151
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Affiliation(s)
- Robert Hirten
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, 1468 Madison Avenue, Box 1069, New York, NY 10029-6574, USA
| | - Bruce E. Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, 1468 Madison Avenue, Box 1069, New York, NY 10029-6574, USA
| | - Benjamin L. Cohen
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at The Mount Sinai Hospital, 1468 Madison Avenue, Box 1069, New York, NY 10029-6574, USA
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152
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Colombel JF, Sands BE, Rutgeerts P, Sandborn W, Danese S, D'Haens G, Panaccione R, Loftus EV, Sankoh S, Fox I, Parikh A, Milch C, Abhyankar B, Feagan BG. The safety of vedolizumab for ulcerative colitis and Crohn's disease. Gut 2017; 66:839-851. [PMID: 26893500 PMCID: PMC5531223 DOI: 10.1136/gutjnl-2015-311079] [Citation(s) in RCA: 536] [Impact Index Per Article: 76.6] [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: 11/11/2015] [Revised: 01/14/2016] [Accepted: 01/15/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Vedolizumab is a gut-selective antibody to α4β7 integrin for the treatment of ulcerative colitis (UC) and Crohn's disease (CD). We report an integrated summary of the safety of vedolizumab. DESIGN Safety data (May 2009-June 2013) from six trials of vedolizumab were integrated. Adverse events were evaluated in patients who received ≥1 dose of vedolizumab or placebo and were reported as exposure-adjusted incidence rates as the number of patients experiencing the event per 100 person-years (PYs) of exposure. Predictors of serious infection were assessed using a Cox proportional hazards model. RESULTS In total, 2830 patients had 4811 PYs of vedolizumab exposure (median exposure range, 1-1977 days). No increased risk of any infection or serious infection was associated with vedolizumab exposure. Serious clostridial infections, sepsis and tuberculosis were reported infrequently (≤0.6% of patients). No cases of progressive multifocal leucoencephalopathy were observed. Independent risk factors for serious infection in UC were prior failure of a tumour necrosis factor α antagonist (HR, 1.99; 95% CIs 1.16 to 3.42; p=0.0122) and narcotic analgesic use (HR, 2.68; 95% CI 1.57 to 4.58; p=0.0003), and in CD were younger age (HR, 0.97; 95% CI 0.95 to 0.98; p<0.0001), corticosteroid (HR, 1.88; 95% CI 1.35 to 2.63; p=0.0002) or narcotic analgesic use (HR, 2.72; 95% CI 1.90 to 3.89; p<0.0001). Investigator-defined infusion-related reactions were reported for ≤5% of patients in each study. Eighteen vedolizumab-exposed patients (<1%) were diagnosed with a malignancy. CONCLUSIONS Vedolizumab has a favourable safety profile with low incidence rates of serious infections, infusion-related reactions and malignancies over an extended treatment period. TRIAL REGISTRATION NUMBER NCT01177228, NCT00619489, NCT00783718, NCT00783692, NCT01224171, NCT00790933.
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Affiliation(s)
- Jean-Frédéric Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Bruce E Sands
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA
| | - Paul Rutgeerts
- Division of Gastroenterology, Katholieke Universiteit and University Hospital Gasthuisberg, Leuven, Belgium
| | - William Sandborn
- Division of Gastroenterology, University of California San Diego and UC San Diego Health System, La Jolla, California, USA
| | - Silvio Danese
- Department of Gastroenterology, Istituto Clinico Humanitas, Milan, Italy
| | - Geert D'Haens
- Department of Gastroenterology, Academic Medical Center, Amsterdam, TheNetherlands
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Serap Sankoh
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | - Irving Fox
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | - Asit Parikh
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | - Catherine Milch
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | - Brihad Abhyankar
- Takeda Global Research and Development Centre (Europe) Ltd., London, UK
| | - Brian G Feagan
- Department of Medicine, Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
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153
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Vermeire S, Loftus EV, Colombel JF, Feagan BG, Sandborn WJ, Sands BE, Danese S, D'Haens GR, Kaser A, Panaccione R, Rubin DT, Shafran I, McAuliffe M, Kaviya A, Sankoh S, Mody R, Abhyankar B, Smyth M. Long-term Efficacy of Vedolizumab for Crohn's Disease. J Crohns Colitis 2017; 11:412-424. [PMID: 27683798 DOI: 10.1093/ecco-jcc/jjw176] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 06/24/2016] [Accepted: 09/27/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Vedolizumab is a gut-selective α4β7 integrin antagonist therapy for ulcerative colitis and Crohn's disease. The GEMINI long-term safety [LTS] trial is an ongoing open-label study investigating the safety of vedolizumab. We present interim exploratory analyses of efficacy in patients with Crohn's disease. METHODS Patients from the C13004, GEMINI 2 and GEMINI 3 studies and vedolizumab-naïve patients could enrol in GEMINI LTS and received vedolizumab every 4 weeks. Data were collected from May 22, 2009 to June 27, 2013. Outcomes of clinical response and remission, defined by the Harvey-Bradshaw Index, and health-related quality of life [HRQL] were assessed for up to 152 weeks of treatment in the efficacy population. RESULTS Among patients with response at week 6 in GEMINI 2 who received vedolizumab continuously, 83% [n=100/120] and 89% [n=62/70] of patients with available data were in remission after 104 and 152 weeks, respectively. Increased dosing frequency from every 8 weeks [GEMINI 2] to every 4 weeks [GEMINI LTS] improved outcomes in patients who had withdrawn early from GEMINI 2, with 47% [n=27/57] experiencing clinical response and 32% [n=18/57] in remission at week 52 of GEMINI LTS [up from 39% and 4% before the dose increase]. Similar improvements were observed regardless of prior tumour necrosis factor [TNF] antagonist exposure. Long-term benefits of HRQL were also observed. CONCLUSIONS The clinical benefits of vedolizumab continued with long-term treatment regardless of prior TNF antagonist exposure. Increased dosing frequency might improve outcomes in patients who lose response to conventional 8-weekly dosing.
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Affiliation(s)
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | - William J Sandborn
- University of California San Diego and UC San Diego Health System, La Jolla, California, USA
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | | | | | - Arthur Kaser
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Remo Panaccione
- Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
| | - David T Rubin
- University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois, USA
| | - Ira Shafran
- Shafran Gastroenterology Center, Winter Park, Florida, USA
| | - Megan McAuliffe
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | | | - Serap Sankoh
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | - Reema Mody
- Takeda Pharmaceuticals International, Inc., Deerfield, Illinois, USA
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154
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Loftus EV, Colombel JF, Feagan BG, Vermeire S, Sandborn WJ, Sands BE, Danese S, D'Haens GR, Kaser A, Panaccione R, Rubin DT, Shafran I, McAuliffe M, Kaviya A, Sankoh S, Mody R, Abhyankar B, Smyth M. Long-term Efficacy of Vedolizumab for Ulcerative Colitis. J Crohns Colitis 2017; 11:400-411. [PMID: 27683800 DOI: 10.1093/ecco-jcc/jjw177] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 06/24/2016] [Accepted: 09/27/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS The GEMINI long-term safety [LTS] study is a continuing phase 3 trial investigating the safety and efficacy of vedolizumab, an α4β7 integrin antagonist for ulcerative colitis [UC] and Crohn's disease. We provide an interim analysis of efficacy in patients with UC. METHODS Patients from the C13004 and GEMINI 1 studies and a cohort of vedolizumab-naïve patients received open-label vedolizumab every 4 weeks. Interim data were collected from May 22, 2009 to June 27, 2013. Clinical response and remission, evaluated using partial Mayo scores, and health-related quality of life [HRQL] were assessed for up to 152 weeks of cumulative treatment in the efficacy population. RESULTS As of June 27, 2013, 63% of the efficacy population [n = 532/845] were continuing treatment. Among patients who responded to vedolizumab induction and had data available, 88% [n = 120/136] were in remission after 104 weeks of exposure (96% [n = 70/73] after 152 weeks). Among patients who withdrew from every-8-week vedolizumab maintenance in GEMINI 1 [n = 32] before week 52, increased dosing to every 4 weeks in GEMINI LTS resulted in response and remission rates of 41% and 28%, respectively, after 52 weeks, an increase from 19% and 6%, respectively, from before the dose increase. Similar benefits were demonstrated regardless of prior tumour necrosis factor-antagonist exposure. Durable benefits on HRQL were also observed. CONCLUSIONS Patients with UC experienced clinical and HRQL improvements with continued vedolizumab treatment. Increased dosing frequency to every 4 weeks was beneficial in patients who had loss of response to 8-weekly dosing.
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Affiliation(s)
- Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, London, Ontario, Canada
| | | | - William J Sandborn
- University of California San Diego and UC San Diego Health System, La Jolla, California, USA
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, New York, USA
| | | | | | - Arthur Kaser
- Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Remo Panaccione
- Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta, Canada
| | - David T Rubin
- University of Chicago Inflammatory Bowel Disease Center, Chicago, Illinois, USA
| | - Ira Shafran
- Shafran Gastroenterology Center, Winter Park, Florida, USA
| | - Megan McAuliffe
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | | | - Serap Sankoh
- Takeda Pharmaceuticals International Co., Cambridge, Massachusetts, USA
| | - Reema Mody
- Takeda Pharmaceuticals International, Inc., Deerfield, Illinois, USA
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155
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Abstract
BACKGROUND In inflammatory bowel diseases (IBD), a pivotal step in the initiation and perpetuation of mucosal inflammation entails the recruitment of inflammatory leukocytes to the gut. Understanding the carefully coordinated series of molecular events that culminate in the recruitment of leukocytes to the gut has resulted in novel interventions with new capabilities in treating both Crohn's disease and ulcerative colitis. Key Messages: Natalizumab, an anti-α4 integrin antibody, was the first agent to demonstrate the efficacy of this approach for the induction and maintenance of response and remission in Crohn's disease. Widespread adoption was mitigated by the previously unknown risk of progressive multifocal leukoencephalopathy (PML) with this approach. Current approaches employ a more selective inhibition of adhesion molecules targeting the gut to avoid broad suppression of surveillance for JC virus, the causal pathogen of PML. Subsequently, vedolizumab, a humanized anti-α4β7 integrin antibody, has demonstrated efficacy in patients with IBD and has an excellent safety profile. To date, there have been no cases of PML in patients treated with vedolizumab, suggesting that this more selective agent does not have the same risk for PML as natalizumab. Other agents target β7 integrin (etrolizumab) and mucosal addressin cellular adhesion molecule-1, the endothelial ligand of α4β7 integrin. Efforts to inhibit the chemokine receptor CCR9 using the agent CCX282-B in Crohn's disease were not successful. An orally administered anti-α4 integrin compound showed some promise in a phase 2 trial but raises concern for PML. Finally, the S1P1 receptor agonist ozanimod showed promise in early trials in ulcerative colitis. CONCLUSIONS In summary, anti-trafficking agents have the potential to provide safe and effective therapy for IBD, and are a burgeoning class of novel agents.
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Affiliation(s)
- Bruce E Sands
- Dr. Burrill B. Crohn Professor of Medicine, Chief of the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, Mount Sinai Health System, New York, N.Y., USA
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156
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Feagan BG, Sandborn WJ, Gasink C, Jacobstein D, Lang Y, Friedman JR, Blank MA, Johanns J, Gao LL, Miao Y, Adedokun OJ, Sands BE, Hanauer SB, Vermeire S, Targan S, Ghosh S, de Villiers WJ, Colombel JF, Tulassay Z, Seidler U, Salzberg BA, Desreumaux P, Lee SD, Loftus EV, Dieleman LA, Katz S, Rutgeerts P. Ustekinumab as Induction and Maintenance Therapy for Crohn's Disease. N Engl J Med 2016; 375:1946-1960. [PMID: 27959607 DOI: 10.1056/nejmoa1602773] [Citation(s) in RCA: 1123] [Impact Index Per Article: 140.4] [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 Ustekinumab, a monoclonal antibody to the p40 subunit of interleukin-12 and interleukin-23, was evaluated as an intravenous induction therapy in two populations with moderately to severely active Crohn's disease. Ustekinumab was also evaluated as subcutaneous maintenance therapy. METHODS We randomly assigned patients to receive a single intravenous dose of ustekinumab (either 130 mg or approximately 6 mg per kilogram of body weight) or placebo in two induction trials. The UNITI-1 trial included 741 patients who met the criteria for primary or secondary nonresponse to tumor necrosis factor (TNF) antagonists or had unacceptable side effects. The UNITI-2 trial included 628 patients in whom conventional therapy failed or unacceptable side effects occurred. Patients who completed these induction trials then participated in IM-UNITI, in which the 397 patients who had a response to ustekinumab were randomly assigned to receive subcutaneous maintenance injections of 90 mg of ustekinumab (either every 8 weeks or every 12 weeks) or placebo. The primary end point for the induction trials was a clinical response at week 6 (defined as a decrease from baseline in the Crohn's Disease Activity Index [CDAI] score of ≥100 points or a CDAI score <150). The primary end point for the maintenance trial was remission at week 44 (CDAI score <150). RESULTS The rates of response at week 6 among patients receiving intravenous ustekinumab at a dose of either 130 mg or approximately 6 mg per kilogram were significantly higher than the rates among patients receiving placebo (in UNITI-1, 34.3%, 33.7%, and 21.5%, respectively, with P≤0.003 for both comparisons with placebo; in UNITI-2, 51.7%, 55.5%, and 28.7%, respectively, with P<0.001 for both doses). In the groups receiving maintenance doses of ustekinumab every 8 weeks or every 12 weeks, 53.1% and 48.8%, respectively, were in remission at week 44, as compared with 35.9% of those receiving placebo (P=0.005 and P=0.04, respectively). Within each trial, adverse-event rates were similar among treatment groups. CONCLUSIONS Among patients with moderately to severely active Crohn's disease, those receiving intravenous ustekinumab had a significantly higher rate of response than did those receiving placebo. Subcutaneous ustekinumab maintained remission in patients who had a clinical response to induction therapy. (Funded by Janssen Research and Development; ClinicalTrials.gov numbers, NCT01369329 , NCT01369342 , and NCT01369355 .).
