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Bouhnik Y, Carbonnel F, Fumery M, Flamant M, Buisson A, Camoin A, Addison J. The PERFUSE study: The experience of patients receiving Adalimumab biosimilar SB5. Dig Liver Dis 2023; 55:1658-1666. [PMID: 37308394 DOI: 10.1016/j.dld.2023.05.025] [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: 01/31/2023] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND SB5 is an EMA-approved adalimumab biosimilar, having demonstrated bioequivalence, equivalent efficacy, and similar safety and immunogenicity to the reference product. AIMS Describe patient training and satisfaction using patient-reported outcome measures (PROMs) and assess their impact on 12-month persistence on SB5. METHODS The observational PERFUSE study included 318 Crohn's disease (CD) patients and 88 ulcerative colitis (UC) patients in 27 sites across France between October 2018 and December 2020. PROMs were collected at 1-month post-baseline using an online questionnaire (ePRO) designed with patient associations. Treatment persistence was collected during routine visits (up to 15 months post-initiation). Results are presented by prior experience with subcutaneous biologics and training in proper use of the injection device. RESULTS 57.1% (n = 145) and 44.1% (n = 67) of naïve and pre-treated patients, respectively, answered the ePRO. Naïve patients were offered training more often (86.9% vs 31.3% respectively, p < 0.05), with disparities between sites. All subgroups' satisfaction scores were high. 12-month persistence on SB5 was significantly higher for respondents than for non-respondents (68.0% [60.9; 74.1] vs 52.3% [44.5; 59.6]; p < 0.05) and in patients with a better perception of their illness (OR=1.02, [1.0; 1.05]; p < 0.05). CONCLUSIONS Early patient questionnaires may be useful to identify patients at higher risk of treatment discontinuation.
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Affiliation(s)
- Yoram Bouhnik
- Paris IBD Center, Groupe hospitalier privé Ambroise Paré - Hartmann, 25 Boulevard Victor Hugo, 92200 Neuilly sur Seine, France.
| | - Franck Carbonnel
- Hôpital Bicêtre, AP-HP, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Mathurin Fumery
- CHU Amiens, Département de Gastroentérologie, 1 Rond-point du Professeur Christian Cabrol, 80054 Amiens, France
| | - Mathurin Flamant
- Clinique Jules Verne, Département de Gastroentérologie, 2-4 Route de Paris, 44300 Nantes, France
| | - Anne Buisson
- AFA Crohn RCH, 32 rue de Cambrai, 75019 Paris, France
| | - Armelle Camoin
- Biogen France SAS, Gastroenterology & Rhumatologie, Biosimilars, 1 Passerelle des Reflets, 92400 Courbevoie, France
| | - Janet Addison
- Biogen IDEC, Clinical Research, Biosimilars, Innovation House 70 Norden Road, Maidenhead, Berkshire SL6 4AY, United Kingdom
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Pernencar C, Saboia I, Dias JC. How Far Can Conversational Agents Contribute to IBD Patient Health Care—A Review of the Literature. Front Public Health 2022; 10:862432. [PMID: 35844879 PMCID: PMC9282671 DOI: 10.3389/fpubh.2022.862432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Modern societies are facing health and healthcare challenges as never seen before. The digital world in which we are living today considers digital health interventions such as “internet-delivered” therapy (e-Therapy) or mobile apps as an integrated part of healthcare systems. Digital transformation in health care requires the active involvement of patients as the central part of healthcare interventions. In the case of chronic health conditions, such as inflammatory bowel disease (IBD), it is believed that the adoption of new digital tools helps to maintain and extend the health and care of patients, optimizing the course of the treatment of the disease. The study goal was to undertake a literature review associating the use of chatbot technology with IBD patients' health care. This study intends to support digital product developments, mainly chatbot for IBD or other chronic diseases. The work was carried out through two literature review phases. The first one was based on a systematic approach and the second was a scoping review focused only on Frontiers Journals. This review followed a planned protocol for search and selection strategy that was created by a research team discussion. Chatbot technology for chronic disease self-management can have high acceptance and usability levels. The more interaction with a chatbot, the more patients are able to increase their self-care practice, but there is a challenge. The chatbot ontology to personalize the communication still needed to have strong guidelines helping other researchers to define which Electronic Medical Records (EMRs) should be used in the chatbots to improve the user satisfaction, engagement, and dialog quality. The literature review showed us both evidence and success of these tools in other health disorders. Some of them revealed a huge potential for conversational agents as a part of digital health interventions.
