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Ye S, Lyu Y, Chen L, Wang Y, He Y, Li Q, Tian L, Liu F, Wang X, Ai F. Construction of a molecular inflammatory predictive model with histone modification-related genes and identification of CAMK2D as a potential response signature to infliximab in ulcerative colitis. Front Immunol 2024; 14:1282136. [PMID: 38274809 PMCID: PMC10808628 DOI: 10.3389/fimmu.2023.1282136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Background Ulcerative colitis (UC) is a lifelong inflammatory disease affecting the rectum and colon with numerous treatment options that require an individualized treatment plan. Histone modifications regulate chromosome structure and gene expression, resulting in effects on inflammatory and immune responses. However, the relationship between histone modification-related genes and UC remains unclear. Methods Transcriptomic data from GSE59071 and GSE66407 were obtained from the Gene Expression Omnibus (GEO), encompassing colonic biopsy expression profiles of UC patients in inflamed and non-inflamed status. Differentially expressed gene (DEG) analyses, functional enrichment analyses, weighted gene co-expression network analysis (WGCNA), and random forest were performed to identify histone modification-related core genes associated with UC inflammation. Features were screened through the least absolute shrinkage and selection operator (LASSO) and support vector machine-recursive feature elimination (SVM-RFE), establishing a molecular inflammatory predictive model using logistic regression. The model was validated in the GSE107499 dataset, and the performance of the features was assessed using receiver operating characteristic (ROC) and calibration curves. Immunohistochemistry (IHC) staining of colonic biopsy tissues from UC patients treated with infliximab was used to further confirm the clinical application value. Univariate logistic regression on GSE14580 highlighted features linked to infliximab response. Results A total of 253 histone modification-related DEGs were identified between inflammatory and non-inflammatory patients with UC. Seven key genes (IL-1β, MSL3, HDAC7, IRF4, CAMK2D, AUTS2, and PADI2) were selected using WGCNA and random forest. Through univariate logistic regression, three core genes (CAMK2D, AUTS2, and IL-1β) were further incorporated to construct the molecular inflammatory predictive model. The area under the curve (AUC) of the model was 0.943 in the independent validation dataset. A significant association between CAMK2D protein expression and infliximab response was observed, which was validated in another independent verification set of GSE14580 from the GEO database. Conclusion The molecular inflammatory predictive model based on CAMK2D, AUTS2, and IL-1β could reliably distinguish the mucosal inflammatory status of UC patients. We further revealed that CAMK2D was a predictive marker of infliximab response. These findings are expected to provide a new evidence base for personalized treatment and management strategies for UC patients.
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Affiliation(s)
- Shuyu Ye
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yongqing Lyu
- Center for Medical Genetics and Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Libin Chen
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yiwei Wang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yue He
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Quansi Li
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Li Tian
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Fen Liu
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoyan Wang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Feiyan Ai
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
- Hunan Key Laboratory of Non-Resolving Inflammation and Cancer, The Third Xiangya Hospital, Central South University, Changsha, China
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Savelkoul EHJ, Thomas PWA, Derikx LAAP, den Broeder N, Römkens TEH, Hoentjen F. Systematic Review and Meta-analysis: Loss of Response and Need for Dose Escalation of Infliximab and Adalimumab in Ulcerative Colitis. Inflamm Bowel Dis 2023; 29:1633-1647. [PMID: 36318229 PMCID: PMC10547237 DOI: 10.1093/ibd/izac200] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Loss of response to infliximab or adalimumab in ulcerative colitis occurs frequently, and dose escalation may aid in regaining clinical benefit. This study aimed to systematically assess the annual loss of response and dose escalation rates for infliximab and adalimumab in ulcerative colitis. METHODS A systematic search was conducted from August 1999 to July 2021 for studies reporting loss of response and dose escalation during infliximab and/or adalimumab use in ulcerative colitis patients with primary response. Annual loss of response, dose escalation rates, and clinical benefit after dose escalation were calculated. Subgroup analyses were performed for studies with 1-year follow-up or less. RESULTS We included 50 unique studies assessing loss of response (infliximab, n = 24; adalimumab, n = 21) or dose escalation (infliximab, n = 21; adalimumab, n = 16). The pooled annual loss of response for infliximab was 10.1% (95% confidence interval [CI], 7.1-14.3) and 13.6% (95% CI, 9.3-19.9) for studies with 1-year follow-up. The pooled annual loss of response for adalimumab was 13.4% (95% CI, 8.2-21.8) and 23.3% (95% CI, 15.4-35.1) for studies with 1-year follow-up. Annual pooled dose escalation rates were 13.8% (95% CI, 8.7-21.7) for infliximab and 21.3% (95% CI, 14.4-31.3) for adalimumab, regaining clinical benefit in 72.4% and 52.3%, respectively. CONCLUSIONS Annual loss of response was 10% for infliximab and 13% for adalimumab, with higher rates during the first year. Annual dose escalation rates were 14% (infliximab) and 21% (adalimumab), with clinical benefit in 72% and 52%, respectively. Uniform definitions are needed to facilitate more robust evaluations.