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Affiliation(s)
- Brian G Feagan
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - William J Sandborn
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Christopher Gasink
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Douglas Jacobstein
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Yinghua Lang
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Joshua R Friedman
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Marion A Blank
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Jewel Johanns
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Long-Long Gao
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Ye Miao
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Omoniyi J Adedokun
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Bruce E Sands
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Stephen B Hanauer
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Severine Vermeire
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Stephan Targan
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Subrata Ghosh
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Willem J de Villiers
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Jean-Frédéric Colombel
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Zsolt Tulassay
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Ursula Seidler
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Bruce A Salzberg
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Pierre Desreumaux
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Scott D Lee
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Edward V Loftus
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Levinus A Dieleman
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Seymour Katz
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
| | - Paul Rutgeerts
- From Robarts Clinical Trials, Robarts Research Institute, Western University, London, ON (B.G.F.), University of Calgary, Calgary, AB (S.G.), and the Division of Gastroenterology and CEGIIR, University of Alberta, Edmonton (L.A.D.) - all in Canada; University of California, San Diego, La Jolla (W.J.S.), and Cedars-Sinai Medical Center, Los Angeles (S.T.) - both in California; Janssen Research and Development, Spring House (C.G., D.J., Y.L., J.R.F., J.J., L.-L.G., Y.M., O.J.A.), and Janssen Scientific Affairs, Horsham (M.A.B.) - both in Pennsylvania; the Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai (B.E.S., J.-F.C.), and New York University School of Medicine (S.K.) - both in New York; Feinberg School of Medicine, Northwestern University, Chicago (S.B.H.); University Hospitals Leuven, Leuven, Belgium (S.V., P.R.); Stellenbosch University, Stellenbosch, South Africa (W.J.V.); Semmelweis University of Budapest, Budapest, Hungary (Z.T.); the Department of Gastroenterology, Hannover Medical School, Hannover, Germany (U.S.); Atlanta Gastroenterology Specialists, Atlanta (B.A.S.); Hôpital Claude Huriez, Lille, France (P.D.); University of Washington Medical Center, Seattle (S.D.L.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (E.V.L.)
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157
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Chuang LS, Villaverde N, Hui KY, Mortha A, Rahman A, Levine AP, Haritunians T, Evelyn Ng SM, Zhang W, Hsu NY, Facey JA, Luong T, Fernandez-Hernandez H, Li D, Rivas M, Schiff ER, Gusev A, Schumm LP, Bowen BM, Sharma Y, Ning K, Remark R, Gnjatic S, Legnani P, George J, Sands BE, Stempak JM, Datta LW, Lipka S, Katz S, Cheifetz AS, Barzilai N, Pontikos N, Abraham C, Dubinsky MJ, Targan S, Taylor K, Rotter JI, Scherl EJ, Desnick RJ, Abreu MT, Zhao H, Atzmon G, Pe’er I, Kugathasan S, Hakonarson H, McCauley JL, Lencz T, Darvasi A, Plagnol V, Silverberg MS, Muise AM, Brant SR, Daly MJ, Segal AW, Duerr RH, Merad M, McGovern DP, Peter I, Cho JH. A Frameshift in CSF2RB Predominant Among Ashkenazi Jews Increases Risk for Crohn's Disease and Reduces Monocyte Signaling via GM-CSF. Gastroenterology 2016; 151:710-723.e2. [PMID: 27377463 PMCID: PMC5037012 DOI: 10.1053/j.gastro.2016.06.045] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Crohn's disease (CD) has the highest prevalence in Ashkenazi Jewish populations. We sought to identify rare, CD-associated frameshift variants of high functional and statistical effects. METHODS We performed exome sequencing and array-based genotype analyses of 1477 Ashkenazi Jewish individuals with CD and 2614 Ashkenazi Jewish individuals without CD (controls). To validate our findings, we performed genotype analyses of an additional 1515 CD cases and 7052 controls for frameshift mutations in the colony-stimulating factor 2-receptor β common subunit gene (CSF2RB). Intestinal tissues and blood samples were collected from patients with CD; lamina propria leukocytes were isolated and expression of CSF2RB and granulocyte-macrophage colony-stimulating factor-responsive cells were defined by adenomatous polyposis coli (APC) time-of-flight mass cytometry (CyTOF analysis). Variants of CSF2RB were transfected into HEK293 cells and the expression and functions of gene products were compared. RESULTS In the discovery cohort, we associated CD with a frameshift mutation in CSF2RB (P = 8.52 × 10(-4)); the finding was validated in the replication cohort (combined P = 3.42 × 10(-6)). Incubation of intestinal lamina propria leukocytes with granulocyte-macrophage colony-stimulating factor resulted in high levels of phosphorylation of signal transducer and activator of transcription (STAT5) and lesser increases in phosphorylation of extracellular signal-regulated kinase and AK straining transforming (AKT). Cells co-transfected with full-length and mutant forms of CSF2RB had reduced pSTAT5 after stimulation with granulocyte-macrophage colony-stimulating factor, compared with cells transfected with control CSF2RB, indicating a dominant-negative effect of the mutant gene. Monocytes from patients with CD who were heterozygous for the frameshift mutation (6% of CD cases analyzed) had reduced responses to granulocyte-macrophage colony-stimulating factor and markedly decreased activity of aldehyde dehydrogenase; activity of this enzyme has been associated with immune tolerance. CONCLUSIONS In a genetic analysis of Ashkenazi Jewish individuals, we associated CD with a frameshift mutation in CSF2RB. Intestinal monocytes from carriers of this mutation had reduced responses to granulocyte-macrophage colony-stimulating factor, providing an additional mechanism for alterations to the innate immune response in individuals with CD.
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Affiliation(s)
- Ling-Shiang Chuang
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Nicole Villaverde
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Ken Y. Hui
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA 06520,Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Arthur Mortha
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Adeeb Rahman
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Adam P. Levine
- Centre for Molecular Medicine, Division of Medicine, University College, London, UK WC1E 6JF
| | - Talin Haritunians
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA 90048
| | - Sok Meng Evelyn Ng
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Wei Zhang
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Nai-Yun Hsu
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Jody-Ann Facey
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Tramy Luong
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | | | - Dalin Li
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA 90048
| | - Manuel Rivas
- Department of Medical and Population Genetics, Broad Institute, Cambridge, MA, USA 02142,Analytical and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA 02114,Nuffield Department of Clinical Medicine, Wellcome Trust Centre for Human Genetics Research, University of Oxford, Oxford, UK OX3 UBN
| | - Elena R. Schiff
- Centre for Molecular Medicine, Division of Medicine, University College, London, UK WC1E 6JF
| | - Alexander Gusev
- Department of Epidemiology, Harvard University, Boston, MA, USA 02115
| | - L. Phillip Schumm
- Department of Health Studies, University of Chicago, Chicago, IL, USA 60637
| | - Beatrice M. Bowen
- Department of Genetics, Yale University, New Haven, CT, USA 06520,Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Yashoda Sharma
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029,Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Kaida Ning
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520,Department of Molecular and Computational Biology, University of Southern California, Los Angeles, CA, USA 90033
| | - Romain Remark
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Sacha Gnjatic
- Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Peter Legnani
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - James George
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Bruce E. Sands
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Joanne M. Stempak
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada M5T3L9,Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G1X5
| | - Lisa W. Datta
- Harvey M. and Lyn P. Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21231,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 21231
| | - Seth Lipka
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA 33606
| | - Seymour Katz
- Department of Medicine, New York University School of Medicine, New York, NY, USA10016
| | - Adam S. Cheifetz
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA 02215
| | - Nir Barzilai
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA 10461
| | - Nikolas Pontikos
- Centre for Molecular Medicine, Division of Medicine, University College, London, UK WC1E 6JF
| | - Clara Abraham
- Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA 06520
| | - Marla J. Dubinsky
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029,Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Stephan Targan
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA 90048
| | - Kent Taylor
- Institute for Translational Genomics and Population Sciences, Division of Genomic Outcomes, Harbor-UCLA Medical Center, Torrance, CA, USA 90502
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Division of Genomic Outcomes, Harbor-UCLA Medical Center, Torrance, CA, USA 90502
| | - Ellen J. Scherl
- The Division of Gastroenterology & Hepatology, Sanford I. Weill College of Cornell University—New York Presbyterian Hospital, New York, NY, USA 10021
| | - Robert J. Desnick
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Maria T. Abreu
- Division of Gastroenterology, University of Miami, Miller School of Medicine, Miami, Florida, USA 33136
| | - Hongyu Zhao
- Department of Biostatistics, Yale University, New Haven, CT, USA 06520
| | - Gil Atzmon
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA 10461
| | - Itsik Pe’er
- Department of Computer Science, Columbia University, New York, NY, USA 10027
| | - Subra Kugathasan
- Department of Pediatrics, Emory University, Atlanta, GA, USA 30322
| | - Hakon Hakonarson
- Centre for Applied Genomics, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA 19104,Division of Human Genetics, University of Pennsylvania, Philadelphia, PA, USA 19014
| | - Jacob L. McCauley
- John P. Hussman Institute for Human Genomics, University of Miami, Miller School of Medicine, Miami, Florida, USA 33136,Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami, Miller School of Medicine, Miami, Florida, USA 33136
| | - Todd Lencz
- Feinstein Institute for Medical Research, North Shore – Long Island Jewish Health System, Manhasset, NY, USA 11030
| | - Ariel Darvasi
- Department of Genetics, The Hebrew University of Jerusalem, Jerusalem, Israel 91904
| | - Vincent Plagnol
- Genetics Institute, Division of Biosciences, University College, London, UK WC1E 6BT
| | - Mark S. Silverberg
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, Ontario, Canada M5T3L9,Department of Medicine, University of Toronto, Toronto, Ontario, Canada M5G1X5
| | - Aleixo M. Muise
- Inflammatory Bowel Disease Centre and Cell Biology Program, The Hospital for Sick Children, Toronto, ON, Canada M5G1X8,Department of Pediatrics, University of Toronto, Toronto, ON, Canada M5G1X8
| | - Steven R. Brant
- Harvey M. and Lyn P. Meyerhoff Inflammatory Bowel Disease Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA 21231,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 21231
| | - Mark J. Daly
- Department of Medical and Population Genetics, Broad Institute, Cambridge, MA, USA 02142,Center for Human Genetic Research, Department of Medicine, Massachusetts General Hospital, Boston, MA USA 02114,Department of Genetics, Harvard Medical School, Boston, MA, USA 02115
| | - Anthony W. Segal
- Centre for Molecular Medicine, Division of Medicine, University College, London, UK WC1E 6JF
| | - Richard H. Duerr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA, 15261
| | - Miriam Merad
- Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Dermot P.B. McGovern
- F. Widjaja Foundation Inflammatory Bowel and Immunobiology Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA 90048
| | - Inga Peter
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029
| | - Judy H. Cho
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029,Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029,The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA 10029,To whom correspondence should be addressed. The corresponding author’s contact information: Judy Cho, Hess CSM Building Floor 8th Room 118, 1470 Madison Avenue, New York, NY 10029, TEL. (212) 824-8940, FAX. (646) 537-9452,
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158
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Hagin S, Lobato DJ, Sands BE, Korzenik JR, Merrick M, Shah SA, Bancroft B, Bright R, Law M, Moniz H, Shapiro J, LeLeiko NS. Dietary behaviors in newly diagnosed youth with inflammatory bowel disease. Children's Health Care 2016. [DOI: 10.1080/02739615.2016.1227935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Sarah Hagin
- The Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hasbro Children’s Hospital/The Rhode Island Hospital, Providence, RI
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Debra J. Lobato
- The Division of Child and Adolescent Psychiatry, Department of Psychiatry, Hasbro Children’s Hospital/The Rhode Island Hospital, Providence, RI
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Bruce E. Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua R. Korzenik
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Boston, MA
| | | | - Samir A. Shah
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Barbara Bancroft
- The Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, The Department of Pediatrics, Hasbro Children’s Hospital/The Rhode Island Hospital, Providence, RI
| | - Renee Bright
- The Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, The Department of Pediatrics, Hasbro Children’s Hospital/The Rhode Island Hospital, Providence, RI
| | - Meaghan Law
- The Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, The Department of Pediatrics, Hasbro Children’s Hospital/The Rhode Island Hospital, Providence, RI
| | - Heather Moniz
- The Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, The Department of Pediatrics, Hasbro Children’s Hospital/The Rhode Island Hospital, Providence, RI
| | - Jason Shapiro
- The Warren Alpert Medical School of Brown University, Providence, RI
- The Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, The Department of Pediatrics, Hasbro Children’s Hospital/The Rhode Island Hospital, Providence, RI
| | - Neal S. LeLeiko
- The Warren Alpert Medical School of Brown University, Providence, RI
- The Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, The Department of Pediatrics, Hasbro Children’s Hospital/The Rhode Island Hospital, Providence, RI
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159
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Shah SC, Colombel JF, Sands BE, Narula N. Mucosal Healing Is Associated With Improved Long-term Outcomes of Patients With Ulcerative Colitis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2016; 14:1245-1255.e8. [PMID: 26829025 DOI: 10.1016/j.cgh.2016.01.015] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/20/2016] [Accepted: 01/24/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The paradigm for treatment for ulcerative colitis (UC) is shifting from resolving symptoms toward objective measures such as mucosal healing (MH). However, it is unclear whether MH is associated with improved long-term outcomes. We performed a systematic review and meta-analysis to identify and analyze studies comparing long-term outcomes of patients with MH with those without MH. METHODS We performed a systematic search of 3 large databases to identify prospective studies of patients with active UC that included outcomes of patients found to have MH at the first endoscopic evaluation after initiation of UC therapy (MH1) compared with those without MH1. The primary outcome was clinical remission after at least 52 weeks. Secondary outcomes included proportions of patients who were free of colectomy or corticosteroids and rate of MH after at least 52 weeks. RESULTS We analyzed 13 studies comprising 2073 patients with active UC. Patients with MH1 had pooled odds ratio of 4.50 for achieving long-term (after at least 52 weeks) clinical remission (95% confidence interval [CI], 2.12-9.52), 4.15 for remaining free of colectomy (95% CI, 2.53-6.81), 8.40 for achieving long-term MH (95% CI, 3.13-22.53), and 9.70 for achieving long-term corticosteroid-free clinical remission (95% CI, 0.94-99.67), compared with patients without MH1. We found no difference in outcomes if patients achieved MH1 while receiving biologic versus non-biologic therapy. CONCLUSIONS In a meta-analysis, we associated MH with long-term clinical remission, avoidance of colectomy, and corticosteroid-free clinical remission. MH is therefore appropriate goal of UC therapy.
