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Talar-Wojnarowska R, Caban M, Jastrzębska M, Woźniak M, Strigáč A, Małecka-Wojciesko E. Inflammatory Bowel Diseases in the Elderly: A Focus on Disease Characteristics and Biological Therapy Patterns. J Clin Med 2024; 13:2767. [PMID: 38792308 PMCID: PMC11122211 DOI: 10.3390/jcm13102767] [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: 04/12/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024] Open
Abstract
Background: The incidence of inflammatory bowel diseases (IBDs) in elderly patients is constantly increasing. It results from the combination of an aging population with compounding prevalence of IBD, as well as the growing burden of elderly-onset IBD. The clinical characteristics of elderly patients differ from young subjects with IBD due to the multimorbidity or polypharmacy, affecting the choice of adequate therapeutic options. The aim of this study was to determine the clinical aspects and biological therapy safety in elderly Polish IBD patients. Methods: We conducted a retrospective study aimed at describing the demographic, clinical, and management characteristics of IBD patients treated with a biological therapy in two referral centers within the National Drug Program in Poland. Results: Out of the entire group of 366 studied patients, 51 (13.9%) were aged over 60-32 with ulcerative colitis (UC) and 19 with Crohn's disease (CD). The disease location was predominantly ileocolonic (57.89%) in patients with CD and pancolitis for patients with UC (56.25%). Most of the elderly IBD subjects were characterized by significant comorbidities, with Charlson Comorbidity Index (CCI) ≥ 1 in 66.67% patients. The probability of stopping biological therapy due to adverse events had the tendency to be higher in the CCI ≥ 1 group (20.58% vs. 5.88% in CCI = 0; p = 0.087). The main reasons for the therapy discontinuation included hypersensitivity reactions and liver enzyme abnormalities. Conclusions: In conclusion, our results underline the importance of assessing the comorbidity status instead of the age prior to initiating biological therapy, analyzing additional safety risks, and close monitoring in IBD patients with multiple comorbidities.
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Affiliation(s)
- Renata Talar-Wojnarowska
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland; (R.T.-W.); (M.W.); (A.S.); (E.M.-W.)
| | - Miłosz Caban
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland; (R.T.-W.); (M.W.); (A.S.); (E.M.-W.)
- Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, 92-215 Lodz, Poland
| | - Marta Jastrzębska
- Department of Gastroenterology, Health Care Center, 26-200 Konskie, Poland;
| | - Małgorzata Woźniak
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland; (R.T.-W.); (M.W.); (A.S.); (E.M.-W.)
| | - Aleksandra Strigáč
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland; (R.T.-W.); (M.W.); (A.S.); (E.M.-W.)
| | - Ewa Małecka-Wojciesko
- Department of Digestive Tract Diseases, Faculty of Medicine, Medical University of Lodz, 90-153 Lodz, Poland; (R.T.-W.); (M.W.); (A.S.); (E.M.-W.)
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Velikova T, Sekulovski M, Peshevska-Sekulovska M. Immunogenicity and Loss of Effectiveness of Biologic Therapy for Inflammatory Bowel Disease Patients Due to Anti-Drug Antibody Development. Antibodies (Basel) 2024; 13:16. [PMID: 38534206 DOI: 10.3390/antib13010016] [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: 08/31/2023] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
Many patients with inflammatory bowel disease (IBD) experience a loss of effectiveness to biologic therapy (i.e., anti-TNF therapy, etc.). Therefore, in addition to the adverse effects of the treatment, these patients also face failure to achieve and maintain remission. Immunogenicity, the process of production of antibodies to biological agents, is fundamental to the evolution of loss of response to treatment in IBD patients. The presence of these antibodies in patients is linked to decreased serum drug levels and inhibited biological activity. However, immunogenicity rates exhibit significant variability across inflammatory disease states, immunoassay formats, and time periods. In this review, we aimed to elucidate the immunogenicity and immune mechanisms of antibody formation to biologics, the loss of therapy response, clinical results of biological treatment for IBD from systematic reviews and meta-analyses, as well as to summarize the most recent strategies for overcoming immunogenicity and approaches for managing treatment failure in IBD.
