151
|
Dal Buono A, Faita F, Peyrin-Biroulet L, Danese S, Allocca M. Ultrasound Elastography in Inflammatory Bowel Diseases: A Systematic Review of Accuracy Compared with Histopathological Assessment. J Crohns Colitis 2022; 16:1637-1646. [PMID: 35696668 PMCID: PMC9624288 DOI: 10.1093/ecco-jcc/jjac082] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/09/2022] [Accepted: 06/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Ultrasound elastography [USE] is an innovative, non-invasive, promptly available, ancillary technique that has been proposed in the evaluation of intestinal fibrosis as a monitorable biomarker, in terms of stiffness. The non-invasive estimate of fibrosis by USE appears appealing for dedicated physicians, in order to optimise the treatments for inflammatory bowel disease [IBD] patients [surgical vs non-surgical]. We aimed to systematically review literature evidence on ultrasound elastography in IBD patients. METHODS For this qualitative systematic review, we searched PubMed, EMBASE, and Scopus to identify all studies, published until October 2021, investigating the application of USE in IBD patients compared with histopathological assessment. RESULTS Overall, 12 papers published between 2011 and 2019 were included. A total of 275 IBD patients were included: 272 Crohn's disease [CD] [98.9%] and three ulcerative colitis [UC] [1.1%]. Seven [58.3%] and four [41.6%] studies investigated strain elastography [SE] and shear wave elastography [SWE], respectively; in one study [0.1%] both techniques were addressed. The histological evaluation was largely conducted on surgical specimens and in two studies endoscopic biopsies were also included. The histological assessment was semi-quantitative in all the included studies, except for two where the fibrosis was evaluated only qualitatively. In 10/12 publications USE could accurately distinguish inflammation from fibrosis in the examined bowel tracts. CONCLUSIONS From the preliminary available data, an overall moderate-to-good accuracy of USE in detecting histological fibrosis [10/12 studies] was found. Point-shear wave elastography has been shown to perform superiorly. Further studies are needed to confirm these evidences.
Collapse
Affiliation(s)
- Arianna Dal Buono
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Francesco Faita
- Italian National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, and University Vita-Salute San Raffaele, Milan, Italy
| | - Mariangela Allocca
- Corresponding author: Mariangela Allocca, MD, PhD, IBD Center, Department of Gastroenterology, Ospedale Vita-Salute San Raffaele, IRCCS, Milan, Italy. Tel.: +39026432069; E-mail:
| |
Collapse
|
152
|
Peyrin-Biroulet L, Arkkila P, Armuzzi A, Danese S, Guardiola J, Jahnsen J, Lees C, Louis E, Lukáš M, Reinisch W, Roblin X, Jang M, Byun HG, Kim DH, Lee SJ, Atreya R. Comparative efficacy and safety of infliximab and vedolizumab therapy in patients with inflammatory bowel disease: a systematic review and meta-analysis. BMC Gastroenterol 2022; 22:291. [PMID: 35676620 PMCID: PMC9178865 DOI: 10.1186/s12876-022-02347-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/24/2022] [Indexed: 02/08/2023] Open
Abstract
Background and aims There are limited comparative data for infliximab and vedolizumab in inflammatory bowel disease patients.
Methods We conducted a systematic review and meta-analysis to compare the efficacy and safety of infliximab and vedolizumab in adult patients with moderate-to-severe Crohn’s disease or ulcerative colitis. Results We identified six eligible Crohn’s disease and seven eligible ulcerative colitis trials that randomised over 1900 participants per disease cohort to infliximab or vedolizumab. In the Crohn’s disease and ulcerative colitis cohorts, infliximab yielded better efficacy than vedolizumab for all analysed outcomes (CDAI-70, CDAI-100 responses, and clinical remission for Crohn’s disease and clinical response and clinical remission for ulcerative colitis) during the induction phase, with non-overlapping 95% confidence intervals. In the maintenance phase, similar proportions of infliximab- or vedolizumab-treated patients achieved clinical response, clinical remission, or mucosal healing in both Crohn’s disease and ulcerative colitis. For the safety outcomes, rates of adverse events, serious adverse events, and discontinuations due to adverse events were similar in infliximab- and vedolizumab-treated patients in both diseases. The infection rate was higher in infliximab for Crohn’s disease and higher in vedolizumab when treating patients with ulcerative colitis. There was no difference between the treatments in the proportions of patients who reported serious infections in both indications. Conclusions Indirect comparison of infliximab and vedolizumab trials in adult patients with moderate-to severe Crohn’s disease or ulcerative colitis demonstrated that infliximab has better efficacy in the induction phase and comparable efficacy during the maintenance phase and overall safety profile compared to vedolizumab. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02347-1.
Collapse
Affiliation(s)
| | - Perttu Arkkila
- Department of Gastroenterology, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | | | - Silvio Danese
- Gastroenterology and Endoscopy, University Vita-Salute San Raffaele, Milan, Italy
| | - Jordi Guardiola
- Digestive Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jørgen Jahnsen
- Department of Gastroenterology, Institute of Clinical Medicine, Akershus University Hospital, University of Oslo, Oslo, Norway
| | - Charles Lees
- Center of Genomics and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Edouard Louis
- Department of Gastroenterology, University Hospital CHU of Liège, Liège, Belgium
| | - Milan Lukáš
- ISCARE Clinical Centre, Prague, Czech Republic
| | | | - Xavier Roblin
- University Hospital of Saint-Etienne, Saint-Etienne, France
| | | | | | | | | | - Raja Atreya
- Medical Department 1, University Hospital Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg, Ulmenweg 18, 91054, Erlangen, Germany.
| |
Collapse
|
153
|
Lavelle A, Nancey S, Reimund JM, Laharie D, Marteau P, Treton X, Allez M, Roblin X, Malamut G, Oeuvray C, Rolhion N, Dray X, Rainteau D, Lamaziere A, Gauliard E, Kirchgesner J, Beaugerie L, Seksik P, Peyrin-Biroulet L, Sokol H. Fecal microbiota and bile acids in IBD patients undergoing screening for colorectal cancer. Gut Microbes 2022; 14:2078620. [PMID: 35638103 PMCID: PMC9176255 DOI: 10.1080/19490976.2022.2078620] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 02/04/2023] Open
Abstract
Due to the potential role of the gut microbiota and bile acids in the pathogenesis of both inflammatory bowel disease (IBD) and sporadic colorectal cancer, we aimed to determine whether these factors were associated with colorectal cancer in IBD patients. 215 IBD patients and 51 non-IBD control subjects were enrolled from 10 French IBD centers between September 2011 and July 2018. Fecal samples were processed for bacterial 16S rRNA gene sequencing and bile acid profiling. Demographic, clinical, endoscopic, and histological outcomes were recorded. Characteristics of IBD patients included: median age: 41.6 (IQR 22); disease duration 13.2 (13.1); 47% female; 21.9% primary sclerosing cholangitis; 109 patients with Crohn's disease (CD); 106 patients with ulcerative colitis (UC). The prevalence of cancer was 2.8% (6/215: 1 CD; 5 UC), high-grade dysplasia 3.7% (8/215) and low-grade dysplasia 7.9% (17/215). Lachnospira was decreased in IBD patients with cancer, while Agathobacter was decreased and Escherichia-Shigella increased in UC patients with any neoplasia. Bile acids were not associated with cancer or neoplasia. Unsupervised clustering identified three gut microbiota clusters in IBD patients associated with bile acid composition and clinical features, including a higher risk of neoplasia in UC in two clusters when compared to the third (relative risk (RR) 4.07 (95% CI 1.6-10.3, P < .01) and 3.56 (95% CI 1.4-9.2, P < .01)). In this multicentre observational study, a limited number of taxa were associated with neoplasia and exploratory microbiota clusters co-associated with clinical features, including neoplasia risk in UC. Given the very small number of cancers, the robustness of these findings will require assessment and validation in future studies.
Collapse
Affiliation(s)
- Aonghus Lavelle
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France,APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Stéphane Nancey
- Gastroenterology Department University Claude Bernard Lyon 1Hospices Civils de Lyon, CHU Lyon-Sud, Lyon, France
| | - Jean-Marie Reimund
- Hôpital de Hautpierre, CHU de Strasbourg, Service d’Hépato-gastroentérologie et Assistance Nutritive, Strasbourg, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d’Hépato-gastroentérologie et oncologie digestive – Université de Bordeaux, Bordeaux, France
| | - Philippe Marteau
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Tenon Hospital, Paris, France
| | - Xavier Treton
- Gastroentérologie, MICI et Assistance Nutritive, DMU DIGEST, hôpital Beaujon, 100 bd du général Leclerc, Clichy, France
| | - Matthieu Allez
- Department of Hepato-Gastroenterology, Hôpital Saint-Louis, Paris, France
| | - Xavier Roblin
- Gastroenterology Department, CHU de Saint-Étienne - Hôpital Bellevue, St Etienne, France
| | - Georgia Malamut
- Gastroenterology Department, Hôpital Européen Georges-Pompidou, Paris, France
| | - Cyriane Oeuvray
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Nathalie Rolhion
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Xavier Dray
- Sorbonne University, Endoscopy Unit, AP-HP, Hôpital Saint-Antoine, Paris, France
| | - Dominique Rainteau
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Antonin Lamaziere
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Emilie Gauliard
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Julien Kirchgesner
- Paris Centre for Microbiome Medicine FHU, Paris, France,Department of Gastroenterology, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Laurent Beaugerie
- Paris Centre for Microbiome Medicine FHU, Paris, France,Department of Gastroenterology, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Paris, France
| | - Philippe Seksik
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Nancy, France,Inserm NGERE, Université de Lorraine, Vandœuvre-Lès-Nancy, France,FHU Cure, Nancy, France
| | - Harry Sokol
- Gastroenterology Department, Sorbonne University, INSERM, Centre de Recherche Saint-Antoine, CRSA, AP-HP, Saint Antoine Hospital, Paris, France,Paris Centre for Microbiome Medicine FHU, Paris, France,INRA, UMR1319 Micalis & AgroParisTech, Jouy en Josas, France,CONTACT Harry Sokol Gastroenterology Department, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75571Paris CEDEX 12, France
| |
Collapse
|
154
|
Massimino L, Spanò S, Lamparelli LA, Fuggetta D, Peyrin-Biroulet L, Sileri P, Danese S, D'Alessio S, Ungaro F. Tofacitinib Inhibits Leukocyte Trafficking Across the Intestinal Endothelial Barrier in a Specific Cohort of Ulcerative Colitis Patients. Inflamm Bowel Dis 2022; 28:971-976. [PMID: 35032171 DOI: 10.1093/ibd/izab349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Indexed: 12/09/2022]
Abstract
Lay Summary
The JAK/STAT inhibitor tofacitinib, recently approved for the treatment of ulcerative colitis, is found to modulate the intestinal endothelial barrier functions in directing the leukocyte adhesion and transmigration in ulcerative colitis patients displaying high levels of endothelial STAT3/STAT6 phosphorylation.
Collapse
Affiliation(s)
- Luca Massimino
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele Hospital, Milan, Italy
| | - Salvatore Spanò
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele Hospital, Milan, Italy
| | - Luigi Antonio Lamparelli
- Laboratory of Gastrointestinal Immunopathology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Davide Fuggetta
- Laboratory of Gastrointestinal Immunopathology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Laurent Peyrin-Biroulet
- INSERM NGERE, University of Lorraine, Vandoeuvre-les-Nancy, France.,Nancy University Hospital, Vandoeuvre-les-Nancy, France
| | - Pierpaolo Sileri
- Gastrointestinal Surgery Unit, IRCCS Ospedale San Raffaele, MilanItaly
| | - Silvio Danese
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele Hospital, Milan, Italy.,Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Federica Ungaro
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele Hospital, Milan, Italy.,Laboratory of Gastrointestinal Immunopathology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| |
Collapse
|
155
|
D'Haens GR, Sandborn WJ, Loftus EV, Hanauer SB, Schreiber S, Peyrin-Biroulet L, Panaccione R, Panés J, Baert F, Colombel JF, Ferrante M, Louis E, Armuzzi A, Zhou Q, Goteti VS, Mostafa NM, Doan TT, Petersson J, Finney-Hayward T, Song AP, Robinson AM, Danese S. Higher vs Standard Adalimumab Induction Dosing Regimens and Two Maintenance Strategies: Randomized SERENE CD Trial Results. Gastroenterology 2022; 162:1876-1890. [PMID: 35122766 DOI: 10.1053/j.gastro.2022.01.044] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 07/16/2021] [Revised: 01/07/2022] [Accepted: 01/25/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND & AIMS Dose-optimization strategies for biologic therapies in Crohn's disease (CD) are not well established. The SERENE CD (Study of a Novel Approach to Induction and Maintenance Dosing With Adalimumab in Patients With Moderate to Severe Crohn's Disease) trial evaluated higher vs standard adalimumab induction dosing and clinically adjusted (CA) vs therapeutic drug monitoring (TDM) maintenance strategies in patients with moderately to severely active CD. METHODS In this phase 3, randomized, double-blind, multicenter trial, eligible adults (Crohn's Disease Activity Index score of 220-450, endoscopic evidence of mucosal inflammation, and previous failure of standard therapies) were randomized to higher induction regimen (adalimumab 160 mg at weeks 0, 1, 2, and 3; n = 308) or standard induction regimen (adalimumab 160 mg at week 0 and 80 mg at week 2; n = 206) followed by 40 mg every other week from week 4 onward. Co-primary end points included clinical remission at week 4 and endoscopic response at week 12. At week 12, patients were re-randomized to maintenance therapy optimized by Crohn's Disease Activity Index and C-reactive protein (CA; n = 92) or serum adalimumab concentrations and/or clinical criteria (TDM; n = 92); exploratory end points were evaluated at week 56. RESULTS Similar proportions of patients receiving higher induction regimen and standard induction regimen achieved clinical remission at week 4 (44% in both; P = .939) and endoscopic response at week 12 (43% vs 39%, respectively, P = .462). Week 56 efficacy was similar between CA and TDM. Safety profiles were comparable between dosing regimens. CONCLUSIONS Higher induction regimen was not superior to standard induction regimen, and CA and TDM maintenance strategies were similarly efficacious. Adalimumab therapy was well tolerated, and no new safety concerns were identified. (ClinicalTrials.gov, Number: NCT02065570).