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Affiliation(s)
- Shailja C Shah
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jean-Frederic Colombel
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Neeraj Narula
- McMaster University Medical Centre, Hamilton, Ontario, Canada
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160
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Shah SC, Colombel JF, Sands BE, Narula N. Reply. Clin Gastroenterol Hepatol 2016; 14:1361-2. [PMID: 27073132 DOI: 10.1016/j.cgh.2016.04.002] [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: 02/07/2023]
Affiliation(s)
- Shailja C Shah
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Neeraj Narula
- McMaster University Medical Centre, Hamilton, Ontario, Canada
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161
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Dulai PS, Singh S, Jiang X, Peerani F, Narula N, Chaudrey K, Whitehead D, Hudesman D, Lukin D, Swaminath A, Shmidt E, Wang S, Boland BS, Chang JT, Kane S, Siegel CA, Loftus EV, Sandborn WJ, Sands BE, Colombel JF. The Real-World Effectiveness and Safety of Vedolizumab for Moderate-Severe Crohn's Disease: Results From the US VICTORY Consortium. Am J Gastroenterol 2016; 111:1147-55. [PMID: 27296941 DOI: 10.1038/ajg.2016.236] [Citation(s) in RCA: 230] [Impact Index Per Article: 28.8] [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: 02/02/2016] [Accepted: 04/02/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVES We assessed the real-world effectiveness and safety of vedolizumab (VDZ) in moderate-severe Crohn's disease (CD). METHODS Retrospective cohort study of seven medical centers, from May 2014 to December 2015. Adults with moderate-severe CD treated with VDZ, with follow-up after initiation of therapy, were included. Using the multivariable Cox proportional hazard analyses, we identified independent predictors of clinical remission or mucosal healing with VDZ. Rates of serious infection (requiring antibiotics, resulting in discontinuation of VDZ, hospitalization or death) and serious adverse events (discontinuation of VDZ, hospitalization or death) were described quantitatively. RESULTS We included 212 patients with moderate-severe CD (median age 34 years; 40% male; 90% tumor necrosis factor (TNF)-antagonist exposed) with a median follow-up (IQR) of 39 weeks (25-53). Twelve-month cumulative rates of clinical remission, mucosal healing, and deep remission (clinical remission+mucosal healing) were 35%, 63%, and 26%, respectively. Individuals with prior TNF-antagonist exposure (hazard ratio (HR) 0.40; 95% confidence interval (CI): 0.20-0.81), smoking history (HR 0.47; 95% CI: 0.25-0.89), active perianal disease (HR 0.49; 95% CI: 0.27-0.88), and severe disease activity (HR 0.54; 95% CI: 0.31-0.95) were less likely to achieve clinical remission. Those with prior TNF-antagonist exposure (HR 0.29; 95% CI: 0.12-0.73), and severe disease activity (HR 0.54; 95% CI: 0.31-0.95) were less likely to achieve mucosal healing. During 160 patient years of follow-up (PYF) and 1,433 VDZ infusions, 5 patients developed infusion reactions (3.5 per 1,000 infusions), 21 developed serious infections (13 per 100 PYF), and 17 developed serious adverse events (10 per 100 PYF). A minority of adverse events required discontinuation of therapy (6 per 100 PYF). CONCLUSIONS VDZ is a safe and effective treatment option for moderate-severe CD in routine practice. Clinical remission and deep remission (clinical remission and mucosal healing) can be achieved in 1/3 of individuals, and a minority of individuals require discontinuation of therapy due to adverse events.
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Affiliation(s)
- Parambir S Dulai
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Siddharth Singh
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA.,Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Xiaoqian Jiang
- Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Farhad Peerani
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Neeraj Narula
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Khadija Chaudrey
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minneapolis, USA
| | - Diana Whitehead
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - David Hudesman
- Division of Gastroenterology, New York University (NYU), New York, New York, USA
| | - Dana Lukin
- Division of Gastroenterology, Montefiore Medical Center, New York, New York, USA
| | - Arun Swaminath
- Division of Gastroenterology, NSLIJ Lenox Hill, New York, New York, USA
| | - Eugenia Shmidt
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shuang Wang
- Department of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Brigid S Boland
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - John T Chang
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Sunanda Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minneapolis, USA
| | - Corey A Siegel
- Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minneapolis, USA
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - Bruce E Sands
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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162
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Kochar B, Aldridge M, Cook SF, Bright R, Mallette M, Moniz H, Shah SA, LeLeiko NS, Shapiro J, Sands BE, Chen W, Jaeger E, Galanko J, Long MD, Martin CF, Sandler RS, Kappelman MD. Achieving Synergy: Linking an Internet-Based Inflammatory Bowel Disease Cohort to a Community-Based Inception Cohort and Multicentered Cohort in Inflammatory Bowel Disease. J Med Internet Res 2016; 18:e124. [PMID: 27261008 PMCID: PMC4912687 DOI: 10.2196/jmir.5655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 01/29/2023] Open
Abstract
Background Traditional cohort studies are important contributors to our understanding of inflammatory bowel diseases, but they are labor intensive and often do not focus on patient-reported outcomes. Internet-based studies provide new opportunities to study patient-reported outcomes and can be efficiently implemented and scaled. If a traditional cohort study was linked to an Internet-based study, both studies could benefit from added synergy. Existing cohort studies provide an opportunity to develop and test processes for cohort linkage. The Crohn’s and Colitis Foundation of America’s (CCFA) Partners study is an Internet-based cohort of more than 14,000 participants. The Ocean State Crohn’s and Colitis Area Registry (OSCCAR) is an inception cohort. The Sinai-Helmsley Alliance for Research Excellence (SHARE) is a multicentered cohort of inflammatory bowel disease patients. Both the later cohorts include medical record abstraction, patient surveys, and biospecimen collection. Objective Given the complementary nature of these existing cohorts, we sought to corecruit and link data. Methods Eligible OSCCAR and SHARE participants were invited to join the CCFA Partners study and provide consent for data sharing between the 2 cohorts. After informed consent, participants were directed to the CCFA Partners website to complete enrollment and a baseline Web-based survey. Participants were linked across the 2 cohorts by the matching of an email address. We compared demographic and clinical characteristics between OSCCAR and SHARE participants who did and did not enroll in CCFA Partners and the data linkage. Results Of 408 participants in the OSCCAR cohort, 320 were eligible for participation in the CCFA Partners cohort. Of these participants, 243 consented to participation; however, only 44 enrolled in CCFA Partners and completed the linkage. OSCCAR participants who enrolled in CCFA Partners were better educated (17% with doctoral degrees) than those who did not (3% with doctoral degrees, P=.01). In the SHARE cohort, 436 participants enrolled and linked to the Partners cohort. More women (60% vs 50%) linked and those who linked were predominantly white (96%; P<.01). Crohn’s disease patients who linked had lower mean scores on the Harvey-Bradshaw Index (3.6 vs 4.4, P<.01). Ulcerative colitis patients who linked had less extensive disease than those who did not link (45% vs 60%, P<.01). Conclusions Linkage of CCFA Partners with cohorts such as OSCCAR and SHARE may be a cost-effective way to expand the infrastructure for clinical outcomes and translational research. Although linkage is feasible from a technical, legal, and regulatory perspective, participant willingness appears to be a limiting factor. Overcoming this barrier will be needed to generate meaningful sample sizes to conduct studies of biomarkers, natural history, and clinical effectiveness using linked data.
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Affiliation(s)
- Bharati Kochar
- University of North Carolina, Center for Gastrointestinal Biology and Disease, Chapel Hill, NC, United States.
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163
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Shapiro JM, Hagin SE, Shah SA, Bright R, Law M, Moniz H, Giacalone J, Jackvony T, Taleban S, Samad Z, Merrick M, Sands BE, LeLeiko NS. Corticosteroid Use in a Prospective, Community-Based Cohort of Newly Diagnosed Inflammatory Bowel Disease Patients. Dig Dis Sci 2016; 61:1635-40. [PMID: 26725063 DOI: 10.1007/s10620-015-4010-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/14/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Systemic corticosteroids (CS) are a mainstay of treatment for patients with newly diagnosed inflammatory bowel disease (IBD). Previous population-based studies report CS exposure rates range from 39 to 75 % within the first year of diagnosis with surgical resection rates as high as 13-18 % in the same time frame. These reports represent an older cohort of patients enrolled over prolonged periods of time and do not necessarily reflect current treatment approaches. We examine CS use during the first year of IBD diagnosis in a community-based, inception cohort. METHODS Data were derived from the Ocean State Crohn's and Colitis Area Registry (OSCCAR), a prospective inception cohort of IBD patients who are residents of Rhode Island. RESULTS A total of 272 patients were included in the current analyses. Overall, 60 % of Crohn's disease and 57 % of ulcerative colitis patients were exposed to at least one course of CS during year 1 of study enrollment. Most notably, only 2 % of patients (n = 5) required a surgical resection. CONCLUSIONS In this community-based cohort, 59 % of patients were exposed to at least one course of CS during their first year of enrollment. In contrast to previous studies, OSCCAR represents a more modern cohort of patients. While steroid exposure rates were similar or slightly higher than those in previous reports, we observed a low rate of surgical resection. As our cohort ages, future analysis will focus on the role more contemporary agents may play on the low rates of surgery we observed.
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Affiliation(s)
- Jason M Shapiro
- Division of Gastroenterology, Nutrition and Liver Diseases, Hasbro Children's Hospital/Rhode Island Hospital, 593 Eddy Street, 132 Multiphasic Building, Providence, RI, 02903, USA. .,The Warren Alpert School of Medicine at Brown University, Providence, RI, USA.
| | - Sarah E Hagin
- Division of Child and Adolescent Psychiatry, the Department of Psychiatry, Hasbro Children's Hospital/Rhode Island Hospital, Providence, RI, USA.,The Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Samir A Shah
- The Warren Alpert School of Medicine at Brown University, Providence, RI, USA.,Gastroenterology Associates, Inc., Providence, RI, USA
| | - Renee Bright
- Division of Gastroenterology, Rhode Island Hospital, Providence, RI, USA
| | - Meaghan Law
- Division of Gastroenterology, Rhode Island Hospital, Providence, RI, USA
| | - Heather Moniz
- Division of Gastroenterology, Rhode Island Hospital, Providence, RI, USA
| | - Julie Giacalone
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Taylor Jackvony
- Division of Gastroenterology, Nutrition and Liver Diseases, Hasbro Children's Hospital/Rhode Island Hospital, 593 Eddy Street, 132 Multiphasic Building, Providence, RI, 02903, USA
| | - Sasha Taleban
- The Warren Alpert School of Medicine at Brown University, Providence, RI, USA.,Division of Gastroenterology, Rhode Island Hospital, Providence, RI, USA
| | - Zahid Samad
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | | | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Neal S LeLeiko
- Division of Gastroenterology, Nutrition and Liver Diseases, Hasbro Children's Hospital/Rhode Island Hospital, 593 Eddy Street, 132 Multiphasic Building, Providence, RI, 02903, USA.,The Warren Alpert School of Medicine at Brown University, Providence, RI, USA
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164
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Shah SC, Colombel JF, Sands BE, Narula N. Letter: mucosal healing is associated with improved long-term outcomes in Crohn's disease - authors' reply. Aliment Pharmacol Ther 2016; 43:1347-8. [PMID: 27166988 DOI: 10.1111/apt.13637] [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: 12/08/2022]
Affiliation(s)
- S C Shah
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - J-F Colombel
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - B E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Narula
- McMaster University Medical Centre, Hamilton, ON, Canada
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165
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Lennerz JK, van der Sloot KWJ, Le LP, Batten JM, Han JY, Fan KC, Siegel CA, Srivastava A, Park DY, Chen JH, Sands BE, Korzenik JR, Odze RD, Dias-Santagata D, Borger DR, Khalili H, Iafrate AJ, Lauwers GY. Colorectal cancer in Crohn's colitis is comparable to sporadic colorectal cancer. Int J Colorectal Dis 2016; 31:973-982. [PMID: 27026089 DOI: 10.1007/s00384-016-2574-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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] [Accepted: 03/22/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE It is now recognized that Crohn's disease (CD), similar to ulcerative colitis (UC), carries an up to 20-fold higher cancer risk, and the development of colorectal carcinoma (CRC) is a major long-term complication. Once CRC is present, molecular profiling is one of the components in selecting appropriate treatment strategies; however, in contrast to UC, genetic alterations in Crohn's colitis-associated CRC are poorly understood. METHODS In a series of 227 patients with Crohn's colitis, we identified 33 cases of CRC (~14 %) and performed targeted mutational analysis of BRAF/KRAS/NRAS and determined microsatellite status as well as immunophenotype of the tumors. RESULTS In the CRC cohort, the median age at time of cancer diagnosis was 58 (range 34-77 vs. 59.5 in sporadic; P = 0.81) and the median CD duration was 29 years (range 6-45). As a group, CRC complicating Crohn's colitis is BRAF (97 %) and NRAS (100 %) wild type and the vast majority is microsatellite stable (94 %); KRAS-mutations were found in six cases (18 %). Stage grouping, anatomic distribution, and overall survival were similar to sporadic CRC; however, long-standing CD (≥25 years) as well as gastric-immunophenotype (MUC5AC+) was associated with significantly shorter overall survival (P = 0.0029; P = 0.036, respectively). CONCLUSION In summary, the clinicopathological and molecular profile of CD-associated CRC is similar to that observed in sporadic CRC.