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Affiliation(s)
- Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria
| | - Metodija Sekulovski
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, 1 Kozyak Str., 1407 Sofia, Bulgaria
| | - Monika Peshevska-Sekulovska
- Medical Faculty, Sofia University St. Kliment Ohridski, 1 Kozyak Str., 1407 Sofia, Bulgaria
- Department of Gastroenterology, University Hospital Lozenetz, 1407 Sofia, Bulgaria
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3
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Zhu F, Hu Z, Yu W, Dai F, Jing D, Zhou G. Ulcerative Colitis Concomitant with Cytomegalovirus Infection, Bullous Sweet's Syndrome, and Acute Myeloid Leukemia: A Case Report and Literature Review. J Inflamm Res 2023; 16:3715-3723. [PMID: 37663756 PMCID: PMC10473406 DOI: 10.2147/jir.s422057] [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: 05/19/2023] [Accepted: 08/11/2023] [Indexed: 09/05/2023] Open
Abstract
Background Ulcerative colitis (UC) is a chronic, relapsing progressive inflammatory immune disease. There is still no cure for it. Even worse, UC may predispose patients to opportunistic infections, and several extra-intestinal manifestations (EIMs) and comorbidities may antedate, occur with, or postdate the onset of UC, which may increase the mortality risk. But case reports of UC patients simultaneously concomitant with opportunistic infection, EIM, and comorbidity are extremely rare. Case Presentation We report a case of 51-year-old male patient with incipient UC accompanied by cytomegalovirus (CMV) infection and bullous Sweet's syndrome (bSS, a cutaneous EIM of UC) after treatment with oral mesalazine and prednisolone for 3 weeks. After clearance of the CMV infection by using ganciclovir, the patient was administered two cycles of infliximab to cure UC and bSS; however, he developed acute myeloid leukemia (AML) a month later and died after two cycles of chemotherapy. Conclusion Based on this rare case of UC concomitant with CMV infection, bSS and AML, we recommend that it is important to distinguish between an acute UC flare and opportunistic infections, especially in patients receiving immunosuppressive therapy, and monitor EIMs and comorbidities timely. Particular attention should be paid to cancer surveillance. Clinicians should be mindful of these facts to adopt optimal therapeutic options to address all aspects of UC. Early initiation of biological therapy may be of benefit to patients with newly diagnosed severe UC.
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Affiliation(s)
- Fengqin Zhu
- Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, 272000, People’s Republic of China
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250355, People’s Republic of China
| | - Zongjing Hu
- Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, 272000, People’s Republic of China
| | - Wei Yu
- Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, 272000, People’s Republic of China
| | - Fengxian Dai
- Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, 272000, People’s Republic of China
| | - Dehuai Jing
- Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, 272000, People’s Republic of China
| | - Guangxi Zhou
- Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining Medical University, Jining, Shandong, 272000, People’s Republic of China
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4
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McCormack MD, Wahedna NA, Aldulaimi D, Hawker P. Emerging role of dual biologic therapy for the treatment of inflammatory bowel disease. World J Clin Cases 2023; 11:2621-2630. [PMID: 37214562 PMCID: PMC10198105 DOI: 10.12998/wjcc.v11.i12.2621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/07/2023] [Accepted: 03/24/2023] [Indexed: 04/25/2023] Open
Abstract
Biologic agents have now been used in the management of inflammatory bowel disease (IBD) for many years where experience, expertise and confidence in their use has developed over time. In the United Kingdom, there are well established guidelines and recommendations for both single agent biologic treatments, and with combination therapy of a biologic agent with a small molecule agent in maintenance therapy. In recent times, there has been increasing interest and experience using dual biologic therapy (DBT) in IBD, primarily in difficult to treat and refractory cases with high disease burden. However, published data on use, experience and safety profiles is limited and large-scale studies remain low in number in this developing area. We therefore aim to present a summary and review of the available published data in this area to help us better understand the emerging role of DBT in IBD.
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Affiliation(s)
- Matthew D McCormack
- Department of Gastroenterology, South Warwickshire NHS Foundation Trust, Warwick Hospital, Warwick CV34 5BW, United Kingdom
| | - Natasha A Wahedna
- Department of Gastroenterology, South Warwickshire NHS Foundation Trust, Warwick Hospital, Warwick CV34 5BW, United Kingdom
| | - David Aldulaimi
- Department of Gastroenterology, South Warwickshire NHS Foundation Trust, Warwick Hospital, Warwick CV34 5BW, United Kingdom
| | - Peter Hawker
- Department of Gastroenterology, South Warwickshire NHS Foundation Trust, Warwick Hospital, Warwick CV34 5BW, United Kingdom
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Holmgren J, Fröborg A, Visuri I, Halfvarson J, Hjortswang H, Karling P, Myrelid P, Olén O, Ludvigsson JF, Grip O. The Risk of Serious Infections Before and After Anti-TNF Therapy in Inflammatory Bowel Disease: A Retrospective Cohort Study. Inflamm Bowel Dis 2023; 29:339-348. [PMID: 35776552 PMCID: PMC9977242 DOI: 10.1093/ibd/izac097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Serious infections have been observed in patients with inflammatory bowel disease (IBD) on anti-TNF use-but to what extent these infections are due to anti-TNF or the disease activity per se is hard to disentangle. We aimed to describe how the rates of serious infections change over time both before and after starting anti-TNF in IBD. METHODS Inflammatory bowel disease patients naïve to anti-TNF treatment were identified at 5 centers participating in the Swedish IBD Quality Register, and their medical records examined in detail. Serious infections, defined as infections requiring in-patient care, the year before and after the start of anti-TNF treatment were evaluated. RESULTS Among 980 patients who started their first anti-TNF therapy between 1999 and 2016, the incidence rate of serious infections was 2.19 (95% CI,1.43-3.36) per 100 person years the year before and 2.11 (95% CI, 1.33-3.34) per 100 person years 1 year after treatment start. This corresponded to an incidence rate ratio 1 year after anti-TNF treatment of 0.97 (95% CI, 0.51-1.84). Compared with before anti-TNF therapy, the incidence of serious infection was significantly decreased more than 1 year after treatment (incidence rate ratio 0.56; 95% CI, 0.33-0.95; P = .03). CONCLUSIONS In routine clinical practice in Sweden, the incidence rate of serious infection among IBD patients did not increase with anti-TNF therapy. Instead, serious infections seemed to decrease more than 1 year after initiation of anti-TNF treatment.