Collapse
Affiliation(s)
- Geert R D'Haens
- Amsterdam Gastroenterology Endocrinology Metabolism and Gastroenterology and Hepatology Departments, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - William J Sandborn
- Gastroenterology Department, University of California San Diego, La Jolla, California
| | - Edward V Loftus
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephen B Hanauer
- Department of Medicine (Gastroenterology and Hepatology), Northwestern University, Chicago, Illinois
| | - Stefan Schreiber
- Department of Internal Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Centre Hospitalier Règional Universitaire de Nancy, Nutrition-Genetics and Exposure to Environmental Risks, Institut National de la Santè et de la Recherche Mèdicale, University of Lorraine, Nancy, France
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Julián Panés
- Department of Gastroenterology, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute, Biomedical Research Networking Center in Hepatic and Digestive Diseases, Barcelona, Spain
| | - Filip Baert
- Department of Gastroenterology, AZ Delta, Roeselare-Menen, Belgium
| | - Jean-Frederic Colombel
- Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Edouard Louis
- Department of Gastroenterology, University Hospital Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Alessandro Armuzzi
- Inflammatory Bowel Diseases Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | | | | | | | | | | | | | | | | | - Silvio Danese
- Gastroenterology and Endoscopy, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
156
|
Schreiber S, Ben-Horin S, Alten R, Westhovens R, Peyrin-Biroulet L, Danese S, Hibi T, Takeuchi K, Magro F, An Y, Kim DH, Yoon S, Reinisch W. Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era. Adv Ther 2022. [DOI: 10.1007/s12325-021-01990-6
expr 982114691 + 941296860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
|
157
|
Soubrier M, Viguier M, Peyrin-Biroulet L, Czernichow S. AB1457 OPALE: A PROSPECTIVE OBSERVATIONAL STUDY OF THE REAL-WORLD USE OF AN ADALIMUMAB BIOSIMILAR AND EVALUATION OF NUTRITIONAL STATUS ON THE THERAPEUTIC RESPONSE. PATIENTS NUTRITIONAL STATUS AT BASELINE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundChronic inflammatory diseases treatment has been greatly improved since the introduction of TNF inhibitors and later, of their biosimilars. In addition, epidemiological and interventional studies suggest a pathophysiological or therapeutic role, respectively, of nutrition in Inflammatory Rheumatic Diseases (IRDs).ObjectivesThe objective of the OPALE observational study was to describe in real life the profile of patients treated with an adalimumab biosimilar and to assess the impact of nutrition on disease evolution and response to treatment.MethodsThe study planned a one-year follow-up of patients with at least three visits: inclusion, six months and one year. In this study, 754 patients treated with Fresenius-Kabi adalimumab were included: 54.4 % of patients with an IRD, 42.8 % with Inflammatory Bowel Disease (IBD) and 2.8 % patients with a psoriasis. Patients’ condition was assessed using a Clinical Global Impression of disease scale (CGI, primary end point of the study). Nutritional status was assessed through clinical data (weight, BMI (Body Mass Index), abdominal circumference) and the available biological analyses results. Screening for sarcopenia was based on a SARC-F score ≥ 4. Nutritional behavior was assessed using a diet questionnaire with a list of 48 foods divided into 6 classes (Fruits & vegetables, meat, fish & eggs, dairy products & fats, starchy foods, sweet foods and drinks). Foods voluntarily withdrawn due to illness and those avoided at acute flare-ups were recommended to be reported. This analysis aims to describe IRD patients’ nutritional status at baseline.ResultsFrom 754 included patients, 410 patients presented with an IRD (Psoriatic Arthritis (PsA), n= 80 / Rheumatoid Arthritis (RA), n=102 / SpondyloArthritis (SpA), n=228). Mean patients’ age was 47.7± 14.1 years, 56% are female, mean BMI was 26.0 ± 5.4 kg/m2. From this IRD population, 28.5% of patients have a family history of chronic inflammatory disease.Mean disease duration was of 6.4 ± 8.4 years. Concerning the previous IRD treatment, 47.4% of patients had previously been treated by methotrexate among them 58% were still receiving this treatment at inclusion. Among IRD patients recruited in OPALE study, 72.8% received Fresenius Kabi adalimumab as their first biotherapy. Most of patients were assessed on the CGI scale as markedly ill (50.7%) or moderately ill (29.9%) and 110 patients (37.3%) had a score ≥ 4 on the SARC-F questionnaire (mean age 48.9 ± 14.1 years and mean BMI 27.2 ±5.6 kg/m2).Concerning the disease history at baseline, the descriptive analysis of self-administered questionnaire shows that 68.3% of patients may have changed their nutritional behavior because of their illness, by banishing several foods (mean number: 12.7 ± 10.1). These restrictions are increased during flare-ups: 32.7% of patients removed an average of 6.0 ± 5.8 additional foods number. These changes are in part based on the patients’ own beliefs: 17% of them consider that certain foods can improve their illness, 35% of patients think they have identified the foods likely to make it worse (Table 1).Table 1.Patient-reported influence of certain foods on diseasePsARASpATOTAL IRD(n=60)(n=72)(n=177)(n=309)Patients identifying foods with negative influence21225810137.5% [24.9% - 51.5%]32.4% [21.5% - 44.8%]36.0% [28.6% - 44.0%]35.4% [29.9% - 41.3%]Patients identifying foods with positive influence912274816.4% [7.8% - 28.8%]17.6% [9.5% - 28.8%]17.2% [11.7% - 24.0%]17.1% [12.9% - 22.1%]ConclusionThese preliminary baseline data from OPALE observational study confirm the risk of decreased muscle mass in IRD. Mean BMI of patients screened for sarcopenia is higher than that of non-sarcopenic patients (respectively 27.2 ± 5.6 kg/m2 and 25.6 ± 4.8 kg/m2; p=0.02). These results plead for a systematic screening for sarcopenia in IRD patients. The risk of sarcopenia could be further aggravated by inappropriate nutritional behaviors aimed at excluding food groups, which would justify dietary education of these IRD patients.Disclosure of InterestsMartin SOUBRIER Consultant of: Fresenius Kabi, Manuelle VIGUIER Consultant of: Fresenius Kabi, Laurent Peyrin-Biroulet Consultant of: Fresenius Kabi, Sebastien Czernichow Consultant of: Fresenius Kabi
Collapse
|
158
|
Panés J, Colombel JF, D'Haens GR, Schreiber S, Panaccione R, Peyrin-Biroulet L, Loftus EV, Danese S, Tanida S, Okuyama Y, Louis E, Armuzzi A, Ferrante M, Vogelsang H, Hibi T, Watanabe M, Lefebvre J, Finney-Hayward T, Sanchez Gonzalez Y, Doan TT, Mostafa NM, Ikeda K, Xie W, Huang B, Petersson J, Kalabic J, Robinson AM, Sandborn WJ. Higher vs Standard Adalimumab Induction and Maintenance Dosing Regimens for Treatment of Ulcerative Colitis: SERENE UC Trial Results. Gastroenterology 2022; 162:1891-1910. [PMID: 35227777 DOI: 10.1053/j.gastro.2022.02.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 07/20/2021] [Revised: 02/02/2022] [Accepted: 02/20/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS SERENE UC (Study of a Novel Approach to Induction and Maintenance Dosing With Adalimumab in Patients With Moderate to Severe Ulcerative Colitis) evaluated the efficacy of higher adalimumab induction and maintenance dose regimens in patients with ulcerative colitis. METHODS This phase 3, double-blind, randomized trial included induction and maintenance studies, with a main study (ex-Japan) and Japan substudy. Eligible patients (18-75 years, full Mayo score 6-12, centrally read endoscopy subscore 2-3) were randomized 3:2 to higher induction regimen (adalimumab 160 mg at weeks 0, 1, 2, and 3) or standard induction regimen (160 mg at week 0 and 80 mg at week 2); all received 40 mg at weeks 4 and 6. At week 8, all patients were rerandomized 2:2:1 (main study) to 40 mg every week (ew), 40 mg every other week (eow), or exploratory therapeutic drug monitoring; or 1:1 (Japan substudy) to 40 mg ew or 40 mg eow maintenance regimens. RESULTS In the main study, 13.3% vs 10.9% of patients receiving the higher induction regimen vs standard induction regimen achieved clinical remission (full Mayo score ≤2 with no subscore >1) at week 8 (induction primary end point; P = .265); among week-8 responders, 39.5% vs 29.0% receiving 40 mg ew vs 40 mg eow achieved clinical remission at week 52 (maintenance primary end point; P = .069). In the integrated (main + Japan) population, 41.1% vs 30.1% of week-8 responders receiving 40 mg ew vs 40 mg eow achieved clinical remission at week 52 (nominal P = .045). Safety profiles were comparable between dosing regimens. CONCLUSION Although primary end points were not met, a >10% absolute difference in clinical remission was demonstrated with higher adalimumab maintenance dosing. Higher dosing regimens were generally well tolerated and consistent with the known safety profile of adalimumab in ulcerative colitis. CLINICALTRIALS gov, Number: NCT002209456.
Collapse
Affiliation(s)
- Julián Panés
- Hospital Clinic de Barcelona, August Pi i Sunyer Biomedical Research Institute, Biomedical Research Networking Center in Hepatic and Digestive Diseases, Barcelona, Spain.
| | | | - Geert R D'Haens
- Amsterdam Gastroenterology Endocrinology Metabolism and Gastroenterology and Hepatology Departments, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Stefan Schreiber
- Department of Internal Medicine, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Remo Panaccione
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Centre Hospitalier Régional Universitaire de Nancy, Nutrition-Genetics and Exposure to Environmental Risks, Institut National de la Santé et de la Recherche Médicale, University of Lorraine, Nancy, France
| | - Edward V Loftus
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Silvio Danese
- Gastroenterology and Endoscopy, Istituto di Ricovero e Cura a Carattere Scientifico, Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Satoshi Tanida
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Yusuke Okuyama
- Department of Gastroenterology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Edouard Louis
- Department of Gastroenterology, University Hospital Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Alessandro Armuzzi
- Inflammatory Bowel Diseases Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Toshifumi Hibi
- Center for Advanced Inflammatory Bowel Disease Research and Treatment, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Mamoru Watanabe
- Advanced Research Institute and Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - William J Sandborn
- Gastroenterology Department, University of California San Diego, La Jolla, California
| |
Collapse
|
159
|
Grandmougin A, D'Amico F, Remen T, Danese S, Bonneton M, Galloy MA, Peyrin-Biroulet L, Laurent V. Role of Cross-Sectional Imaging in Pediatric Inflammatory Bowel Disease. Dig Dis Sci 2022; 67:2462-2470. [PMID: 34159487 DOI: 10.1007/s10620-021-07016-z] [Citation(s) in RCA: 1] [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: 02/04/2021] [Accepted: 04/15/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The association between radiological remission and natural history of disease in children with inflammatory bowel diseases (IBD) is poorly known. AIMS (i) To assess the correlation between cross-sectional imaging (CSI) (ultrasound and magnetic resonance imaging) and clinical, biomarker and endoscopic disease activity; (ii) to evaluate the impact of radiological activity on the occurrence of complications in pediatric patients with IBD. METHODS A retrospective study including pediatric patients with IBD and radiological follow-up of at least one year was conducted between 2003 and 2019 at the Nancy University Hospital. RESULTS In total, 118 patients (66 Crohn's disease (CD) and 52 ulcerative colitis (UC)) were included. Median follow-up duration was 5.2 years (range: 1.1-15.4). Seventeen (25.8%) patients with CD and 7 (13.5%) patients with UC achieved and maintained radiological remission until last follow-up. No IBD patient achieving radiological remission experienced complications or relapse. In patients not achieving radiologic remission, complications and surgery occurred in 13/49 (26.5%) and 8/49 (16.3%) patients with CD and in 5/45 (11.1%) and 5 (11.1%) subjects with UC. Among patients with CD, the association for remission status between radiological and endoscopic assessment was excellent (Cramer's V test (V) = 0.50), and moderate between radiological and either clinical (V = 0.30) or biochemical (V = 0.33) assessments. In UC, the association for remission status between radiological and either endoscopic or clinical assessments were weak (V = 0.19 and V = 0.20 respectively), and moderate (V = 0.23) between radiological and biochemical assessments. CONCLUSION CSI may replace endoscopic monitoring in pediatric CD. Radiological remission status predicts long-term disease outcomes.
Collapse
Affiliation(s)
- Aurélie Grandmougin
- Department of Radiology, Nancy University Hospital, Lorraine University, 1 Allée du Morvan, 54511, Vandoeuvre-lès-Nancy, France
| | - Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Thomas Remen
- Methodology, Data Management and Statistic Unit, MPI Department, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IBD Center, Humanitas Research Hospital-IRCCS, Rozzano, Milan, Italy
| | - Marjorie Bonneton
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Childrens Hospital of Nancy, Vandoeuvre-le`s-Nancy, France
| | - Marie Agnes Galloy
- Department of Pediatric Radiology, Childrens University Hospital, Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Lorraine University, 1 Allée du Morvan, 54511, Vandoeuvre-lès-Nancy, France.
| |
Collapse
|
160
|
Schreiber S, Ben-Horin S, Alten R, Westhovens R, Peyrin-Biroulet L, Danese S, Hibi T, Takeuchi K, Magro F, An Y, Kim DH, Yoon S, Reinisch W. Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era. Adv Ther 2022; 39:2342-2364. [PMID: 34988877 PMCID: PMC8731678 DOI: 10.1007/s12325-021-01990-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/05/2021] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has prompted significant changes in patient care in rheumatology and gastroenterology, with clinical guidance issued to manage ongoing therapy while minimising the risk of nosocomial infection for patients and healthcare professionals (HCPs). Subcutaneous (SC) formulations of biologics enable patients to self-administer treatments at home; however, switching between agents may be undesirable. CT-P13 SC is the first SC formulation of infliximab that received regulatory approval and may be termed a biobetter as it offers significant clinical advantages over intravenous (IV) infliximab, including improved pharmacokinetics and a convenient mode of delivery. Potential benefits in terms of reduced immunogenicity have also been suggested. With a new SC formulation, infliximab provides an additional option for dual formulation, which enables patients to transition from IV to SC administration route without changing agent. Before COVID-19, clinical trials supported the efficacy and safety of switching from IV to SC infliximab for patients with rheumatoid arthritis and inflammatory bowel disease (IBD), and SC infliximab may have been selected on the basis of patient and HCP preferences for SC agents. During the pandemic, patients with rheumatic diseases and IBD have successfully switched from IV to SC infliximab, with some clinical benefits and high levels of patient satisfaction. As patients switched to SC therapeutics, the reduction in resource requirements for IV infusion services may have been particularly welcome given the pandemic, facilitating reorganisation and redeployment in overstretched healthcare systems, alongside pharmacoeconomic benefits and a reduction in exposure to nosocomial infection. Telemedicine and contactless healthcare have been pushed to the forefront during the pandemic, and a lasting shift towards remote patient management and community/home-based drug administration is anticipated. SC infliximab supports the implementation of this paradigm for future improvements of healthcare value delivered. The accumulation of real-world data during the pandemic supports the high level of confidence, with patients, physicians, and healthcare systems benefitting from its uptake.
Collapse
Affiliation(s)
- Stefan Schreiber
- Department of Medicine I, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Shomron Ben-Horin
- Gastroenterology Department, Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - Rieke Alten
- Department of Internal Medicine II, Rheumatology, Clinical Immunology, Osteology, Schlosspark Klinik, University Medicine Berlin, Berlin, Germany
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandoeuvre-les-Nancy, France
- Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Ken Takeuchi
- Department of Gastroenterology, IBD Center, Tsujinaka Hospital Kashiwanoha, Chiba, Japan
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
- MedInUP, Centre for Drug Discovery and Innovative Medicines, Porto, Portugal
| | - Yoorim An
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Dong-Hyeon Kim
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - SangWook Yoon
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
161
|
Ferrante M, Panaccione R, Baert F, Bossuyt P, Colombel JF, Danese S, Dubinsky M, Feagan BG, Hisamatsu T, Lim A, Lindsay JO, Loftus EV, Panés J, Peyrin-Biroulet L, Ran Z, Rubin DT, Sandborn WJ, Schreiber S, Neimark E, Song A, Kligys K, Pang Y, Pivorunas V, Berg S, Duan WR, Huang B, Kalabic J, Liao X, Robinson A, Wallace K, D'Haens G. Risankizumab as maintenance therapy for moderately to severely active Crohn's disease: results from the multicentre, randomised, double-blind, placebo-controlled, withdrawal phase 3 FORTIFY maintenance trial. Lancet 2022; 399:2031-2046. [PMID: 35644155 DOI: 10.1016/s0140-6736(22)00466-4] [Citation(s) in RCA: 89] [Impact Index Per Article: 44.5] [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] [Received: 12/07/2021] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is a great unmet need for new therapeutics with novel mechanisms of action for patients with Crohn's disease. The ADVANCE and MOTIVATE studies showed that intravenous risankizumab, a selective p19 anti-interleukin (IL)-23 antibody, was efficacious and well tolerated as induction therapy. Here, we report the efficacy and safety of subcutaneous risankizumab as maintenance therapy. METHODS FORTIFY is a phase 3, multicentre, randomised, double-blind, placebo-controlled, maintenance withdrawal study across 273 clinical centres in 44 countries across North and South America, Europe, Oceania, Africa, and the Asia-Pacific region that enrolled participants with clinical response to risankizumab in the ADVANCE or MOTIVATE induction studies. Patients in ADVANCE or MOTIVATE were aged 16-80 years with moderately to severely active Crohn's disease. Patients in the FORTIFY substudy 1 were randomly assigned again (1:1:1) to receive either subcutaneous risankizumab 180 mg, subcutaneous risankizumab 360 mg, or withdrawal from risankizumab to receive subcutaneous placebo (herein referred to as withdrawal [subcutaneous placebo]). Treatment was given every 8 weeks. Patients were stratified by induction dose, post-induction endoscopic response, and clinical remission status. Patients, investigators, and study personnel were masked to treatment assignments. Week 52 co-primary endpoints were clinical remission (Crohn's disease activity index [CDAI] in the US protocol, or stool frequency and abdominal pain score in the non-US protocol) and endoscopic response in patients who received at least one dose of study drug during the 52-week maintenance period. Safety was assessed in patients receiving at least one dose of study medication. This study is registered with ClinicalTrials.gov, NCT03105102. FINDINGS 712 patients were initially assessed and, between April 9, 2018, and April 24, 2020, 542 patients were randomly assigned to either the risankizumab 180 mg group (n=179), the risankizumab 360 mg group (n=179), or the placebo group (n=184). Greater clinical remission and endoscopic response rates were reached with 360 mg risankizumab versus placebo (CDAI clinical remission was reached in 74 (52%) of 141 patients vs 67 (41%) of 164 patients, adjusted difference 15% [95% CI 5-24]; stool frequency and abdominal pain score clinical remission was reached in 73 (52%) of 141 vs 65 (40%) of 164, adjusted difference 15% [5-25]; endoscopic response 66 (47%) of 141 patients vs 36 (22%) of 164 patients, adjusted difference 28% [19-37]). Higher rates of CDAI clinical remission and endoscopic response (but not stool frequency and abdominal pain score clinical remission [p=0·124]) were also reached with risankizumab 180 mg versus withdrawal (subcutaneous placebo; CDAI clinical remission reached in 87 [55%] of 157 patients, adjusted difference 15% [95% CI 5-24]; endoscopic response 74 [47%] of 157, adjusted difference 26% [17-35]). Results for more stringent endoscopic and composite endpoints and inflammatory biomarkers were consistent with a dose-response relationship. Maintenance treatment was well tolerated. Adverse event rates were similar among groups, and the most frequently reported adverse events in all treatment groups were worsening Crohn's disease, arthralgia, and headache. INTERPRETATION Subcutaneous risankizumab is a safe and efficacious treatment for maintenance of remission in patients with moderately to severely active Crohn's disease and offers a new therapeutic option for a broad range of patients by meeting endpoints that might change the future course of disease. FUNDING AbbVie.