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Affiliation(s)
- Jochen K Lennerz
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02116, USA.
| | | | - Long Phi Le
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02116, USA
| | - Julie M Batten
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02116, USA
| | - Jae Young Han
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02116, USA.,M.D. Anderson Cancer Center, School of Health Professions, The University of Texas, Houston, TX, USA
| | - Kenneth C Fan
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02116, USA
| | - Corey A Siegel
- Dartmouth-Hitchcock Inflammatory Bowel Disease Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Do Youn Park
- Department of Pathology, Pusan National University Hospital and Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jey-Hsin Chen
- Swedish Medical Center, CellNetix Pathology and Laboratories, Seattle, WA, USA
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Joshua R Korzenik
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA, USA
| | - Robert D Odze
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Dora Dias-Santagata
- Division of Gastroenterology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Darrell R Borger
- Department of Hematology/Oncology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Hamed Khalili
- Division of Gastroenterology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.,Clinical and Translational Epidemiology Unit, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02116, USA
| | - Gregory Y Lauwers
- Department of Pathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02116, USA
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166
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Sandborn WJ, Colombel JF, Ghosh S, Sands BE, Dryden G, Hébuterne X, Leong RW, Bressler B, Ullman T, Lakatos PL, Reinisch W, Xu LA, Luo A. Eldelumab [Anti-IP-10] Induction Therapy for Ulcerative Colitis: A Randomised, Placebo-Controlled, Phase 2b Study. J Crohns Colitis 2016; 10:418-28. [PMID: 26721935 PMCID: PMC4946756 DOI: 10.1093/ecco-jcc/jjv224] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/30/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Interferon-γ-inducible protein-10 [IP-10] mediates immune cell trafficking from the circulation to the inflamed colon and decreases gut epithelial cell survival. IP-10 expression is increased in patients with ulcerative colitis [UC]. We report efficacy and safety results from a dose-ranging induction study of eldelumab, a fully human monoclonal antibody to IP-10, in moderately to severely active UC. METHODS A total of 252 adults with UC [Mayo score ≥ 6 and endoscopic subscore ≥ 2] were randomised 1:1:1 to placebo or eldelumab 15 or 25 mg/kg administered intravenously on Days 1 and 8 and every other week thereafter. The primary endpoint was clinical remission [Mayo score ≤ 2; no individual subscale score > 1] at Week 11. Key secondary endpoints included Mayo score clinical response and mucosal healing at Week 11. RESULTS Neither eldelumab 15 or 25 mg/kg resulted in significant increases vs placebo in the proportion of patients achieving Week 11 clinical remission. Remission and response rates were 17.6% and 47.1% with eldelumab 25mg/kg, 13.1% and 44.0% with eldelumab 15mg/kg, and 9.6% and 31.3% with placebo. Clinical remission and response rates were higher in anti-tumour necrosis factor [TNF]-naïve patients treated with eldelumab compared with placebo. Eldelumab treatment was well tolerated and no immunogenicity was observed. CONCLUSIONS The primary endpoint was not achieved with induction treatment with eldelumab 15 or 25 mg/kg in patients with UC. Trends towards clinical remission and response were observed in the overall population and were more pronounced in anti-TNF naïve patients. Eldelumab safety signals were consistent with those reported previously [ClinicalTrials.gov number, NCT01294410].
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Affiliation(s)
- William J. Sandborn
- Inflammatory Bowel Disease Center, University of California San Diego, La Jolla, CA, USA
| | - Jean-Frédéric Colombel
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Subrata Ghosh
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Bruce E. Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gerald Dryden
- Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville School of Medicine, Louisville, KY, USA
| | - Xavier Hébuterne
- Faculté de Médecine, Université de Nice-Sophia Antipolis, Hôpital de l’Archet, Nice, France
| | - Rupert W. Leong
- Concord Hospital, Gastroenterology and Liver Services, University of New South Wales, Sydney, Australia
| | - Brian Bressler
- Division of Gastroenterology, St Paul’s Hospital, Vancouver, BC, Canada
| | - Thomas Ullman
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Peter L. Lakatos
- 1st Department of Medicine, Semmelweis University, Budapest, Hungary
| | - Walter Reinisch
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria, and McMaster University, Department of Internal Medicine, Hamilton, ON, Canada
| | - Li-An Xu
- Bristol-Myers Squibb, Lawrenceville, NJ, USA
| | - Allison Luo
- Formerly of Bristol-Myers Squibb, Lawrenceville, NJ, USA
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167
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Tinsley A, Naymagon S, Mathers B, Kingsley M, Sands BE, Ullman TA. Early readmission in patients hospitalized for ulcerative colitis: incidence and risk factors. Scand J Gastroenterol 2016; 50:1103-9. [PMID: 25866237 DOI: 10.3109/00365521.2015.1020862] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 02/04/2023]
Abstract
OBJECTIVE Early readmission rates are becoming an integral measure of the quality of care for hospitalized patients with chronic diseases. The incidence and predictors of early readmission in patients with inflammatory bowel disease (IBD) are uncertain. Risk factors for readmission over the first few weeks may differ from those that influence re-hospitalization at later time points. We examined the incidence and predictors of both 30-day and 90-day readmissions among ulcerative colitis (UC) patients. MATERIALS AND METHODS A retrospective, cohort study was performed including all severe UC patients admitted to a tertiary-care hospital between January 2007 and December 2011. All-cause readmissions to the medical or surgical service within 30 and 90 days were recorded to allow the calculation of early readmission rates. We used multiple logistic regression to analyze demographic, hospital-related, general medical and IBD-specific factors as potential risk factors for readmission. RESULTS There were a total of 229 patients discharged following hospitalization for severe UC. The 30- and 90-day readmission rates were 11.7% and 20.5%, respectively. Forty-seven percent of early readmissions were for colectomy. In the 30-day analysis, only the presence of extensive colitis (odds ratio 3.59; 95% confidence interval [CI] 1.41-9.13) compared with left-sided disease was independently associated with readmission. Extensive colitis (3.09, 95% CI 1.33-7.08), albumin on admission (0.56, 0.31-0.99) and being admitted to a housestaff service (2.87, 95% CI 1.14-6.54), were independent predictors of readmission at 90 days. CONCLUSIONS Early readmission is common in IBD. Independent risk factors for early readmission included extensive colitis, admission albumin, and being admitted to a housestaff service.
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Affiliation(s)
- Andrew Tinsley
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center , Hershey, PA 17033 , USA
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168
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Shah SC, Colombel JF, Sands BE, Narula N. Systematic review with meta-analysis: mucosal healing is associated with improved long-term outcomes in Crohn's disease. Aliment Pharmacol Ther 2016; 43:317-33. [PMID: 26607562 DOI: 10.1111/apt.13475] [Citation(s) in RCA: 236] [Impact Index Per Article: 29.5] [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: 09/22/2015] [Revised: 10/10/2015] [Accepted: 10/22/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clinical manifestations of Crohn's disease (CD) do not reliably correlate with endoscopic activity. While treating to achieve clinical remission (CR) has neither proven to improve CD outcomes nor alter the natural disease course, it is unclear whether targeting objective measures like mucosal healing (MH) is associated with improved long-term outcomes. AIM To perform a systematic review and meta-analysis comparing long-term outcomes in active CD patients who achieve MH compared to those who do not. METHODS We performed a systematic literature search to identify studies with prospective cohorts of active CD patients that included outcomes of patients who achieved MH at first endoscopic assessment (MH1) compared to those who did not. The primary outcome was long-term (≥50 weeks) CR. Secondary outcomes included CD-related surgery-free rate, hospitalisation-free rate and long-term MH rate. Pooled odds ratio (OR) and 95% confidence intervals (CI) were calculated. RESULTS Twelve studies with 673 patients met inclusion criteria. Patients achieving MH1 had a pooled OR of 2.80 (95%CI, 1.91-4.10) for achieving long-term CR, 2.22 (95%CI, 0.86-5.69) for CD-related surgery-free rate, and 14.30 (95%CI, 5.57-36.74) for long-term MH. Sensitivity analyses suggested no difference in outcomes if MH1 was achieved on biologics vs. non-biologics. No significant publication bias or heterogeneity was detected. CONCLUSIONS Achieving MH1 is associated with increased rates of long-term clinical remission, and maintenance of mucosal healing in active Crohn's disease and may therefore be a reasonable therapeutic target.
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Affiliation(s)
- S C Shah
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - J-F Colombel
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - B E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - N Narula
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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169
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Affiliation(s)
- John M. Carethers
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan,Correspondence: John M. Carethers, M.D., Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, TEL: 734-615-1717, FAX: 734-615-2645,
| | - Jonathan Braun
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Bruce E. Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
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170
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Abstract
Recent observations suggest that subjective measures of disease activity in inflammatory bowel disease (IBD) are often misleading. Objective measures of inflammation are more closely associated with important long-term outcomes, but often depend upon invasive and costly procedures such as ileocolonoscopy and cross-sectional imaging by computed tomography or magnetic resonance imaging. Noninvasive, accurate, and inexpensive measures of intestinal inflammation would allow clinicians to adopt widely the paradigm of adjusting therapies with a goal of controlling inflammation. Blood, stool, and urine markers have all been explored as indicators of intestinal inflammation in IBD, and although none has been universally adopted, some have been well-characterized, and others hold great promise. Serum C-reactive protein and fecal calprotectin are among the best-studied noninvasive biomarkers of inflammation in IBD, and their test characteristics have been described in the setting of differentiating IBD from irritable bowel syndrome, for grading inflammation, to describe the response to therapy, and in demonstrating recurrent inflammation after medical or surgically induced remission. High-throughput research platforms, including gene expression arrays, metabolomics and proteomics, are also being applied to the discovery of novel biomarkers of inflammation. It is certain that biomarkers of inflammation will attain growing importance in the clinic as we strive for more effective and cost-effective strategies to treat patients with IBD.
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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.
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171
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Travis SPL, Schnell D, Feagan BG, Abreu MT, Altman DG, Hanauer SB, Krzeski P, Lichtenstein GR, Marteau PR, Mary JY, Reinisch W, Sands BE, Schnell P, Yacyshyn BR, Colombel JF, Bernhardt CA, Sandborn WJ. The Impact of Clinical Information on the Assessment of Endoscopic Activity: Characteristics of the Ulcerative Colitis Endoscopic Index Of Severity [UCEIS]. J Crohns Colitis 2015; 9:607-16. [PMID: 25956538 PMCID: PMC4584567 DOI: 10.1093/ecco-jcc/jjv077] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/07/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS To determine whether clinical information influences endoscopic scoring by central readers using the Ulcerative Colitis Endoscopic Index of Severity [UCEIS; comprising 'vascular pattern', 'bleeding', 'erosions and ulcers']. METHODS Forty central readers performed 28 evaluations, including 2 repeats, from a library of 44 video sigmoidoscopies stratified by Mayo Clinic Score. Following training, readers were randomised to scoring with ['unblinded', n = 20, including 4 control videos with misleading information] or without ['blinded', n 20] clinical information. A total of 21 virtual Central Reader Groups [CRGs], of three blinded readers, were created. Agreement criteria were pre-specified. Kappa [κ] statistics quantified intra- and inter-reader variability. RESULTS Mean UCEIS scores did not differ between blinded and unblinded readers for any of the 40 main videos. UCEIS standard deviations [SD] were similar [median blinded 0.94, unblinded 0.93; p = 0.97]. Correlation between UCEIS and visual analogue scale [VAS] assessment of overall severity was high [r blinded = 0.90, unblinded = 0.93; p = 0.02]. Scores for control videos were similar [UCEIS: p ≥ 0.55; VAS: p ≥ 0.07]. Intra- [κ 0.47-0.74] and inter-reader [κ 0.40-0.53] variability for items and full UCEIS was 'moderate'-to-'substantial', with no significant differences except for intra-reader variability for erosions and ulcers [κ blinded: 0.47 vs unblinded: 0.74; p 0.047]. The SD of CRGs was lower than for individual central readers [0.54 vs 0.95; p < 0.001]. Correlation between blinded UCEIS and patient-reported symptoms was high [stool frequency: 0.76; rectal bleeding: 0.82; both: 0.81]. CONCLUSIONS The UCEIS is minimally affected by knowledge of clinical details, strongly correlates with patient-reported symptoms, and is a suitable instrument for trials. CRGs performed better than individuals.
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Affiliation(s)
- Simon P L Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK
| | | | - Brian G Feagan
- Robarts Research Institute, University of Western Ontario, London, ON, Canada
| | - Maria T Abreu
- Division of Gastroenterology, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Stephen B Hanauer
- Digestive Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Gary R Lichtenstein
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Philippe R Marteau
- AP-HP, Hôpital Lariboisière Medicosurgical Department of Digestive Diseases and University Denis Diderot, Paris, France
| | - Jean-Yves Mary
- INSERM U717 Biostatistics and Clinical Epidemiology, Université Paris Diderot, Paris, France
| | - Walter Reinisch
- Division of Gastroenterology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Bruce R Yacyshyn
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, OH, USA
| | | | | | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
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172
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Shapiro JM, Cho JH, Sands BE, LeLeiko NS. Bridging the gap between host immune response and intestinal dysbiosis in inflammatory bowel disease: does immunoglobulin A mark the spot? Clin Gastroenterol Hepatol 2015; 13:842-6. [PMID: 25725444 DOI: 10.1016/j.cgh.2015.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) is a chronic, debilitating condition characterized by relapsing and remitting episodes of gastrointestinal inflammation. As the incidence and prevalence have increased, so has our understanding of the pathophysiology of this complex, immunologically mediated disease. With advances in bacterial and human gene sequencing technologies, a significant amount of work has focused on how alterations in the intestinal microbiome affect disease onset and progression. A recent study in Cell suggests that it may be possible to identify specific bacteria responsible for promoting a proinflammatory state by assessing the degree to which they are coated by the immunoglobulin (Ig) A. A combination of antibody-based bacterial cell sorting, flow cytometry, and 16s ribosomal RNA gene sequencing was used to identify IgA-coated bacteria from stool of specific pathogen-free mice. This technique was used to demonstrate that IgA-coated bacteria were indeed detectable and increased in a mouse model of colitis. Stool from patients with IBD was then used to generate 2 groups of IgA+ and IgA- bacterial consortia. When transplanted into specific pathogen-free mice, no initial clinical differences were noted. However, when mice with dextran sodium sulfate-induced colitis were transplanted with the IgA+ bacterial strains, they exhibited severe exacerbation of intestinal inflammation, whereas the IgA- group developed minimal symptoms. These findings suggest that bacteria highly coated with IgA are potentially responsible for driving gut inflammation in patients with IBD. These results may represent a critical advance in our understanding of the complex interactions between the host immune system and commensal microorganisms as it relates to the development and disease course of IBD. Future work will focus on how these findings can be translated into the development of individualized, microbiota-specific therapies.