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Affiliation(s)
- Johanna Holmgren
- Skåne University Hospital, Department of Gastroenterology, Malmö, Sweden.,Section of Medicine, Department of Clinical sciences, Lund University, Malmö, Sweden
| | - Anna Fröborg
- Karlskrona Hospital, Department of Ear, Nose and Throat Diseases, Karlskrona, Sweden
| | - Isabella Visuri
- Örebro University, Department of Gastroenterology, Faculty of Medicine and Health, Örebro, Sweden
| | - Jonas Halfvarson
- Örebro University, Department of Gastroenterology, Faculty of Medicine and Health, Örebro, Sweden
| | - Henrik Hjortswang
- Linköping University, Department of Biomedical and Clinical Sciences, Linköping, Sweden.,Linköping University, Department of Gastroenterology, Linköping, Sweden
| | - Pontus Karling
- Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden
| | - Pär Myrelid
- Linköping University, Department of Biomedical and Clinical Sciences, Linköping, Sweden.,Linköping University Hospital, Department of Surgery, Linköping, Sweden
| | - Ola Olén
- Karolinska Institutet, Clinical Epidemiology Unit, Department of Medicine Solna, Stockholm, Sweden.,Stockholm South General Hospital, Sachs' Children and Youth Hospital, Stockholm, Sweden.,Karolinska Institutet, Department of Clinical Science and Education Södersjukhuset, Stockholm, Sweden
| | | | - Jonas F Ludvigsson
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.,Örebro University Hospital, Department of Pediatrics, Örebro, Sweden
| | - Olof Grip
- Skåne University Hospital, Department of Gastroenterology, Malmö, Sweden.,Section of Medicine, Department of Clinical sciences, Lund University, Malmö, Sweden
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Kutschera M, Novacek G, Reinisch W, Högenauer C, Petritsch W, Haas T, Moschen A, Dejaco C. Tofacitinib in the treatment of ulcerative colitis : A position paper issued by the Inflammatory Bowel Disease Working Group of the Austrian Society of Gastroenterology and Hepatology (ÖGGH). Wien Klin Wochenschr 2023; 135:1-13. [PMID: 36454302 PMCID: PMC9713195 DOI: 10.1007/s00508-022-02110-2] [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: 09/25/2022] [Accepted: 10/17/2022] [Indexed: 12/03/2022]
Abstract
Ulcerative colitis (UC) is one of the main forms of inflammatory bowel disease (IBD). Despite the widening range of drug treatment options, primary nonresponse, secondary loss of response as well as adverse events call for additional treatment alternatives.Tofacitinib is an oral small-molecule drug of the class of Janus kinase inhibitors which, in the European Union, was approved for the treatment of moderate to severe active UC in August 2018. This position paper, drawn up by the IBD Working Group of the Austrian Society of Gastroenterology and Hepatology, summarizes the mechanism of action, clinical development, marketing authorization status, efficacy and safety of tofacitinib. Also, by providing a synopsis of available data from both pivotal and post-marketing studies, clinical aspects of specific interest are highlighted and discussed.The available body of evidence indicates that tofacitinib is an additional effective medication for the treatment of UC that exhibits a good safety profile. This position paper aims at optimizing the safe and effective use of tofacitinib in daily clinical practice.
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Affiliation(s)
- Maximilian Kutschera
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Gottfried Novacek
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Christoph Högenauer
- Division of Gastroenterology and Hepatology, Medical Department, Medical University of Graz, Graz, Austria
| | - Wolfgang Petritsch
- Division of Gastroenterology and Hepatology, Medical Department, Medical University of Graz, Graz, Austria
| | - Thomas Haas
- Gastroenterology Office (Darmpraxis), Salzburg, Austria
| | - Alexander Moschen
- Second Medical Department, Kepler University Hospital, Linz, Austria
| | - Clemens Dejaco
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
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7
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Barbieri MA, Viola A, Cicala G, Spina E, Fries W. Effectiveness and Safety Profiles of Biological Therapies in Inflammatory Bowel Disease: Real Life Data from an Active Pharmacovigilance Project. Biomedicines 2022; 10:biomedicines10123280. [PMID: 36552036 PMCID: PMC9775949 DOI: 10.3390/biomedicines10123280] [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: 11/26/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Post-marketing surveillance is essential to evaluate the risk/benefit profile of drugs; however, pharmacovigilance studies comparing persistence and safety of biologic therapies in patients with inflammatory bowel disease (IBD) are scant. The aim of this study was to prospectively investigate persistence together with safety profiles of biologics in a cohort of patients diagnosed with Crohn's Disease (CD) or ulcerative colitis (UC) followed by the IBD unit of Messina and treated with infliximab (IFX), adalimumab (ADA), golimumab (GOL), vedolizumab (VED), and ustekinumab (UST) from 2017 through 2021. Descriptive and treatment persistence analyses with predictors for discontinuation and occurrence of adverse drug reactions (ADRs) were performed. A total of 675 IBD patients were enrolled. A higher persistence rate was noted for UST and ADA in the first year (83.8% and 83.1%, respectively) and for IFX in the fifth year of treatment (58.1%). GOL, VED, and UST-all used as second/third-line therapies-seemed to have a higher risk of non-persistence than IFX (in order HR: 2.19; CI 95%: 1.33-3.61, 1.45; 1.04-2.04, 2.25; 1.25-4.07) as well as switchers and those who had at least one ADR (18.1; 13.22-24.68 and 1.55; 1.20-1.99, respectively). The reported ADRs, which were generally mild-moderate, were largely known. However, real-world data should be implemented to further study undetected safety concerns, including risk of malignancy.