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Affiliation(s)
- Edo H J Savelkoul
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Pepijn W A Thomas
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lauranne A A P Derikx
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nathan den Broeder
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Tessa E H Römkens
- Department of Gastroenterology and Hepatology, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, the Netherlands
| | - Frank Hoentjen
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
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Wang Y, Huang X, Zhou G, Han J, Xie Z, Zhang M, Li X, Wu QR, Li L, Ye Z, Chen M, Qiu Y, Zhang S. A Novel Nomogram Combining Mucus Barrier Index for Predicting Treatment Failures in Ulcerative Colitis. J Inflamm Res 2023; 16:1879-1894. [PMID: 37152865 PMCID: PMC10162100 DOI: 10.2147/jir.s410057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
Background Treatment failures (TFs) generally exist in the course of ulcerative colitis (UC), while early reliable predictors of TFs are still lacking. We aimed to generate nomograms for the prediction of TFs. Methods In this retrospective case-control study, the endpoint was the occurrence of TFs, which included medically associated treatment failures and surgery-associated treatment failures (colectomy). Clinical features and mucus integrity evident by goblet cells (GCs) number, expression levels of MUC2 and SLC26A3 were enrolled in the univariate analysis. Nomogram performance was evaluated by discrimination and calibration. Results We identified 256 UC patients at our center from January 2010 to June 2022. Fourteen variables for TFs and 9 for colectomy were identified by univariate analysis. Five baseline indices were incorporated into the nomogram for the prediction of TFs: area of GCs, age at diagnosis, disease duration, hemoglobin, and Mayo score. The model was presented with decent discrimination (C index of 0.822) and well calibration. In addition, the colectomy predictive nomogram was built using MUC2 intensity, age at onset, and Mayo score with a good discrimination (C index of 0.92). Conclusion Nomograms based on comprehensive factors including mucus barrier function were developed to predict TFs in UC patients with great discrimination, which may serve as practical tools aiming to identify high-risk subgroups warrant timely intervention.
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Affiliation(s)
- Ying Wang
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xuanzhi Huang
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Gaoshi Zhou
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Jing Han
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Zhuo Xie
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Mudan Zhang
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Xiaoling Li
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Qi-rui Wu
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Li Li
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Ziyin Ye
- Department of Pathology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Minhu Chen
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Yun Qiu
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
| | - Shenghong Zhang
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, People’s Republic of China
- Correspondence: Shenghong Zhang; Yun Qiu, Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road 2, Guangzhou Province, 510080, People’s Republic of China, Tel/Fax +86-20-87332916, Email ;
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Kishi M, Hirai F, Takatsu N, Hisabe T, Takada Y, Beppu T, Takeuchi K, Naganuma M, Ohtsuka K, Watanabe K, Matsumoto T, Esaki M, Koganei K, Sugita A, Hata K, Futami K, Ajioka Y, Tanabe H, Iwashita A, Shimizu H, Arai K, Suzuki Y, Hisamatsu T. A review on the current status and definitions of activity indices in inflammatory bowel disease: how to use indices for precise evaluation. J Gastroenterol 2022; 57:246-266. [PMID: 35235037 PMCID: PMC8938394 DOI: 10.1007/s00535-022-01862-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/06/2022] [Indexed: 02/04/2023]
Abstract
Many clinical trials have been conducted for inflammatory bowel disease (IBD), so various clinical indices (CIs) and endoscopic indices (EIs) have also been evaluated. However, recently, with the progress of IBD management, review of established indices from previous studies, and establishment of new indices, the landscape of the use of indices in clinical trials have changed. We investigated the number and frequency of the indices adapted in recent clinical trials for ulcerative colitis (CI and EI) and Crohn's disease (CI, EI, index related to magnetic resonance imaging, index for evaluating patient-reported outcomes, and health-related quality of life). Based on the results, we selected representative indices and further reviewed their content and characteristics. Moreover, various definitions, including clinical and endoscopic response or remission, have been described by means of representative indices in clinical trials.
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Affiliation(s)
- Masahiro Kishi
- Inflammatory Bowel Disease Center, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Fumihito Hirai
- Department of Gastroenterology, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka City, Fukuoka 814-0180 Japan
| | - Noritaka Takatsu
- Inflammatory Bowel Disease Center, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Takashi Hisabe
- Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Yasumichi Takada
- Inflammatory Bowel Disease Center, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Tsuyoshi Beppu
- Inflammatory Bowel Disease Center, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | | | - Makoto Naganuma
- The Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Kazuo Ohtsuka
- Department of Endoscopy, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenji Watanabe
- Center for Inflammatory Bowel Disease, Division of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Medicine, Iwate Medical University, Iwate, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazutaka Koganei
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan
| | - Akira Sugita
- Department of Inflammatory Bowel Disease, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan
| | - Keisuke Hata
- Nihonbashi Muromachi Mitsui Tower Midtown Clinic, Tokyo, Japan
| | - Kitarou Futami
- Department of Surgery, Fukuoka University Chikushi Hospital, Chikushino, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medicine and Dental Sciences, Niigata University, Niigata, Japan
| | - Hiroshi Tanabe
- Department of Pathology, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Akinori Iwashita
- AII Research Institute of Pathology and Image Diagnosis, Fukuoka, Japan
| | - Hirotaka Shimizu
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Katsuhiro Arai
- Center for Pediatric Inflammatory Bowel Disease, Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | | | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, Tokyo, Japan
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Long-term real-life efficacy and safety of infliximab and adalimumab in the treatment of inflammatory bowel diseases outpatients. Eur J Gastroenterol Hepatol 2021; 33:670-679. [PMID: 33741797 DOI: 10.1097/meg.0000000000002087] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Infliximab and adalimumab are widely used for the treatment of Crohn's disease and ulcerative colitis. AIM To compare the long-term efficacy and safety of infliximab and adalimumab in a large cohort of Crohn's disease and ulcerative colitis patients reflecting real-life clinical practice. METHODS Seven hundred twelve patients were retrospectively reviewed, 410 with Crohn's disease (268 treated with adalimumab and 142 with infliximab; median follow-up 60 months, range, 36-72) and 302 with ulcerative colitis (118 treated with adalimumab and 184 with infliximab; median follow-up 48 months, range, 36-84). RESULTS In Crohn's disease, clinical remission was maintained in 75.0% of adalimumab vs. in 72.5% of infliximab patients (P = 0.699); mucosal healing and steroid-free remission were maintained in 49.5% of adalimumab vs. 63.9% of infliximab patients (P = 0.077) and in 77.7% of adalimumab vs. 77.3% in infliximab group (P = 0.957), respectively. In ulcerative colitis, clinical remission was maintained in 50.0% of adalimumab vs. 65.8% of infliximab patients (P < 0.000); mucosal healing and steroid-free remission were maintained in 80.6% of adalimumab vs. 77.0% of infliximab patients (P = 0.494) and in 90.2% of adalimumab vs. 87.5% of infliximab patients (P = 0.662), respectively. At the multivariate analysis, ileocolonic location and simple endoscopic score for Crohn's disease >10 were predictors of failure in Crohn's disease; treatment with adalimumab, BMI ≥30 and Mayo score >10 were predictors of failure in ulcerative colitis. infliximab was more likely to cause adverse events than adalimumab (16.6 vs. 6.2%, P < 0.000). CONCLUSION Both adalimumab and infliximab are effective in long-term outpatients management of inflammatory bowel diseases. Adalimumab had a lower rate of adverse events.
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Ulcerative Colitis: A Critical Approach to the Global Research Output Employing Density-equalizing Mapping and Scientometric Methods. J Clin Gastroenterol 2021; 55:e19-e26. [PMID: 32324679 DOI: 10.1097/mcg.0000000000001351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/05/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND AIMS Despite decades of effort, numerous aspects on ulcerative colitis (UC) remain unknown and require further investigation. Scientists experience numerous challenges to survey >40,000 items that have been published on UC since 1900, to evaluate their scientific impact or to identify collaborative networks publishing the most relevant work. Hence, no current, detailed and comprehensive knowledge regarding the worldwide research architecture of UC has been established until now. METHODS We conducted a scientometric study employing the previously validated NewQIS (New Quality and Quantity Indices in Science) platform to quantify the global research activity in the field of UC. Hereby, the total research productivity, scientific output of countries, individual institutions, authors, journals, their collaborative networks as well as semiqualitative aspects were assessed. Results were visualized via state-of-the-art density-equalizing mapping projections. RESULTS The United States, Germany, and the United Kingdom play leading roles regarding scientific activity, multilateral and bilateral cooperations. Within the past decades, research on UC diversified into a field covering numerous subject areas. Recently published studies predict that the scientific progress will be mainly depending on international cooperations; we can confirm that development by now. CONCLUSIONS Scientometrics proofed to be a useful methodical approach to evaluate quantitative and semiqualitative aspects regarding UC. Also, we conclude that the influence of international cooperations on the scientific progress in the field of UC is constantly progressing.
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Dal Buono A, Roda G, Argollo M, Paridaens K, Peyrin-Biroulet L, Danese S. 'Treat to Target' in Mild to Moderate Ulcerative Colitis: Evidence to Support this Strategy. Curr Drug Targets 2020; 22:117-125. [PMID: 32718289 DOI: 10.2174/1389450121666200727120305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND The management of chronic conditions, above all rheumatic disease and diabetes, now incorporates a "treat to target" strategy where treatment aims to achieve objective outcomes. This is applicable in ulcerative colitis (UC) as well. Targets are demonstrated to prevent endorgan dysfunction, specifically bowel damage and its complications, and lastly colorectal cancer. Recently, the scientific community has tried to define further targets beyond those currently recommended, namely mucosal healing and clinical remission. Studies that prospectively investigated this approach in UC are scanty and a treat-to-target (T2T) algorithm is not routinely used in daily clinical practice. OBJECTIVE We aim to review current evidence on T2T in UC and discuss its adoption in routine clinical practice as well as in clinical trials. METHODS A PubMed search was conducted in February 2020 to identify published papers investigating targets' achievement rates in UC. RESULTS Different targets can be achieved through approved drugs for mild to moderate UC; histological remission is emerging as a robust target with respect to long-term outcomes. CONCLUSION Further studies to compare a T2T strategy with the traditional care are needed, particularly in the mild to moderate spectrum of disease.