Collapse
Affiliation(s)
- Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit and Gastrointestinal Research, University of Calgary, Calgary, AB, Canada
| | | | - Peter Bossuyt
- Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium
| | | | - Silvio Danese
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Brian G Feagan
- Division of Gastroenterology, Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Kyorin University, Tokyo, Japan
| | - Allen Lim
- University of Alberta, Edmonton, AB, Canada
| | - James O Lindsay
- Centre for Immunobiology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Julián Panés
- Department of Gastroenterology, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, University of Lorraine, CHRU-Nancy, Nancy, France; Department of Gastroenterology, University of Lorraine, Inserm, NGERE, Nancy, France
| | - Zhihua Ran
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center, Shanghai, China; Renji Hospital School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Digestive Disease, Shanghai, China
| | - David T Rubin
- Section of Gastroenterology, Hepatology and Nutrition and Digestive Diseases Center, The University of Chicago Medicine, Chicago, IL, USA
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Stefan Schreiber
- Department of General Internal Medicine, Christian-Albrechts-University, Kiel, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Geert D'Haens
- Inflammatory Bowel Disease Centre, Amsterdam University Medical Centre, Amsterdam, Netherlands
| |
Collapse
|
162
|
D'Amico F, Tasopoulou O, Fiorino G, Zilli A, Furfaro F, Allocca M, Sileri P, Spinelli A, Peyrin-Biroulet L, Danese S. Early Biological Therapy in Operated Crohn's Disease Patients Is Associated With a Lower Rate of Endoscopic Recurrence and Improved Long-term Outcomes: A Single-center Experience. Inflamm Bowel Dis 2022; 29:539-547. [PMID: 35640113 PMCID: PMC10069661 DOI: 10.1093/ibd/izac110] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/25/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Two-thirds of Crohn's disease (CD) patients require surgery during their disease course. However, surgery is not curative, and endoscopic recurrence is observed in up to 90% of cases. Our aim was to investigate the impact of postoperative biological therapy on the incidence of endoscopic recurrence and long-term outcomes in CD patients. METHODS This retrospective cohort study was conducted at the Humanitas Research Hospital-IRCCS (Milan, Italy) between 2014 and 2021. All consecutive CD patients who underwent surgery and colonoscopy at 6-12 months postoperatively were eligible for inclusion. RESULTS A total of 141 patients were included (42.6% female, mean age 44 years). Median follow-up was 28 months. About one-third of patients were treated with biologics at baseline colonoscopy. A higher rate of endoscopic recurrence was detected in patients without biologic therapy at the time of colonoscopy compared with those treated (80.8% vs 45.2%, P < .0001). Hospitalization and surgery occurred more in untreated patients than in subjects undergoing biological therapy (12.1% vs 0.0%, P = .01). The Kaplan-Meier curves showed that the no treatment group at baseline had a >23.3% 5-year rate of hospitalization and surgery (log-rank P = .0221) and a >49.7% 5-year rate of medical therapy escalation (log-rank P = .0013) compared with the treatment arm. In the logistic regression model, absence of biologic therapy was independently associated with the risk of endoscopic disease recurrence (odds ratio, 0.22; 95% CI, 0.1-0.51; P = .0004). CONCLUSION Operated CD patients treated early with biologics experience decreased rates of endoscopic recurrence and improved long-term outcomes.
Collapse
Affiliation(s)
- Ferdinando D'Amico
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Olga Tasopoulou
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Furfaro
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Pierpaolo Sileri
- Gastrointestinal Surgery Unit, IRCCS Ospedale San Raffaele, Milan Italy
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Colon and Rectal Surgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- University of Lorraine, CHRU-Nancy, Department of Gastroenterology, F-54000 Nancy, France.,University of Lorraine, Inserm, NGERE, F-54000 Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
163
|
D'Haens G, Panaccione R, Baert F, Bossuyt P, Colombel JF, Danese S, Dubinsky M, Feagan BG, Hisamatsu T, Lim A, Lindsay JO, Loftus EV, Panés J, Peyrin-Biroulet L, Ran Z, Rubin DT, Sandborn WJ, Schreiber S, Neimark E, Song A, Kligys K, Pang Y, Pivorunas V, Berg S, Duan WR, Huang B, Kalabic J, Liao X, Robinson A, Wallace K, Ferrante M. Risankizumab as induction therapy for Crohn's disease: results from the phase 3 ADVANCE and MOTIVATE induction trials. Lancet 2022; 399:2015-2030. [PMID: 35644154 DOI: 10.1016/s0140-6736(22)00467-6] [Citation(s) in RCA: 114] [Impact Index Per Article: 57.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/22/2022] [Accepted: 03/03/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Risankizumab, an interleukin (IL)-23 p19 inhibitor, was evaluated for safety and efficacy as induction therapy in patients with moderately to severely active Crohn's disease. METHODS ADVANCE and MOTIVATE were randomised, double-masked, placebo-controlled, phase 3 induction studies. Eligible patients aged 16-80 years with moderately to severely active Crohn's disease, previously showing intolerance or inadequate response to one or more approved biologics or conventional therapy (ADVANCE) or to biologics (MOTIVATE), were randomly assigned to receive a single dose of intravenous risankizumab (600 mg or 1200 mg) or placebo (2:2:1 in ADVANCE, 1:1:1 in MOTIVATE) at weeks 0, 4, and 8. We used interactive response technology for random assignment, with stratification by number of previous failed biologics, corticosteroid use at baseline, and Simple Endoscopic Score for Crohn's disease (SES-CD). All patients and study personnel (excluding pharmacists who prepared intravenous solutions) were masked to treatment allocation throughout the study. Coprimary endpoints were clinical remission (defined by Crohn's disease activity index [CDAI] or patient-reported outcome criteria [average daily stool frequency and abdominal pain score]) and endoscopic response at week 12. The intention-to-treat population (all eligible patients who received at least one dose of study drug in the 12-week induction period) was analysed for efficacy outcomes. Safety was assessed in all patients who received at least one dose of study drug. Both trials were registered on ClinicalTrials.gov, NCT03105128 (ADVANCE) and NCT03104413 (MOTIVATE), and are now complete. FINDINGS Participants were enrolled between May 10, 2017, and Aug 24, 2020 (ADVANCE trial), and Dec 18, 2017 and Sept 9, 2020 (MOTIVATE trial). In ADVANCE, 931 patients were assigned to either risankizumab 600 mg (n=373), risankizumab 1200 mg (n=372), or placebo (n=186). In MOTIVATE, 618 patients were assigned to risankizumab 600 mg (n=206), risankizumab 1200 mg (n=205), or placebo (n=207). The primary analysis population comprised 850 participants in ADVANCE and 569 participants in MOTIVATE. All coprimary endpoints at week 12 were met in both trials with both doses of risankizumab (p values ≤0·0001). In ADVANCE, CDAI clinical remission rate was 45% (adjusted difference 21%, 95% CI 12-29; 152/336) with risankizumab 600 mg and 42% (17%, 8-25; 141/339) with risankizumab 1200 mg versus 25% (43/175) with placebo; stool frequency and abdominal pain score clinical remission rate was 43% (22%, 14-30; 146/336) with risankizumab 600 mg and 41% (19%, 11-27; 139/339) with risankizumab 1200 mg versus 22% (38/175) with placebo; and endoscopic response rate was 40% (28%, 21-35; 135/336) with risankizumab 600 mg and 32% (20%, 14-27; 109/339) with risankizumab 1200 mg versus 12% (21/175) with placebo. In MOTIVATE, CDAI clinical remission rate was 42% (22%, 13-31; 80/191) with risankizumab 600 mg and 40% (21%, 12-29; 77/191) with risankizumab 1200 mg versus 20% (37/187) with placebo; stool frequency and abdominal pain score clinical remission rate was 35% (15%, 6-24; 66/191) with risankizumab 600 mg and 40% (20%, 12-29; 76/191) with risankizumab 1200 mg versus 19% (36/187) with placebo; and endoscopic response rate was 29% (18%, 10-25; 55/191) with risankizumab 600 mg and 34% (23%, 15-31; 65/191) with risankizumab 1200 mg versus 11% (21/187) with placebo. The overall incidence of treatment-emergent adverse events was similar among the treatment groups in both trials. Three deaths occurred during induction (two in the placebo group [ADVANCE] and one in the risankizumab 1200 mg group [MOTIVATE]). The death in the risankizumab-treated patient was deemed unrelated to the study drug. INTERPRETATION Risankizumab was effective and well tolerated as induction therapy in patients with moderately to severely active Crohn's disease. FUNDING AbbVie.
Collapse
Affiliation(s)
- Geert D'Haens
- Inflammatory Bowel Disease Centre, Amsterdam University Medical Center, Amsterdam, Netherlands.
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit and Gastrointestinal Research, University of Calgary, Calgary, AB, Canada
| | | | - Peter Bossuyt
- Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium
| | | | - Silvio Danese
- Gastroenterology and Gastrointestinal Endoscopy Unit, Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Brian G Feagan
- Division of Gastroenterology, Department of Medicine, University of Western Ontario, London, ON, Canada; Alimentiv, London, ON, Canada
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
| | - Allen Lim
- University of Alberta, Edmonton, AB, Canada
| | - James O Lindsay
- Centre for Immunobiology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Edward V Loftus
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Julian Panés
- Department of Gastroenterology, Hospital Clinic Barcelona, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - Laurent Peyrin-Biroulet
- University of Lorraine, CHRU-Nancy, Department of Gastroenterology, Nancy, France; University of Lorraine, Inserm, NGERE, Nancy, France
| | - Zhihua Ran
- Division of Gastroenterology and Hepatology, Key Laboratory of Gastroenterology and Hepatology, Ministry of Health, Inflammatory Bowel Disease Research Center, Shanghai, China; Renji Hospital School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Institute of Digestive Disease, Shanghai, China
| | - David T Rubin
- Section of Gastroenterology, Hepatology and Nutrition and Digestive Diseases Center, The University of Chicago Medicine, Chicago, IL, USA
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Stefan Schreiber
- Department of Medicine I, University Hospital Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals, KU Leuven, Leuven, Belgium
| |
Collapse
|
164
|
Achit H, Peyrin-Biroulet L, Ayav C, Guillemin F, Frimat L. Lack of Monitoring Is Associated with Risk of Acute Kidney Events among Patients with Inflammatory Bowel Disease. J Clin Med 2022; 11:jcm11112954. [PMID: 35683343 PMCID: PMC9181326 DOI: 10.3390/jcm11112954] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/15/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Although the iatrogenic risk of kidney failure is infrequent with treatment for inflammatory bowel disease (IBD), the repercussions for the patient could be major. The aim of this study was to assess the incidence of kidney events in IBD and to examine the protective effect of kidney function monitoring. Methods: In the French National Health Insurance database, 94,363 patients had a diagnosis of IBD between January 2010 and December 2016. By using a survival model with time-dependent covariates, we analyzed the time from inclusion in this IBD cohort to the first hospitalization for acute kidney impairment (AKI) according to patient characteristics, comorbidities, IBD phenotype and presence of monitoring. Results: A total of 693 patients were hospitalized for AKI, with an incidence of 1.36/1000 person−years (95% confidence interval [CI] 1.26−1.47). The incidence of AKI was lower than those without 5-aminosalicylic acid (5-ASA) use. Patients with 5-ASA use rarely had any lack of monitoring as compared with those not under 5-ASA use (3% vs. 17%). On multivariate analysis, lack of monitoring was associated with a substantial risk of AKI (hazard ratio 3.96, 95% CI [3.20−4.90], p < 0.0001). Conclusions: Increased frequency of monitoring is essential to identify nephropathy at an early stage and avoid the progression to chronic kidney disease.
Collapse
Affiliation(s)
- Hamza Achit
- Clinical Epidemiology Centre CIC-1433 CHRU-Nancy, Inserm, Université de Lorraine, 54500 Vandoeuvre-les-Nancy, France; (C.A.); (F.G.)
- Correspondence: ; Tel.: +33-3-83-85-93-14
| | - Laurent Peyrin-Biroulet
- Inserm NGERE and Department of Gastroenterology, University Hospital of Nancy, Université de Lorraine, 54511 Vandoeuvre-les-Nancy, France;
| | - Carole Ayav
- Clinical Epidemiology Centre CIC-1433 CHRU-Nancy, Inserm, Université de Lorraine, 54500 Vandoeuvre-les-Nancy, France; (C.A.); (F.G.)
| | - Francis Guillemin
- Clinical Epidemiology Centre CIC-1433 CHRU-Nancy, Inserm, Université de Lorraine, 54500 Vandoeuvre-les-Nancy, France; (C.A.); (F.G.)
| | - Luc Frimat
- Department of Nephrology, University Hospital of Nancy, 54511 Vandoeuvre-les-Nancy, France;
| |
Collapse
|
165
|
Weber S, Didelot A, Agrinier N, Peyrin-Biroulet L, Schvoerer E, Rabaud C, Jeulin H. SARS-CoV-2 seroprevalence in healthcare workers and risk factors. Infect Dis Health 2022; 27:203-210. [PMID: 35644801 PMCID: PMC9110541 DOI: 10.1016/j.idh.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Exposure of healthcare workers (HCW) to SARS-CoV-2 is a public health concern. Not only are HCWs particularly exposed to SARS-CoV-2, but their contamination can also weaken the healthcare system. METHODS We analyzed exposure of French University Hospital HCWs to SARS-CoV-2 through history of positive RT-PCR test and SARS-CoV-2 seroprevalence. Potential risk factors, such as age, BMI, having children or not, working in a COVID-19 unit, or smoking were explored. RESULTS From May to June 2020, among the 8960 employees of the University Hospital of Nancy, a serological test was performed in 4696 HCWs. The average (SD) age was 40.4 (11.4) years, and the sample included 3926 women (83.6%). Of the 4696 HCWs, 1050 were smokers (22.4%). Among them, 2231 HCWs had a history of COVID-19 symptoms and/or flu-like syndrome (47.5%) and 238 were seropositive (5.1%). Neither gender, sex, BMI, nor having children were associated with a history of positive RT-PCR test or seropositive status. Previous work in a COVID-19 unit was associated with a history of positive RT-PCR test (p = 0.045), but not with seroprevalence (p = 0.215). As expected, history of COVID-19 clinical manifestations was more frequent in HCWs with positive serology than in HCWs with negative serology (adjusted OR = 1.9, 95%CI [1.4-2.5], p < 0.001). Less expected, smoking was associated with a reduced risk of seropositivity among HCWs (adjusted OR = 0.6, 95%CI [0.4-0.9], p = 0.019). CONCLUSION HCW are patently exposed to SARS-CoV-2. Care to COVID-19 patients was not associated with a higher SARS-CoV-2 seroprevalence. Smoking appears here associated to a lower seroprevalence.