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Affiliation(s)
- Jason M Shapiro
- Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island; Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.
| | - Judy H Cho
- Icahn School of Medicine at Mount Sinai, Dr Henry D. Janowitz Division of Gastroenterology, New York, New York
| | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, Dr Henry D. Janowitz Division of Gastroenterology, New York, New York
| | - Neal S LeLeiko
- Division of Pediatric Gastroenterology, Nutrition and Liver Diseases, Department of Pediatrics, Hasbro Children's Hospital/Rhode Island Hospital, Providence, Rhode Island; Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
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173
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Marion JF, Sands BE. The SCENIC consensus statement on surveillance and management of dysplasia in inflammatory bowel disease: praise and words of caution. Gastroenterology 2015; 148:462-7. [PMID: 25702851 DOI: 10.1053/j.gastro.2015.01.029] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [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: 12/20/2022]
Affiliation(s)
- James F Marion
- 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
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174
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Abstract
BACKGROUND Inadequate response to infliximab [IFX] therapy in Crohn's disease [CD] may necessitate dose intensification. We evaluated safety and efficacy of high-dose IFX [HD IFX] [greater than 10mg/kg every 8 weeks] in CD and characterized predictors of response to HD IFX intensification. METHODS Electronic medical records were queried for CD patients between 2010 and 2012 who received HD IFX and were reviewed for history, medications, laboratory data, efficacy, and safety. RESULTS In all, 86 patients received HD IFX for CD at doses between 10 and 22.5mg/kg every 4 to 7 weeks. In early HD IFX therapy [week 1-16], 25.8% and 59.1% experienced full and partial response, respectively. In later HD IFX therapy [week 38-100], 27.9% and 34.4% experienced full and partial response, respectively. Median serum IFX levels increased from 1.7 to 7.3 µ/mL [p = 0.017], and median C-reactive protein [CRP] values decreased from 20.5 at baseline to 4.7 mg/L after 16 weeks [p < 0.001]. Baseline CRP values were significantly elevated in the group that responded at 1-16 weeks compared with nonresponders [22.0 vs 3.5mg/L, p < 0.01]. HD IFX therapy was discontinued in 26% and 7.3% of patients for inadequate response and adverse events, respectively. Eleven cases of infection required hospitalization for a serious infection rate of 7.41 events per 100 patient-years. CONCLUSIONS HD IFX therapy may benefit CD patients who have failed standard doses of IFX. HD IFX therapy may be associated with more serious adverse events compared with standard dosing. Baseline CRP value may predict clinical response to HD IFX.
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Affiliation(s)
- Steven A Hendler
- Department of Medicine, Icahn School of Medicine at Mount
Sinai, New York, NY, USA
| | - Benjamin L Cohen
- Division of Gastroenterology, Icahn School of Medicine at
Mount Sinai, New York, NY,
USA
| | - Jean-Frédéric Colombel
- 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
| | - Lloyd Mayer
- Division of Clinical Immunology, Icahn School of Medicine
at Mount Sinai, New York, NY,
USA.
| | - Shradha Agarwal
- Division of Clinical Immunology, Icahn School of Medicine
at Mount Sinai, New York, NY,
USA.
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175
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Krishnarao A, de Leon L, Bright R, Moniz H, Law M, Leleiko N, Sands BE, Merrick M, Shapiro J, Wallenstein S, Giacalone J, Shah SA. Testing for Clostridium difficile in patients newly diagnosed with inflammatory bowel disease in a community setting. Inflamm Bowel Dis 2015; 21:564-9. [PMID: 25581825 DOI: 10.1097/mib.0000000000000309] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The incidence of Clostridium difficile infection (CDI) in inflammatory bowel disease (IBD) is increasing, and CDI has a negative impact on IBD outcomes with both increased morbidity and mortality. Data are lacking regarding the rate of appropriate testing for CDI at the time of diagnosis. METHODS We sought to determine the rate of CDI testing and CDI positivity at diagnosis of IBD using data collected through the Ocean State Crohn's and Colitis Area Registry (OSCCAR), a prospective cohort of patients with newly diagnosed IBD. CDI testing and CDI positivity were determined by reviewing the medical records of patients enrolled into the registry and diagnosed with IBD between January 2008 and July 2011. RESULTS Of 320 enrolled patients, 227 (70.9%) reported diarrhea, and CDI testing was performed for 113 (49.8%) of the 227 patients. CDI testing was not recorded as being performed for the remaining 114 patients who reported having diarrhea. An additional 24 patients were tested for CDI but did not report having diarrhea. Seven (5.1%) of the 137 patients tested for CDI were positive. CONCLUSIONS Testing for CDI is significantly lower than expected at diagnosis of IBD. Although the prevalence of CDI among tested patients is approximately 5%, a low testing rate suggests a significant quality issue in the diagnosis of IBD, with the potential for delayed diagnosis of CDI.
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Affiliation(s)
- Anita Krishnarao
- *Department of Medicine, Division Gastroenterology, Alpert Medical School, Brown University, Providence, Rhode Island; †Department of Medicine, Rhode Island Hospital, Providence, Rhode Island; ‡Division of Pediatric Gastroenterology, Hasbro Children's Hospital, Providence, Rhode Island; §Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; and ‖Crohn's & Colitis Foundation of America, New York, New York
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176
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Atreja A, Khan S, Rogers JD, Otobo E, Patel NP, Ullman T, Colombel JF, Moore S, Sands BE. Impact of the Mobile HealthPROMISE Platform on the Quality of Care and Quality of Life in Patients With Inflammatory Bowel Disease: Study Protocol of a Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2015; 4:e23. [PMID: 25693610 PMCID: PMC4376196 DOI: 10.2196/resprot.4042] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 12/23/2014] [Indexed: 12/30/2022] Open
Abstract
Background Inflammatory bowel disease (IBD) is a chronic condition of the bowel that affects over 1 million people in the United States. The recurring nature of disease makes IBD patients ideal candidates for patient-engaged care that is centered on enhanced self-management and improved doctor-patient communication. In IBD, optimal approaches to management vary for patients with different phenotypes and extent of disease and past surgical history. Hence, a single quality metric cannot define a heterogeneous disease such as IBD, unlike hypertension and diabetes. A more comprehensive assessment may be provided by complementing traditional quality metrics with measures of the patient’s quality of life (QOL) through an application like HealthPROMISE. Objective The objective of this pragmatic randomized controlled trial is to determine the impact of the HealthPROMISE app in improving outcomes (quality of care [QOC], QOL, patient adherence, disease control, and resource utilization) as compared to a patient education app. Our hypothesis is that a patient-centric self-monitoring and collaborative decision support platform will lead to sustainable improvement in overall QOL for IBD patients. Methods Participants will be recruited during face-to-face visits and randomized to either an interventional (ie, HealthPROMISE) or control (ie, education app). Patients in the HealthPROMISE arm will be able to update their information and receive disease summary, quality metrics, and a graph showing the trend of QOL (SIBDQ) scores and resource utilization over time. Providers will use the data for collaborative decision making and quality improvement interventions at the point of care. Patients in the control arm will enter data at baseline, during office visits, and at the end of the study but will not receive any decision support (trend of QOL, alert, or dashboard views). Results Enrollment in the trial will be starting in first quarter of 2015. It is intended that up to 300 patients with IBD will be recruited into the study (with 1:1 allocation ratio). The primary endpoint is number of quality indicators met in HealthPROMISE versus control arm. Secondary endpoints include decrease in number of emergency visits due to IBD, decrease in number of hospitalization due to IBD, change in generic QOL score from baseline, proportion of patients in each group who meet all eligible outpatient quality metrics, and proportion of patients in disease control in each group. In addition, we plan to conduct protocol analysis of intervention patients with adequate HealthPROMISE utilization (more than 6 log-ins with data entry from week 0 through week 52) achieving above mentioned primary and secondary endpoints. Conclusions HealthPROMISE is a unique cloud-based patient-reported outcome (PRO) and decision support tool that empowers both patients and providers. Patients track their QOL and symptoms, and providers can use the visual data in real time (integrated with electronic health records [EHRs]) to provide better care to their entire patient population. Using pragmatic trial design, we hope to show that IBD patients who participate in their own care and share in decision making have appreciably improved outcomes when compared to patients who do not. Trial Registration ClinicalTrials.gov NCT02322307; https://clinicaltrials.gov/ct2/show/NCT02322307 (Archived by WebCite at http://www.webcitation.org/6W8PoYThr).
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Affiliation(s)
- Ashish Atreja
- Sinai AppLab, Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
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177
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Levesque BG, Sandborn WJ, Ruel J, Feagan BG, Sands BE, Colombel JF. Converging goals of treatment of inflammatory bowel disease from clinical trials and practice. Gastroenterology 2015; 148:37-51.e1. [PMID: 25127678 DOI: 10.1053/j.gastro.2014.08.003] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [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: 05/17/2014] [Revised: 08/02/2014] [Accepted: 08/05/2014] [Indexed: 12/21/2022]
Abstract
It is important to have clear goals for treating inflammatory bowel disease in clinical practice and in research. Conventional end points for trials in ulcerative colitis and Crohn's disease have been based on composite indices, such as the Mayo Clinic Score and the Crohn's Disease Activity Index; these indices incorporate symptoms, signs, and findings from laboratory tests and sometimes endoscopic assessments. Although definitions of clinical response and remission have been based on these indices for regulatory purposes, they are difficult to apply to practice because they are complex and not intuitive to clinicians. This has caused a disconnect between clinical trials and practice. Recently, the use of composite indices in trials has been reevaluated in Food and Drug Administration-sponsored Gastroenterology Regulatory Endpoints and the Advancement of Therapeutics workshops due to concerns about the validity of the indices. Alternative measures of outcome and definitions of response are being developed. Patient-reported outcomes are psychometric instruments created and defined by patients to quantify symptoms. A combination of end points, comprising patient-reported outcomes and objective evaluation of inflammation by endoscopy, offers a clinically meaningful and scientifically valid alternative to existing composite indices. Unlike composite indices, response definitions based on endoscopy and patient-reported outcomes can be readily applied in practice. This convergence of outcome assessment in clinical trials and practice could expedite implementation of "treat-to-target" algorithms, in which therapy is progressively intensified until a specific treatment goal is reached. This approach could improve patient care by reducing rates of disease-related complications, surgery, and hospitalization.
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Affiliation(s)
- Barrett G Levesque
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California.
| | - Joannie Ruel
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, Department of Medicine, Western University, London, Ontario, Canada
| | - Bruce E Sands
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jean-Frederic Colombel
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
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178
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Abstract
TNF antagonists have revolutionized the treatment of IBD. Nevertheless, between 30 and 45% of patients discontinue infliximab and other TNF antagonists over a 2- to 6-year period due to nonresponse, loss of response, or adverse events. Accordingly, the need for novel therapies grows each year. Recent studies have demonstrated the promise of new drugs with distinct modes of action for the treatment of ulcerative colitis (UC) and Crohn's disease (CD). These include agents targeting leukocyte trafficking, therapies directed against IL-12/23 and Janus kinases (JAK), and antibodies against the classic inflammatory cytokine, IL-6. The anti-α4-integrin antibody, natalizumab, was the first effective antitrafficking agent for CD; however, its use has been greatly limited by the risk of progressive multifocal leukoencephalopathy. Therefore, second-generation antitrafficking agents have focused on restricting leukocyte blockade to the intestine through mechanisms interfering with α4β7-integrin and its interaction with mucosal addressin cellular adhesion molecule 1. IL-23 is a cytokine central to the adaptive immune responses that characterize IBD. Ustekinumab, targeting the p40 subunit of IL-12 and IL-23, and the oral JAK inhibitor tofacitinib have proven to be effective in phase 2 trials in CD and UC, respectively. In addition, antibodies targeting the proinflammatory cytokine IL-6 are being studied in CD. Each of the approaches described have promise as well as limitations, so it is likely that the search for novel agents in IBD will continue.
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Affiliation(s)
- Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, N.Y., USA
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179
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Itzkowitz SH, Sands BE, Ullman TA, Rustgi AK. Mark Warren Babyatsky, MD (June 29, 1959-August 25, 2014). Gastroenterology 2014; 147:1189-90. [PMID: 25449021 DOI: 10.1053/j.gastro.2014.10.030] [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: 12/02/2022]
Affiliation(s)
- Steven H Itzkowitz
- 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
| | - Thomas A Ullman
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Anil K Rustgi
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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180
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Sands BE, Feagan BG, Rutgeerts P, Colombel JF, Sandborn WJ, Sy R, D'Haens G, Ben-Horin S, Xu J, Rosario M, Fox I, Parikh A, Milch C, Hanauer S. Effects of vedolizumab induction therapy for patients with Crohn's disease in whom tumor necrosis factor antagonist treatment failed. Gastroenterology 2014; 147:618-627.e3. [PMID: 24859203 DOI: 10.1053/j.gastro.2014.05.008] [Citation(s) in RCA: 492] [Impact Index Per Article: 49.2] [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: 12/20/2013] [Revised: 04/10/2014] [Accepted: 05/19/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS There is an increasing need for new treatments for patients with Crohn's disease (CD) in whom previous therapy with tumor necrosis factor (TNF) antagonists has failed. We performed a placebo-controlled, phase 3, double-blind trial to evaluate the efficacy and safety of vedolizumab, an antibody against the integrin α4β7, as induction therapy. METHODS Patients with moderately to severely active CD (CD activity index [CDAI] score, 220-400 points) were assigned randomly to groups given vedolizumab (300 mg) or placebo intravenously at weeks 0, 2, and 6. The primary analysis involved 315 patients with previous TNF antagonist failure (ie, an inadequate response to, loss of response to, or intolerance of ≥1 TNF antagonists); we determined the proportion of patients in clinical remission (CDAI, ≤150 points) at week 6. Secondary analyses evaluated outcomes at weeks 6 and 10 in this population and in the overall population (N = 416), which included patients naive to TNF antagonist therapy (n = 101). RESULTS Among patients who had experienced previous TNF antagonist failure, 15.2% of those given vedolizumab and 12.1% of those given placebo were in remission at week 6 (P = .433). At week 10, a higher proportion of this population given vedolizumab was in remission (26.6%) than those given placebo (12.1%) (nominal P = .001; relative risk, 2.2; 95% confidence interval, 1.3-3.6). A higher proportion of patients with previous TNF antagonist failure given vedolizumab also had a CDAI-100 response (≥100-point decrease in CDAI score from baseline) at week 6 than those given placebo (39.2% vs 22.3%; nominal P = .001; relative risk, 1.8; 95% confidence interval, 1.2-2.5). Adverse event results were similar among all groups. CONCLUSIONS Vedolizumab was not more effective than placebo in inducing clinical remission at week 6 among patients with CD in whom previous treatment with TNF antagonists had failed. The therapeutic benefits of vedolizumab in these patients were detectable at week 10. ClinicalTrials.gov number: NCT01224171.