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Roy S, Dhaneshwar S, Mahmood T, Kumar S, Saxena SK. Pre-clinical Investigation of Protective Effect of Nutraceutical D-Glucosamine on TNBS-induced Colitis. Immunopharmacol Immunotoxicol 2022; 45:172-184. [PMID: 36154797 DOI: 10.1080/08923973.2022.2128370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The level of precursors involved in the biosynthesis of glycosaminoglycan (GAG), glucosamine synthase, and N-acetyl glucosamine (NAG), are significantly reduced in inflammatory bowel disease (IBD). This results in deficient GAG content in mucosa, which eventually disrupts the gut wall integrity, provoking abnormal immunological responses. This is characterized by colossal liberation of inflammatory mediators including tumor necrosis factor-alpha (TNF-α), interleukins (IL), and reactive oxygen species provoking colonic inflammation. D-glucosamine (D-GLU) is reported to suppress oxidative stress, and pro-inflammatory cytokines and acts as a starting material for biosynthesis of NAG. The potential of D-GLU and its combination with mesalamine (5-ASA) was investigated in 2,4,6-trinitrobenzene sulfonic acid (TNBS)-instigated IBD in Wistar rats. Standard and test drugs were given orally for five days to separate groups of rats. Colonic inflammation was evaluated by disease activity score rate (DASR), colon/body weight ratio, colon length, diameter, colon pH, histological injury and score. Inflammatory biomarkers IL-1β, TNF-α, along with reduced glutathione (GSH), and malondialdehyde (MDA) were assessed. Combination of D-GLU +5-ASA significantly ameliorated severity of colonic inflammation by lowering DASR (P < 0.001) and colon/body weight ratio (P < 0.001), restored the colonic architecture and suppressed the histopathological score (P < 0.001), along with the absence of major adverse reactions. The combination suppressed the levels of inflammatory markers (P < 0.001) and MDA (P < 0.001) while enhancing GSH level (P < 0.001). In comparison to individual 5-ASA and D-GLU, combination of drugs significantly diminished colitis severity through their combined anti-inflammatory and antioxidant effects by acting on multiple targets simultaneously. The combination holds remarkable potential in the management of IBD.
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Affiliation(s)
- Supriya Roy
- Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Sector 125, Noida, 201313, India
| | - Suneela Dhaneshwar
- Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Sector 125, Noida, 201313, India
| | - Tarique Mahmood
- Faculty of Pharmacy, Integral University, Dasauli, Lucknow, Uttar Pradesh, 226026, India
| | - Swatantra Kumar
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George's Medical University (KGMU), Lucknow, 226003, India
| | - Shailendra K Saxena
- Centre for Advanced Research (CFAR), Faculty of Medicine, King George's Medical University (KGMU), Lucknow, 226003, India
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Fuschillo G, Celentano V, Rottoli M, Sciaudone G, Gravina AG, Pellegrino R, Marfella R, Romano M, Selvaggi F, Pellino G. Influence of diabetes mellitus on inflammatory bowel disease course and treatment outcomes. A systematic review with meta-analysis. Dig Liver Dis 2022; 55:580-586. [PMID: 36058820 DOI: 10.1016/j.dld.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/08/2022] [Accepted: 08/04/2022] [Indexed: 12/18/2022]
Abstract
BACKGROUND Diabetes Mellitus (DM) may occur in IBD and influence the disease progression. AIM To compare disease course and treatment outcomes in IBD patients with and without DM. METHODS This is a systematic review with meta-analysis comparing patients with IBD plus DM with patients with IBD only. PRIMARY ENDPOINTS need for surgery, IBD-related complications, hospitalizations, sepsis, mortality. Quality of life and costs were assessed. RESULTS Five studies with 71,216 patients (49.1% with DM) were included. Risk for IBD-related complications (OR=1.12, I2 98% p = 0.77), mortality (OR=1.52, I2 98% p = 0.37) and IBD-related surgery (OR=1.20, I2 81% p = 0.26) did not differ. Risk of IBD-related hospitalizations (OR=2.52, I2 0% p < 0.00001) and sepsis (OR=1.56, I2 88% p = 0.0003) was higher in the IBD+DM group. Risk of pneumonia and urinary tract infections was higher in the IBD+DM group (OR=1.72 and OR=1.93), while risk of C. Difficile infection did not differ (OR=1.22 I2 88% p = 0.37). Mean Short Inflammatory Bowel Disease Questionnaire score was lower in the IBD+DM group (38.9 vs. 47, p = 0.03). Mean health care costs per year were $10,598.2 vs $3747.3 (p < 0.001). CONCLUSION DM might negatively affect the course of IBD by increasing the risk of hospitalization and infections, but not IBD-related complications and mortality.
