 10% higher in treatment-naïve patients. CONCLUSIONS Higher vedolizumab serum concentrations were associated with higher remission rates after induction therapy in patients with moderately to severely active UC or CD. This relationship is affected by several factors, including previous TNFα antagonist use. Prospective studies are needed to assess vedolizumab dose individualisation and optimisation.
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Affiliation(s)
- Maria Rosario
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | | | | | - Serap Sankoh
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Asit Parikh
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Huyuan Yang
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
| | - Silvio Danese
- Inflammatory Bowel Disease Clinical and Research Unit, Istituto Clinico Humanitas, Milan, Italy
| | | | | | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Brian G Feagan
- Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria, and Department of Internal Medicine, McMaster University, Hamilton, ON, Canada
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Miguel Sans
- Digestive Diseases Service, Centro Médico Teknon, Barcelona, Spain
| | - Irving Fox
- Clinical Pharmacology Department, Millennium Pharmaceuticals Inc., a wholly owned subsidiary of Takeda Pharmaceutical Company Ltd, Cambridge, MA, USA
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147
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Sands BE, Chen J, Feagan BG, Penney M, Rees WA, Danese S, Higgins PDR, Newbold P, Faggioni R, Patra K, Li J, Klekotka P, Morehouse C, Pulkstenis E, Drappa J, van der Merwe R, Gasser RA. Efficacy and Safety of MEDI2070, an Antibody Against Interleukin 23, in Patients With Moderate to Severe Crohn's Disease: A Phase 2a Study. Gastroenterology 2017; 153:77-86.e6. [PMID: 28390867 DOI: 10.1053/j.gastro.2017.03.049] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/10/2017] [Accepted: 03/23/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS MEDI2070 is a human monoclonal antibody that selectively inhibits interleukin 23 (IL23), a cytokine implicated in the pathogenesis of Crohn's disease (CD). We analyzed its safety and efficacy in treatment of CD in a phase 2a study. METHODS We conducted a double-blind, placebo-controlled study of 119 adults with moderate to severe CD failed by treatment with tumor necrosis factor antagonists. Patients were randomly assigned (1:1) to groups given MEDI2070 (700 mg) or placebo intravenously at weeks 0 and 4. Patients received open-label MEDI2070 (210 mg) subcutaneously every 4 weeks from weeks 12 to 112. The CD Activity Index was used to measure disease activity. RESULTS The primary outcome, clinical response (either a 100-point decrease in CD Activity Index score from baseline or clinical remission, defined as CD Activity Index score <150) at week 8 occurred in 49.2% of patients receiving MEDI2070 (n = 59) compared with 26.7% receiving placebo (n = 60; absolute difference, 22.5%; 95% confidence interval, 5.6%-39.5%; P = .010). Clinical response at week 24 occurred in 53.8% of patients who continued to receive open-label MEDI2070 and in 57.7% of patients who had received placebo during the double-blind period and open-label MEDI2070 thereafter. The most common adverse events were headache and nasopharyngitis. Higher baseline serum concentrations of IL22, a cytokine whose expression is induced by IL23, were associated with greater likelihood of response to MEDI2070 compared with placebo. CONCLUSIONS In a phase 2a trial of patients with moderate to severe Crohn's disease who had failed treatment with tumor necrosis factor antagonists, 8 and 24 weeks of treatment with MEDI2070 were associated with clinical improvement. ClinicalTrials.gov ID: NCT01714726.