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Affiliation(s)
- Bruce E Sands
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Brian G Feagan
- Robarts Clinical Trials Inc, and Robarts Research Institute, Department of Medicine, and Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada
| | - Paul Rutgeerts
- Department of Gastroenterology, University Hospital Gasthuisberg and Katholieke Universiteit, Leuven, Belgium
| | - Jean-Frédéric Colombel
- The Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York; Département d'Hépato-Gastroentérologie et Centre d'Investigations Cliniques, Centre Hospitalier Régional Universitaire de Lille, Université Lille Nord de France, Lille, France
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California
| | - Richmond Sy
- Department of Gastroenterology, University of Ottawa, Ottawa, Ontario, Canada
| | - Geert D'Haens
- Department of Gastroenterology, Inflammatory Bowel Disease Centre of the Academic Medical Centre, Amsterdam, the Netherlands
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jing Xu
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts
| | - Maria Rosario
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts
| | - Irving Fox
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts
| | - Asit Parikh
- Takeda Pharmaceuticals International, Inc, Deerfield, Illinois
| | - Catherine Milch
- Takeda Pharmaceuticals International Co, Cambridge, Massachusetts
| | - Stephen Hanauer
- Division of Gastroenterology, The University of Chicago Medical Center, Chicago, Illinois
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181
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Fowler SA, Ananthakrishnan AN, Gardet A, Stevens CR, Korzenik JR, Sands BE, Daly MJ, Xavier RJ, Yajnik V. SMAD3 gene variant is a risk factor for recurrent surgery in patients with Crohn's disease. J Crohns Colitis 2014; 8:845-51. [PMID: 24461721 PMCID: PMC4237062 DOI: 10.1016/j.crohns.2014.01.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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: 08/20/2013] [Revised: 12/12/2013] [Accepted: 01/03/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS More than 80% of Crohn's disease (CD) patients will require surgery. Surgery is not curative and rates of re-operation are high. Identification of genetic variants associated with repeat surgery would allow risk stratification of patients who may benefit from early aggressive therapy and/or post-operative prophylactic treatment. METHODS CD patients who had at least one CD-related bowel resection were identified from the Prospective Registry in IBD Study at Massachusetts General Hospital (PRISM). The primary outcome was surgical recurrence. Covariates and potential interactions were assessed using the Cox proportional hazard model. Kaplan-Meier curves for time to surgical recurrence were developed for each genetic variant and analyzed with the log-rank test. RESULTS 194 patients were identified who had at least 1 resection. Of these, 69 had two or more resections. Clinical predictors for repeat surgery were stricturing (HR 4.18, p=0.022) and penetrating behavior (HR 3.97, p=0.024). Smoking cessation was protective for repeat surgery (HR 0.45, p=0.018). SMAD3 homozygosity for the risk allele was also independently associated with increased risk of repeat surgery (HR 4.04, p=0.001). NOD2 was not associated with increased risk of surgical recurrence. CONCLUSION Stricturing and penetrating behavior were associated with increased risk of surgical recurrence, while smoking cessation was associated with a decreased risk. A novel association between SMAD3 and increased risk of repeat operation and shorter time to repeat surgery was observed. This finding is of particular interest as SMAD3 may represent a new therapeutic target specifically for prevention of post-surgical disease recurrence.
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Affiliation(s)
- Sharyle A Fowler
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Agnes Gardet
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA,Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA
| | | | - Joshua R Korzenik
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bruce E Sands
- Division of Gastroenterology, Mount Sinai School of Medicine, New York, NY
| | - Mark J Daly
- Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA
| | - Ramnik J Xavier
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA,Center for Computational and Integrative Biology, Massachusetts General Hospital, Boston, MA
| | - Vijay Yajnik
- Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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182
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Feagan BG, Colombel JF, Hanauer SB, Parikh A, Rutgeerts P, Sandborn WJ, Sands BE. Comment on 'anti-adhesion therapies and the rule of 3 for rare events'. Am J Gastroenterol 2014; 109:1083-4. [PMID: 24989100 DOI: 10.1038/ajg.2014.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 12/11/2022]
Affiliation(s)
| | | | - Stephen B Hanauer
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Asit Parikh
- Takeda Pharmaceuticals Inc., Deerfield, Illinois, USA
| | | | | | - Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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183
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Cohen BL, Zoëga H, Shah SA, LeLeiko N, Lidofsky S, Bright R, Flowers N, Law M, Moniz H, Merrick M, Sands BE. Fatigue is highly associated with poor health-related quality of life, disability and depression in newly-diagnosed patients with inflammatory bowel disease, independent of disease activity. Aliment Pharmacol Ther 2014; 39:811-22. [PMID: 24612278 PMCID: PMC4670472 DOI: 10.1111/apt.12659] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [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: 04/18/2013] [Revised: 05/06/2013] [Accepted: 01/24/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fatigue is common in Crohn's disease (CD) and ulcerative colitis (UC). Data on fatigue in newly diagnosed patients are unavailable. AIM To report prevalence of fatigue in newly diagnosed CD and UC patients and examine its association with health-related quality of life (HRQOL), depression and disability. METHODS The Ocean State Crohn's and Colitis Area Registry (OSCCAR) is a statewide cohort of newly diagnosed inflammatory bowel disease patients in Rhode Island. Fatigue was assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue Scale. Patients were administered instruments measuring HRQOL, overall disability and work impairment, and depression. RESULTS Fatigue was prevalent in 26.4% of 220 subjects. Cohen's d effect sizes for fatigue were large: Short-Form 36 Health Survey mental health component (CD 1.5, UC 1.4) and physical health component (CD 1.4, UC 1.4), EuroQol-5D valuation of current health state (CD 1.2, UC 1.0), Inflammatory Bowel Disease Questionnaire (CD 1.9, UC 1.6) and Patient Health Questionnaire depression scale (CD 1.8, UC 1.7). Fatigued patients reported more work impairment (Score difference: CD 29.5%, UC 23.8%) and activity impairment (score difference: CD 32.3%, UC 25.7%) on the Work Productivity and Activity Impairment Questionnaire. Fatigue's association with all scores remained highly significant despite controlling for disease activity. CONCLUSIONS Fatigue is strongly associated with poor HRQOL, disability and depression similarly in CD and UC even when controlling for disease activity. Fatigue's association with a wide range of patient-reported outcome measures suggests that monitoring fatigue is a simple way to screen for overall disruption in patient life.
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Affiliation(s)
- B L Cohen
- Division of Gastroenterology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
| | - H Zoëga
- Division of Gastroenterology, Icahn School of Medicine at Mount SinaiNew York, NY, USA,Faculty of Medicine, Center of Public Health Sciences, University of IcelandReykjavik, Iceland
| | - S A Shah
- The Warren Alpert Medical School of Brown University, Gastroenterology Associates, Inc.Providence, RI, USA
| | - N LeLeiko
- Division of Pediatric Gastroenterology, Nutrition, and Liver Disease, Warren Alpert Medical School of Brown University, Hasbro Children's Hospital/Rhode Island HospitalProvidence, RI, USA
| | - S Lidofsky
- The Warren Alpert Medical School of Brown University, Gastroenterology Associates, Inc.Providence, RI, USA
| | - R Bright
- Division of Gastroenterology, Rhode Island HospitalProvidence, RI, USA
| | - N Flowers
- Centers for Disease Control and PreventionAtlanta, GA, USA
| | - M Law
- Division of Gastroenterology, Rhode Island HospitalProvidence, RI, USA
| | - H Moniz
- Division of Gastroenterology, Rhode Island HospitalProvidence, RI, USA
| | - M Merrick
- Crohn's & Colitis Foundation of AmericaNew York, NY, USA
| | - B E Sands
- Division of Gastroenterology, Icahn School of Medicine at Mount SinaiNew York, NY, USA
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184
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Travis SPL, Schnell D, Krzeski P, Abreu MT, Altman DG, Colombel JF, Feagan BG, Hanauer SB, Lichtenstein GR, Marteau PR, Reinisch W, Sands BE, Yacyshyn BR, Schnell P, Bernhardt CA, Mary JY, Sandborn WJ. Reliability and initial validation of the ulcerative colitis endoscopic index of severity. Gastroenterology 2013; 145:987-95. [PMID: 23891974 DOI: 10.1053/j.gastro.2013.07.024] [Citation(s) in RCA: 294] [Impact Index Per Article: 26.7] [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: 03/08/2013] [Revised: 07/12/2013] [Accepted: 07/13/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS We studied the reliability of the previously described Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and validated it with an independent cohort of investigators. METHODS We created a new library of 57 videos of flexible sigmoidoscopy and stratified them based on disease severity. Twenty-five investigators were each randomly assigned to assess 28 videos (which included 4 duplicates to assess intraobserver reliability). Investigators were blinded to clinical details except for 2 of 4 duplicated videos (to assess the impact of knowledge of symptoms on assessment). Three descriptors ("vascular pattern", "bleeding", and "erosions and ulcers") comprising the UCEIS were scored with a visual analogue scale (VAS) to assess overall severity. Intrainvestigator and interinvestigator agreement was characterized by κ statistical analysis; reliability ratios were used to compare VAS and UCEIS scores. RESULTS There was a high level of correlation between UCEIS scores and overall assessment of severity (correlation coefficient, 0.93). Internal consistency (Cronbach α analysis) was 0.86. Intrainvestigator and interinvestigator reliability ratios for UCEIS scores were 0.96 and 0.88, respectively. Intrainvestigator agreement in determination of the UCEIS score was good (κ = 0.72), with individual descriptors ranging from a κ of 0.47 (for bleeding) to 0.87 (for vascular pattern). Interinvestigator agreement in determination of UCEIS scores was moderate (κ = 0.50), with descriptors ranging from a κ of 0.48 (for bleeding) to 0.54 (for vascular pattern). Intrainvestigator variability in determining UCEIS scores did not change appreciably when a video was presented with clinical details. CONCLUSIONS The UCEIS and its components show satisfactory intrainvestigator and interinvestigator reliability. Among investigators, the UCEIS accounted for a median of 86% of the variability in evaluation of overall severity on the VAS when assessing the endoscopic severity of UC and was unaffected by knowledge of clinical details.
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Affiliation(s)
- Simon P L Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, England.
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Sands BE, Katz S, Wolf DC, Feagan BG, Wang T, Gustofson LM, Wong C, Vandervoort MK, Hanauer S. A randomised, double-blind, sham-controlled study of granulocyte/monocyte apheresis for moderate to severe Crohn's disease. Gut 2013; 62:1288-94. [PMID: 22760005 DOI: 10.1136/gutjnl-2011-300995] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Activated granulocytes and monocytes may contribute to the pathogenesis of Crohn's disease (CD). In small, uncontrolled studies, granulocyte/monocyte apheresis (GMA) has shown promise in treating CD. We conducted a randomised, double-blind study to compare GMA with a sham procedure in patients with moderate to severe CD. DESIGN Patients with active CD as defined by a Crohn's Disease Activity Index (CDAI) of 220-450 were randomly allocated in a 2:1 ratio to treatment with GMA using the Adacolumn Apheresis System (JIMRO, Takasaki, Japan) or sham apheresis. Ten apheresis sessions were scheduled over a 9-week period, and efficacy was evaluated at week 12. The primary end point was the proportion of patients achieving clinical remission (CDAI score ≤ 150 without use of prohibited drugs). RESULTS Clinical remission was achieved by 17.8% of patients in the GMA group (n = 157) compared with 19.2% of those in the sham control group (n = 78) (absolute difference--1.4% (95% CI--12.8% to 8.5%), p = 0.858). Clinical response (defined as a ≥ 100-point decrease in CDAI) was achieved by 28.0% and 26.9% of patients in the GMA and sham groups, respectively (p = 1.000). The two treatments produced similar changes from baseline in CDAI and quality of life, as well as in disease severity assessed endoscopically. The incidence and types of adverse events did not differ between groups. CONCLUSIONS GMA was well tolerated, but this study did not demonstrate its effectiveness over a sham procedure in inducing clinical remission or response in patients with moderate to severe CD.
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Affiliation(s)
- Bruce E Sands
- Division of Gastroenterology, Mount Sinai Medical Center and Mount Sinai School of Medicine, New York, NY 10029, USA.
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Sandborn WJ, Feagan BG, Rutgeerts P, Hanauer S, Colombel JF, Sands BE, Lukas M, Fedorak RN, Lee S, Bressler B, Fox I, Rosario M, Sankoh S, Xu J, Stephens K, Milch C, Parikh A. Vedolizumab as induction and maintenance therapy for Crohn's disease. N Engl J Med 2013; 369:711-21. [PMID: 23964933 DOI: 10.1056/nejmoa1215739] [Citation(s) in RCA: 1425] [Impact Index Per Article: 129.5] [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: 12/11/2022]
Abstract
BACKGROUND The efficacy of vedolizumab, an α4β7 integrin antibody, in Crohn's disease is unknown. METHODS In an integrated study with separate induction and maintenance trials, we assessed intravenous vedolizumab therapy (300 mg) in adults with active Crohn's disease. In the induction trial, 368 patients were randomly assigned to receive vedolizumab or placebo at weeks 0 and 2 (cohort 1), and 747 patients received open-label vedolizumab at weeks 0 and 2 (cohort 2); disease status was assessed at week 6. In the maintenance trial, 461 patients who had had a response to vedolizumab were randomly assigned to receive placebo or vedolizumab every 8 or 4 weeks until week 52. RESULTS At week 6, a total of 14.5% of the patients in cohort 1 who received vedolizumab and 6.8% who received placebo were in clinical remission (i.e., had a score on the Crohn's Disease Activity Index [CDAI] of ≤150, with scores ranging from 0 to approximately 600 and higher scores indicating greater disease activity) (P=0.02); a total of 31.4% and 25.7% of the patients, respectively, had a CDAI-100 response (≥100-point decrease in the CDAI score) (P=0.23). Among patients in cohorts 1 and 2 who had a response to induction therapy, 39.0% and 36.4% of those assigned to vedolizumab every 8 weeks and every 4 weeks, respectively, were in clinical remission at week 52, as compared with 21.6% assigned to placebo (P<0.001 and P=0.004 for the two vedolizumab groups, respectively, vs. placebo). Antibodies against vedolizumab developed in 4.0% of the patients. Nasopharyngitis occurred more frequently, and headache and abdominal pain less frequently, in patients receiving vedolizumab than in patients receiving placebo. Vedolizumab, as compared with placebo, was associated with a higher rate of serious adverse events (24.4% vs. 15.3%), infections (44.1% vs. 40.2%), and serious infections (5.5% vs. 3.0%). CONCLUSIONS Vedolizumab-treated patients with active Crohn's disease were more likely than patients receiving placebo to have a remission, but not a CDAI-100 response, at week 6; patients with a response to induction therapy who continued to receive vedolizumab (rather than switching to placebo) were more likely to be in remission at week 52. Adverse events were more common with vedolizumab. (Funded by Millennium Pharmaceuticals; GEMINI 2 ClinicalTrials.gov number, NCT00783692.).