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Affiliation(s)
- Arianna Dal Buono
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, 20089 Milan, Italy
| | - Giulia Roda
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, 20089 Milan, Italy
| | - Marjorie Argollo
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, 20089 Milan, Italy
| | | | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University of Lorraine, 54500 Vandoeuvre-les- Nancy, France
| | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center-IRCCS, Rozzano, 20089 Milan, Italy
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Dal Buono A, Roda G, Argollo M, Zacharopoulou E, Peyrin-Biroulet L, Danese S. Treat to target or 'treat to clear' in inflammatory bowel diseases: one step further? Expert Rev Gastroenterol Hepatol 2020; 14:807-817. [PMID: 32762582 DOI: 10.1080/17474124.2020.1804361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Inflammatory bowel diseases (IBD) are chronic and progressive diseases. Long-term complications are demolitive surgery and colon-rectal cancer. A 'treat to target' strategy, in which the treatment aims to achieve objective outcomes, has already been introduced in the management of chronic conditions as rheumatic diseases. This approach is emerging as suitable for ulcerative colitis and Crohn's disease. Targets are predefined therapeutic goals demonstrated to prevent end-organ dysfunction. An optimization or switch of therapy is considered depending on the target's achievement, with regular monitoring. AREAS COVERED According to the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) indications, mucosal healing and clinical remission are the main targets in IBDs. Histological remission is increasingly being considered as a novel target and has given rise to the new concept of 'disease clearance' which includes clinical, endoscopic and microscopic remission. We aim to review current evidence on the treat-to-target strategy in comparison to a stricter treat-to-clear in the IBD field. EXPERT OPINION Prospective studies on treat-to-target algorithm are sparse; a treat-to-clear approach is desirable but far from adoption in the daily practice and clinical trials. The ultimate goals of a treat-to-clear strategy differ in UC and in CD, including histological healing and transmural healing, respectively.
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Affiliation(s)
- Arianna Dal Buono
- IBD Center, Department of Gastroenterology, Humanitas Clincal and Research Hospital (IRCCS) , Milan, Italy
| | - Giulia Roda
- IBD Center, Department of Gastroenterology, Humanitas Clincal and Research Hospital (IRCCS) , Milan, Italy
| | - Marjorie Argollo
- Gastroenterology, Universidade Federal de São Paulo , São Paulo, Brazil
| | - Eirini Zacharopoulou
- IBD Center, Department of Gastroenterology, Humanitas Clincal and Research Hospital (IRCCS) , 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
- IBD Center, Department of Gastroenterology, Humanitas Clincal and Research Hospital (IRCCS) , Milan, Italy.,Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, Milan, Italy
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Tursi A, Mocci G, Faggiani R, Allegretta L, Valle ND, Medici AD, Forti G, Franceschi M, Ferronato A, Gallina S, Grasso G, Larussa T, Luzza F, Lorenzetti R, Penna A, Rodino' S, Sebkova L, Lauria A, Piergallini S, Pranzo G, Scorza S, Zampaletta C, Picchio M, Elisei W. Vedolizumab is effective and safe in real-life treatment of inflammatory bowel diseases outpatients: A multicenter, observational study in primary inflammatory bowel disease centers. Eur J Intern Med 2019; 66:85-91. [PMID: 31208827 DOI: 10.1016/j.ejim.2019.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 06/07/2019] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Italian data currently available in managing ulcerative colitis (UC) and Crohn's disease (CD) patients with vedolizumab (VDZ) are coming just from secondary and tertiary centers. The present study aimed to assess the real-life efficacy and safety of VDZ to achieve remission in inflammatory bowel diseases (IBD) outpatients in primary gastroenterology centers. METHODS Clinical activity was scored according to the Mayo score in UC and to the Harvey-Bradshaw Index (HBI) in CD. The primary endpoints were the achievement of clinical remission and safety. Secondary endpoints were clinical response to treatment, achievement of mucosal healing (MH), and steroid discontinuation. RESULTS One hundred and thirty-six pts. were enrolled (91 UC and 45 CD pts). During an 18-month median follow-up, clinical remission was present in 63 (46.3%) pts.: in particular, it occurred in 48 (52.7%) patients in UC group and in 15 (33.3%) patients in CD group (p = 0.003). more in UC group. Fecal calprotectin ≥400 μg/g and presence of comorbidities were factors significantly related to the failure of remission in UC and CD, respectively. Ten (7.3%) cases of adverse events were recorded (2 required suspension of treatment). Clinical response was present in 105 (72.2%) pts.: 71 (78.0%) in UC and 34 (75.5%) in CD group. MH occurred in 47 (62.7%) UC and in 9 (50.0%) CD patients. Steroids discontinuation occurred in 92 (67.6%) pts.; 61 (67.0%) UC and 31 (68.9%) CD pts. CONCLUSION VDZ is effective and safe in IBD outpatients, especially in UC patients.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria, Italy.
| | - Giammarco Mocci
- Division of Gastroenterology, "Brotzu" Hospital, Cagliari, Italy
| | - Roberto Faggiani
- Division of Gastroenterology, "Belcolle" Hospital, Viterbo, Italy
| | - Leonardo Allegretta
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina (LE), Italy
| | | | - Antonio de Medici
- Territorial Gastroenterology Service, PST Catanzaro Lido, Catanzaro, Italy
| | - Giacomo Forti
- Division of Digestive Endoscopy, "S. Maria Goretti" Hospital, Latina, Italy
| | | | | | - Sara Gallina
- Division of Gastroenterology, "Belcolle" Hospital, Viterbo, Italy
| | - Giuseppina Grasso
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina (LE), Italy
| | - Tiziana Larussa
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Francesco Luzza
- Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | - Roberto Lorenzetti
- Division of Gastroenterology, "Nuovo Regina Margherita" Territorial Hospital, Roma, Italy
| | - Antonio Penna
- Division of Gastroenterology, "S. Paolo" Hospital, Bari, Italy
| | - Stefano Rodino'
- Division of Gastroenterology, "Ciaccio-Pugliese" Hospital, Catanzaro, - Italy
| | - Ladislava Sebkova
- Division of Gastroenterology, "Ciaccio-Pugliese" Hospital, Catanzaro, - Italy
| | - Angelo Lauria
- Division of Gastroenterology, A.O. "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Simona Piergallini
- Division of Gastroenterology, IBD Unit, "A. Murri" Hospital, Fermo, Italy
| | - Giuseppe Pranzo
- Ambulatory for IBD Treatment, "Valle D'Itria" Hospital, Martina Franca (TA), Italy
| | - Stefano Scorza
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina (LE), Italy
| | | | - Marcello Picchio
- Division of General Surgery, "P. Colombo" Hospital, ASL Roma 6, Velletri, Roma, Italy
| | - Walter Elisei
- Division of Gastroenterology, ASL Roma 6, Albano Laziale, Roma, Italy
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Tursi A, Mocci G, Faggiani R, Allegretta L, Valle ND, Forti G, Franceschi M, Ferronato A, Gallina S, Larussa T, Luzza F, Lorenzetti R, Penna A, Rodino S, Sebkova L, Lauria A, Piergallini S, Pranzo G, Ricciardelli C, Zampaletta C, Elisei W, Picchio M. Infliximab biosimilar CT-P13 is effective and safe in treating inflammatory bowel diseases: a real-life multicenter, observational study in Italian primary inflammatory bowel disease centers. Ann Gastroenterol 2019; 32:392-399. [PMID: 31263362 PMCID: PMC6595921 DOI: 10.20524/aog.2019.0377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 04/01/2019] [Indexed: 12/24/2022] Open
Abstract
Background The purpose of this study was to assess the efficacy and safety of biosimilar infliximab (IFX) CT-P13 in treating outpatients with inflammatory bowel disease (IBD) in Italian primary gastroenterology centers. Methods Consecutive IBD outpatients who completed the induction treatment were evaluated retrospectively. Clinical activity was scored according to the Mayo score for ulcerative colitis (UC) and to the Harvey-Bradshaw Index (HBI) for Crohn’s disease (CD). The primary endpoint was the achievement of clinical remission (Mayo score ≤2 in UC and HBI ≤5 in CD). Secondary endpoints were clinical response to treatment, achievement of mucosal healing, and safety. Results One hundred forty-one patients (96 UC and 45 CD) were enrolled. Previous treatment with anti-tumor necrosis factor (TNF)α had been provided to 26% of UC patients and 28.9% of CD patients. Remission was achieved in 57.3% UC patients and in 75.6% CD patients during a median (interquartile range) follow up of 24 (6-24) months. Clinical response and mucosal healing were achieved in 87.5% and 75.0% of UC patients and in 84.4% and 84.2% of CD patients, respectively. By both univariate and multivariate analysis, age >40 years, presence of comorbidities, and naivety to anti-TNFα were significantly related to remission. Only one (0.7%) adverse event was reported in the CD group. Surgery was performed in 2.1% of UC patients and 6.7% of CD patients. Switching from IFX originator to biosimilar did not influence the maintenance of the clinical remission. Conclusion This study confirmed the long-term efficacy and safety of CT-P13 therapy in IBD, in both naïve patients and those switching from IFX originator.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria (Antonio Tursi)
| | - Giammarco Mocci
- Division of Gastroenterology, "Brotzu" Hospital, Cagliari (Giammarco Mocci)
| | - Roberto Faggiani
- Division of Gastroenterology, "Belcolle" Hospital, Viterbo (Roberto Faggiani, Sara Gallina, Costantino Zampaletta)
| | - Leonardo Allegretta
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina, LE (Leonardo Allegretta)
| | - Nicola Della Valle
- Division of Gastroenterology, A.O. "Ospedali Riuniti", Foggia (Nicola Della Valle)
| | - Giacomo Forti
- Division of Digestive Endoscopy, "S. Maria Goretti" Hospital, Latina (Nicola Della Valle, Giacomo Forti)
| | - Marilisa Franceschi
- Digestive Endoscopy Unit, ULSS7 Pedemontana, Santorso (VI) (Marilisa Franceschi, Antonio Ferronato)
| | - Antonio Ferronato
- Digestive Endoscopy Unit, ULSS7 Pedemontana, Santorso (VI) (Marilisa Franceschi, Antonio Ferronato)
| | - Sara Gallina
- Division of Gastroenterology, "Belcolle" Hospital, Viterbo (Roberto Faggiani, Sara Gallina, Costantino Zampaletta)
| | - Tiziana Larussa
- Department of Health Science, University of Catanzaro, Catanzaro (Tiziana Larussa, Francesco Luzza)
| | - Francesco Luzza
- Department of Health Science, University of Catanzaro, Catanzaro (Tiziana Larussa, Francesco Luzza)
| | - Roberto Lorenzetti
- Division of Gastroenterology, PTP "Nuovo Regina Margherita", Rome (Roberto Lorenzetti)
| | - Antonio Penna
- Division of Gastroenterology, "S. Paolo" Hospital, Bari (Antonio Penna)
| | - Stefano Rodino
- Division of Gastroenterology, "Ciaccio-Pugliese" Hospital, Catanzaro (Stefano Rodino, Ladislava Sebkova)
| | - Ladislava Sebkova
- Division of Gastroenterology, "Ciaccio-Pugliese" Hospital, Catanzaro (Stefano Rodino, Ladislava Sebkova)
| | - Angelo Lauria
- Division of Gastroenterology, A.O. "Bianchi-Melacrino-Morelli", Reggio Calabria (Angelo Lauria)
| | - Simona Piergallini
- Division of Gastroenterology, IBD Unit, "A. Murri" Hospital, Fermo (Simona Piergallini)
| | - Giuseppe Pranzo
- Ambulatory for IBD Treatment, "Valle D'Itria" Hospital, Martina Franca (TA) (Giuseppe Pranzo)
| | - Cristina Ricciardelli
- Division of Gastroenterology, "Veris Delli Ponti" Hospital, Scorrano (LE) (Cristina Ricciardelli)
| | - Costantino Zampaletta
- Division of Gastroenterology, "Belcolle" Hospital, Viterbo (Roberto Faggiani, Sara Gallina, Costantino Zampaletta)
| | - Walter Elisei
- Division of Gastroenterology, ASL Roma 6, Albano Laziale, Rome (Walter Elisei)
| | - Marcello Picchio
- Division of General Surgery, "P. Colombo" Hospital, ASL Roma 6, Velletri, Rome (Marcello Picchio), Italy
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11
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Tursi A, Elisei W, Faggiani R, Allegretta L, Valle ND, Forti G, Franceschi M, Ferronato A, Gallina S, Larussa T, Luzza F, Lorenzetti R, Mocci G, Penna A, Rodino’ S, Sebkova L, de Medici A, Pranzo G, Ricciardelli C, Grasso G, Scorza S, Zampaletta C, Picchio M. Effectiveness and safety of adalimumab to treat outpatient ulcerative colitis: A real-life multicenter, observational study in primary inflammatory bowel disease centers. Medicine (Baltimore) 2018; 97:e11897. [PMID: 30142791 PMCID: PMC6112877 DOI: 10.1097/md.0000000000011897] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Adalimumab (ADA) was approved in Italy for the treatment of ulcerative colitis (UC) unresponsive to standard treatments in 2014, but no data from real life are currently available. The aim of the present study was to assess the real-life efficacy and safety of ADA in managing UC outpatients in some Italian primary inflammatory bowel disease (IBD) centers after approval of ADA reimbursement.Consecutive UC outpatients with at least 3-month follow-up were retrospectively evaluated. The primary end point was the induction and maintenance of remission in UC, defined as Mayo score ≤2.One hundred seven patients were included. At 3-month follow-up, obtained in 102 (95.3%) patients, 56 (54.9%) patients achieved a clinical remission. At univariate analysis, both Mayo partial score >7 and Mayo subscore for endoscopy = 3 at entry showed to be significantly associated with the lack of remission induction.During a median (95% confidence interval [CI]) follow-up of 18 (12-24) months, 56.6% of patients were under clinical remission; clinical response was achieved in 89.2% of cases. Mucosal healing was achieved in 66 (76.7%) patients, and colectomy occurred in 3 (2.8%) patients. Both C-reactive protein and fecal calprotectin values significantly decreased during follow-up. Steroids discontinuation occurred in 67 (66.7%) patients, and ADA dose escalation was adopted in 9 (16.1%) patients under remission. No factor was significantly related to the maintenance of clinical remission.This first Italian experience found ADA safe and effective to induce and maintain remission in real-life UC outpatients.
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Affiliation(s)
- Antonio Tursi
- Territorial Gastroenterology Service, ASL BAT, Andria
| | - Walter Elisei
- Division of Gastroenterology, ASL Roma 6, Albano Laziale (Roma)
| | | | - Leonardo Allegretta
- Division of Gastroenterology, “Santa Caterina Novella” Hospital, Galatina (LE)
| | | | - Giacomo Forti
- Division of Digestive Endoscopy, “S. Maria Goretti” Hospital, Latina
| | | | | | - Sara Gallina
- Division of Gastroenterology, A.O. “Ospedali Riuniti,” Foggia
| | - Tiziana Larussa
- Department of Health Science, University of Catanzaro, Catanzaro
| | - Francesco Luzza
- Department of Health Science, University of Catanzaro, Catanzaro
| | | | | | - Antonio Penna
- Division of Gastroenterology, “S. Paolo” Hospital, Bari
| | - Stefano Rodino’
- Division of Gastroenterology, “Ciaccio-Pugliese” Hospital, Catanzaro
| | - Ladislava Sebkova
- Division of Gastroenterology, “Ciaccio-Pugliese” Hospital, Catanzaro
| | | | - Giuseppe Pranzo
- Ambulatory for IBD Treatment, “Valle D’Itria” Hospital, Martina Franca (TA)
| | | | - Giuseppina Grasso
- Division of Gastroenterology, “Santa Caterina Novella” Hospital, Galatina (LE)
| | - Stefano Scorza
- Division of Gastroenterology, A.O. “Ospedali Riuniti,” Foggia
| | | | - Marcello Picchio
- Division of General Surgery, “P. Colombo” Hospital, ASL Roma 6, Velletri (Roma), Italy
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12
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Tursi A, Allegretta L, Della Valle N, Hadad Y, Penna A, Pranzo G, Ricciardelli C, Paiano P, Picchio M. Effectiveness of golimumab in inducing remission and clinical response in outpatient ulcerative colitis. Clin Res Hepatol Gastroenterol 2016; 40:e61-e63. [PMID: 27297910 DOI: 10.1016/j.clinre.2016.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/02/2016] [Indexed: 02/04/2023]
Affiliation(s)
- Antonio Tursi
- Servizio di Gastroenterologia Territoriale, Via Torino, 49, 76123 Andria, Italy.
| | - Leonardo Allegretta
- Division of Gastroenterology, "Santa Caterina Novella" Hospital, Galatina (LE), Italy
| | | | - Yusef Hadad
- Division of Internal Medicine, "Card. Panico" Hospital, Tricase (LE), Italy
| | - Antonio Penna
- Division of Gastroenterology, "S. Paolo" Hospital, Bari, Italy
| | - Giuseppe Pranzo
- Ambulatory of IBD, "Valle D'Itria" Hospital, Martina Franca (TA), Italy
| | | | - Primaldo Paiano
- Division of Gastroenterology, "Veris Delli Ponti" Hospital, Scorrano (LE), Italy
| | - Marcello Picchio
- Division of Surgery, "P. Colombo" Hospital, Velletri, Roma, Italy
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13
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Shah SC, Colombel JF, Sands BE, Narula N. Mucosal Healing Is Associated With Improved Long-term Outcomes of Patients With Ulcerative Colitis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2016; 14:1245-1255.e8. [PMID: 26829025 DOI: 10.1016/j.cgh.2016.01.015] [Citation(s) in RCA: 217] [Impact Index Per Article: 27.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/20/2016] [Accepted: 01/24/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The paradigm for treatment for ulcerative colitis (UC) is shifting from resolving symptoms toward objective measures such as mucosal healing (MH). However, it is unclear whether MH is associated with improved long-term outcomes. We performed a systematic review and meta-analysis to identify and analyze studies comparing long-term outcomes of patients with MH with those without MH. METHODS We performed a systematic search of 3 large databases to identify prospective studies of patients with active UC that included outcomes of patients found to have MH at the first endoscopic evaluation after initiation of UC therapy (MH1) compared with those without MH1. The primary outcome was clinical remission after at least 52 weeks. Secondary outcomes included proportions of patients who were free of colectomy or corticosteroids and rate of MH after at least 52 weeks. RESULTS We analyzed 13 studies comprising 2073 patients with active UC. Patients with MH1 had pooled odds ratio of 4.50 for achieving long-term (after at least 52 weeks) clinical remission (95% confidence interval [CI], 2.12-9.52), 4.15 for remaining free of colectomy (95% CI, 2.53-6.81), 8.40 for achieving long-term MH (95% CI, 3.13-22.53), and 9.70 for achieving long-term corticosteroid-free clinical remission (95% CI, 0.94-99.67), compared with patients without MH1. We found no difference in outcomes if patients achieved MH1 while receiving biologic versus non-biologic therapy. CONCLUSIONS In a meta-analysis, we associated MH with long-term clinical remission, avoidance of colectomy, and corticosteroid-free clinical remission. MH is therefore appropriate goal of UC therapy.
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Affiliation(s)
- Shailja C Shah
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Jean-Frederic Colombel
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruce E Sands
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Neeraj Narula
- McMaster University Medical Centre, Hamilton, Ontario, Canada
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Fernández-Salazar L, Muñoz F, Barrio J, Muñoz C, Pajares R, Rivero M, Prieto V, Legido J, Bouhmidi A, Herranz M, Fernández N, Sánchez-Ocaña R, Joao D, Santos F. Infliximab in ulcerative colitis: real-life analysis of factors predicting treatment discontinuation due to lack of response or colectomy: ECIA (ACAD Colitis and Infliximab Study). Scand J Gastroenterol 2016. [PMID: 26200929 DOI: 10.3109/00365521.2015.1070900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To describe clinical practice with infliximab (IFX) in ulcerative colitis (UC); identification of predictive factors for IFX treatment discontinuation due to insufficient response and for colectomy. MATERIAL AND METHODS Retrospective, multicentric and observational study including every UC IFX-treated patient in 10 Spanish hospitals. Variables analyzed: epidemiological data; variables for poor prognosis; IFX prior treatments; characteristics of the IFX treatment; time from the UC diagnosis to induction with IFX; time from induction to colectomy or until data collection. Predictive and protective factors for IFX discontinuation due to lack of response and for colectomy were analyzed with binary logistic regression and Cox analysis. RESULTS Follow-up time from induction with IFX to the collection of data or colectomy: 36.7 ± 25.7 months. Prior treatment with immunomodulator medications (IMM): 79%; IFX + immunosuppressant therapy: 77%; discontinuation of IFX: 26%, colectomy 16%. Independent predictive or protective factors for IFX discontinuation: IMM resistance (OR: 2.9, p = 0.022, 95% CI: 1.2-7.2), prior use of leukocytapheresis (OR: 3.3, p = 0.024, 95% CI: 1.1-9.4), IFX + IMM therapy (OR: 0.3, p = 0.022, 95% CI: 0.1-0.9, and HR: 0.4, p = 0.006, 95% CI: 0.2-0.8) and corticosteroid use in induction (HR: 1.9, p = 0.049, 95% CI: 1.0-3.8). Independent predictive or protective factors for colectomy: Use of leukocytapheresis (OR: 3.0, p = 0.036, 95% CI: 1.1-8.4), IFX + IMM therapy (OR: 0.3, p = 0.022, 95% CI: 0.1-0.8, and HR: 0.3, p = 0.011, 95% CI: 0.1-0.8) and severe cortico-resistant flare-up (HR: 2.5, p = 0.032, 95% CI: 1.1-5.9). CONCLUSIONS Prior use of IMM and leukocytapheresis, the use of corticosteroids in induction and a severe cortico-resistant flare predict a worse response to IFX and the need for colectomy. Combination therapy is a protective factor for both.
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Affiliation(s)
| | - Fernando Muñoz
- b 2 Gastroenterology Unit, Complejo Asistencial Universitario , León, Spain
| | - Jesús Barrio
- c 3 Gastroenterology Unit, Hospital Universitario Río Hortega , Valladolid, Spain
| | - Concepción Muñoz
- d 4 Gastroenterology Unit, Hospital Virgen de la Salud , Toledo, Spain
| | - Ramón Pajares
- e 5 Gastroenterology Unit, Hospital Infanta Sofía, San Sebastián de los Reyes , Madrid, Spain
| | - Montserrat Rivero
- f 6 Gastroenterology Unit, Hospital Universitario Marqués de Valdecilla , Santander, Spain
| | - Vanessa Prieto
- g 7 Gastroenterology Unit, Complejo Asistencial Universitario , Salamanca, Spain
| | - Jesús Legido
- h 8 Gastroenterology Unit, Complejo Asistencial , Segovia, Spain
| | - Abdel Bouhmidi
- i 9 Gastroenterology Unit, Hospital Santa Bárbara de Puertollano , Ciudad Real, Spain
| | - Maite Herranz
- j 10 Gastroenterology Unit, Complejo Asistencial , Ávila, Spain
| | - Nereida Fernández
- b 2 Gastroenterology Unit, Complejo Asistencial Universitario , León, Spain
| | - Ramón Sánchez-Ocaña
- c 3 Gastroenterology Unit, Hospital Universitario Río Hortega , Valladolid, Spain
| | - Diana Joao
- b 2 Gastroenterology Unit, Complejo Asistencial Universitario , León, Spain
| | - Fernando Santos
- c 3 Gastroenterology Unit, Hospital Universitario Río Hortega , Valladolid, Spain
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Colectomy rates in patients with ulcerative colitis following treatment with infliximab or ciclosporin: a systematic literature review. Eur J Gastroenterol Hepatol 2016; 28:369-82. [PMID: 26825217 DOI: 10.1097/meg.0000000000000568] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review aimed to compile all available published data on colectomy rates following treatment using infliximab or ciclosporin in adult ulcerative colitis patients and to analyse colectomy rates, timing to colectomy and postcolectomy mortality for each treatment. We systematically reviewed the literature after 1990 reporting colectomy rates in ulcerative colitis patients treated with infliximab or ciclosporin, excluding articles on paediatric patients, patients with indeterminate colitis or Crohn's disease and bowel surgery not related to ulcerative colitis. We presented weighted mean colectomy rates and mortality rates. Cox's regression was used to assess time to colectomy adjusting for colitis severity, patient age and sex. We tabulated 78 studies reporting on ciclosporin and/or infliximab and colectomy rates or postcolectomy mortality rates. Not all studies reported data in a standardized manner. Infliximab had a significantly lower colectomy rate than ciclosporin at 36 months when analysing all studies, studies directly comparing infliximab and ciclosporin and studies using severe colitis patients, but not at 3, 12 or 24 months. Severity and age were key indicators in the likelihood of undergoing colectomy after treatment. Postcolectomy mortality rates were less than 1.5% for both drugs. This review indicates that long-term colectomy rates following infliximab are significantly lower than ciclosporin in the longer term, and that postcolectomy mortality following infliximab and ciclosporin is very low. However, many key data items were missing from research articles, reducing our ability to establish with more confidence the actual impact of these two drugs on colectomy rates and postcolectomy mortality rates.
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Alexakis C, Pollok RCG. Impact of thiopurines and anti-tumour necrosis factor therapy on hospitalisation and long-term surgical outcomes in ulcerative colitis. World J Gastrointest Surg 2015; 7:360-9. [PMID: 26730281 PMCID: PMC4691716 DOI: 10.4240/wjgs.v7.i12.360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/22/2015] [Accepted: 11/10/2015] [Indexed: 02/06/2023] Open
Abstract
Ulcerative colitis (UC) is a chronic inflammatory condition affecting the large bowel and is associated with a significant risk of both requirement for surgery and the need for hospitalisation. Thiopurines, and more recently, anti-tumour necrosis factor (aTNF) therapy have been used successfully to induce clinical remission. However, there is less data available on whether these agents prevent long-term colectomy rates or the need for hospitalisation. The focus of this article is to review the recent and pertinent literature on the long-term impact of thiopurines and aTNF on long-term surgical and hospitalisation rates in UC. Data from population based longitudinal research indicates that thiopurine therapy probably has a protective role against colectomy, if used in appropriate patients for a sufficient duration. aTNF agents appear to have a short term protective effect against colectomy, but data is limited for longer periods. Whereas there is insufficient evidence that thiopurines affect hospitalisation, evidence favours that aTNF therapy probably reduces the risk of hospitalisation within the first year of use, but it is less clear on whether this effect continues beyond this period. More structured research needs to be conducted to answer these clinically important questions.
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Managing patients with ulcerative colitis with infliximab in primary and referral gastroenterology centers: similarities and differences. Inflamm Bowel Dis 2014; 20:E24-5. [PMID: 25374289 DOI: 10.1097/mib.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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