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Affiliation(s)
- Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - Brian G Feagan
- Robarts Clinical Trials, University of Western Ontario, London, Ontario
| | | | | | - Silvio Danese
- Humanitas Clinical and Research Center, Milan, Italy
| | | | | | | | | | - Jing Li
- MedImmune, Mountain View, California
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148
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Sandborn WJ, Rutgeerts P, Colombel JF, Ghosh S, Petryka R, Sands BE, Mitra P, Luo A. Eldelumab [anti-interferon-γ-inducible protein-10 antibody] Induction Therapy for Active Crohn's Disease: a Randomised, Double-blind, Placebo-controlled Phase IIa Study. J Crohns Colitis 2017; 11:811-819. [PMID: 28333187 DOI: 10.1093/ecco-jcc/jjx005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [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: 11/15/2016] [Accepted: 01/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS This 11-week Phase IIa induction study evaluated the efficacy and safety of eldelumab in patients with active Crohn's disease. METHODS Adults with Crohn's Disease Activity Index 220-450 were randomised 1:1:1 to placebo or eldelumab 10 or 20 mg/kg intravenously on Days 1 and 8, and alternate weeks thereafter. All patients underwent ileocolonoscopy at baseline. Patients with active inflammation according to the Simplified Endoscopic Score for Crohn's Disease criteria [the originally planned endoscopy cohort] underwent another ileocolonoscopy at Week 11 at the investigator's discretion. All ileocolonoscopies were centrally read. The primary objective was identification of the eldelumab target exposure for induction of remission [absolute Crohn's Disease Activity Index score < 150]. Rates of clinical response [reduction of ≥ 100 from baseline or absolute score < 150 Crohn's Disease Activity Index], remission, and endoscopic improvements were also assessed. RESULTS A total of 121 patients were randomised. The eldelumab exposure-remission relationship was not significant at Week 11. Numerically higher remission and response rates were reported with eldelumab 20 mg/kg [29.3% and 41.5%, respectively] and 10 mg/kg [22.5% and 47.5%] versus placebo [20.0% and 35.0%]. A higher proportion of patients with a baseline Simplified Endoscopic Score for Crohn's Disease > 2 who received eldelumab achieved a 50% improvement in score and greater reductions from baseline endoscopy scores overall versus placebo. Adverse events were comparable across treatment groups. CONCLUSIONS No exposure-remission relationship was seen with eldelumab. Eldelumab induction treatment demonstrated trends towards clinical and endoscopic efficacy. Safety was consistent with that reported previously. ClinicalTrials.gov identifier: NCT01466374.
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Affiliation(s)
- William J Sandborn
- Inflammatory Bowel Disease Center, University of California San Diego, La Jolla, CA, USA
| | - Paul Rutgeerts
- Department of Gastroenterology, Catholic University Leuven, Belgium
| | - Jean-Frédéric Colombel
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Subrata Ghosh
- Division of Gastroenterology, University of Calgary, Calgary, AB, Canada
| | - Robert Petryka
- NZOZ Vivamed, Zespól Lekarzy Specjalistów, Warszawa, Poland
| | - Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Allison Luo
- Bristol-Myers Squibb, Lawrenceville, NJ, USA
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149
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Panés J, Sandborn WJ, Schreiber S, Sands BE, Vermeire S, D'Haens G, Panaccione R, Higgins PDR, Colombel JF, Feagan BG, Chan G, Moscariello M, Wang W, Niezychowski W, Marren A, Healey P, Maller E. Tofacitinib for induction and maintenance therapy of Crohn's disease: results of two phase IIb randomised placebo-controlled trials. Gut 2017; 66:1049-1059. [PMID: 28209624 PMCID: PMC5532457 DOI: 10.1136/gutjnl-2016-312735] [Citation(s) in RCA: 239] [Impact Index Per Article: 34.1] [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: 07/27/2016] [Revised: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Tofacitinib is an oral, small-molecule Janus kinase inhibitor that is being investigated for IBD. We evaluated the efficacy and safety of tofacitinib for induction and maintenance treatment in patients with moderate-to-severe Crohn's disease (CD). DESIGN We conducted two randomised, double-blind, placebo-controlled, multicentre phase IIb studies. Adult patients with moderate-to-severe CD were randomised to receive induction treatment with placebo, tofacitinib 5 or 10 mg twice daily for 8 weeks. Those achieving clinical response-100 or remission were re-randomised to maintenance treatment with placebo, tofacitinib 5 or 10 mg twice daily for 26 weeks. Primary endpoints were clinical remission at the end of the induction study, and clinical response-100 or remission at the end of the maintenance study. RESULTS 180/280 patients randomised in the induction study were enrolled in the maintenance study. At week 8 of induction, the proportion of patients with clinical remission was 43.5% and 43.0% with 5 and 10 mg twice daily, respectively, compared with 36.7% in the placebo group (p=0.325 and 0.392 for 5 and 10 mg twice daily vs placebo). At week 26 of maintenance, the proportion of patients with clinical response-100 or remission was 55.8% with tofacitinib 10 mg twice daily compared with 39.5% with tofacitinib 5 mg twice daily and 38.1% with placebo (p=0.130 for 10 mg twice daily vs placebo). Compared with placebo, the change in C-reactive protein from baseline was statistically significant (p<0.0001) with 10 mg twice daily after both induction and maintenance treatments. CONCLUSIONS Primary efficacy endpoints were not significantly different from placebo, although there was evidence of a minor treatment effect. No new safety signals were observed for tofacitinib. TRIAL REGISTRATION NUMBERS NCT01393626 and NCT01393899.
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Affiliation(s)
- Julian Panés
- Hospital Clinic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - William J Sandborn
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Stefan Schreiber
- Klinik für Innere Medizin I, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Séverine Vermeire
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
| | - Geert D'Haens
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Peter D R Higgins
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jean-Frederic Colombel
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Gary Chan
- Pfizer Inc, Collegeville, Pennsylvania, USA
| | | | | | | | - Amy Marren
- Pfizer Inc, Collegeville, Pennsylvania, USA
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150
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Sandborn WJ, Su C, Sands BE, D'Haens GR, Vermeire S, Schreiber S, Danese S, Feagan BG, Reinisch W, Niezychowski W, Friedman G, Lawendy N, Yu D, Woodworth D, Mukherjee A, Zhang H, Healey P, Panés J. Tofacitinib as Induction and Maintenance Therapy for Ulcerative Colitis. N Engl J Med 2017; 376:1723-1736. [PMID: 28467869 DOI: 10.1056/nejmoa1606910] [Citation(s) in RCA: 985] [Impact Index Per Article: 140.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tofacitinib, an oral, small-molecule Janus kinase inhibitor, was shown to have potential efficacy as induction therapy for ulcerative colitis in a phase 2 trial. We further evaluated the efficacy of tofacitinib as induction and maintenance therapy. METHODS We conducted three phase 3, randomized, double-blind, placebo-controlled trials of tofacitinib therapy in adults with ulcerative colitis. In the OCTAVE Induction 1 and 2 trials, 598 and 541 patients, respectively, who had moderately to severely active ulcerative colitis despite previous conventional therapy or therapy with a tumor necrosis factor antagonist were randomly assigned to receive induction therapy with tofacitinib (10 mg twice daily) or placebo for 8 weeks. The primary end point was remission at 8 weeks. In the OCTAVE Sustain trial, 593 patients who had a clinical response to induction therapy were randomly assigned to receive maintenance therapy with tofacitinib (either 5 mg or 10 mg twice daily) or placebo for 52 weeks. The primary end point was remission at 52 weeks. RESULTS In the OCTAVE Induction 1 trial, remission at 8 weeks occurred in 18.5% of the patients in the tofacitinib group versus 8.2% in the placebo group (P=0.007); in the OCTAVE Induction 2 trial, remission occurred in 16.6% versus 3.6% (P<0.001). In the OCTAVE Sustain trial, remission at 52 weeks occurred in 34.3% of the patients in the 5-mg tofacitinib group and 40.6% in the 10-mg tofacitinib group versus 11.1% in the placebo group (P<0.001 for both comparisons with placebo). In the OCTAVE Induction 1 and 2 trials, the rates of overall infection and serious infection were higher with tofacitinib than with placebo. In the OCTAVE Sustain trial, the rate of serious infection was similar across the three treatment groups, and the rates of overall infection and herpes zoster infection were higher with tofacitinib than with placebo. Across all three trials, adjudicated nonmelanoma skin cancer occurred in five patients who received tofacitinib and in one who received placebo, and adjudicated cardiovascular events occurred in five who received tofacitinib and in none who received placebo; as compared with placebo, tofacitinib was associated with increased lipid levels. CONCLUSIONS In patients with moderately to severely active ulcerative colitis, tofacitinib was more effective as induction and maintenance therapy than placebo. (Funded by Pfizer; OCTAVE Induction 1, OCTAVE Induction 2, and OCTAVE Sustain ClinicalTrials.gov numbers, NCT01465763 , NCT01458951 , and NCT01458574 , respectively.).
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Affiliation(s)
- William J Sandborn
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Chinyu Su
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Bruce E Sands
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Geert R D'Haens
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Séverine Vermeire
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Stefan Schreiber
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Silvio Danese
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Brian G Feagan
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Walter Reinisch
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Wojciech Niezychowski
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Gary Friedman
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Nervin Lawendy
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Dahong Yu
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Deborah Woodworth
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Arnab Mukherjee
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Haiying Zhang
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Paul Healey
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
| | - Julian Panés
- From the Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla (W.J.S.); Pfizer, Collegeville, PA (C.S., W.N., G.F., N.L., D.Y., D.W., H.Z.); Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York (B.E.S.); the Department of Gastroenterology, Academic Medical Center, Amsterdam (G.R.D.); the Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium (S.V.); Department of Internal Medicine I, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany (S.S.); the Inflammatory Bowel Disease Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Milan (S.D.); Robarts Clinical Trials, Robarts Research Institute, Western University, London (B.G.F.), and McMaster University, Hamilton (W.R.) - both in Ontario, Canada; Pfizer, Groton, CT (A.M., P.H.); and the Networking Biomedical Research Center on Hepatic and Digestive Diseases (CIBERehd), August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clínic de Barcelona, Barcelona (J.P.)
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