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, University of California, San Diego, La Jolla, CA 92093-0956, USA.
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187
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Feagan BG, Rutgeerts P, Sands BE, Hanauer S, Colombel JF, Sandborn WJ, Van Assche G, Axler J, Kim HJ, Danese S, Fox I, Milch C, Sankoh S, Wyant T, Xu J, Parikh A. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med 2013; 369:699-710. [PMID: 23964932 DOI: 10.1056/nejmoa1215734] [Citation(s) in RCA: 1637] [Impact Index Per Article: 148.8] [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: 12/12/2022]
Abstract
BACKGROUND Gut-selective blockade of lymphocyte trafficking by vedolizumab may constitute effective treatment for ulcerative colitis. METHODS We conducted two integrated randomized, double-blind, placebo-controlled trials of vedolizumab in patients with active disease. In the trial of induction therapy, 374 patients (cohort 1) received vedolizumab (at a dose of 300 mg) or placebo intravenously at weeks 0 and 2, and 521 patients (cohort 2) received open-label vedolizumab at weeks 0 and 2, with disease evaluation at week 6. In the trial of maintenance therapy, patients in either cohort who had a response to vedolizumab at week 6 were randomly assigned to continue receiving vedolizumab every 8 or 4 weeks or to switch to placebo for up to 52 weeks. A response was defined as a reduction in the Mayo Clinic score (range, 0 to 12, with higher scores indicating more active disease) of at least 3 points and a decrease of at least 30% from baseline, with an accompanying decrease in the rectal bleeding subscore of at least 1 point or an absolute rectal bleeding subscore of 0 or 1. RESULTS Response rates at week 6 were 47.1% and 25.5% among patients in the vedolizumab group and placebo group, respectively (difference with adjustment for stratification factors, 21.7 percentage points; 95% confidence interval [CI], 11.6 to 31.7; P<0.001). At week 52, 41.8% of patients who continued to receive vedolizumab every 8 weeks and 44.8% of patients who continued to receive vedolizumab every 4 weeks were in clinical remission (Mayo Clinic score ≤2 and no subscore >1), as compared with 15.9% of patients who switched to placebo (adjusted difference, 26.1 percentage points for vedolizumab every 8 weeks vs. placebo [95% CI, 14.9 to 37.2; P<0.001] and 29.1 percentage points for vedolizumab every 4 weeks vs. placebo [95% CI, 17.9 to 40.4; P<0.001]). The frequency of adverse events was similar in the vedolizumab and placebo groups. CONCLUSIONS Vedolizumab was more effective than placebo as induction and maintenance therapy for ulcerative colitis. (Funded by Millennium Pharmaceuticals; GEMINI 1 ClinicalTrials.gov number, NCT00783718.).
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Affiliation(s)
- Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, and Department of Medicine, University of Western Ontario, London, Canada.
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Abstract
Crohn's disease and ulcerative colitis are heterogeneous conditions with highly variable courses of disease. Recent studies have focused on the time soon after diagnosis as a potential window of opportunity before which complicated disease behaviors have ensued and in which attaining adequate control of the inflammatory process might improve long-term outcomes. This review covers the use of immune suppression and biological therapy early in the course of inflammatory bowel disease. It includes the rationale for using these medications earlier, the features of early disease that may lead to improved outcomes with early intervention, the most optimal strategies for early treatment, the benefits of early intervention and the risks of this approach. In addition, we discuss the issue of which patients to choose for early intervention through risk stratification.
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Affiliation(s)
- Bruce E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Mount Sinai School of Medicine, New York, NY 10029, USA. bruce.sands @ mssm.edu
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Hueber W, Sands BE, Lewitzky S, Vandemeulebroecke M, Reinisch W, Higgins PDR, Wehkamp J, Feagan BG, Yao MD, Karczewski M, Karczewski J, Pezous N, Bek S, Bruin G, Mellgard B, Berger C, Londei M, Bertolino AP, Tougas G, Travis SPL. Secukinumab, a human anti-IL-17A monoclonal antibody, for moderate to severe Crohn's disease: unexpected results of a randomised, double-blind placebo-controlled trial. Gut 2012; 61:1693-700. [PMID: 22595313 PMCID: PMC4902107 DOI: 10.1136/gutjnl-2011-301668] [Citation(s) in RCA: 1099] [Impact Index Per Article: 91.6] [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: 12/12/2022]
Abstract
OBJECTIVE The authors tested whether the anti-interleukin (IL)-17A monoclonal antibody secukinumab was safe and effective for the treatment of active Crohn's disease. DESIGN In a double-blind, randomised, placebo-controlled proof-of-concept study, 59 patients with moderate to severe Crohn's disease (Crohn's Disease Activity Index (CDAI) ≥220 to ≤450) were assigned in a 2:1 ratio to 2×10 mg/kg intravenous secukinumab or placebo. The primary end point, addressed by bayesian statistics augmented with historical placebo information, was the probability that secukinumab reduces the CDAI by ≥50 points more than placebo at week 6. Ancillary analyses explored associations of 35 candidate genetic polymorphisms and faecal calprotectin response. RESULTS 59 patients (39 secukinumab, 20 placebo, mean baseline CDAI 307 and 301, respectively) were recruited. 18/59 (31%) patients discontinued prematurely (12/39 (31%) secukinumab, 6/20 (30%) placebo), 10/59 (17%) due to insufficient therapeutic effect (8/39 (21%) secukinumab, 2/20 (10%) placebo). Fourteen serious adverse events occurred in 10 patients (seven secukinumab, three placebo); 20 infections, including four local fungal infections, were seen on secukinumab versus none on placebo. Primary end point analysis estimated <0.1% probability (CDAI (SD) =33.9 (19.7), 95% credible interval -4.9 to 72.9) that secukinumab reduces CDAI by ≥50 points more than placebo. Secondary area under the curve analysis (weeks 4-10) showed a significant difference (mean ΔCDAI=49; 95% CI (2 to 96), p=0.043) in favour of placebo. Post hoc subgroup analysis showed that unfavourable responses on secukinumab were driven by patients with elevated inflammatory markers (CRP≥10 mg/l and/or faecal calprotectin≥200 ng/ml; mean ΔCDAI=62; 95% CI (-1 to 125), p=0.054 in favour of placebo). Absence of the minor allele of tumour necrosis factor-like ligand 1A was strongly associated with lack of response measured by baseline-adjusted changes in calprotectin at week 6 (p=0.00035 Bonferroni-corrected). CONCLUSIONS Blockade of IL-17A was ineffective and higher rates of adverse events were noted compared with placebo. CLINICAL TRIAL REGISTRATION This trial was registered at ClinicalTrial.gov with the number NCT01009281.
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Affiliation(s)
- Wolfgang Hueber
- Novartis Institutes for BioMedical Research, Basel, Switzerland.
| | | | - Steve Lewitzky
- Novartis Institutes for BioMedical Research, Cambridge, Massachusetts, USA
| | | | | | | | - Jan Wehkamp
- IKB Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Brian G Feagan
- Robarts Research Institute University of Western Ontario, London, Ontario, Canada
| | - Michael D Yao
- National Institutes of Health, Bethesda, Maryland, USA
| | | | | | | | - Stephan Bek
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Gerard Bruin
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Bjoern Mellgard
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Claudia Berger
- Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Marco Londei
- Novartis Genomics Institute of the Novartis Research Foundation, San Diego, USA
| | | | | | - Simon P L Travis
- Translational Gastroenterology Unit, Nuffield Department of Experimental Medicine, University of Oxford, Oxford, UK
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Dhanda AD, Creed TJ, Greenwood R, Sands BE, Probert CS. Can endoscopy be avoided in the assessment of ulcerative colitis in clinical trials? Inflamm Bowel Dis 2012; 18:2056-62. [PMID: 22271464 DOI: 10.1002/ibd.22879] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 12/19/2011] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is no gold standard index in the measurement of ulcerative colitis (UC) disease activity in clinical trials. Mucosal healing has been described as an important clinical endpoint requiring endoscopic assessment, which is unpleasant for the patient and may hamper recruitment to trials. The aim of this study was to determine whether endoscopy is necessary in the assessment of UC disease activity and whether a noninvasive disease activity index (partial Mayo score) could be used to predict the Mayo score. METHODS In all, 149 subjects with moderate to severe UC enrolled in a clinical trial were assessed using total and partial Mayo scores. Histologic assessment of biopsies was performed. A regression model was constructed to predict total Mayo score from the partial Mayo score and histology score from the Mayo score. A Bland-Altman test of agreement was performed. RESULTS The partial Mayo score correlated closely with the total Mayo score at week 4 (rho = 0.97) and week 8 (rho = 0.98). The model to predict total from partial Mayo score showed excellent correlation (rho = 0.97) and good agreement with the total Mayo score at week 4 and the week 8 validation set (rho = 0.97) and accurately classified disease severity (kappa = 0.82). The model to predict histology score from the Mayo score correlated only moderately with the actual histology score at week 4 (rho = 0.59) and week 8 (rho = 0.36). CONCLUSIONS The Mayo score can be accurately predicted from the partial Mayo score. A noninvasive index can replace the Mayo score in future clinical trials.
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Affiliation(s)
- Ashwin D Dhanda
- School of Clinical Sciences, University of Bristol, Bristol, UK.
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191
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Sandborn WJ, Gasink C, Gao LL, Blank MA, Johanns J, Guzzo C, Sands BE, Hanauer SB, Targan S, Rutgeerts P, Ghosh S, de Villiers WJS, Panaccione R, Greenberg G, Schreiber S, Lichtiger S, Feagan BG. Ustekinumab induction and maintenance therapy in refractory Crohn's disease. N Engl J Med 2012; 367:1519-28. [PMID: 23075178 DOI: 10.1056/nejmoa1203572] [Citation(s) in RCA: 779] [Impact Index Per Article: 64.9] [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: 12/12/2022]
Abstract
BACKGROUND In patients with Crohn's disease, the efficacy of ustekinumab, a human monoclonal antibody against interleukin-12 and interleukin-23, is unknown. METHODS We evaluated ustekinumab in adults with moderate-to-severe Crohn's disease that was resistant to anti-tumor necrosis factor (TNF) treatment. During induction, 526 patients were randomly assigned to receive intravenous ustekinumab (at a dose of 1, 3, or 6 mg per kilogram of body weight) or placebo at week 0. During the maintenance phase, 145 patients who had a response to ustekinumab at 6 weeks underwent a second randomization to receive subcutaneous injections of ustekinumab (90 mg) or placebo at weeks 8 and 16. The primary end point was a clinical response at 6 weeks. RESULTS The proportions of patients who reached the primary end point were 36.6%, 34.1%, and 39.7% for 1, 3, and 6 mg of ustekinumab per kilogram, respectively, as compared with 23.5% for placebo (P=0.005 for the comparison with the 6-mg group). The rate of clinical remission with the 6-mg dose did not differ significantly from the rate with placebo at 6 weeks. Maintenance therapy with ustekinumab, as compared with placebo, resulted in significantly increased rates of clinical remission (41.7% vs. 27.4%, P=0.03) and response (69.4% vs. 42.5%, P<0.001) at 22 weeks. Serious infections occurred in 7 patients (6 receiving ustekinumab) during induction and 11 patients (4 receiving ustekinumab) during maintenance. Basal-cell carcinoma developed in 1 patient receiving ustekinumab. CONCLUSIONS Patients with moderate-to-severe Crohn's disease that was resistant to TNF antagonists had an increased rate of response to induction with ustekinumab, as compared with placebo. Patients with an initial response to ustekinumab had significantly increased rates of response and remission with ustekinumab as maintenance therapy. (Funded by Janssen Research and Development; CERTIFI ClinicalTrials.gov number, NCT00771667.).
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California 92093-0956, USA.
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Sands BE, Sandborn WJ, Creed TJ, Dayan CM, Dhanda AD, Van Assche GA, Greguš M, Sood A, Choudhuri G, Stempien MJ, Levitt D, Probert CS. Basiliximab does not increase efficacy of corticosteroids in patients with steroid-refractory ulcerative colitis. Gastroenterology 2012; 143:356-64.e1. [PMID: 22549092 DOI: 10.1053/j.gastro.2012.04.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [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: 01/18/2012] [Revised: 04/04/2012] [Accepted: 04/19/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Basiliximab is a chimeric monoclonal antibody that binds CD25 and thereby inhibits interleukin (IL)-2-mediated proliferation of lymphocytes. IL-2 might contribute to the resistance of T cells to corticosteroids. We investigated the efficacy and safety of basiliximab as a corticosteroid-sensitizing agent in patients with corticosteroid-refractory ulcerative colitis (UC). METHODS We studied 149 patients with moderate to severe UC (Mayo score ≥6 and endoscopic subscore ≥2) despite treatment for at least 14 days with oral prednisone (40-50 mg/day). Subjects were randomly assigned to groups that were given 20 mg (n = 46) or 40 mg (n = 52) basiliximab or placebo (n = 51) at weeks 0, 2, and 4. All subjects received 30 mg/day prednisone through week 2; the dose was reduced by 5 mg each week to 20 mg/day, which was maintained until week 8. At week 8, we compared the rates of clinical remission (Mayo score ≤2, no subscore >1) for patients given basiliximab with the rate for patients given placebo. RESULTS Twenty-eight percent of patients given placebo, 29% of those given the 40-mg dose of basiliximab, and 26% of those given the 20-mg dose of basiliximab achieved clinical remission (P = 1.00 vs placebo for each dose). Basiliximab was generally well tolerated. Six subjects who received basiliximab had serious adverse events (6.1%) compared with 2 who received placebo (3.9%; P = .72). In subjects given basiliximab, incomplete saturation of CD25 (<50%) on peripheral T cells was associated with the presence of anti-basiliximab antibodies (odds ratio, 21; 95% confidence interval, 2.4-184). CONCLUSIONS Basiliximab does not increase the effect of corticosteroids in the induction of remission in outpatients with corticosteroid-resistant moderate to severe UC.
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Sandborn WJ, Colombel JF, Sands BE, Rutgeerts P, Targan SR, Panaccione R, Bressler B, Geboes K, Schreiber S, Aranda R, Gujrathi S, Luo A, Peng Y, Salter-Cid L, Hanauer SB. Abatacept for Crohn's disease and ulcerative colitis. Gastroenterology 2012; 143:62-69.e4. [PMID: 22504093 DOI: 10.1053/j.gastro.2012.04.010] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [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: 12/26/2011] [Revised: 03/30/2012] [Accepted: 04/06/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The efficacy of abatacept, a selective costimulation modulator, in Crohn's disease (CD) and ulcerative colitis (UC) is unknown. METHODS Four placebo-controlled trials evaluated the efficacy and safety of abatacept as induction (IP) and maintenance (MP) therapy in adults with active, moderate-to-severe CD (CD-IP; CD-MP) and UC (UC-IP1; UC-MP). In CD-IP and UC-IP1, 451 patients with CD and 490 patients with UC were randomized to abatacept 30, 10, or 3 mg/kg (according to body weight) or placebo, and dosed at weeks 0, 2, 4, and 8. In MP, 90 patients with CD and 131 patients with UC who responded to abatacept at week 12 in the induction trials were randomized to abatacept 10 mg/kg or placebo every 4 weeks through week 52. RESULTS In CD-IP, 17.2%, 10.2%, and 15.5% of patients receiving abatacept 30, 10, and 3 mg/kg achieved a clinical response at weeks 8 and 12, vs 14.4% receiving placebo (P = .611, P = .311, and P = .812, respectively). In UC-IP1, 21.4%, 19.0%, and 20.3% of patients receiving abatacept 30, 10, and 3 mg/kg achieved a clinical response at week 12, vs 29.5% receiving placebo (P = .124, P = .043, and P = .158, respectively). In CD-MP, 23.8% vs 11.1% of abatacept vs placebo patients were in remission at week 52. In UC-MP, 12.5% vs 14.1% of patients receiving abatacept vs placebo were in remission at week 52. Safety generally was comparable between groups. CONCLUSIONS The studies showed that abatacept is not efficacious for the treatment of moderate-to-severe CD or UC.
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Affiliation(s)
- William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, 92093-0956,USA.
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Morgan XC, Tickle TL, Sokol H, Gevers D, Devaney KL, Ward DV, Reyes JA, Shah SA, LeLeiko N, Snapper SB, Bousvaros A, Korzenik J, Sands BE, Xavier RJ, Huttenhower C. Dysfunction of the intestinal microbiome in inflammatory bowel disease and treatment. Genome Biol 2012; 13:R79. [PMID: 23013615 PMCID: PMC3506950 DOI: 10.1186/gb-2012-13-9-r79] [Citation(s) in RCA: 1877] [Impact Index Per Article: 156.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 09/13/2012] [Accepted: 09/26/2012] [Indexed: 02/06/2023] Open
Abstract
Background The inflammatory bowel diseases (IBD) Crohn's disease and ulcerative colitis result from alterations in intestinal microbes and the immune system. However, the precise dysfunctions of microbial metabolism in the gastrointestinal microbiome during IBD remain unclear. We analyzed the microbiota of intestinal biopsies and stool samples from 231 IBD and healthy subjects by 16S gene pyrosequencing and followed up a subset using shotgun metagenomics. Gene and pathway composition were assessed, based on 16S data from phylogenetically-related reference genomes, and associated using sparse multivariate linear modeling with medications, environmental factors, and IBD status. Results Firmicutes and Enterobacteriaceae abundances were associated with disease status as expected, but also with treatment and subject characteristics. Microbial function, though, was more consistently perturbed than composition, with 12% of analyzed pathways changed compared with 2% of genera. We identified major shifts in oxidative stress pathways, as well as decreased carbohydrate metabolism and amino acid biosynthesis in favor of nutrient transport and uptake. The microbiome of ileal Crohn's disease was notable for increases in virulence and secretion pathways. Conclusions This inferred functional metagenomic information provides the first insights into community-wide microbial processes and pathways that underpin IBD pathogenesis.
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Affiliation(s)
- Xochitl C Morgan
- Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA
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Travis SPL, Schnell D, Krzeski P, Abreu MT, Altman DG, Colombel JF, Feagan BG, Hanauer SB, Lémann M, Lichtenstein GR, Marteau PR, Reinisch W, Sands BE, Yacyshyn BR, Bernhardt CA, Mary JY, Sandborn WJ. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gut 2012; 61:535-42. [PMID: 21997563 PMCID: PMC3292713 DOI: 10.1136/gutjnl-2011-300486] [Citation(s) in RCA: 376] [Impact Index Per Article: 31.3] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC). OBJECTIVE To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated. DESIGN A two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0-11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0-100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors. RESULTS There was 76% agreement for 'severe', but 27% agreement for 'normal' appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR(2), Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity). CONCLUSION The Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall assessment of endoscopic severity of UC. Validity and responsiveness need further testing before it can be applied as an outcome measure in clinical trials or clinical practice.
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Affiliation(s)
- Simon P L Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
| | | | | | - Maria T Abreu
- Division of Gastroenterology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | - Brian G Feagan
- Robarts Clinical Trials, Robarts Research Institute, University of Western Ontario, Ontario, Canada
| | - Stephen B Hanauer
- Section of Gastroenterology & Nutrition, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Marc Lémann
- Service de Gastroentérologie, Université Paris Diderot, Hôpital St Louis, Paris, France
| | - Gary R Lichtenstein
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Phillippe R Marteau
- AP-HP, Hôpital Lariboisière Medicosurgical Department of Digestive Diseases and University Denis Diderot, Paris, France
| | - Walter Reinisch
- Universitätsklinik Innere Medizin III, Abteilung Gastroenterologie und Hepatologie, Medical University of Vienna, Vienna, Austria
| | | | - Bruce R Yacyshyn
- Division of Digestive Diseases, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Jean-Yves Mary
- INSERM U717 Biostatistics and Clinical Epidemiology, Université Paris Diderot, Paris, France
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
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197
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Travis SPL, Schnell D, Krzeski P, Abreu MT, Altman DG, Colombel JF, Feagan BG, Hanauer SB, Lémann M, Lichtenstein GR, Marteau PR, Reinisch W, Sands BE, Yacyshyn BR, Bernhardt CA, Mary JY, Sandborn WJ. Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). Gut 2012. [PMID: 21997563 DOI: 10.1136/gutjnl-2011-300486[publishedonlinefirst:2011/10/15]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC). OBJECTIVE To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated. DESIGN A two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0-11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0-100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors. RESULTS There was 76% agreement for 'severe', but 27% agreement for 'normal' appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR(2), Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity). CONCLUSION The Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall assessment of endoscopic severity of UC. Validity and responsiveness need further testing before it can be applied as an outcome measure in clinical trials or clinical practice.
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Affiliation(s)
- Simon P L Travis
- Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, UK.
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198
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Abstract
BACKGROUND Influenza vaccination is recommended for patients with inflammatory bowel disease (IBD). The 2009 H1N1 influenza vaccine produced seroprotection rates of >85% in the general population but there are no data on the immunogenicity of the vaccine in patients with IBD. METHODS An observational prospective open-label study was conducted to examine the immunogenicity of the 2009 H1N1 influenza vaccine in 108 patients with IBD. Patient details, medications and disease activity were recorded. Pre- and post-vaccination haemagglutinin inhibition titres and geometric mean titres were measured. A functional assay of T lymphocyte activity was measured at vaccination in a subset of patients as an alternative measure of immunosuppression. Subjects were followed for 6 months post-vaccination. RESULTS Of 108 patients enrolled, 105 completed the study. The post-vaccination seroprotection rate was 50%. Immunosuppressed subjects had a lower rate of seroprotection than non-immunosuppressed subjects (44% vs 64%, p=0.06). The proportion with seroprotection was significantly lower in subjects on combination immunosuppression than in those receiving no immunosuppression (36% vs 64%, p=0.02). Patients receiving combined immunosuppression had a significantly lower fold increase in geometric mean titres than those on monotherapy immunosuppression (3.5 vs 11.5, p=0.03). An assay of T lymphocyte activity was performed in a subgroup of 48 subjects. Those with intermediate activity had lower seroprotection than those with high activity (28% vs 61%, p=0.02). The vaccine was well tolerated. CONCLUSIONS Patients with IBD vaccinated with the 2009 H1N1 influenza vaccine had a low rate of seroprotection, particularly among those who were immunosuppressed. Although there is a need for studies of the clinical benefit of vaccines in this population, patients with IBD need to be aware of this reduced immunogenicity.
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Affiliation(s)
- Garret Cullen
- Crohn's and Colitis Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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199
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Reinisch W, Sandborn WJ, Rutgeerts P, Feagan BG, Rachmilewitz D, Hanauer SB, Lichtenstein GR, de Villiers WJS, Blank M, Lang Y, Johanns J, Colombel JF, Present D, Sands BE. Long-term infliximab maintenance therapy for ulcerative colitis: the ACT-1 and -2 extension studies. Inflamm Bowel Dis 2012; 18:201-11. [PMID: 21484965 DOI: 10.1002/ibd.21697] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [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: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim was to evaluate long-term efficacy, quality of life, and safety in ulcerative colitis patients who received infliximab during the ACT-1 and -2 extension studies. METHODS Adults with moderate-to-severely active ulcerative colitis in the 54-week ACT-1 and 30-week ACT-2 studies who achieved benefit from infliximab were eligible to participate in extension studies and receive up to 3 additional years of therapy. Patients received randomized study medication until all sites were unblinded; placebo-treated patients were discontinued. Patients receiving 5 or 10 mg/kg infliximab continued to receive open-label infliximab every 8 weeks. Patients receiving infliximab 10 mg/kg could decrease to 5 mg/kg; patients receiving infliximab 5 mg/kg could increase to 10 mg/kg if response was lost. RESULTS A total of 229 of 484 infliximab-treated patients from the ACT-1 and ACT-2 main studies entered the long-term extensions. Overall, 70 (30.6%) patients discontinued infliximab infusions for adverse events (24 [10.5%]), lack of efficacy (11 [4.8%]), required a colectomy (1 [0.4%]), or for other reasons (34 [14.8%]). Proportions of patients whose Physician's Global Assessment scores were indicative of no or mild disease (score = 0 or 1) were maintained during the extension studies; 76.5% at Extension week 0 and ranged between 90.0% and 94.3% through Extension week 152. Improvement in Inflammatory Bowel Disease Questionnaire scores observed in the main studies was maintained. During the long-term extension, the infliximab safety profile was consistent with that of the main studies; no new or unexpected safety signals were observed. CONCLUSIONS Long-term treatment with infliximab for up to 3 additional years was effective and well tolerated.
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Affiliation(s)
- Walter Reinisch
- Department of Gastroenterology and Hepatology, Univ Klinik Innere Medizin III, AKH Wien, Vienna, Austria.
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200
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Saha S, Lam M, Roberson E, Shah S, LeLeiko NS, Lidofsky S, Bright R, Flowers N, Merrick M, Sands BE. Evaluation of possible inflammatory bowel disease: a survey of Rhode Island physicians. Med Health R I 2012; 95:4-8. [PMID: 22439454 PMCID: PMC3638801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Patients with undiagnosed inflammatory bowel disease (IBD) are often evaluated initially by primary care physicians (PCPs). Despite the frequency with which PCPs evaluate chronic abdominal pain and chronic diarrhea, little is known about how they approach these symptoms. OBJECTIVES To determine the diagnostic practices and referral patterns of PCPs when confronting a patient with potential IBD. METHODS We conducted a mail survey of PCPs practicing in Rhode Island. Clinical vignettes describing patients with chronic abdominal pain and chronic diarrhea were presented. Respondents were asked to indicate how they would evaluate these scenarios and when they would refer to a specialist. RESULTS 432 PCPs were surveyed; 35.6% responded. Wide variation in PCPs' definitions of chronic abdominal pain and chronic diarrhea was found, with only 26% and 51% of physicians, respectively, defining these symptoms to be chronic per standard definitions. Laboratory testing was found to vary significantly with practice type (p < 0.01 for 2 patient groups). Patient age influenced the ordering of diagnostic imaging (p < 0.0001), while patient gender did not. CONCLUSIONS There is significant variability among PCPs in the threshold after which common gastrointestinal symptoms become chronic as well as in their diagnostic evaluation of these symptoms. This variability may lead to a lag in the diagnosis of IBD and influence patient outcomes.
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Affiliation(s)
| | | | - Erica Roberson
- Gastroenterology Fellow, Division of Gastroenterology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L461, Portland, OR 97239-3098, Phone: (503) 494-2270, Fax: (503) 494-8776
| | - Samir Shah
- Clinical Associate Professor of Medicine, Warren Alpert Medical School of Brown University, Gastroenterology Associates, 44 West River Street, Providence, RI 02904, Phone: 401-274-4800, Fax: 401-454-0410
| | - Neal S. LeLeiko
- Professor of Pediatrics, Warren Alpert Medical School of Brown University, Hasbro Children’s Hospital, Rhode Island Hospital, 593 Eddy Street, MPH 138, Providence, RI 02903, Phone: (401) 444-4917, Fax: (401) 444-8748
| | - Sheldon Lidofsky
- Clinical Assistant Professor of Medicine, Warren Alpert Medical School of Brown University, University Gastroenterology, 33 Staniford Street, Providence, RI 02905, Phone: 401-421-8800, Fax: 401-751-4029
| | - Renee Bright
- Research Supervisor, Rhode Island Hospital, Department of Gastroenterology, Providence, RI 02903, Phone: 401-444-4143, Fax: 404-444-4283
| | - Nicole Flowers
- Division of Adult and Community Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K-67, Atlanta, GA 30341, Phone: 770-730-9179, Fax: 770-488-5965
| | - Marjorie Merrick
- Vice President of Research and Scientific Programs, Crohn’s & Colitis Foundation of America, 386 Park Avenue South - 17th floor, New York, NY 10016, Phone: 646-943-7484, Fax: (212) 679-3567
| | - Bruce E. Sands
- Professor of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1069, New York, NY 10029, Phone: 212-241-6744, Fax: 212-241-5142
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