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Affiliation(s)
- Giacomo Fuschillo
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Valerio Celentano
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom; Department of Surgery and Cancer. Imperial College, London, United Kingdom
| | - Matteo Rottoli
- Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero Universitaria di Bologna, Italy; Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Guido Sciaudone
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonietta Gerarda Gravina
- Department of Precision Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Raffaele Pellegrino
- Department of Precision Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Marco Romano
- Department of Precision Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Selvaggi
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy; Colorectal Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
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10
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Hahn GD, Golovics PA, Wetwittayakhlang P, Santa Maria DM, Britto U, Wild GE, Afif W, Bitton A, Bessissow T, Lakatos PL. Safety of Biological Therapies in Elderly Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis. J Clin Med 2022; 11:jcm11154422. [PMID: 35956040 PMCID: PMC9369299 DOI: 10.3390/jcm11154422] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 02/06/2023] Open
Abstract
Background and Aim: Newer biologics appeared safer in landmark clinical trials, but their safety is understudied in vulnerable populations. The aim of the present study was to perform a systematic review and meta-analysis to assess the safety of available biologicals in the elderly IBD population. Methods: We systematically searched PubMed/Medline and conference proceedings between 1 April 1969 and 1 June 2021 to identify eligible studies that examined the safety of biologics in elderly patients with IBD. Of the 2885 articles and 12 congress abstracts identified, 12 peer reviewed papers and 3 abstracts were included after independent evaluation by two reviewers. The identified studies collected safety data on anti-TNF, vedolizumab (VDZ) and ustekinumab (UST). Results: Rates of AE and infections were not different among the biologics (AE mean rate: 11.3 (CI 95% 9.9–12.7)/100 pts-years; p = 0.11, infection mean rate: 9.5 (CI 95% 8.4–10.6)/100 pts-years; p = 0.56) in elderly IBD patients on anti-TNF, VDZ or UST. Infusion/injection reaction rates were more common on anti-TNFs (mean rate: 2.51 (CI 95% 1.7–3.4/100 pts-years; p = 0.02). and malignancy rates were higher on VDZ/UST (mean rate: 2.14 (CI 95% 1.6–2.8)/100 pts-years; p = 0.01). Conclusions: Rates of AEs and infections were not different among biologicals. Infusion/injection reactions were more common on anti-TNFs. Current data are insufficient to suggest the sequencing of biologicals in elderly patients based on safety.
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Affiliation(s)
- Gustavo Drügg Hahn
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
- School of Medicine, Graduate Course Sciences in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil; (D.M.S.M.); (U.B.)
| | - Petra Anna Golovics
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
- Department of Gastroenterology, Hungarian Defense Forces, Medical Centre, 1062 Budapest, Hungary
| | - Panu Wetwittayakhlang
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
- Unit of Gastroenterology and Hepatology, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Dirlene Melo Santa Maria
- School of Medicine, Graduate Course Sciences in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil; (D.M.S.M.); (U.B.)
| | - Usiara Britto
- School of Medicine, Graduate Course Sciences in Gastroenterology and Hepatology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-002, Brazil; (D.M.S.M.); (U.B.)
| | - Gary Edward Wild
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
| | - Waqqas Afif
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
| | - Alain Bitton
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
| | - Talat Bessissow
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
| | - Peter Laszlo Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada; (G.D.H.); (P.A.G.); (P.W.); (G.E.W.); (W.A.); (A.B.); (T.B.)
- 1st Department of Medicine, Semmelweis University, 1085 Budapest, Hungary
- Correspondence:
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11
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Roy S, Dhaneshwar S, Mahmood T. Exploring the Potential of IL-1β Inhibitor Diacerein and its Combination with 5-Aminosalicylic Acid for the Possible Ameliorating Effect in TNBS-induced Experimental Colitis in Wistar Rats. CURRENT DRUG THERAPY 2022. [DOI: 10.2174/1574885517666220328142715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Pro-inflammatory mediators such as tumor necrosis factor-alpha (TNF-α), interleukin (IL), and oxidative stress are crucial players in the pathophysiology of inflammatory bowel disease (IBD) that contribute in perpetuating intestinal inflammation. Targeting them presents a novel approach in disease management. In the present study, the potential of an antiosteoarthritic IL-inhibitor drug, diacerein (DIA) was investigated in 2, 4, 6-trinitrobenzene sulfonic acid (TNBS)- instigated ulcerative colitis (UC) in Wistar rats. A comparative study was also undertaken to investigate the potential of combination therapy of DIA with the standard drug 5-aminosalicylic acid (5-ASA) versus monotherapy.
Methods:
Colitis was developed by single intra-colonic administration of TNBS (100mg/kg); whereas drugs 5-ASA (25.5 mg/kg), DIA (100 mg/kg), and DIA+5-ASA (100+ 25.5 mg/kg) were administered orally for five days post-induction to various groups of rats. Parameters like disease activity score, colon/body weight ratio, colon length, diameter, gut pH were assessed, and histopathological analysis was carried out. Biochemical markers of colonic inflammation such as IL-1β, TNF-α, reduced glutathione (GSH), and malondialdehyde (MDA) were also estimated.
Results:
Combination of DIA and 5-ASA demonstrated the most significant reduction of the colon to body weight ratio and disease activity score. It prominently restored the colon length, diameter, and gut pH to normal. It attenuated the biochemical alterations induced by TNBS, indicating a highly significant defensive outcome against colonic inflammation. The histopathological report demonstrated the renovating effect of the combination of disrupted colonic histology with minimally distressing liver, stomach, or pancreas compared to individual drugs.
Conclusion:
The combination remarkably downregulated the level of inflammation by suppressing both provocative cytokines and reactive oxygen species production. It can be evaluated further in a clinical setup as a novel and promising drug therapy for UC.
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Affiliation(s)
- Supriya Roy
- Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Sector 125, Noida, 201313, India
| | - Suneela Dhaneshwar
- Amity Institute of Pharmacy, Lucknow, Amity University Uttar Pradesh, Sector 125, Noida, 201313, India
| | - Tarique Mahmood
- Faculty of Pharmacy, Integral University, Dasauli, Lucknow, India
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12
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Mishra J, Stubbs M, Kuang L, Vara N, Kumar P, Kumar N. Inflammatory Bowel Disease Therapeutics: A Focus on Probiotic Engineering. Mediators Inflamm 2022; 2022:9621668. [PMID: 35082553 PMCID: PMC8786545 DOI: 10.1155/2022/9621668] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/01/2021] [Accepted: 12/22/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammatory condition of gastrointestinal (GI) tract with dysregulated mucosal immune functions and disturbed commensal ecosystem of the intestinal lumen. IBD is categorized into two major subsets: Crohn's disease (CD) and ulcerative colitis (UC). Though advent of biologics has shifted the treatment with relatively longer remission compared to small molecule pharmaceuticals, patients still suffer from long-term complications. Since gut-microbiome is now accepted as another human organ holding potential for long-lasting human health, probiotics, and its engineering hold great promises to treat several previously untreatable chronic inflammatory conditions including IBD. Several emerging biological engineering tools have unlimited potential to manipulate probiotic bacterial system. These can produce useful therapeutic biologics with a goal to either ameliorate and/or treat previously untreatable chronic inflammatory conditions. As gut-microbiome is diverse and vary in different ethnic, geographic, and cultural human population, it will be important to develop vision for personalized probiotic treatment and develop the technology thereof to make personalized probiotic options a reality. The aim of this review paper is to present an overview of the current knowledge on both pharmacological and nonpharmacological IBD treatment modalities with a special emphasis on probiotic strains that are developed through the probiotic engineering. These engineered probiotics contain the most anti-inflammatory cytokines found within the human immune response and are currently being used to treat the intestinal inflammation in IBD for the IBD treatment.
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Affiliation(s)
- Jayshree Mishra
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Madyson Stubbs
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Longxiang Kuang
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Nitza Vara
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
| | - Priyam Kumar
- Santa Gertrudis Academy High School, Kingsville, Texas, USA
| | - Narendra Kumar
- Department of Pharmaceutical Sciences, Irma Lerma Rangel College of Pharmacy Texas A&M Health Science Center, Kingsville, TX 78363, USA
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13
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Andersson P, Karling P. Impact of treatment with immunomodulators and tumour necrosis factor antagonists on the incidence of infectious events in patients with inflammatory bowel disease. Ups J Med Sci 2022; 127:8167. [PMID: 35140875 PMCID: PMC8788654 DOI: 10.48101/ujms.v127.8167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/25/2021] [Accepted: 12/08/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Corticosteroids, immunomodulators (IM) and tumour necrosis factor antagonists (anti-TNF) are commonly used in the treatment of inflammatory bowel disease (IBD) but they also supress the defence against infectious disease. The aim of this study was to analyse the incidence of infectious events in patients with IBD and the association to concomitant medical therapy. METHODS We performed a retrospective medical chart review of patients with IBD aged 18-65 years included in the Swedish Registry of Inflammatory Bowel Disease in the catchment area of Umeå University Hospital, Sweden. Data were collected from the period 01 January 2006, to 31 January 2019. An infectious event was defined as an outpatient prescription of antimicrobials or a positive diagnostic test for infection. RESULTS During a period of 5,120 observation-years, we observed 1,394 events in 593 patients. The mean number of infectious events per 100 person-years was 27.2 (standard deviation [SD]: 0.46). There were no differences in mean incidence rates between patients treated with no immunosuppression (23.0 events per 100 person-years, SD: 50.4), patients treated with IM monotherapy (27.6 events per 100 person-years, SD: 49.9), patients treated with anti-TNF monotherapy (34.3 events per 100 person-years, SD: 50.1) and patients on combination therapy (22.5 events per 100-person-years, SD: 44.2). In a multivariate logistic regression, female gender (adjusted odds ratio [AOR]: 2.24; 95% confidence interval [CI]: 1.49-3.37) and combination therapy (AOR: 3.46; 95% CI: 1.52-7.85) were associated with higher risks of infection (>32 events per 100 person years). Also, patients treated with any immunosuppression treatment for 25-75% (AOR: 2.29; 95% CI: 1.21-4.34) and for >75% (AOR: 1.93; 95% CI: 1.19-3.12) of the observation period were at higher risks compared to patients treated with immunosuppression <25% of the observation period. CONCLUSION We observed no significant difference in risk for infections between patients on monotherapy with IM or anti-TNF and patients with low use of immunosuppression, but there was a significant risk for combination therapy.
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Affiliation(s)
- Per Andersson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Pontus Karling
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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14
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Shibuya T, Nomura O, Nagahara A. Safety and Efficacy of Ustekinumab for Ulcerative Colitis in a Liver Transplant Patient. Inflamm Bowel Dis 2021; 27:e150-e151. [PMID: 34255040 DOI: 10.1093/ibd/izab169] [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: 12/25/2022]
Affiliation(s)
- Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Osamu Nomura
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
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15
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Ludvigsson JF, Holmgren J, Grip O, Halfvarson J, Askling J, Sachs MC, Olén O. Adult-onset inflammatory bowel disease and rate of serious infections compared to the general population: a nationwide register-based cohort study 2002-2017. Scand J Gastroenterol 2021; 56:1152-1162. [PMID: 34369254 DOI: 10.1080/00365521.2021.1924259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate absolute and relative risk of serious infections in adult/elderly inflammatory bowel disease (IBD) diagnosed 2002-2017. METHODS Nationwide, register-based cohort study of Swedish patients with IBD compared with general population matched reference individuals with regard to time to first serious infection, equal to hospital admission. Multivariable Cox regression estimated hazard ratios (HRs) for any serious infection. Secondary outcomes included site-specific infections, opportunistic infections and sepsis. RESULTS We identified 47 798 individuals with IBD. During a follow-up of 329 000 person-years, they had 8752 first serious infections (26.6 per 1000 person-years). This compared with an incidence rate of 10.7 per 1000 person-years in matched reference individuals, corresponding to a 2.53-fold increased hazard of serious infections (95%CI = 2.47-2.59). The HR for serious infection in elderly-onset IBD was 2.01 (95%CI = 1.95-2.08). The relative hazard of serious infection was somewhat higher in Crohn's disease (2.94; 95%CI = 2.81-3.06) than in ulcerative colitis (2.24; 95%CI = 2.17-2.31). The HR for serious infections was high in the first year of follow-up (5.17; 95%CI = 4.93-5.42). Individuals with IBD were at a particularly high relative hazard of gastrointestinal and opportunistic infections. The HR for sepsis was 2.47 (95%CI = 2.32-2.63). The relative rates for serious infections in IBD increased in recent years. CONCLUSIONS Patients with adult-onset IBD are at increased risk of serious infections, particularly gastrointestinal and opportunistic infections. Relative rates were highest just after IBD diagnosis, and seem to have increased in recent years.
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Affiliation(s)
- Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Pediatrics, Orebro University Hospital, Orebro, Sweden
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Johanna Holmgren
- Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Olof Grip
- Department of Gastroenterology, Skåne University Hospital, Malmö, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johan Askling
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Michael C Sachs
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ola Olén
- Division of Clinical Epidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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16
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Gaffney CD, Fainberg J, Punjani N, Aboukhshaba A, Pierce H, Patel N, Zheng X, Sun T, Sedrakyan A, Kashanian JA. Immune Deficiency Does Not Increase Inflatable Penile Prosthesis Reoperation Rates. J Sex Med 2021; 18:1427-1433. [PMID: 37057448 DOI: 10.1016/j.jsxm.2021.06.005] [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: 02/01/2021] [Revised: 05/11/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Immunocompromised patients are postulated to have higher rates of post-operative infection. We sought to determine if inflatable penile prosthesis (IPP) reoperation rates (due to infection, erosion, device malfunction or patient dissatisfaction) are higher among immunocompromised men. METHODS We analyzed men who underwent initial IPP insertion from 2000 to 2016 in the New York Statewide Planning and Research Cooperative System database. Immunocompromised patients were propensity-score matched in a 1:3 fashion with immunocompetent patients. We estimated and compared reoperation rates (including removal, reoperation due to infection, revision, or replacement of an IPP after an index procedure) at 30 days, 90 days, 1 year and 3 years of follow up between immunocompromised men and controls by performing a Kaplan Meier analysis and Log-rank tests. Cox proportional hazards models were built to examine the overall association between immune deficient status and the risk of reoperation. MAIN OUTCOME MEASURE Reoperation rate and time to reoperation after index IPP placement. RESULTS A total of 245 immunocompromised patients who received an initial IPP between 2000 and 2016 were identified. After propensity score matching, we analyzed 235 immunocompromised men and 705 controls. There was no difference in overall reoperation rates between immunocompromised men and controls within any time period assessed (30 days, 90 days, 1 year, or 3 years). In our Cox proportional hazards model, the hazards of overall reoperation, removal, or revision/replacement (HR 1.11 [95% CI 0.74-1.67], HR 1.58 [95% CI 0.90-2.79)], and HR 0.83 [95% CI 0.47-1.45], respectively) were not significant different between immunocompromised men and controls. Reoperation due to infection was also not significantly different between immunocompromised and immunocompetent men (HR 2.06 [95% CI 0.97-4.40]). STRENGTHS & LIMITATIONS This study is strengthened by its size as the largest cohort of immunocompromised men treated with IPP to date in the literature, but is limited by the retrospective nature of the database which may introduce selection bias and by the low event rate for IPP reoperation. CONCLUSIONS Reoperation rates, including those due to infection, are not significantly different between immunocompromised men and immunocompetent controls. Therefore, immune status in appropriately selected candidates does not appear to place patients at substantially higher risk of explant or revision. Gaffney CD, Fainberg J, Aboukhshaba A, et al. Immune Deficiency Does Not Increase Inflatable Penile Prosthesis Reoperation Rates. J Sex Med 2021;18:1427-1433.
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Affiliation(s)
| | | | - Nahid Punjani
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | | | - Hudson Pierce
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Neal Patel
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Xinyan Zheng
- Department of Population Health Science, New York, NY, USA
| | - Tianyi Sun
- Department of Population Health Science, New York, NY, USA
| | - Art Sedrakyan
- Department of Population Health Science, New York, NY, USA
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17
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Kucharzik T, Ellul P, Greuter T, Rahier JF, Verstockt B, Abreu C, Albuquerque A, Allocca M, Esteve M, Farraye FA, Gordon H, Karmiris K, Kopylov U, Kirchgesner J, MacMahon E, Magro F, Maaser C, de Ridder L, Taxonera C, Toruner M, Tremblay L, Scharl M, Viget N, Zabana Y, Vavricka S. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:879-913. [PMID: 33730753 DOI: 10.1093/ecco-jcc/jjab052] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- T Kucharzik
- Department of Gastroenterology, Klinikum Lüneburg, University of Hamburg, Lüneburg, Germany
| | - P Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - T Greuter
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland, and Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois CHUV, University Hospital Lausanne, Lausanne, Switzerland
| | - J F Rahier
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Yvoir, Belgium
| | - B Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium, and Department of Chronic Diseases, Metabolism and Ageing, TARGID-IBD, KU Leuven, Leuven, Belgium
| | - C Abreu
- Infectious Diseases Service, Centro Hospitalar Universitário São João, Porto, Portugal.,Instituto de Inovação e Investigação em Saúde [I3s], Faculty of Medicine, Department of Medicine, University of Porto, Portugal
| | - A Albuquerque
- Gastroenterology Department, St James University Hospital, Leeds, UK
| | - M Allocca
- Humanitas Clinical and Research Center - IRCCS -, Rozzano [Mi], Italy.,Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - M Esteve
- Hospital Universitari Mútua Terrassa, Digestive Diseases Department, Terrassa, Catalonia, and Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain
| | - F A Farraye
- Inflammatory Bowel Disease Center, Department of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA
| | - H Gordon
- Department of Gastroenterology, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - K Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Greece
| | - U Kopylov
- Department of Gastroenterology, Sheba Medical Center, Ramat Gan, Israel, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - J Kirchgesner
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France
| | - E MacMahon
- Department of Infectious Diseases, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - F Magro
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal.,Institute of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Portugal
| | - C Maaser
- Outpatient Department of Gastroenterology, Department of Geriatrics, Klinikum Lüneburg, University of Hamburg, Lüneburg, Germany
| | - L de Ridder
- Department of Paediatric Gastroenterology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C Taxonera
- IBD Unit, Department of Gastroenterology, Hospital Clínico San Carlos and Instituto de Investigación del Hospital Clínico San Carlos [IdISSC], Madrid, Spain
| | - M Toruner
- Ankara University School of Medicine, Department of Gastroenterology, Ankara, Turkey
| | - L Tremblay
- Centre Hospitalier de l'Université de Montréal [CHUM] Pharmacy Department and Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - M Scharl
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland
| | - N Viget
- Department of Infectious Diseases, Tourcoing Hospital, Tourcoing, France
| | - Y Zabana
- Hospital Universitari Mútua Terrassa, Digestive Diseases Department, Terrassa, Catalonia, and Centro de Investigación Biomédica en red de Enfermedades Hepáticas y Digestivas CIBERehd, Madrid, Spain
| | - S Vavricka
- University Hospital Zürich, