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Barreiro-de Acosta M, Rodríguez-Lago I. Editorial: Mucosal healing with steroids: Once upon a time in ulcerative colitis. Aliment Pharmacol Ther 2024. [PMID: 38853405 DOI: 10.1111/apt.18094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
LINKED CONTENTThis article is linked to Fukuda et al papers. To view these articles, visit https://doi.org/10.1111/apt.18013 and https://doi.org/10.1111/apt.18111
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Affiliation(s)
- Manuel Barreiro-de Acosta
- Gastroenterology Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - Iago Rodríguez-Lago
- Gastroenterology Department, Hospital Universitario de Galdakao, Biocruces Bizkaia Health Research Institute, Galdakao, Spain
- School of Medicine, University of Deusto, Bilbao, Spain
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2
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D'Amico F, Magro F, Siegmund B, Kobayashi T, Kotze PG, Solitano V, Caron B, Al Awadhi S, Hart A, Jairath V, Dignass A, Peyrin-Biroulet L, Danese S. Disease Clearance as a New Outcome in Ulcerative Colitis: a Systematic Review and Expert Consensus. Inflamm Bowel Dis 2024; 30:1009-1017. [PMID: 37549104 DOI: 10.1093/ibd/izad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Indexed: 08/09/2023]
Abstract
The concept of disease clearance has been proposed as a potential target in ulcerative colitis (UC). We conducted a systematic review to investigate the role of disease clearance, defined as a composite outcome including simultaneous clinical, endoscopic, and histologic remission of disease in the management of patients with UC. Based on the literature data, statements regarding disease clearance were developed and voted on by the members of the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) according to a Delphi methodology. A definition of disease clearance was proposed to standardize its use in clinical practice and clinical trials and to provide practical recommendations for its implementation as a therapeutic target in UC.
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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
| | - Fernando Magro
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Britta Siegmund
- Medizinische Klinik m. S. Gastroenterologie, Infektiologie und Rheumatologie, Charité, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Paulo Gustavo Kotze
- Colorectal Surgery Unit, Hospital Universitário Cajuru, Pontifícia Universidade Católica do Paraná (PUCPR), Curitiba, Brazil
| | - Virginia Solitano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Benedicte Caron
- University of Lorraine, CHRU-Nancy, Department of Gastroenterology, F-54000 Nancy, France
- University of Lorraine, Inserm, NGERE, F-54000 Nancy, France
| | - Sameer Al Awadhi
- Digestive Diseases Unit, Rashid Hospital, Dubai 003206, United Arab Emirates
| | - Ailsa Hart
- St Mark's Hospital, Harrow, Middlesex, UK
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, Ontario, Canada
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital, Goethe-University, Frankfurt am Main, Germany
| | - 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
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Chen R, Tie Y, Huang Y, Zhang X, Zeng Z, Chen M, Li L, Zhang S. Rapidly achieving clinical remission in ulcerative colitis indicates better endoscopic and histological outcomes. United European Gastroenterol J 2024; 12:459-468. [PMID: 38159047 PMCID: PMC11091780 DOI: 10.1002/ueg2.12515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/27/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Clinical remission (CR) is the principal short-term treatment target in patients with ulcerative colitis (UC). However, whether rapidly achieving CR indicates better outcomes remains unclear. OBJECTIVES We aimed to explore the associations between the timing of CR and therapeutic outcomes in UC. METHODS This study included UC patients from the UNIFI trial. Week-2 CR and time to CR were the major variables of interest. Endoscopic remission (ER) at week 52 was the primary outcome. Multivariate logistic regression was performed to evaluate the association between variables and outcomes. RESULTS Week-2 CR was associated with ER (aOR: 2.37 [95% CI: 1.28, 4.37], p = 0.006) and Histological remission (HR) (aOR: 2.87 [95% CI: 1.42, 5.72], p = 0.003) at week 52. Moreover, C-reactive protein (CRP) remission could further stratify patients without CR and predict week-52 outcomes. Patients with clinical activity + CRP remission (aOR: 0.49 [95% CI: 0.26, 0.93], p = 0.039) and clinical activity + CRP activity (aOR: 0.24 [95% CI: 0.11, 0.52], p < 0.001) had gradually decreased likelihood of achieving ER, when compared to those with CR. For time to CR, we found that the earlier to CR, the better endoscopic and histological outcomes patients would attain. Patients achieving CR at weeks 2, 4/8, 12/16 and >16 had gradually reduced proportions of ER (51.9% vs. 40.8% vs. 31.6% vs. 8.8%, p < 0.001) and HR (37.0% vs. 19.8% vs. 17.1% vs. 6.1%, p < 0.001) at week 52. Compared with week 2, achieving CR at weeks 4/8, 12/16 and >16 had 39%, 55% and 92% lower likelihoods of week-52 ER, respectively. CONCLUSIONS Week-2 CR indicates better outcomes in UC patients receiving ustekinumab. Moreover, achieving CR more rapidly is associated with higher probability of ER and HR.
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Affiliation(s)
- Rirong Chen
- Department of GastroenterologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yizhe Tie
- Department of GastroenterologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yongle Huang
- Department of GastroenterologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
- Zhongshan School of MedicineSun Yat‐sen UniversityGuangzhouChina
| | - Xi Zhang
- Department of GastroenterologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
- Zhongshan School of MedicineSun Yat‐sen UniversityGuangzhouChina
| | - Zhirong Zeng
- Department of GastroenterologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Minhu Chen
- Department of GastroenterologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Li Li
- Department of GastroenterologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Shenghong Zhang
- Department of GastroenterologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
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Peyrin-Biroulet L, Adsul S, Stancati A, Dehmeshki J, Kubassova O. An artificial intelligence-driven scoring system to measure histological disease activity in ulcerative colitis. United European Gastroenterol J 2024. [PMID: 38590110 DOI: 10.1002/ueg2.12562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND AND AIMS Assessment and scoring of histological images in Ulcerative colitis (UC) is prone to inter- and intra-observer variability. This study aimed to investigate whether an artificial intelligence (AI) system developed using image processing and machine learning algorithms could measure histological disease activity based on the Nancy index. METHODS A total of 200 histological images of patients with UC were used in this study. A novel AI algorithm was developed using state-of-the-art image processing and machine learning algorithms based on deep learning and feature extraction. The cell regions of each image, followed by the Nancy index, were manually annotated and measured independently by four histopathologists. Manual and AI-automated measurements of the Nancy index score were conducted and assessed using the intraclass correlation coefficient (ICC). RESULTS The 200-image dataset was divided into two groups (80% was used for training and 20% for testing). Intraclass correlation coefficient statistical analyses were performed to evaluate the AI tool and used as a reference to calculate the accuracy. The average ICC among the histopathologists was 89.3 and the average ICC between histopathologists and the AI tool was 87.2. The AI tool was found to be highly correlated with histopathologists. CONCLUSIONS The high correlation of performance of the AI method suggests promising potential for inflammatory bowel disease clinical applications. A standardized automated histological AI-driven scoring system can potentially be used in daily inflammatory bowel disease practice to reduce training needs and resource use, eliminate the subjectivity of the pathologists, and assess disease severity for treatment decisions.
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Affiliation(s)
- Laurent Peyrin-Biroulet
- Department of Gastroenterology, INFINY Institute, FHU-CURE, INSERM NGERE, Nancy University Hospital, Vandoeuvre-lès-Nancy, France
| | - Shashi Adsul
- Takeda Pharmaceutical Company, Zurich, Switzerland
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Hassan SA, Kapur N, Sheikh F, Fahad A, Jamal S. Disease clearance in ulcerative colitis: A new therapeutic target for the future. World J Gastroenterol 2024; 30:1801-1809. [PMID: 38659483 PMCID: PMC11036494 DOI: 10.3748/wjg.v30.i13.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/16/2024] [Accepted: 03/19/2024] [Indexed: 04/03/2024] Open
Abstract
Advancements in murine modeling systems for ulcerative colitis have diversified our understanding of the pathophysiological factors involved in disease onset and progression. This has fueled the identification of molecular targets, resulting in a rapidly expanding therapeutic armamentarium. Subsequently, management strategies have evolved from symptomatic resolution to well-defined objective endpoints, including clinical remission, endoscopic remission and mucosal healing. While the incorporation of these assessment modalities has permitted targeted intervention in the context of a natural disease history and the prevention of complications, studies have consistently depicted discrepancies associated with ascertaining disease status through clinical and endoscopic measures. Current recommendations lack consideration of histological healing. The simultaneous achievement of clinical, endoscopic, and histologic remission has not been fully investigated. This has laid the groundwork for a novel therapeutic outcome termed disease clearance (DC). This article summarizes the concept of DC and its current evidence.
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Affiliation(s)
- Syed Adeel Hassan
- Division of Digestive Disease and Nutrition, University of Kentucky, Lexington, KY 40536, United States
| | - Neeraj Kapur
- Division of Digestive Disease and Nutrition, University of Kentucky, Lexington, KY 40536, United States
| | - Fahad Sheikh
- Department of Pathology and Laboratory Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10461, United States
| | - Anam Fahad
- Division of Primary Care, Essen Healthcare, New York, NY 10457, United States
| | - Somia Jamal
- Department of Internal Medicine, Karachi Medical and Dental College, Karachi 74700, Sindh, Pakistan
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Neri B, Mancone R, Fiorillo M, Schiavone SC, De Cristofaro E, Migliozzi S, Biancone L. Comprehensive overview of novel chemical drugs for ulcerative colitis: focusing on phase 3 and beyond. Expert Opin Pharmacother 2024; 25:485-499. [PMID: 38591242 DOI: 10.1080/14656566.2024.2339926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 04/03/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Despite the growing number of highly efficacious biologics and chemical drugs for ulcerative colitis (UC), steroid-free disease control is still difficult to achieve in subgroups of patients due to refractoriness, adverse events, primary or secondary failure. New treatments are therefore still required in order to optimize clinical management of patients with UC. AREAS COVERED The efficacy and safety of both currently available and newly developed small molecules have been summarized. The PubMed database and clinicaltrials.gov were considered in order to search for phase 2b and 3 trials on new chemical drugs for UC. The study drugs reviewed included Janus kinases (JAK) and sphingosine-1-phosphate receptor (S1Pr) inhibitors, α4 integrin antagonist, and micro-RNA-124 upregulators. EXPERT OPINION Rapidity of onset, low immunogenicity, and safety are the main characteristics of small molecules currently available or under evaluation for treatment patients with UC. Among the currently available chemical drugs, the selective JAK and the S1Pr inhibitors are characterized by a good safety profile combined with the ability to induce clinical remission in UC. A relatively low frequency of endoscopic improvement and healing currently appears associated with their use, being higher in UC patients treated with S1Pr inhibitor Etrasimod. Overall, additional new safe and effective drugs are still required in order to optimize disease control in a larger majority of UC patients.
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Affiliation(s)
- Benedetto Neri
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Roberto Mancone
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Mariasofia Fiorillo
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Sara Concetta Schiavone
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Elena De Cristofaro
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Stefano Migliozzi
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
| | - Livia Biancone
- Department of Systems Medicine, Gastroenterological Unit, University "Tor Vergata" of Rome, Rome, Italy
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7
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D'Amico F, Fasulo E, Jairath V, Paridaens K, Peyrin-Biroulet L, Danese S. Management and treatment optimization of patients with mild to moderate ulcerative colitis. Expert Rev Clin Immunol 2024; 20:277-290. [PMID: 38059454 DOI: 10.1080/1744666x.2023.2292768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/05/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION Ulcerative colitis (UC) is a chronic inflammatory bowel disease with a significant health-care burden worldwide. While medical therapy aims to induce and maintain remission, optimal management of mild to moderate UC remains challenging due to heterogeneity in severity classifications and non-standardized approaches. This comprehensive review summarizes current evidence and knowledge gaps to optimize clinical decision-making in patients with mild to moderate UC. AREAS COVERED After an extensive literature search of PubMed, Medline, and Embase through August 2023, we provide an overview of definitions utilized to characterize mild to moderate UC severity and established therapeutic targets. Current medical treatments including mesalazine formulations, corticosteroids, and their combinations are surveyed. The role of emerging intestinal ultrasound, telemedicine, and home testing is explored. Individualized, patient-centered paradigms aiming to streamline care delivery through proactive identification of relapses are also examined. EXPERT OPINION Addressing inconsistencies in disease activity stratification will better align tailored regimens with each patient's profile. Advancing noninvasive technologies like ultrasound criteria and home testing could improve UC management by enabling personalized models. Realizing individualized plans through informed shared-decision making between health-care providers and fully engaged patients holds promise to maximize quality of life outcomes. Continuous improvement relies on innovation bridging different domains to overcome current limitations and push the field toward more predictive and tailored care.
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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
| | - Ernesto Fasulo
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Western University, London, Ontario, Canada
| | | | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Nancy, France
- INSERM, NGERE, University of Lorraine, Nancy, France
- INFINY Institute, Nancy University Hospital, Nancy, France
- FHU-CURE, Nancy University Hospital, Nancy, France
- Groupe Hospitalier privé Ambroise Paré - Hartmann, Paris IBD center, Neuilly sur Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, Quebec, Canada
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
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Jucan AE, Gavrilescu O, Dranga M, Popa IV, Mihai IR, Mihai VC, Stefanescu G, Drug VL, Prelipcean CC, Vulpoi RA, Barboi OB, Ciortescu I, Mihai C. Evaluation of Disease Activity in Inflammatory Bowel Disease: Diagnostic Tools in the Assessment of Histological Healing. Biomedicines 2023; 11:3090. [PMID: 38002090 PMCID: PMC10669373 DOI: 10.3390/biomedicines11113090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/10/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
Inflammatory bowel disease (IBD) comprises two types of chronic intestinal disorders: Crohn's disease and ulcerative colitis. In long-standing ulcerative colitis disease activity, histological persistent inflammation has been linked to an increased risk of relapse, and long-term corticosteroid use, even when endoscopic remission is reached. In Crohn's disease, the discontinuous nature of lesions and transmural inflammation have limited the standardized histological assessment. The current evidence from research proposes that besides clinical and endoscopic healing, the achievement of histological healing constitutes an endpoint to assess disease activity and remission in IBD patients concerning better long-term disease outcomes. Histological alterations may persist even in the absence of endoscopic lesions. For these reasons, new advanced techniques promise to revolutionize the field of IBD by improving the endoscopic and histologic assessment, disease characterization, and ultimately patient care, with an established role in daily practice for objective assessment of lesions. This review outlines the importance of including microscopic evaluation in IBD, highlighting the clinical benefits of a deep state of disease remission using validated diagnostic methods and scoring systems for daily clinical practice.
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Affiliation(s)
- Alina Ecaterina Jucan
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Otilia Gavrilescu
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Mihaela Dranga
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Iolanda Valentina Popa
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Ioana-Ruxandra Mihai
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Vasile-Claudiu Mihai
- Department of Radiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Gabriela Stefanescu
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Vasile Liviu Drug
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Cristina Cijevschi Prelipcean
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
| | - Radu-Alexandru Vulpoi
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Oana-Bogdana Barboi
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Irina Ciortescu
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
| | - Catalina Mihai
- Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania; (O.G.); (G.S.); (V.L.D.); (C.C.P.); (O.-B.B.); (I.C.); (C.M.)
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.V.P.); (R.-A.V.)
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Awadhi SA, Alboraie M, Albaba EA, Almutairdi A, Alsaad M, Azzam N, Barakat H, D’Amico F, Danese S, El Kady M, Ghoneim H, Hamoudi W, Jazzar A, Mosli M, Shehab H, Sneineh AA. Treatment of Patients with Mild to Moderate Ulcerative Colitis: A Middle East Expert Consensus. J Clin Med 2023; 12:6929. [PMID: 37959394 PMCID: PMC10650478 DOI: 10.3390/jcm12216929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
The prevalence of ulcerative colitis (UC) in the Middle East is increasing, impacting the economic and healthcare burden. The management of patients with mild to moderate UC is still a challenge as several factors can affect optimal care, including drug choice, induction and maintenance dose, treatment optimization and de-escalation, therapy duration, monitoring, and safety profile. We conducted an expert consensus to standardize the management of patients with mild to moderate UC. Sixteen experts in inflammatory bowel diseases, through a well-established and accepted Delphi methodology, voted and approved eight statements in order to provide practical guidance to clinicians in the Middle East.
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Affiliation(s)
- Sameer Al Awadhi
- Digestive Diseases Unit, Rashid Hospital, Dubai 003206, United Arab Emirates
| | - Mohamed Alboraie
- Department of Internal Medicine, Al-Azhar University, Cairo 11884, Egypt;
| | - Emad Aldin Albaba
- Department of Medicine, Almana General Hospital, Alkhobar 31952, Saudi Arabia;
| | - Abdulelah Almutairdi
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh 11564, Saudi Arabia;
| | - Monther Alsaad
- Al Madar Medical Centre, Sharjah P.O. Box 80789, United Arab Emirates;
| | - Nahla Azzam
- Division of Gastroenterology, Department of Medicine, College of Medicine, King Saud University, Riyadh 11451, Saudi Arabia;
| | - Husam Barakat
- Department of Gastroenterology, Yarmouk University, Irbid 21163, Jordan;
| | - Ferdinando D’Amico
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.D.); (S.D.)
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20132 Milan, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, 20132 Milan, Italy; (F.D.); (S.D.)
| | - Mohamed El Kady
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Cairo 11559, Egypt;
| | - Hossam Ghoneim
- Immunology and Allergy Department, Medical Research Institute, Alexandria University, Alexandria 5424041, Egypt;
| | - Waseem Hamoudi
- Internal Medicine Department, Al-Bashir Hospital, Amman 11151, Jordan;
| | - Ahmad Jazzar
- Gastroenterology Division, Sheikh Khalifa Medical City, Abu Dhabi 51900, United Arab Emirates;
| | - Mahmoud Mosli
- Department of Medicine, King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia;
| | - Hany Shehab
- Integrated Clinical and Research Center for Intestinal Disorders (ICRID), Gastroenterology Division, Endemic Medicine Department, Cairo University, Cairo 3725121, Egypt;
| | - Awni Abu Sneineh
- Gastroenterology and Hepatology, University of Jordan, Amman 11942, Jordan;
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10
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D’Amico F, Peyrin‐Biroulet L, Danese S. Disease clearance in ulcerative colitis: Is the ultimate therapeutic target? United European Gastroenterol J 2023; 11:717-719. [PMID: 37401029 PMCID: PMC10576599 DOI: 10.1002/ueg2.12436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Affiliation(s)
- Ferdinando D’Amico
- Gastroenterology and EndoscopyIRCCS Ospedale San Raffaele and Vita‐Salute San Raffaele UniversityMilanItaly
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Laurent Peyrin‐Biroulet
- Department of GastroenterologyNancy University HospitalVandœuvre‐lès‐NancyFrance
- INSERMNGEREUniversity of LorraineNancyFrance
- INFINY InstituteNancy University HospitalVandœuvre‐lès‐NancyFrance
- FHU‐CURENancy University HospitalVandœuvre‐lès‐NancyFrance
- Groupe Hospitalier Privé Ambroise Paré – HartmannParis IBD CenterNeuilly‐sur‐SeineFrance
- Division of Gastroenterology and HepatologyMcGill University Health CentreMontrealQuebecCanada
| | - Silvio Danese
- Gastroenterology and EndoscopyIRCCS Ospedale San Raffaele and Vita‐Salute San Raffaele UniversityMilanItaly
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11
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Kruis W, Meszaros S, Wehrum S, Mueller R, Greinwald R, Nacak T. Mesalazine granules promote disease clearance in patients with mild-to-moderate ulcerative colitis. United European Gastroenterol J 2023; 11:775-783. [PMID: 37490352 PMCID: PMC10576598 DOI: 10.1002/ueg2.12435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/01/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Over the past decade, treatment targets for ulcerative colitis (UC) have become more stringent, incorporating multiple parameters. Recently, the concept of 'disease clearance'-defined as combined clinical, endoscopic, and histological remission-has been proposed as an ultimate endpoint in treating UC. OBJECTIVE To determine the rates of disease clearance in patients with mild-to-moderate UC treated with different doses of mesalazine granules as induction therapy. METHODS In a post hoc analysis, data were pooled from four randomised, active-controlled, phase 3 clinical trials in patients with mild-to-moderate UC receiving 8-week induction therapy with mesalazine granules at daily doses of 1.5, 3.0 or 4.5 g. Rates of clinical, endoscopic, and histological remission were determined using stringent criteria and used to calculate rates of the composite endpoints of clinical plus endoscopic remission, endoscopic plus histological remission, and disease clearance (clinical plus endoscopic plus histological remission). RESULTS A total of 860 patients were included in the analysis. Among the total population, 20.0% achieved disease clearance with mesalazine granules: 13.1% in patients receiving 1.5 g mesalazine granules/day, 21.8% in those receiving 3.0 g/day and 18.9% in those receiving 4.5 g/day. Among patients with moderate UC, 16.8% achieved disease clearance: 7.1% with 1.5 g/day, 18.8% with 3.0 g/day and 16.2% with 4.5 g/day. CONCLUSION Disease clearance, proposed to be predictive of improved long-term outcomes, can be achieved in a clinically meaningful proportion of mild-to-moderate UC patients treated with mesalazine granules. A daily dose of 3.0 g appears optimal to reach this target.