Collapse
Affiliation(s)
- Stéphanie Weber
- CHRU-Nancy, Laboratoire de Virologie, Nancy, F-54000, France
| | - Alice Didelot
- CHRU-Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, F-54000, France
| | - Nelly Agrinier
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, F-54000, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm U1256 NGERE, Nancy University Hospital, Université de Lorraine, Vandœuvre-lès-Nancy, France
| | - Evelyne Schvoerer
- CHRU-Nancy, Laboratoire de Virologie, Nancy, F-54000, France; Université de Lorraine, CNRS, LCPME, Nancy, F-54000, France
| | - Christian Rabaud
- CHRU-Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, F-54000, France
| | - Hélène Jeulin
- CHRU-Nancy, Laboratoire de Virologie, Nancy, F-54000, France; Université de Lorraine, CNRS, LCPME, Nancy, F-54000, France.
| |
Collapse
|
166
|
Magro F, Sottomayor C, Alves C, Santiago M, Ministro P, Lago P, Correia L, Gonçalves R, Carvalho D, Portela F, Dias CC, Dignass A, Danese S, Peyrin-Biroulet L, Estevinho MM, Leão Moreira P. Composite outcomes in observational studies of Crohn's disease: a systematic review and meta-analysis. Therap Adv Gastroenterol 2022; 15:17562848221092754. [PMID: 35601803 PMCID: PMC9118904 DOI: 10.1177/17562848221092754] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/18/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND This systematic review and meta-analysis aims to assess composite and aggregate outcomes of observational studies in Crohn's disease and to evaluate whether the number and type of variables included affect the frequency of the outcome. METHODS MEDLINE [via PubMed], Scopus and Web of Science were searched to identify observational studies that enrolled patients with Crohn's disease and evaluated a composite or aggregate outcome. The proportion of patients achieving the outcome was determined and a random-effects meta-analysis was performed to evaluate how the frequency of each outcome varies according to the reporting of predefined variables. RESULTS From 10,257 identified records, 46 were included in the qualitative analysis and 38 in the meta-analysis. The frequency for composite and aggregate outcomes was 0.445 [95% confidence interval (CI): 0.389-0.501] and 0.140 (95% CI: 0.000-0.211), respectively. When comparing composite outcomes by number of included variables, the frequency was 0.271 (95% CI: 0.000-0.405) and 0.698 (95% CI: 0.651-0.746), for one and six variables, respectively. The frequency of the composite outcome varied according to the identity of the variables being reported. Specific pairs of predefined variables had a significant effect in the frequency of composite outcomes. CONCLUSION Composite outcomes with increasing number of predefined variables show an increase in frequency. Outcomes including variables such as 'Surgery' and 'Steroids' had higher frequencies when compared with the ones that did not include these variables. These results show that the frequency of composite outcomes is dependent on the number and type of variables being reported.
Collapse
Affiliation(s)
| | | | - Catarina Alves
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mafalda Santiago
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Paula Ministro
- Department of Gastroenterology, Tondela-Viseu Hospital Centre, Viseu, Portugal
| | - Paula Lago
- Department of Gastroenterology, Santo António University Hospital Center (CHUPorto), Porto, Portugal
| | - Luís Correia
- Department of Gastroenterology, Lisbon North Hospital Centre, Santa Maria Hospital, Lisbon, Portugal
| | | | - Diana Carvalho
- Department of Gastroenterology, Santo António dos Capuchos Hospital at Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Francisco Portela
- Department of Gastroenterology, University Hospital Centre of Coimbra, Coimbra, Portugal
| | - Cláudia Camila Dias
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal,Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Frankfurt, Germany
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy,Inflammatory Bowel Disease (IBD) Center, Department of Gastroenterology, Humanitas Clinical and Research Center (IRCCS), Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Maria Manuela Estevinho
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal,Department of Gastroenterology, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paula Leão Moreira
- Department of Clinical Pharmacology, São João University Hospital Center (CHUSJ), Porto, Portugal
| |
Collapse
|
167
|
Danese S, Peyrin-Biroulet L. Evolution of IL-23 Blockade in Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:ii1-ii2. [PMID: 35553668 PMCID: PMC9097673 DOI: 10.1093/ecco-jcc/jjab188] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Silvio Danese
- Corresponding author: Silvio Danese, MD, PhD, Gastroenterology and Endoscopy, IRCCS San Raffaele and Universita’ Vita-Salute, Via Olgettina 60, 20132 Milan, Italy.
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and INSERM U1256, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
168
|
Abstract
The treatment of patients with moderate to severe Crohn's disease [CD] is still challenging. Therapeutic options include steroids, immunosuppressants, anti-TNFα agents, vedolizumab, and ustekinumab. Ustekinumab is a monoclonal antibody blocking the p40 subunit of IL-12 and IL-23. It showed to be effective and safe in randomised clinical trials and real-life studies and is currently approved for the management of CD patients who are naive to biologics and those who have already been treated with such medications. However, to date, a detailed and approved therapeutic algorithm is not available. The aim of this review is to report the most recent and updated data on the efficacy and safety of ustekinumab for the treatment of patients with moderate to severe CD and to define the optimal management of these patients.
Collapse
Affiliation(s)
- Ferdinando D’Amico
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy,Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Corresponding author: Prof. Silvio Danese, MD, PhD, Gastroenterology and Endoscopy IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy, Tel.: [+39] 0282244771; fax: [+39] 0282242591;
| |
Collapse
|
169
|
Vavricka SR, Greuter T, Cohen BL, Reinisch W, Steinwurz F, Fellmann M, Guo X, Lawendy N, Paulissen J, Peyrin-Biroulet L. Corticosteroid-free efficacy and safety outcomes in patients receiving tofacitinib in the OCTAVE Sustain maintenance study. Therap Adv Gastroenterol 2022; 15:17562848221090834. [PMID: 35574426 PMCID: PMC9096189 DOI: 10.1177/17562848221090834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 03/10/2022] [Indexed: 02/04/2023] Open
Abstract
Background Tofacitinib is an oral, small molecule Janus kinase inhibitor for the treatment of ulcerative colitis (UC). Here, we report steroid-free efficacy and safety with tofacitinib among patients with UC who received corticosteroids at baseline of the maintenance study (OCTAVE Sustain). Methods This analysis included patients with clinical response following OCTAVE Induction 1 and 2 who were re-randomized to receive placebo, or tofacitinib 5 or 10 mg twice daily (b.d.), in OCTAVE Sustain for 52 weeks and were receiving corticosteroids at OCTAVE Sustain baseline. Corticosteroid tapering was mandatory during OCTAVE Sustain. Rates of steroid-free remission, endoscopic improvement, and clinical response were assessed, stratified by baseline characteristics. Adverse events (AEs) were stratified by treatment and steroid-free remission status. Results Overall, 289/593 patients had corticosteroid use at OCTAVE Sustain baseline. At week 52, steroid-free remission, endoscopic improvement, and clinical response rates were 10.9%, 11.9%, and 17.8% among patients receiving placebo, 27.7%, 29.7%, and 40.6% among patients receiving tofacitinib 5 mg b.d., and 27.6%, 29.9%, and 43.7% among patients receiving tofacitinib 10 mg b.d., respectively (non-responder imputation; all p < 0.05 tofacitinib 5 or 10 mg b.d. versus placebo). Discontinuations due to AEs were lower among patients with steroid-free remission versus without. AEs of special interest were infrequent. Conclusion For patients with baseline corticosteroid use in OCTAVE Sustain, the odds of achieving steroid-free efficacy endpoints were significantly higher for tofacitinib versus placebo, irrespective of tofacitinib dose. There were no apparent differences in AEs of special interest by steroid-free remission status.ClinicalTrials.gov: NCT01458574.
Collapse
Affiliation(s)
- Stephan R. Vavricka
- Department of Gastroenterology and Hepatology, University Hospital Zürich and Center for Gastroenterology and Hepatology, Vulkanplatz 8, CH - 8048, Zürich, Switzerland
| | - Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Benjamin L. Cohen
- Department of Gastroenterology, Hepatology, and Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Flavio Steinwurz
- Unit of Inflammatory Bowel Disease, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | | | | | | | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm U1256 NGERE, Nancy University Hospital, Université de Lorraine, Vandœuvre-lès-Nancy, France
| |
Collapse
|
170
|
Schreiber S, Ben-Horin S, Alten R, Westhovens R, Peyrin-Biroulet L, Danese S, Hibi T, Takeuchi K, Magro F, An Y, Kim DH, Yoon S, Reinisch W. Correction to: Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era. Adv Ther 2022; 39:2281. [PMID: 35287234 PMCID: PMC8918596 DOI: 10.1007/s12325-022-02082-9] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Stefan Schreiber
- Department of Medicine I, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Shomron Ben-Horin
- Gastroenterology Department, Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - Rieke Alten
- Department of Internal Medicine II, Rheumatology, Clinical Immunology, Osteology, Schlosspark Klinik, University Medicine Berlin, Berlin, Germany
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandoeuvre-les-Nancy, France
- Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Ken Takeuchi
- Department of Gastroenterology, IBD Center, Tsujinaka Hospital Kashiwanoha, Chiba, Japan
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
- MedInUP, Centre for Drug Discovery and Innovative Medicines, Porto, Portugal
| | - Yoorim An
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Dong-Hyeon Kim
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - SangWook Yoon
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| |
Collapse
|
171
|
Schaefer M, Laurent V, Grandmougin A, Vuitton L, Bourreille A, Luc A, Clerc-Urmes I, Orry X, Frampas E, De Billy M, Pouillon L, Le Berre C, Gay C, Meyer J, Baumann C, Peyrin-Biroulet L. A Magnetic Resonance Imaging Index to Predict Crohn's Disease Postoperative Recurrence: The MONITOR Index. Clin Gastroenterol Hepatol 2022; 20:e1040-e1049. [PMID: 34216820 DOI: 10.1016/j.cgh.2021.06.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/01/2021] [Accepted: 06/25/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS We developed and validated a magnetic resonance imaging-based index to predict Crohn's disease (CD) postoperative recurrence (POR). METHODS Patients with CD who underwent a postoperative evaluation for recurrence (with colonoscopy and MRI no longer than 105 days apart) were included between 2006 and 2016 in University Hospital of Nancy, France. MRI items with good levels of intra-rater and inter-rater agreement (Gwet's coefficient ≥0.5) were selected. The MRI in Crohn's Disease to Predict Postoperative Recurrence (MONITOR) index's performance was assessed in terms of the area under the receiver operating characteristic curve (AUROC) and accuracy, by considering the Rutgeerts score as the gold standard. The MONITOR index was validated with a bootstrap method and an independent cohort. RESULTS Seventy-three MRI datasets were interpreted by 2 radiologists. Seven items (bowel wall thickness, contrast enhancement, T2 signal increase, diffusion-weighted signal increase, edema, ulcers, and the length of the diseased segment) had a Gwet's coefficient ≥0.5 and were significantly associated with the Rutgeerts score, leading to their inclusion in the MONITOR index. All the items had a weighting of 1, except the "ulcers" item weighting 2.5, reflecting the higher adjusted odds ratio. The AUROC [95% confidence interval] for the prediction of endoscopic POR (Rutgeerts score >i1) was 0.80 [0.70-0.90]. The optimal threshold was a MONITOR index ≥1, giving a sensitivity of 79%, a specificity of 55%, a predictive positive value of 68%, and a predictive negative value of 68%. The bootstrap validation gave an AUROC of 0.85 [0.73-0.97]. In the validation cohort, a MONITOR index ≥1 gave a sensitivity of 87%, a specificity of 75%, a predictive positive value of 84.6%, and a predictive negative value of 75%. CONCLUSIONS The MONITOR index is an efficient, reliable, easy-to-apply tool that can be used in clinical practice to predict the POR of CD.
Collapse
Affiliation(s)
- Marion Schaefer
- Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Valérie Laurent
- Central Department of Radiology, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Aurélie Grandmougin
- Central Department of Radiology, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, Besancon
| | | | - Amandine Luc
- Unit of Methodology, Data Management and Statistic, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Isabelle Clerc-Urmes
- Unit of Methodology, Data Management and Statistic, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Xavier Orry
- Central Department of Radiology, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Eric Frampas
- Department of Radiology, Nantes University Hospital, Nantes
| | | | - Lieven Pouillon
- Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | | | - Claire Gay
- Department of Gastroenterology, Besançon University Hospital, Besancon
| | - Jeremy Meyer
- Department of Radiology, Nantes University Hospital, Nantes
| | - Cédric Baumann
- Unit of Methodology, Data Management and Statistic, Nancy University Hospital, Vandoeuvre-lès-Nancy
| | - Laurent Peyrin-Biroulet
- Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre-lès-Nancy; INSERM U1256, Nutrition-Génétique et Exposition aux Risques Environnementaux, Faculté de Médecine, Université de Lorraine, Vandoeuvre-les-Nancy, France.
| |
Collapse
|
172
|
Vieujean S, Caron B, Jairath V, Benetos A, Danese S, Louis E, Peyrin-Biroulet L. Is it time to include older adults in inflammatory bowel disease trials? A call for action. Lancet Healthy Longev 2022; 3:e356-e366. [PMID: 36098310 DOI: 10.1016/s2666-7568(22)00060-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023] Open
Abstract
The therapeutic management of older patients with inflammatory bowel disease (IBD) is challenging, particularly because of the absence of evidence-based guidelines for these patients, who seem to frequently be excluded from clinical trials. In this systematic review we investigated the exclusion of older patients with IBD from phase 3 studies registered on PubMed and ClinicalTrials.gov, by assessing the upper limit of age exclusion criteria and the percentage of patients older than 65 years included in the trials. Exclusion criteria other than age were also recorded, and comorbidities were analysed separately. Our review of 222 phase 3 studies shows that older patients are frequently excluded from IBD clinical trials because of their age, which was used as an exclusion criterion in 129 (58%) of the 222 assessed trials. Of the 32 trials that detailed the percentage of included patients who were 65 years or older, only 763 (5·4%) patients of the 14 124 patients included were older than 65 years. In addition to age, patients were also excluded because of comorbidities (mainly renal, hepatic, and cardiovascular, and used as an exclusion criterion in 76% of trials), a history of dysplasia (45% of trials), and previous treatment for IBD (19% of trials). We propose a three-step process that should enable the inclusion of all older patients in IBD clinical trials, regardless of their age, comorbidities, and frailty.
Collapse
Affiliation(s)
- Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Vipul Jairath
- Department of Medicine, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Alimentiv, London, ON, Canada
| | - Athanase Benetos
- Inserm, DCAC, University of Lorraine, Vandoeuvre-lès-Nancy, France; CHRU-Nancy Brabois, Department of Clinical Geriatrics, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Edouard Louis
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France.
| |
Collapse
|
173
|
Schwartz DA, Peyrin-Biroulet L, Lasch K, Adsul S, Danese S. Efficacy and Safety of 2 Vedolizumab Intravenous Regimens for Perianal Fistulizing Crohn's Disease: ENTERPRISE Study. Clin Gastroenterol Hepatol 2022; 20:1059-1067.e9. [PMID: 34597729 DOI: 10.1016/j.cgh.2021.09.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Fistulizing Crohn's disease (CD) is challenging to treat. We report results from ENTERPRISE, a randomized, double-blind, phase 4 trial evaluating 2 vedolizumab intravenous dosing regimens in patients with fistulizing CD. METHODS Patients with moderately to severely active CD and 1-3 active perianal fistulae (identified on magnetic resonance imaging [MRI]) received vedolizumab 300 mg intravenously at weeks 0, 2, 6, 14, and 22 (VDZ) or the same regimen plus an additional vedolizumab dose at week 10 (VDZ + wk10). Reduction from baseline in draining perianal fistulae and disease activity, MRI assessments, health-related quality of life (HRQoL), and safety were evaluated. Enrollment was stopped prematurely because of recruitment challenges; analyses are descriptive. RESULTS Of 32 patients with ≥1 active fistulae at baseline per MRI and postbaseline fistulae healing assessment, 28 (14 per dosing regimen) had ≥1 draining fistulae at baseline (assessed by gentle finger compression during clinical exam). Rapid and sustained fistula closure was observed; 53.6% (VDZ, 64.3%; VDZ + wk10, 42.9%) and 42.9% (VDZ, 50.0%; VDZ + wk10, 35.7%) of patients achieved ≥50% decrease in draining fistulae and 100% fistulae closure, respectively, at week 30. Mean (standard deviation) CD and Perianal Disease Activity Index scores decreased by 51.1 (78.3) and 4.1 (3.3), respectively, at week 30. HRQoL improved throughout the study. No new safety signals were observed. CONCLUSIONS Sustained improvements in fistulizing CD were seen with both vedolizumab regimens. An additional dose at week 10 does not appear to alter treatment outcomes. Safety profile was consistent with other vedolizumab studies. CLINICALTRIALS gov no: NCT02630966; EudraCT: 2015-000852-12.
Collapse
Affiliation(s)
- David A Schwartz
- Inflammatory Bowel Disease Center, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Nancy, France; Inserm U1256 NGERE, Lorraine University, Nancy, France
| | - Karen Lasch
- Takeda Pharmaceuticals USA Inc, Lexington, Massachusetts
| | - Shashi Adsul
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | - Silvio Danese
- IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milano, Italy
| |
Collapse
|
174
|
Parigi TL, D'Amico F, Abreu MT, Rubin DT, Dignass A, Dotan I, Jairath V, Magro F, Peyrin-Biroulet L, Ghosh S, Danese S. Difficult-to-treat inflammatory bowel disease: results from a global IOIBD survey. Lancet Gastroenterol Hepatol 2022; 7:390-391. [PMID: 35397241 DOI: 10.1016/s2468-1253(22)00085-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/01/2022] [Accepted: 03/01/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Tommaso Lorenzo Parigi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Maria T Abreu
- Center for Crohn's and Colitis, Division of Gastroenterology and Hepatology, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt am Main, Germany
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Vipul Jairath
- Department of Medicine, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Fernando Magro
- Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Gastroenterology, São João University Hospital Center, Porto, Portugal
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, University of Lorraine, CHRU-Nancy, Nancy, France; University of Lorraine, Inserm, NGERE, Nancy, France
| | - Subrata Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, National University Ireland, Cork, Ireland
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy.
| |
Collapse
|
175
|
Abstract
LINKED CONTENTThis article is linked to Falloon et al papers. To view these articles, visit https://doi.org/10.1111/apt.16853 and https://doi.org/10.1111/apt.16907
Collapse
Affiliation(s)
- Lucas Guillo
- Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
176
|
Guillo L, Uzzan M, Beaugerie L, Gornet JM, Amiot A, Pelletier AL, Altwegg R, Laharie D, Abitbol V, Filippi J, Goutorbe F, Nachury M, Nancey S, Viennot S, Reenaers C, Amil M, Caillo L, Buisson A, Collins M, Picon L, Vidon M, Benezech A, Rabaud C, Baumann C, Rousseau H, Dubourg G, Serrero M, Peyrin-Biroulet L. Impact of HIV Infection on the Course of Inflammatory Bowel Disease and Drug Safety Profile: A Multicenter GETAID Study. Clin Gastroenterol Hepatol 2022; 20:787-797.e2. [PMID: 33359726 DOI: 10.1016/j.cgh.2020.12.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 11/16/2020] [Revised: 12/14/2020] [Accepted: 12/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel diseases (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), and human immunodeficiency virus (HIV) both impact innate and adaptive immunity in the intestinal mucosa. As it is a rare situation, the intersection between HIV and IBD remains unclear, especially the impact of HIV infection on the course of IBD, and the drug safety profile is unknown. METHODS We conducted a multicenter retrospective cohort study between January 2019 and August 2020. All adult patients with IBD and concomitant HIV infection were included. Each IBD patient with HIV was matched to two HIV-uninfected IBD patients. RESULTS Overall, 195 patients with IBD were included, including 65 HIV-infected patients and 130 without HIV infection. Of the 65 infected patients, 22 (33.8%) required immunosuppressants and 31 (47.7%) biologics. In the HIV-infected group, the need for immunosuppressants (p = 0.034 for CD and p = 0.012 for UC) and biologics (p = 0.004 for CD and p = 0.008 for UC) was significantly lower. The disease course, using a severity composite criterion, was not significantly different between the two groups for CD (hazard ration (HR) = 1.3 [0.7; 2.4], p = 0.45) and UC (HR, 1.1 [0.5; 2.7], p = 0.767). The overall drug safety profile was statistically similar between the two groups. CONCLUSION Although HIV-infected patients receive less treatments, the course of their IBD did not differ than uninfected, suggesting that HIV infection might attenuate IBD. The drug safety profile is reassuring, allowing physician to treat these patients according to current recommendations.
Collapse
Affiliation(s)
- Lucas Guillo
- Department of Gastroenterology, University Hospital of Marseille Nord, Aix-Marseille, Marseille University, Marseille, France; French Institute of Health and Medical Research Nutrition-Genetics and Exposure to Environmental Risks U1256, Department of Gastroenterology, University Hospital of Nancy, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Mathieu Uzzan
- IBD Unit, Department of Gastroenterology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Laurent Beaugerie
- Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Jean-Marc Gornet
- Department of Gastroenterology, Saint-Louis Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélien Amiot
- EC2M3-EA7375, Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, Assistance Publique-Hôpitaux de Paris, University of Paris Est Créteil, Créteil, France
| | - Anne-Laure Pelletier
- Department of Gastroenterology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - David Laharie
- Service d'Hépato-gastroentérologie et oncologie digestive, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Vered Abitbol
- Departement of Gastroenterology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Jérôme Filippi
- Department of Gastroenterology, Archet 2 University Hospital, Nice, France
| | - Felix Goutorbe
- Department of Gastroenterology, Hospital of Bayonne, Bayonne, France
| | - Maria Nachury
- U1286 Institute for Translational Research in Inflammation, French Institute of Health and Medical Research, Centre Hospitalier Universitaire de Lille, University of Lille, Lille, France
| | - Stéphane Nancey
- French Institute of Health and Medical Research U1111-CIRI, Department of Gastroenterology, Lyon-Sud University Hospital, Hospices Civils de Lyon, Pierre Bénite, France
| | - Stéphanie Viennot
- Departement of Gastroenterology, University Hospital of Caen, Caen, France
| | - Catherine Reenaers
- Departement of Gastroenterology, University Hospital of Liège, Liège, Belgium
| | - Morgane Amil
- Departement of Gastroenterology, Les Oudairies Hospital, La Roche-sur-Yon, France
| | - Ludovic Caillo
- Department of Gastroenterology, University Hospital of Nîmes, Nîmes, France
| | - Anthony Buisson
- Infection, Inflammation et Interaction Hôtes Pathogènes, French Institute of Health and Medical Research U1071, Service d'Hépato-Gastroentérologie, Centre Hospitalier Universitaire de Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Michael Collins
- Department of Gastroenterology, Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Laurence Picon
- Department of Gastroenterology, University Hospital of Tours, Tours, France
| | - Mathias Vidon
- Department of gastroenterology, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Alban Benezech
- Departement of Gastroenterology, Henri Duffaut Hospital, Avignon, France
| | - Christian Rabaud
- Department of Infectious Disease, University Hospital of Nancy, University of Lorraine, Vandœuvre-lès-Nancy, France
| | - Cédric Baumann
- Methodology, Data Management and Statistic Unit, Délégation à la Recherche Clinique et à l'Innovation, Methodology Promotion Investigation Department, University Hospital of Nancy, Vandœuvre-Lès-Nancy, France
| | - Hélène Rousseau
- Methodology, Data Management and Statistic Unit, Délégation à la Recherche Clinique et à l'Innovation, Methodology Promotion Investigation Department, University Hospital of Nancy, Vandœuvre-Lès-Nancy, France
| | - Grégory Dubourg
- Institut Hospitalo-Universitaire en Maladies Infectieuses de Marseille, Marseille, France; Microbes, Evolution Phylogénie et Infections, Institute de la Recherche pour le Développement, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Mélanie Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, Aix-Marseille, Marseille University, Marseille, France
| | - Laurent Peyrin-Biroulet
- French Institute of Health and Medical Research Nutrition-Genetics and Exposure to Environmental Risks U1256, Department of Gastroenterology, University Hospital of Nancy, University of Lorraine, Vandœuvre-lès-Nancy, France.
| |
Collapse
|
177
|
Lasa JS, Olivera PA, Peyrin-Biroulet L. Ranking treatments in the network meta-analysis should consider the certainty of evidence – Authors' reply. Lancet Gastroenterol Hepatol 2022; 7:288. [DOI: 10.1016/s2468-1253(22)00018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 10/18/2022]
|
178
|
Le Berre C, Ricciuto A, Peyrin-Biroulet L, Turner D. Evolving Short- and Long-Term Goals of Management of Inflammatory Bowel Diseases: Getting It Right, Making It Last. Gastroenterology 2022; 162:1424-1438. [PMID: 34995529 DOI: 10.1053/j.gastro.2021.09.076] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/28/2021] [Accepted: 09/07/2021] [Indexed: 12/13/2022]
Abstract
Short- and long-term treatment targets in inflammatory bowel diseases (IBDs) evolved during the last decade, shifting from symptom control to endoscopic healing and patient-centered parameters. The STRIDE-II consensus placed these targets on a timeline from initiating treatment and introduced additional targets, normalization of serum and fecal biomarkers, restoration of quality of life, prevention of disability, and, in children, restoration of growth. Transmural healing in Crohn's disease and histologic healing in ulcerative colitis currently serve as adjunct measures to gauge remission depth. However, whether early treatment according to a treat-to-target paradigm affects the natural course of IBD remains unclear, leading to the need for prospective disease-modification trials. The SPIRIT consensus defined the targets for these trials to assess the long-term impact of early treatment on quality of life, disability, disease complications, risk of neoplastic lesions, and mortality. As further data emerge about the risk-benefit balance of aiming toward deeper healing, the targets in treating IBDs may continue to shift.
Collapse
Affiliation(s)
- Catherine Le Berre
- Department of Gastroenterology and Inserm TENS U1235, Institut des Maladies de l'Appareil Digestif, Nantes University Hospital, Nantes, France
| | - Amanda Ricciuto
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Laurent Peyrin-Biroulet
- University of Lorraine, CHRU-Nancy, Department of Gastroenterology, F-54000 Nancy, France, and University of Lorraine, Inserm, NGERE, F-54000 Nancy, France
| | - Dan Turner
- Juliet Keidan Institute of Pediatric Gastroenterology, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| |
Collapse
|
179
|
Abreu MT, Rowbotham DS, Danese S, Sandborn WJ, Miao Y, Zhang H, Tikhonov I, Panaccione R, Hisamatsu T, Scherl EJ, Leong RW, Arasaradnam RP, Afif W, Peyrin-Biroulet L, Sands BE, Marano C. Efficacy and Safety of Maintenance Ustekinumab for Ulcerative Colitis Through 3 Years: UNIFI Long-term Extension. J Crohns Colitis 2022; 16:1222-1234. [PMID: 35239968 PMCID: PMC9426670 DOI: 10.1093/ecco-jcc/jjac030] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/01/2022] [Accepted: 03/02/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS The UNIFI long-term extension [LTE] study reports the efficacy and safety of subcutaneous 90 mg ustekinumab through 3 years of maintenance therapy. METHODS Patients randomised to ustekinumab every 12 weeks [q12w] or every 8 weeks [q8w] at maintenance baseline [N = 348] and randomised ustekinumab-treated patients in the LTE [N = 284] were evaluated. Symptomatic remission [Mayo stool frequency = 0/1, rectal bleeding = 0] was assessed. Safety included all LTE patients [N = 188 placebo and N = 457 ustekinumab]. RESULTS Among patients randomised to the ustekinumab q12w and q8w groups at maintenance baseline, 54.1% and 56.3% achieved symptomatic remission at Week 152, respectively. Overall, 20% of patients discontinued ustekinumab, 10% of biologic-naïve and 30% of biologic-exposed patients. Among patients in symptomatic remission at Year 3, 94.6% and 98.0% of patients were also corticosteroid free, respectively. Corticosteroid-free symptomatic remission rates in the ustekinumab q12w and q8w groups were 51.2% and 55.1% at Week 152, respectively. Remission rates were higher for biologic-naïve patients than for those with a history of biologic failure. Biochemical evidence of response was demonstrated by stable, decreased C-reactive protein and faecal calprotectin measurements over 3 years. From Weeks 96 to 156, no deaths, major adverse cardiovascular events, or tuberculosis occurred. Nasopharyngitis, ulcerative colitis, and upper respiratory tract infection were most frequently reported. One ustekinumab-treated patient with a history of basal cell carcinoma [BCC] reported two BCCs. One patient in the q8w ustekinumab group, who was receiving concomitant 6-mercaptopurine, experienced serious adverse events of neutropenic sepsis and oral herpes. CONCLUSIONS Efficacy of ustekinumab in patients with ulcerative colitis was confirmed through 3 years. No new safety signals were observed.
Collapse
Affiliation(s)
- Maria T Abreu
- Corresponding author: Maria T. Abreu, MD, Crohn’s & Colitis Center, 1011 NW 15th Street, [D-149], Gautier Bldg, Ste. 510, Miami, FL 33136, USA. Tel.: 305-243-6404; fax: [305] 243-6125;
| | - David S Rowbotham
- Department of Gastroenterology & Hepatology, Auckland City Hospital, Auckland, New Zealand
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milano, Italy
| | - William J Sandborn
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
| | - Ye Miao
- Janssen Research & Development LLC., Immunology, Spring House, PA, USA
| | - Hongyan Zhang
- Janssen Research & Development LLC., Immunology, Spring House, PA, USA
| | - Ilia Tikhonov
- Janssen Research & Development LLC., Immunology, Spring House, PA, USA
| | - Remo Panaccione
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada
| | - Tadakazu Hisamatsu
- Department of Internal Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Ellen J Scherl
- Jill Roberts Center for Inflammatory Bowel Disease, New York Presbyterian Weill Cornell Medical College, New York, NY, USA
| | - Rupert W Leong
- Gastroenterology and Liver Services Concord Hospital and Department of Gastroenterology Macquarie University Hospital, Sydney, NSW, Australia
| | - Ramesh P Arasaradnam
- Department of Gastroenterology, University Hospital Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC, Canada
| | - Laurent Peyrin-Biroulet
- University of Lorraine, CHRU-Nancy, Department of Gastroenterology and Nutrition, Genetics, and Environmental Risk Exposure, Nancy, France
| | - Bruce E Sands
- Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Colleen Marano
- Janssen Research & Development LLC., Immunology, Spring House, PA, USA
| |
Collapse
|
180
|
Guillo L, Delanaye P, Flamant M, Figueres L, Karam S, Lemoine S, Benezech A, Pelletier AL, Amiot A, Caron B, Stefanescu C, Boschetti G, Bouguen G, Rahier JF, Gornet JM, Hugot JP, Bonnet J, Vuitton L, Nachury M, Vidon M, Uzzan M, Serrero M, Dib N, Seksik P, Hebuterne X, Bertocchio JP, Mariat C, Peyrin-Biroulet L. Kidney function monitoring in inflammatory bowel disease: The MONITORED consensus. Dig Liver Dis 2022; 54:309-315. [PMID: 34866011 DOI: 10.1016/j.dld.2021.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 09/06/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel diseases (IBD) are exposed to drug-related nephrotoxicity and kidney-related extra-intestinal manifestations (EIMs). Patients should be monitored but guidance is lacking in current international recommendations. The objective of the Kidney Function Monitoring in Inflammatory Bowel Disease (MONITORED) initiative was to achieve an expert consensus about monitoring kidney function in IBD. METHODS A literature review was first conducted. Then, an expert consensus meeting, involving 28 attendees representing French-speaking gastroenterologists and nephrologists, was held as part of an academic initiative on May 28, 2021. An anonymous Delphi process was used to discuss and vote on statements. Agreement was defined as at least 75% of participants voting for any one statement. RESULTS Experts reached consensus on 11 criteria for referral to the nephrologist. Concerning kidney function monitoring, participants unanimously validated the use of serum creatinine with estimation of the glomerular filtration rate via the MDRD or CKD-EPI equations. A blood ionogram and a urine sample with measurement of a protein-to-creatinine ratio were also broadly agreed validated. Experts recommended performing this monitoring at IBD diagnosis, prior introducing a new treatment, and annually for EIMs screening and evaluation of treatment tolerance. An evaluation 3 months after starting mesalamine and then every 6 months was felt necessary, while for biologics an annually monitoring was deemed sufficient. CONCLUSION The MONITORED consensus proposed guidelines on how to monitor kidney function in IBD. These recommendations should be considered in clinical practice to preserve kidney function and ensure the best approach to our patients.
Collapse
Affiliation(s)
- Lucas Guillo
- Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France.
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULiege), CHU Sart Tilman, Liège, Belgium; Department of Nephrology-Dialysis-Apheresis, Hôpital Universitaire Carémeau, Nîmes, France
| | - Martin Flamant
- Physiologie-Explorations Fonctionnelles, FHU APOLLO, Assistance Publique Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Université de Paris, CRI, INSERM F-75018, Paris, France
| | - Lucile Figueres
- Université de Nantes, Institut de Transplantation Urologie Néphrologie (ITUN), CHU Nantes, Service de néphrologie-immunologie clinique, CHU de Nantes, France
| | - Sabine Karam
- Division of Nephrology and Hypertension, Saint-George Hospital University Medical Center, Beirut, Lebanon
| | - Sandrine Lemoine
- Service de Néphrologie, dialyse, hypertension et exploration fonctionnelle rénale, Hôpital Edouard Herriot, Lyon, France
| | - Alban Benezech
- Departement of Gastroenterology, Henri Duffaut Hospital, Avignon, France
| | | | - Aurélien Amiot
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, University of Paris Est Créteil, Créteil, France
| | - Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Carmen Stefanescu
- Department of Gastroenterology, IBD unit, Beaujon Hospital, APHP, Clichy, France
| | - Gilles Boschetti
- Department of Gastroenterology, Hospices Civils de Lyon, Lyon-Sud Hospital, Pierre Bénite, and INSERM U1111 - CIRI, Lyon, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Centre Hospitalier Universitaire Pontchaillou, Rennes, France
| | | | - Jean-Marc Gornet
- Department of Gastroenterology, Saint-Louis Hospital, APHP, Paris, France
| | - Jean-Pierre Hugot
- Department of Pediatric Gastroenterology, Hôpital Universitaire Robert Debré, Assistance Publique Hôpitaux de Paris, Université de Paris, Paris, France
| | - Joëlle Bonnet
- Department of Gastroenterology, Saint-Louis Hospital, APHP, Paris, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Maria Nachury
- Univ, Lille, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
| | - Mathias Vidon
- Department of gastroenterology, CHI Créteil, Créteil, France
| | - Mathieu Uzzan
- Department of Gastroenterology, IBD unit, Beaujon Hospital, APHP, Clichy, France
| | - Mélanie Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, University of Aix-Marseille, Marseille, France
| | - Nina Dib
- Hepato-Gastroenterology Department, Angers University Hospital, Angers, France; HIFIH Laboratory, UPRES 3859, SFR 4208, Angers University, Angers, France
| | - Philippe Seksik
- Department of Gastroenterology, Centre de recherche Saint-Antoine, Sorbonne Université, APHP, Hôpital Saint-Antoine, Paris, France
| | - Xavier Hebuterne
- Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Jean-Philippe Bertocchio
- Nephrology Department, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Mariat
- Service de Néphrologie, Dialyse, Transplantation Rénale, Hôpital Nord, CHU de Saint-Etienne, EA 3065, Université Jean MONNET, Saint-Etienne, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
181
|
Parigi TL, Peyrin-Biroulet L, Danese S. Endoscopic Surveillance in Inflammatory Bowel Disease: The VIRTUE Is in High Definition. Gastroenterology 2022; 162:988-990. [PMID: 34688711 DOI: 10.1053/j.gastro.2021.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Tommaso Lorenzo Parigi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Immunology and Immunotherapy, Birmingham University, Birmingham, UK
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital and, Inserm U1256 NGERE, Lorraine University, Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, and, University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
182
|
Allocca M, Dell'Avalle C, Craviotto V, Furfaro F, Zilli A, D'Amico F, Bonovas S, Peyrin-Biroulet L, Fiorino G, Danese S. Predictive value of Milan ultrasound criteria in ulcerative colitis: A prospective observational cohort study. United European Gastroenterol J 2022; 10:190-197. [PMID: 35233934 PMCID: PMC8911545 DOI: 10.1002/ueg2.12206] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/16/2022] [Indexed: 12/12/2022] Open
Abstract
Background Endoscopic healing is an established treatment target for ulcerative colitis (UC). We have recently validated the Milan ultrasound criteria (MUC) to assess endoscopic activity in UC; a MUC score > 6.2 is a valid cut‐off to discriminate endoscopic activity (Mayo endoscopic subscore > 1). Objective The aim of this study was to assess the predictive value of MUC on disease course in a prospective cohort of UC patients. Methods UC patients regardless of disease activity and current therapy, underwent colonoscopy and bowel ultrasound (US) at baseline in a blinded fashion. Correlations between baseline MUC and Mayo endoscopic subscore were assessed using Spearman's rank correlation. UC‐related negative course (defined as the need for corticosteroids, or treatment escalation, or hospitalization, or need for colectomy: a composite outcome) over a median 20 months follow‐up, was investigated using the Kaplan‐Meier method and Cox regression analysis. Results 98 UC patients were followed up for a median time of 1.6 years (IQR 0.9¬2.7). Milan ultrasound criteria and Mayo endoscopic subscore significantly correlated at baseline (ρ = 0.653; p < 0.001). 70 patients (71%) had negative disease course during the follow‐up period. Milan ultrasound criteria > 6.2 at baseline was statistically significantly associated with negative disease course (HR: 3.87, 95% CI: 2.25–6.64, p < 0.001). Kaplan–Meier analyses drawed a statistically significantly lower cumulative probability of treatment escalation, need of corticosteroids, hospitalization and colectomy, among patients who had MUC ≤ 6.2 at baseline as compared to patients with MUC > 6.2 (p < 0.05 for all outcomes). Conclusion we have demonstrated for the first time the value of bowel US and an US score in predicting disease course in UC. Milan ultrasound criteria, a validated US‐based score, predicts disease course in UC. Milan ultrasound criteria ≤ 6.2 may be the new treatment target to achieve to reduce the risk of worse outcomes.
Collapse
Affiliation(s)
- Mariangela Allocca
- IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | | | | | | | - Alessandra Zilli
- IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Ferdinando D'Amico
- IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IRCCS Humanitas Research Hospital, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE, University Hospital of Nancy, University of Lorraine, Nancy, France
| | - Gionata Fiorino
- IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Silvio Danese
- IRCCS Hospital San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
183
|
D'Alessio S, Ungaro F, Noviello D, Lovisa S, Peyrin-Biroulet L, Danese S. Revisiting fibrosis in inflammatory bowel disease: the gut thickens. Nat Rev Gastroenterol Hepatol 2022; 19:169-184. [PMID: 34876680 DOI: 10.1038/s41575-021-00543-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [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] [Accepted: 10/27/2021] [Indexed: 12/11/2022]
Abstract
Intestinal fibrosis, which is usually the consequence of chronic inflammation, is a common complication of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. In the past few years, substantial advances have been made in the areas of pathogenesis, diagnosis and management of intestinal fibrosis. Of particular interest have been inflammation-independent mechanisms behind the gut fibrotic process, genetic and environmental risk factors (such as the role of the microbiota), and the generation of new in vitro and in vivo systems to study fibrogenesis in the gut. A huge amount of work has also been done in the area of biomarkers to predict or detect intestinal fibrosis, including novel cross-sectional imaging techniques. In parallel, researchers are embarking on developing and validating clinical trial end points and protocols to test novel antifibrotic agents, although no antifibrotic therapies are currently available. This Review presents the state of the art on the most recently identified pathogenic mechanisms of this serious IBD-related complication, focusing on possible targets of antifibrotic therapies, management strategies, and factors that might predict fibrosis progression or response to treatment.
Collapse
Affiliation(s)
| | - Federica Ungaro
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Noviello
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Sara Lovisa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IBD Centre, Laboratory of Gastrointestinal Immunopathology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Laurent Peyrin-Biroulet
- INSERM NGERE, University of Lorraine, Vandoeuvre-les-Nancy, Nancy, France.,Nancy University Hospital, Vandoeuvre-les-Nancy, Nancy, France
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Milan, Italy. .,University Vita-Salute San Raffaele, Milan, Italy.
| |
Collapse
|
184
|
Caron B, D'Amico F, Danese S, Peyrin-Biroulet L. Cluster Randomized Trials: Lessons for Inflammatory Bowel Disease Trials. J Crohns Colitis 2022; 16:312-318. [PMID: 34389850 DOI: 10.1093/ecco-jcc/jjab149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Randomized clinical trials are the gold standard for the development of new drugs. Clinical trials have become increasingly complex, in particular in the field of inflammatory bowel diseases. For this reason, a new study design called 'cluster randomized trial' has been introduced. Cluster randomized trials randomly assign groups of individuals within a population of interest, such as people in a particular research site, clinic or hospital, and measure the effects of an intervention at the individual level. In contrast to individual randomization, cluster randomization permits the evaluation of a cluster-level intervention, may be logistically simpler and less expensive than a conventional randomized trial, and can help reduce the effect of treatment contamination. An important aspect requiring particular attention in cluster randomized trials is the risk for imbalance of covariates at baseline which decreases the statistical power and precision of the results, and reduces face validity and credibility of the trial results. A variety of restricted randomization methods have been proposed to minimize risk of imbalance. Our aim here is to clarify the advantages and drawbacks of cluster randomized trials in order to properly interpret study results and to identify their role in upcoming inflammatory bowel disease trials.
Collapse
Affiliation(s)
- Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Ferdinando D'Amico
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milano, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
185
|
Panaccione R, Ferrante M, Feagan BG, Sandborn W, Panes J, Peyrin-Biroulet L, Colombel J, Schreiber S, Dubinsky M, Baert F, Hisamatsu T, Neimark E, Huang B, Liao X, Song A, Berg S, Duan W, Pang Y, Pivorunas V, Kligys K, Wallace K, D’Haens G. A37 EFFICACY AND SAFETY OF RISANKIZUMAB AS MAINTENANCE THERAPY IN PATIENTS WITH CROHN’S DISEASE: 52 WEEK RESULTS FROM THE PHASE 3 FORTIFY STUDY. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859234 DOI: 10.1093/jcag/gwab049.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Risankizumab (RZB), an anti-IL-23 p19 inhibitor, was well-tolerated and superior to placebo (PBO) in inducing clinical remission and endoscopic response in patients (pts) with moderate-to-severe Crohn’s disease (CD) in two phase 3 studies at 12 weeks. Aims FORTIFY (NCT03105102), was a 52-week (wk) phase 3 double-blind, re-randomized responder withdrawal study that evaluated the efficacy and safety of continuing RZB as subcutaneous (SC) maintenance therapy versus withdrawal to placebo in pts achieving induction response to RZB Methods Week 12 IV RZB responders were re-randomized 1:1:1 to: RZB SC 360mg (N=141), RZB 180mg (N=157), or PBO (withdrawal from IV RZB; N=164) every 8wks for 52wks. Co-primary endpoints were clinical remission (per CD Activity Index [CDAI] (US); or stool frequency/abdominal pain score [SF/APS] (OUS) and endoscopic response at wk52. Other clinical and endoscopic endpoints, inflammatory biomarkers, RZB serum levels, and safety were assessed over time. Results Rates of clinical remission (CDAI, SF/APS) and clinical response were similar for RZB and PBO groups through wk24, with rates lower for PBO thereafter. At wk52, clinical remission (CDAI, SF/APS) and endoscopic response rates were significantly higher with RZB 360mg than PBO ( P<0.01); RZB 180mg was superior to PBO for clinical remission per CDAI and endoscopic response ( P<0.01). Endoscopic remission and deep remission rates increased over time with 360mg, remained steady with 180mg, and decreased with PBO. Mean fecal calprotectin (FCP) and C-reactive protein (CRP) levels decreased with SC RZB, but increased with PBO, over 52wks. Exposure-adjusted event rates (per 100 pts-years) of serious adverse event (AE) were generally similar among groups (360mg, 21.0 E/100PY and 180mg, 19.5 E/100PY vs PBO, 19.3 E/100PY), as were AEs leading to drug discontinuation (4.8 E/100PY and 2.4 E/100PY vs 3.7 E/100PY), and serious infections (6.0 E/100PY and 3.0 E/100PY vs 5.0 E/100PY). Conclusions In pts with moderate-to-severe CD, a robust pharmacodynamic effect on the IL-23 pathway after 12wks RZB IV induction was maintained with RZB SC maintenance therapy. The durability of RZB was demonstrated with high rates of efficacy over the 52-wk study. RZB was superior to PBO for achieving clinical remission and endoscopic response at wk52. Results for the more stringent endpoints (endoscopic remission\deep remission) and persistent improvements in inflammatory biomarkers are consistent with a dose response relationship. Continued RZB SC maintenance treatment was generally safe and well-tolerated. Funding Agencies AbbVie
Collapse
Affiliation(s)
| | - M Ferrante
- Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven Campus Gasthuisberg, Leuven, Flanders, Belgium
| | | | - W Sandborn
- University of California San Diego, La Jolla, CA
| | - J Panes
- Institut d’Investigacions Biomediques August Pi i Sunyer, Barcelona, Catalunya, Spain
| | | | | | - S Schreiber
- Universitatsklinikum Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | | | - F Baert
- AZ Delta vzw, Roeselare, West-Vlaanderen, Belgium
| | - T Hisamatsu
- Kyorin Daigaku Igakubu Daigakuin Igaku Kenkyuka, Mitaka, Tokyo, Japan
| | | | - B Huang
- AbbVie Inc, North Chicago, IL
| | - X Liao
- AbbVie Inc, North Chicago, IL
| | - A Song
- AbbVie Inc, North Chicago, IL
| | - S Berg
- AbbVie Inc, North Chicago, IL
| | - W Duan
- AbbVie Inc, North Chicago, IL
| | - Y Pang
- AbbVie Inc, North Chicago, IL
| | | | | | | | - G D’Haens
- Universiteit van Amsterdam, Amsterdam, Noord-Holland, Netherlands
| |
Collapse
|
186
|
Muller M, Haghnejad V, Schaefer M, Gauchotte G, Caron B, Peyrin-Biroulet L, Bronowicki JP, Neuzillet C, Lopez A. The Immune Landscape of Human Pancreatic Ductal Carcinoma: Key Players, Clinical Implications, and Challenges. Cancers (Basel) 2022; 14:cancers14040995. [PMID: 35205742 PMCID: PMC8870260 DOI: 10.3390/cancers14040995] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive and deadliest cancer worldwide with an overall survival rate, all stages combined, of still <10% at 5 years. The poor prognosis is attributed to challenges in early detection, a low opportunity for radical resection, limited response to chemotherapy, radiotherapy, and resistance to immune therapy. Moreover, pancreatic tumoral cells are surrounded by an abundant desmoplastic stroma, which is responsible for creating a mechanical barrier, preventing appropriate vascularization and leading to poor immune cell infiltration. Accumulated evidence suggests that PDAC is impaired with multiple “immune defects”, including a lack of high-quality effector cells (CD4, CD8 T cells, dendritic cells), barriers to effector cell infiltration due to that desmoplastic reaction, and a dominance of immune cells such as regulatory T cells, myeloid-derived suppressor cells, and M2 macrophages, resulting in an immunosuppressive tumor microenvironment (TME). Although recent studies have brought new insights into PDAC immune TME, its understanding remains not fully elucidated. Further studies are required for a better understanding of human PDAC immune TME, which might help to develop potent new therapeutic strategies by correcting these immune defects with the hope to unlock the resistance to (immune) therapy. In this review, we describe the main effector immune cells and immunosuppressive actors involved in human PDAC TME, as well as their implications as potential biomarkers and therapeutic targets.
Collapse
Affiliation(s)
- Marie Muller
- Department of Gastroenterology, Nancy University Hospital, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; (V.H.); (M.S.); (B.C.); (L.P.-B.); (J.-P.B.); (A.L.)
- Correspondence:
| | - Vincent Haghnejad
- Department of Gastroenterology, Nancy University Hospital, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; (V.H.); (M.S.); (B.C.); (L.P.-B.); (J.-P.B.); (A.L.)
| | - Marion Schaefer
- Department of Gastroenterology, Nancy University Hospital, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; (V.H.); (M.S.); (B.C.); (L.P.-B.); (J.-P.B.); (A.L.)
| | - Guillaume Gauchotte
- Department of Pathology, Nancy University Hospital, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France;
- INSERM U1256, NGERE, Faculty of Medicine, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Bénédicte Caron
- Department of Gastroenterology, Nancy University Hospital, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; (V.H.); (M.S.); (B.C.); (L.P.-B.); (J.-P.B.); (A.L.)
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; (V.H.); (M.S.); (B.C.); (L.P.-B.); (J.-P.B.); (A.L.)
- INSERM U1256, NGERE, Faculty of Medicine, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Jean-Pierre Bronowicki
- Department of Gastroenterology, Nancy University Hospital, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; (V.H.); (M.S.); (B.C.); (L.P.-B.); (J.-P.B.); (A.L.)
- INSERM U1256, NGERE, Faculty of Medicine, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France
| | - Cindy Neuzillet
- Medical Oncology Department, Curie Institute, Versailles Saint-Quentin University (UVQ), Paris Saclay University, 92064 Saint-Cloud, France;
| | - Anthony Lopez
- Department of Gastroenterology, Nancy University Hospital, University of Lorraine, 54500 Vandœuvre-lès-Nancy, France; (V.H.); (M.S.); (B.C.); (L.P.-B.); (J.-P.B.); (A.L.)
| |
Collapse
|
187
|
Dell'Avalle C, D'Amico F, Gabbiadini R, Dal Buono A, Pugliese N, Zilli A, Furfaro F, Fiorino G, Allocca M, Peyrin-Biroulet L, Danese S. JAK inhibitors in crohn's disease: ready to go? Expert Opin Investig Drugs 2022; 31:145-161. [PMID: 35164629 DOI: 10.1080/13543784.2022.2032639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Crohn's disease (CD) is a chronic, relapsing inflammatory bowel disease that can lead to significant organ damage and impaired quality of life. To date, a considerable proportion of patients does not respond to biologic compounds. It is, therefore, necessary to find alternative options with adequate efficacy and safety profiles in order to increase the chances of obtaining an enduring remission of disease. Janus kinase (JAK) inhibitors are a new class of compounds that might well serve this purpose. The aim of our review is to report the available data from clinical trials testing these new drugs in patients suffering from CD. AREAS COVERED PubMed database and ClinicalTrials.gov website were consulted in order to find the clinical trials evaluating the efficacy and safety profiles of JAK-inhibitors in CD patients, including the following compounds: tofacitinib, filgotinib, upadacitinib, TD-1473, and Pf-06651600/Pf-06700841. EXPERT OPINION JAK-inhibitors are a promising class of oral compounds in moderate-severe CD. Further clinical trials are necessary in order to implement the available knowledge, especially on their long-term safety issues.
Collapse
Affiliation(s)
| | - Ferdinando D'Amico
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | | | - Arianna Dal Buono
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Nicola Pugliese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Alessandra Zilli
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | | | - Gionata Fiorino
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm Ngere U1256, University Hospital of Nancy, University of Lorraine, France
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
188
|
Peyrin-Biroulet L, Soubrier M, Viguier M, Czernichow S. Étude observationnelle évaluant l’état nutritionnel de patients atteints d’une maladie inflammatoire chronique et traités par un biosimilaire de l’adalimumab. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
189
|
Caron B, Fumery M, Netter P, Peyrin-Biroulet L. Letter: treatment with subcutaneous CT-P13 in Crohn's disease patients with intravenous infliximab failure. Aliment Pharmacol Ther 2022; 55:508-509. [PMID: 35092046 DOI: 10.1111/apt.16770] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/11/2022]
Affiliation(s)
- Bénédicte Caron
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Mathurin Fumery
- Department of Gastroenterology, and Peritox, UMR I-01, Amiens University Hospital, Amiens, France
| | - Patrick Netter
- Ingénierie Moléculaire et Ingénierie Articulaire (IMoPA), UMR-7365 CNRS, Faculté de Médecine, University of Lorraine and University Hospital of Nancy, Vandoeuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| |
Collapse
|
190
|
Papamichael K, Afif W, Drobne D, Dubinsky MC, Ferrante M, Irving PM, Kamperidis N, Kobayashi T, Kotze PG, Lambert J, Noor NM, Roblin X, Roda G, Vande Casteele N, Yarur AJ, Arebi N, Danese S, Paul S, Sandborn WJ, Vermeire S, Cheifetz AS, Peyrin-Biroulet L. Therapeutic drug monitoring of biologics in inflammatory bowel disease: unmet needs and future perspectives. Lancet Gastroenterol Hepatol 2022; 7:171-185. [PMID: 35026171 PMCID: PMC10187071 DOI: 10.1016/s2468-1253(21)00223-5] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [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: 04/16/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 01/05/2023]
Abstract
Therapeutic drug monitoring (TDM) has emerged as a useful tool for optimising the use of biologics, and in particular anti-tumour necrosis factor (anti-TNF) therapy, in inflammatory bowel disease (IBD). However, challenges remain and are hindering the widespread implementation of TDM in clinical practice. These barriers include identification of the optimal drug concentration to target, the lag time between sampling and results, and the proper interpretation of anti-drug antibody titres among different assays. Solutions to overcome these barriers include the harmonisation of TDM assays and the use of point-of-care testing. Other unmet needs include well designed prospective studies and randomised controlled trials focusing on proactive TDM, particularly during induction therapy. Future studies should also investigate the utility of TDM for biologics other than anti-TNF therapies in both IBD and other immune-mediated inflammatory diseases such as rheumatoid arthritis and psoriasis, and the use of pharmacokinetic modelling dashboards and pharmacogenetics towards individual personalised medicine.
Collapse
Affiliation(s)
- Konstantinos Papamichael
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Waqqas Afif
- Department of Medicine, Division of Gastroenterology, McGill University Health Center, Montreal, QC, Canada
| | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Marla C Dubinsky
- Department of Pediatrics, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marc Ferrante
- KU Leuven, Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Peter M Irving
- Gastroenterology, Guy's and St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Paulo G Kotze
- Catholic University of Paraná (PUCPR), Curitiba, Brazil
| | - Jo Lambert
- Department of Head and Skin, Ghent University Hospital, Ghent, Belgium
| | - Nurulamin M Noor
- Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Xavier Roblin
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - Giulia Roda
- IBD Center, Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | | | - Naila Arebi
- Department of IBD, St Mark's Hospital, Imperial College London, London, UK
| | - Silvio Danese
- IBD Center, Humanitas Clinical and Research Center-IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Stephane Paul
- Department of Gastroenterology, University Hospital of Saint Etienne, Saint Etienne, France
| | - William J Sandborn
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Séverine Vermeire
- KU Leuven, Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
| | - Adam S Cheifetz
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Nancy, France; INSERM U1256 NGERE, Lorraine University, Nancy, France
| | | |
Collapse
|
191
|
Ben-Horin S, Novack L, Mao R, Guo J, Zhao Y, Sergienko R, Zhang J, Kobayashi T, Hibi T, Chowers Y, Peyrin-Biroulet L, Colombel JF, Kaplan GG, Chen MH. Efficacy of Biologic Drugs in Short-Duration Versus Long-Duration Inflammatory Bowel Disease: A Systematic Review and an Individual-Patient Data Meta-Analysis of Randomized Controlled Trials. Gastroenterology 2022; 162:482-494. [PMID: 34757139 DOI: 10.1053/j.gastro.2021.10.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [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: 06/05/2021] [Revised: 09/11/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS Starting biologic treatment early in the course of inflammatory bowel disease (IBD) may be associated with higher efficacy, especially in Crohn's disease (CD). METHODS This was a systematic review and individual-patient data meta-analysis of all placebo-controlled trials of biologics approved for IBD at study inception (October 2015), using Vivli data-sharing platform. The primary outcome was the proportional biologic/placebo treatment effect on induction of remission in patients with short-duration (≤18 months) vs long-duration disease (>18 months) analyzed separately for CD and ulcerative colitis (UC). We used meta-regression to examine the impact of patients' characteristics on the primary outcome. RESULTS We included 25 trials, testing infliximab, adalimumab, certolizumab, golimumab, natalizumab, or vedolizumab (6168 patients with CD and 3227 patients with UC). In CD, remission induction rates were higher in pooled placebo and patients in active arms with short-duration disease of ≤18 months (41.4% [244 of 589]) compared with disease duration of >18 months (29.8% [852 of 2857], meta-analytically estimated odds ratio, 1.33; 95% confidence interval, 1.09-1.64). The primary outcome, proportional biologic/placebo treatment effect on induction of remission, was not different in short-duration disease of ≤18 months (n = 589, odds ratio, 1.47; 95% confidence interval, 1.01-2.15) compared with longer disease duration (n = 2857, odds ratio, 1.43; 95% confidence interval, 1.19-1.72). In UC trials, both the proportional biologic/placebo remission-induction effect and the pooled biologic-placebo effect were stable, regardless of disease duration. Primary outcome results remained unchanged when tested using alternative temporal cutoffs and when modeled for individual patient's covariates, including prior anti-tumor necrosis factor exposure. CONCLUSIONS There are higher rates of induction of remission with biologics and with placebo in early CD, resulting in a treatment to placebo effect ratio that is similar across disease durations. No such relationships between disease duration and outcomes was found in UC. PROSPERO registration: CRD42018041961.
Collapse
Affiliation(s)
- Shomron Ben-Horin
- Department of Gastroenterology, First Affiliated Hospital of the Sun Yatsen University, Guangzhou, China; Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Lena Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ren Mao
- Department of Gastroenterology, First Affiliated Hospital of the Sun Yatsen University, Guangzhou, China
| | - Jing Guo
- Department of Gastroenterology, First Affiliated Hospital of the Sun Yatsen University, Guangzhou, China
| | - Yue Zhao
- Department of Gastroenterology, First Affiliated Hospital of the Sun Yatsen University, Guangzhou, China
| | - Ruslan Sergienko
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Jian Zhang
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Taku Kobayashi
- Center for Advanced Inflammatory Bowel Disease Research and Treatment, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Toshifumi Hibi
- Center for Advanced Inflammatory Bowel Disease Research and Treatment, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam Health Care Campus, Bruce and Ruth Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | | | - Jean Frederic Colombel
- Helmsley Inflammatory Bowel Disease Center, Icahn School of Medicine, Mount Sinai Hospital, New York, New York
| | - Gilaad G Kaplan
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Min-Hu Chen
- Department of Gastroenterology, First Affiliated Hospital of the Sun Yatsen University, Guangzhou, China.
| |
Collapse
|
192
|
Sands BE, Peyrin-Biroulet L, Kierkus J, Higgins PDR, Fischer M, Jairath V, Hirai F, D'Haens G, Belin RM, Miller D, Gomez-Valderas E, Naegeli AN, Tuttle JL, Pollack PF, Sandborn WJ. Efficacy and Safety of Mirikizumab in a Randomized Phase 2 Study of Patients With Crohn's Disease. Gastroenterology 2022; 162:495-508. [PMID: 34748774 DOI: 10.1053/j.gastro.2021.10.050] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 10/08/2021] [Accepted: 10/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mirikizumab is a humanized monoclonal antibody targeting interleukin 23p19 with demonstrated efficacy in psoriasis and ulcerative colitis. We investigated the safety and efficacy of mirikizumab in patients with moderate-to-severe Crohn's disease (CD). METHODS Patients (N = 191) were randomized (2:1:1:2) to receive placebo (PBO), 200, 600, or 1000 mg mirikizumab, administered intravenously (IV) every 4 weeks. Patients who received mirikizumab and achieved ≥1 point improvement in Simple Endoscopic Score-CD at Week 12 (rerandomized maintenance cohort) were rerandomized to continue their induction IV treatment (combined IV groups [IV-C]) or receive 300 mg mirikizumab subcutaneously (SC) every 4 weeks. Nonrandomized maintenance cohort included endoscopic nonimprovers (1000 mg) and PBO patients (PBO/1000 mg) who received 1000 mg mirikizumab IV from Week 12. The primary objective was to evaluate superiority of mirikizumab to PBO in inducing endoscopic response (50% reduction from baseline in Simple Endoscopic Score-CD) at Week 12. RESULTS At Week 12, endoscopic response was significantly higher by the predefined 2-sided significance level of 0.1 for all mirikizumab groups compared with PBO (200 mg: 25.8%, 8/31, 95% confidence interval [CI], 10.4-41.2, P = .079; 600 mg: 37.5%, 12/32, 95% CI, 20.7-54.3, P = .003; 1000 mg: 43.8%, 28/64, 95% CI, 31.6-55.9, P < .001; PBO: 10.9 %, 7/64, 95% CI, 3.3-18.6). Endoscopic response at Week 52 was 58.5% (24/41) and 58.7% (27/46) in the IV-C and SC groups, respectively. Frequencies of adverse events (AE) in the mirikizumab groups were similar to PBO. Through Week 52, frequencies of treatment-emergent AEs were similar across all groups. Frequencies of serious AE and discontinuations due to AE were higher in the nonrandomized maintenance cohort. CONCLUSION Mirikizumab effectively induced endoscopic response after 12 weeks in patients with moderate-to-severe CD and demonstrated durable efficacy to Week 52. A detailed summary can be found in the Video Abstract. ClinicalTrials.gov, Number: NCT02891226.
Collapse
Affiliation(s)
- Bruce E Sands
- Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | | | | | | | | | | | - Geert D'Haens
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
193
|
Allocca M, Craviotto V, Dell'Avalle C, Furfaro F, Zilli A, D'Amico F, Bonovas S, Peyrin-Biroulet L, Fiorino G, Danese S. Bowel ultrasound score is accurate in assessing response to therapy in patients with Crohn's disease. Aliment Pharmacol Ther 2022; 55:446-454. [PMID: 34783066 DOI: 10.1111/apt.16700] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 07/25/2021] [Revised: 08/15/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND We developed a non-invasive bowel ultrasound score (BUSS) to assess disease activity in Crohn's disease (CD). BUSS >3.52 is an indicator of endoscopic activity (SES-CD>2). AIM To assess whether BUSS, in addition to detecting inflammatory lesions, also detects relevant changes of these lesions over time. METHODS This was a prospective observational study of 49 patients with active CD. All patients underwent bowel ultrasound and colonoscopy at baseline and at re-assessment after treatment with biologics and/or immunosuppressants. The primary objective was to assess the sensitivity to change of BUSS in patients treated for active CD, using the SES-CD as reference standard. RESULTS BUSS changed significantly from baseline to re-assessment in patients achieving endoscopic response (a reduction of SES-CD of at least 50% vs baseline: 4.87 [3.78-6.0] vs 2.47 [2.25-3.36], P < 0.001) and endoscopic remission (SES-CD ≤ 2: 4.65 [3.58-6.03] vs 2.25 [2.25-3.46], P = 0.003). A change of -1.2 in BUSS over time predicted endoscopic response (AUC 0.786, 95% CI 0.645-0.890; sensitivity 74%, specificity 83%). BUSS determined endoscopic response with 80% accuracy, and endoscopic remission with 78% accuracy. BUSS accurately detected changes in lesion severity (Guyatt score: 1.41 and standardized effect score: 1.74). BUSS did not change significantly in patients who did not achieve endoscopic response (5.62 [5.26-6.15] vs 5.70 [4.97-6.19], P = 0.53) or endoscopic remission (5.62 [5.18-6.14] vs 5.10 [4.58-6.05]; P = 0.10). CONCLUSION BUSS is sensitive to change in CD.
Collapse
Affiliation(s)
- Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | | | | | | | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Ferdinando D'Amico
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Stefanos Bonovas
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE 1256, University Hospital of Nancy, Université de Lorraine, Nancy, France
| | - Gionata Fiorino
- IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
194
|
Huynh L, Hass S, Peyrin-Biroulet L, Duh MS, Sipsma H, Cheng M, Lax A, Nag A. Real-World Treatment Patterns and Physician Preferences for Biologics in Moderate-to-Severe Inflammatory Bowel Disease: Retrospective Chart Review in Europe. Crohns Colitis 360 2022; 4:otac001. [PMID: 36777550 PMCID: PMC9802114 DOI: 10.1093/crocol/otac001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background With many options available for treating inflammatory bowel disease (IBD) in Europe, this study sought to characterize physician treatment preferences and real-world treatment patterns in patients with moderate-to-severe ulcerative colitis (UC) and Crohn's disease (CD). Methods This was a retrospective, noninterventional, physician-administered study. Gastroenterologists and general practitioners (n = 348) in France, Germany, and the United Kingdom provided information on treatment preferences and extracted information from records of patients with moderate-to-severe UC (n = 587) or CD (n = 417) who had received biologic, biosimilar or Janus kinase inhibitor therapies (2014-2019) and had IBD-related medical history available 6 months before and after treatment initiation. Results Physicians largely preferred infliximab and adalimumab or their biosimilars as first-line therapy for UC (originators, 65.8%; biosimilars, 26.1%) and CD (originators, 61.8%; biosimilars, 30.5%). Effectiveness was the most cited reason for treatment preference (92%-93% of physicians). Three-quarters of patients (UC, 75.8%; CD, 73.6%) received infliximab or adalimumab originators in the first line, with more patients receiving infliximab biosimilars than adalimumab biosimilars (12.4%-12.5% and 0.5%-4.1%, respectively, across UC and CD). Persistence was longer for first-line infliximab than adalimumab (UC, 26.6 vs 21.2 months; CD, 31.2 vs 26.7 months) and was generally shorter for their respective biosimilars. Nonbiologic treatments were used in combination with biologics in 14.1% (UC) and 11.5% (CD) of patients. Most patients received 1 biologic therapy (UC, 90.6%; CD, 83.2%); only 9.4% (UC) and 16.8% (CD) received a second biologic. Conclusions Infliximab and adalimumab originators dominated first-line biologic therapy for moderate-to-severe UC and CD. Understanding real-world treatment patterns can help assess new treatment uptake and suggest opportunities for improving treatment.
Collapse
Affiliation(s)
- Lynn Huynh
- Analysis Group, Inc., Boston, Massachusetts, USA,Address correspondence to: Lynn Huynh, MPH, MBA, DrPH, Analysis Group, Inc., 111 Huntington Avenue, 14th Floor, Boston, MA 02199, USA ()
| | - Steve Hass
- H. E. Outcomes, LLC, Los Angeles, California, USA
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Université de Lorraine, Nancy, France
| | | | | | - Mu Cheng
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Angie Lax
- Analysis Group, Inc., Boston, Massachusetts, USA
| | - Arpita Nag
- Takeda Development Center Americas, Lexington, Massachusetts, USA
| |
Collapse
|
195
|
Williams I, Pandey S, Haller W, Huynh HQ, Chan A, Düeker G, Bettels R, Peyrin-Biroulet L, Dike CR, DeGeeter C, Smith D, Al Eisa N, Platt N, Marquardt T, Schwerd T, Platt FM, Uhlig HH. Anti-TNF therapy for inflammatory bowel disease in patients with neurodegenerative Niemann-Pick disease Type C. Wellcome Open Res 2022; 7:11. [PMID: 35694196 PMCID: PMC9171292 DOI: 10.12688/wellcomeopenres.16986.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Blockade of tumour necrosis factor (anti-TNF) is effective in patients with Crohn’s Disease but has been associated with infection risk and neurological complications such as demyelination. Niemann-Pick disease Type C1 (NPC1) is a lysosomal storage disorder presenting in childhood with neurological deterioration, liver damage and respiratory infections. Some NPC1 patients develop severe Crohn’s disease. Our objective was to investigate the safety and effectiveness of anti-TNF in NPC1 patients with Crohn’s disease. Methods: Retrospective data on phenotype and therapy response were collected in 2019-2020 for the time period 2014 to 2020 from patients in the UK, France, Germany and Canada with genetically confirmed NPC1 defects and intestinal inflammation. We investigated TNF secretion in peripheral blood mononuclear cells treated with NPC1 inhibitor in response to bacterial stimuli. Results: NPC1 inhibitor treated peripheral blood mononuclear cells (PBMCs) show significantly increased TNF production after lipopolysaccharide or bacterial challenge providing a rationale for anti-TNF therapy. We identified 4 NPC1 patients with Crohn’s disease (CD)-like intestinal inflammation treated using anti-TNF therapy (mean age of onset 8.1 years, mean treatment length 27.75 months, overall treatment period 9.25 patient years). Anti-TNF therapy was associated with reduced gastrointestinal symptoms with no apparent adverse neurological events. Therapy improved intestinal inflammation in 4 patients. Conclusions: Anti-TNF therapy appears safe in patients with NPC1 and is an effective treatment strategy for the management of intestinal inflammation in these patients.
Collapse
Affiliation(s)
- Isabelle Williams
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | - Sumeet Pandey
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
| | | | - Hien Quoc Huynh
- Department of Paediatrics, Stollery Children's Hospital, University of Alberta, Alberta, Canada
| | - Alicia Chan
- Division of Clinical Genetics, Stollery Children's Hospital, University of Alberta, Alberta, Canada
| | | | | | - Laurent Peyrin-Biroulet
- Inserm U1256 NGERE, 8 Lorraine University, Vandoeuvre-les-Nancy, France
- Department of Gastroenterology, Nancy University Hospital Center, Vandoeuvre-les-Nancy, France
| | - Chinenye R. Dike
- Stead Family Department of Pediatrics, University of Iowa, Iowa, USA
| | | | - David Smith
- Department of Pharmacology, University of Oxford, Oxford, UK
| | - Nada Al Eisa
- Department of Pharmacology, University of Oxford, Oxford, UK
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nick Platt
- Department of Pharmacology, University of Oxford, Oxford, UK
| | | | - Tobias Schwerd
- Department of Paediatrics, Dr. von Hauner Children’s Hospital, Munich, Germany
| | | | - Holm H. Uhlig
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- Department of Paediatrics, University of Oxford, Oxford, UK
- Biomedical research centre, University of Oxford, Oxford, UK
| |
Collapse
|
196
|
D’Haens G, Rieder F, Feagan BG, Higgins PD, Panes J, Maaser C, Rogler G, Löwenberg M, van der Voort R, Pinzani M, Peyrin-Biroulet L, Danese S. Challenges in the Pathophysiology, Diagnosis, and Management of Intestinal Fibrosis in Inflammatory Bowel Disease. Gastroenterology 2022; 162:26-31. [PMID: 31254502 PMCID: PMC7680655 DOI: 10.1053/j.gastro.2019.05.072] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [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: 04/25/2020] [Revised: 05/16/2019] [Accepted: 10/03/2020] [Indexed: 01/03/2023]
Abstract
Intestinal fibrosis is a common complication of inflammatory bowel disease (IBD) that is usually the consequence of chronic inflammation. Although the currently available anti-inflammatory therapies have had little impact on intestinal fibrosis in Crohn’s disease (CD), increased understanding of the pathophysiology and the development of therapies targeting fibrogenic pathways hold promise for the future. One of the critical challenges is how reduction or reversal of intestinal fibrosis should be defined and measured in the setting of clinical trials and drug approval. The International Organization for Inflammatory Bowel Disease (IOIBD) organized a workshop in Amsterdam, The Netherlands, on December 19th and 20th, 2018 in an attempt to review the current knowledge of the biological background, diagnosis, treatment of intestinal fibrosis and clinical trial endpoints. Basic and clinical scientists discussed the pathophysiology of intestinal fibrosis, the current status of biomarkers and imaging modalities in stenosing CD, and recent clinical studies in this area. Researchers from outside of the IBD field presented advances in the understanding of fibrotic processes in other organs, such as the skin, liver and lungs. Lastly, the design of clinical trials with antifibrotic therapy for IBD was discussed, with priority on patient populations, patient reported outcomes (PROs) and imaging. This report summarizes the key findings, discussions and conclusions of the workshop.
Collapse
Affiliation(s)
- Geert D’Haens
- Amsterdam University Medical Center, Academic Medical Center, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Florian Rieder
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA,Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brian G. Feagan
- Western University, Department of Medicine, London, ON, Canada
| | - Peter D.R. Higgins
- University of Michigan Medical School, Department of Internal Medicine, Ann Arbor, Michigan, USA
| | - Julian Panes
- Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Christian Maaser
- University Teaching Hospital Lüneburg, Outpatients Department of Gastroenterology, Lüneburg, Germany
| | - Gerhard Rogler
- University Hospital Zurich, Department of Gastroenterology and Hepatology, and University of Zurich, Zurich, Switzerland
| | - Mark Löwenberg
- Amsterdam University Medical Center, Academic Medical Center, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | | | - Massimo Pinzani
- UCL Institute for Liver and Digestive Health, Division of Medicine, Royal Free Hospital, London, UK
| | - Laurent Peyrin-Biroulet
- University Hospital of Nancy, University of Lorraine, Department of Hepato-Gastroenterology and Inserm U954, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- IBD Center, Humanitas Clinical and Research Hospital, Humanitas University, Milan, Italy
| | | |
Collapse
|
197
|
Napolitano M, D’Amico F, Ragaini E, Peyrin-Biroulet L, Danese S. Evaluating Upadacitinib in the Treatment of Moderate-to-Severe Active Ulcerative Colitis: Design, Development, and Potential Position in Therapy. Drug Des Devel Ther 2022; 16:1897-1913. [PMID: 35747444 PMCID: PMC9211104 DOI: 10.2147/dddt.s340459] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/03/2022] [Indexed: 12/20/2022] Open
Abstract
Upadacitinib is a selective small molecule that inhibits Janus kinase (JAK) type 1. This molecule is administrated orally and is currently approved for the treatment of rheumatoid arthritis, atopic dermatitis, and psoriatic arthritis. Upadacitinib has been approved by the United States Food and Drug Administration for the induction and maintenance therapy of moderate-to-severe ulcerative colitis (UC) and is under investigation by the European Medicines Agency. Data from two induction and two maintenance Phase III randomized controlled trials (RCTs) proved the efficacy of upadacitinib in achieving clinical and endoscopic remission in patients with moderate-to-severe UC, regardless of previous inadequate response to other biologic therapies. The most frequently reported adverse events in the induction trials were acne, creatine phosphokinase increase, nasopharyngitis, headache, and anemia, while in the maintenance studies nasopharyngitis, elevation of creatine phosphokinase, UC exacerbation, upper respiratory tract infection, arthralgia, and anemia were reported. A limited proportion of upadacitinib-treated patients experienced adverse events of special interest, like herpes zoster infections or thromboembolic events, indicating a reliable safety profile. The aim of this review is to summarize the available evidence on upadacitinib in UC providing useful insights about the positioning of this drug in the therapeutic algorithm.
Collapse
Affiliation(s)
- Maria Napolitano
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Ferdinando D’Amico
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Elisa Ragaini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, University of Lorraine, CHRU-Nancy, Department of Gastroenterology, Nancy, F-54000, France
- Inserm, NGERE, University of Lorraine, Nancy, F-54000, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
- Correspondence: Silvio Danese, Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Via Olgettina 60, Milan, Italy, Tel/Fax +39 0226432069, Email
| |
Collapse
|
198
|
Peyrin-Biroulet L, Bouguen G, Laharie D, Pellet G, Savoye G, Gilletta C, Michiels C, Buisson A, Fumery M, Trochu JN, Cacoub P. Iron Deficiency in Patients with Inflammatory Bowel Diseases: A Prospective Multicenter Cross-Sectional Study. Dig Dis Sci 2022; 67:5637-5646. [PMID: 35384624 PMCID: PMC9652270 DOI: 10.1007/s10620-022-07474-z] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/01/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Iron deficiency (ID) is a frequent condition in patients with inflammatory bowel disease (IBD). AIM Our aim was to investigate the prevalence of ID in patients with IBD. METHODS This was a prospective multicenter cross-sectional study conducted in 21 gastroenterology departments in France between January and March 2020. All adult patients with confirmed IBD who were admitted to the hospital were eligible for inclusion. ID was defined as ferritinemia ≤ 100 μg/L in patients with signs of inflammation (C-reactive protein (CRP) ≥ 5 mg/L) or ferritinemia < 30 μg/L in the absence of inflammation. RESULTS In total, 1036 IBD (685 Crohn's disease and 351 ulcerative colitis) patients (52.1% women) with a mean age of 41.8 ± 15.5 years were recruited. Approximately half of the patients (504, 51.1%) were in disease remission at the time of enrollment. Systematic monitoring of iron status was performed in 12/21 (57%) participating centers, including measurements of ferritin (12/12, 100%), hemoglobin (11/12, 92%), transferrin saturation (TSAT) (6/12, 50.0%), and serum iron (5/12, 42%). About one-fifth of the patients had been treated with intravenous iron (218, 21.0%), whereas only a small percentage received oral iron (36, 3.5%). ID occurred in 97 patients (23.7% CI 95% 19.8-28.1). Patients with moderate/severe IBD activity (OR: 3.66; CI 95% 24.4-61.2; p = 0.007) or concomitant anemia (OR: 3.66; CI 95% 1.97-6.78; p < 0.001) had an increased likelihood of having ID. CONCLUSION Patients with moderate/severe IBD activity or concomitant anemia are at increased risk of ID. Early detection and management of ID in patients with IBD is recommended.
Collapse
Affiliation(s)
- Laurent Peyrin-Biroulet
- grid.29172.3f0000 0001 2194 6418Department of Gastroenterology, University of Lorraine, CHRU-Nancy, 54000 Nancy, France ,grid.29172.3f0000 0001 2194 6418University of Lorraine, Inserm, NGERE, 54000 Nancy, France ,grid.29172.3f0000 0001 2194 6418Inserm NGERE and Department of Gastroenterology, Nancy University Hospital, University of Lorraine, 1 Allée du Morvan, 54511 Vandoeuvre-lès-Nancy, France
| | - Guillaume Bouguen
- grid.411154.40000 0001 2175 0984CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), CHU Rennes, Univ Rennes, INSERM, 35000 Rennes, France
| | - David Laharie
- grid.42399.350000 0004 0593 7118Service d’Hépato-gastroentérologie et Oncologie Digestive, CHU de Bordeaux, Hôpital Haut-Lévêque, 33000 Bordeaux, France
| | - Gauthier Pellet
- grid.42399.350000 0004 0593 7118Service d’Hépato-gastroentérologie et Oncologie Digestive, CHU de Bordeaux, Hôpital Haut-Lévêque, 33000 Bordeaux, France
| | - Guillaume Savoye
- grid.10400.350000 0001 2108 3034INSERM UMR1073, Université de Rouen, Hôpital Universitaire de Rouen, Rouen, France
| | - Cyrielle Gilletta
- grid.411175.70000 0001 1457 2980Department of Pancreatology and Gastroenterology, University Hospital of Toulouse Rangueil, 31059 Toulouse Cedex 9, France
| | - Christophe Michiels
- grid.31151.37Service d’Hepato-Gastro-Entérologie, CHU Dijon Bourgogne, Dijon, France
| | - Anthony Buisson
- grid.411163.00000 0004 0639 4151Service d’Hépato-Gastroentérologie, Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Mathurin Fumery
- Department of Gastroenterology, University Hospital of Amiens, and Peritox, University of Picardie, Amiens, France
| | | | - Patrice Cacoub
- grid.411439.a0000 0001 2150 9058Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, 83 Boulevard de l’Hôpital, 75651 Paris, Cedex 13, France ,Immunology-Immunopathology- Immunotherapy (I3), Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR S 959, Paris, France ,grid.411439.a0000 0001 2150 9058Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | | |
Collapse
|
199
|
Affiliation(s)
- Tommaso Lorenzo Parigi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Institute of Immunology and Immunotherapy and NIHR Wellcome Trust Clinical Research Facility, University of Birmingham, Birmingham, UK
| | - Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| |
Collapse
|
200
|
Ruiz-Casas L, Evans J, Rose A, Pedra GG, Lobo A, Finnegan A, Hayee B, Peyrin-Biroulet L, Sturm A, Burisch J, Terry H, Avedano L, Tucknott S, Fiorino G, Limdi J. Correction to: The LUCID study: living with ulcerative colitis; identifying the socioeconomic burden in Europe. BMC Gastroenterol 2021; 21:475. [PMID: 34911455 PMCID: PMC8675528 DOI: 10.1186/s12876-021-02062-3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Leonardo Ruiz-Casas
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK
| | - Jonathan Evans
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK.
| | - Alison Rose
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK
| | - Gabriel Ghizzi Pedra
- HCD Economics, The Innovation Centre, Keckwick Lane, Daresbury, Warrington, England, UK
| | - Alan Lobo
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,The University of Sheffield, Sheffield, UK
| | | | - Bu Hayee
- King's College Hospital NHS Foundation Trust London, London, UK
| | | | | | | | - Helen Terry
- Crohn's and Colitis UK, Hatfield, Hertfordshire, UK
| | - Luisa Avedano
- European Federation of Crohn's and Ulcerative Colitis Associations, Brussels, Belgium
| | | | | | - Jimmy Limdi
- Pennine Acute Hospitals NHS Trust, Manchester, UK
| |
Collapse
|