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Affiliation(s)
- Cláudia Pernencar
- ICNOVA—NOVA Institute of Communication, NOVA School of Social Sciences and Humanities, Universidade NOVA de Lisboa, Lisbon, Portugal
- LIDA—Arts and Design Research Lab, Polytechnic Institute of Leiria, Leiria, Portugal
- *Correspondence: Cláudia Pernencar
| | - Inga Saboia
- UFC Virtual, Federal University of Ceará, Fortaleza, Brazil
- DigiMedia—Department of Communication and Art, University of Aveiro, Aveiro, Portugal
| | - Joana Carmo Dias
- COMEGI—Research Center on Organizations, Markets and Industrial Management, Lisbon, Portugal
- UNIDCOM/IADE—Design and Communication Research Centre, Lisbon, Portugal
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Razanskaite V, Kallis C, Young B, Williamson PR, Bodger K. Heterogeneity in outcome assessment for inflammatory bowel disease in routine clinical practice: a mixed-methods study in a sample of English hospitals. BMJ Open 2021; 11:e056413. [PMID: 35679143 PMCID: PMC8719195 DOI: 10.1136/bmjopen-2021-056413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Knowledge of the extent of variation in outcome assessment for inflammatory bowel disease (IBD) in routine practice is limited. We aimed to describe and quantify variation in outcome coverage and to explore patient, clinician and practitioner factors associated with it. DESIGN Prospective exploratory mixed-methods study. SETTING IBD clinics at six hospitals in North West England with differing electronic health record (EHR) systems. METHODS Mixed-methods study comprising: (a) structured observations of outcomes elicited during consultations (102 patients consulting 24 clinicians); (b) retrospective analysis of outcomes recorded in the EHR (909 consultations; 127 clinicians) and (c) semistructured interviews with the 24 observed clinicians. We determined whether specific outcome 'sets' were elicited or recorded, including: (1) a minimum set of symptom pairs ('PRO-2'); (2) symptom sets from disease activity indices and (3) a reference list of 37 symptoms, signs and impacts. Factors associated with variation were explored in univariate and multivariate binary logistic regression analyses and from clinician interviews. RESULTS PRO-2 coverage was not invariable (elicited during 81% of observed consultations; recorded in 56% of EHR) and infrequent for complete activity indices (all domains from Harvey-Bradshaw Index: elicited, 18%; recorded, 5%). The median number of outcomes from the reference list elicited per consultation was 12 (13-fold variation) and recorded in EHR was 7 (>20-fold variation). Symptom quantification (PRO-2) seldom adhered closely to standardised descriptors and an explicit timeframe was defined rarely. PRO-2 recording in EHR was associated with a diagnosis of ulcerative colitis (OR: 2.09 (95% CI 1.15 to 3.80)) and nurse-led consultations (OR: 6.98 (95% CI 3.28 to 14.83)) and a three-way model suggested 26% of total variability lay between clinicians, 17% between patients but the remainder was unexplained. Most clinicians expressed preference for individualised health status evaluations versus standardised outcome assessments. CONCLUSIONS There was little evidence for standardised assessment and recording of IBD outcomes and substantial intra-clinician and inter-clinician variation from one consultation to another. Nurses demonstrated a greater tendency to standardised practice.
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Affiliation(s)
- Violeta Razanskaite
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Constantinos Kallis
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Bridget Young
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Keith Bodger
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
- Digestive Diseases Unit, Aintree University Hospital, Liverpool, UK
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Vande Casteele N, Jairath V, Jeyarajah J, Dulai PS, Singh S, Shackelton LM, Feagan BG, Sandborn WJ. Development and Validation of a Clinical Decision Support Tool That Incorporates Pharmacokinetic Data to Predict Endoscopic Healing in Patients Treated With Infliximab. Clin Gastroenterol Hepatol 2021; 19:1209-1217.e2. [PMID: 32376505 DOI: 10.1016/j.cgh.2020.04.078] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Infliximab is an effective treatment for moderate to severe ulcerative colitis (UC). Little is known about patient-related factors that might be used to predict endoscopic healing with infliximab therapy. METHODS We analyzed data from 484 patients included in the randomized trials of the effects of infliximab therapy for patients with UC (Active Ulcerative Colitis Trials [ACT]-1 and ACT-2). We used a 2-compartment population pharmacokinetic model to calculate baseline infliximab clearance. Two multivariable regression models were derived and validated for their ability to identify patients with endoscopic healing (Mayo endoscopic score, ≤1) at weeks 8 and 30, using only baseline variables. We developed a clinical decision support tool (CDST) and calculator to determine the probability of endoscopic healing in patients starting infliximab. RESULTS Higher baseline infliximab clearance, stool frequency, and rectal bleeding scores were associated negatively with endoscopic healing at week 8. In the validation set, a CDST score of 9 points or fewer identified patients without endoscopic healing at week 8 with 82% sensitivity (95% CI, 76%-88%), whereas a CDST score of 16 points or more identified patients with endoscopic healing at week 8 with 87% specificity (95% CI, 81%-94%). Higher baseline infliximab clearance, stool frequency score, white blood cell count, and lower body weight were associated negatively with endoscopic healing at week 30. In the validation set, CDST scores of 17 points or fewer identified patients without endoscopic healing at week 30 with 90% sensitivity (95% CI, 85%-95%), whereas scores greater than 22 points identified patients with endoscopic healing at week 30 with 80% specificity (95% CI, 73%-87%). External validation models had a modest predictive value, with an area under of the curve of 0.67 (95% CI, 0.61-0.74). Patient-level probabilities of endoscopic healing at weeks 8 or 30 can be calculated online (www.premedibd.com). CONCLUSIONS Using data from 2 clinical trials of patients receiving infliximab therapy for UC, we developed and validated the CDST, which uses data on infliximab clearance and baseline patient and disease measures to identify patients most likely to have endoscopic healing. This tool will facilitate therapy decision making and precision medicine.
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Affiliation(s)
- Niels Vande Casteele
- Department of Medicine, University of California San Diego, La Jolla, California; Department of Medical Research & Development, Robarts Clinical Trials, Inc, London, Ontario, Canada.
| | - Vipul Jairath
- Department of Medical Research & Development, Robarts Clinical Trials, Inc, London, Ontario, Canada; Department of Medicine; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jenny Jeyarajah
- Department of Medical Research & Development, Robarts Clinical Trials, Inc, London, Ontario, Canada
| | - Parambir S Dulai
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Siddharth Singh
- Department of Medicine, University of California San Diego, La Jolla, California
| | - Lisa M Shackelton
- Department of Medical Research & Development, Robarts Clinical Trials, Inc, London, Ontario, Canada
| | - Brian G Feagan
- Department of Medical Research & Development, Robarts Clinical Trials, Inc, London, Ontario, Canada; Department of Medicine; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - William J Sandborn
- Department of Medicine, University of California San Diego, La Jolla, California; Department of Medical Research & Development, Robarts Clinical Trials, Inc, London, Ontario, Canada
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