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Affiliation(s)
- Wolfgang Kruis
- Emeritus Head of GastroenterologyEvangelisches Krankenhaus Kalk gGmbHPulheim‐FreimersdorfGermany
| | - Silke Meszaros
- Dr. Falk Pharma GmbHGlobal Medical AffairsFreiburgGermany
| | - Sarah Wehrum
- Dr. Falk Pharma GmbHGlobal Medical AffairsFreiburgGermany
| | - Ralph Mueller
- Dr. Falk Pharma GmbHClinical Research and DevelopmentFreiburgGermany
| | - Roland Greinwald
- Dr. Falk Pharma GmbHClinical Research and DevelopmentFreiburgGermany
| | - Tanju Nacak
- Dr. Falk Pharma GmbHClinical Research and DevelopmentFreiburgGermany
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12
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Ramos L, Teo-Loy J, Barreiro-de Acosta M. Disease clearance in ulcerative colitis: Setting the therapeutic goals for future in the treatment of ulcerative colitis. Front Med (Lausanne) 2023; 9:1102420. [PMID: 36698823 PMCID: PMC9868775 DOI: 10.3389/fmed.2022.1102420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Ulcerative colitis, one of the phenotypic patterns of inflammatory bowel disease, should be considered a progressive disease with an increased risk of complications if intestinal inflammation is not adequately controlled. The advent of new lines of treatment for this condition has changed and expanded the therapeutic goals to modify its natural history and evolution. The concept of "disease clearance" in ulcerative colitis aims to achieve clinical and biological remission as well as mucosal healing (endoscopic, histological, and in future molecular) in these patients. This review provides the available data on each of the goals of disease clearance in ulcerative colitis to be considered for application in clinical practice in the coming years.
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Affiliation(s)
- Laura Ramos
- IBD Unit, Department of Gastroenterology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain,Department of Internal Medicine, University of La Laguna, Santa Cruz de Tenerife, Spain,*Correspondence: Laura Ramos,
| | - Jeny Teo-Loy
- IBD Unit, Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Barreiro-de Acosta
- IBD Unit, Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
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13
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Estevinho MM, Leão Moreira P, Silva I, Laranjeira Correia J, Santiago M, Magro F. A scoping review on early inflammatory bowel disease: definitions, pathogenesis, and impact on clinical outcomes. Therap Adv Gastroenterol 2022; 15:17562848221142673. [PMID: 36569381 PMCID: PMC9772959 DOI: 10.1177/17562848221142673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Crohn's disease (CD) and ulcerative colitis (UC) arise from a dysregulation of the balance between commensal microbiota and mucosal-associated immune system, in patients with genetic and environmental predisposition. Different pathophysiological mechanisms have been reported to influence disease history, with impact on disease phenotype and risk of complications. OBJECTIVES This review aims to summarize the definitions of early CD and UC, analyze the underlying immunological mechanisms, and evaluate the impact of recognizing and treating early inflammatory bowel disease (IBD) on patients' prognosis (short- and long-term outcomes). DESIGN To address this issue, we have performed a scoping review. DATA SOURCES AND METHODS Three online databases (MEDLINE, Web of Science, and ScienceDirect) were searched and the results were independently screened by two reviewers. RESULTS From 683 records identified, 42 manuscripts evaluating early IBD in adult patients were included. The 'early CD' concept was first described in 2008. Four years later, an international consensus proposed the definition of diagnosis up to 18 months, in patients without previous or current need for disease-modifying therapies. Several other definitions have been proposed; the '2 years since diagnosis' is the most used, regardless of disease characteristics or medication. The amount of evidence on early UC is lower and more recent. Regarding early disease pathogenesis, most theories emphasize the prominent role of innate immunity, followed by early-Th1 adaptive response. CONCLUSION The treatment of early CD seems to be crucial for the management of CD patients, impacting short-, medium-, and long-term outcomes. On the other hand, the early treatment of UC appears to be less advantageous, yet evidence comes from only a few retrospective studies.
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Affiliation(s)
- Maria Manuela Estevinho
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal,Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paula Leão Moreira
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
| | - Isabel Silva
- Unidade de Farmacologia Clínica, São João Hospital University Centre, Porto, Portugal
| | - João Laranjeira Correia
- Department of Gastroenterology, Vila Nova de Gaia Espinho Hospital Center, Vila Nova de Gaia, Portugal
| | - Mafalda Santiago
- Portuguese Group of Studies in Inflammatory Bowel Disease (Grupo de Estudos da Doença Inflamatória Intestinal - GEDII), Porto, Portugal,Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
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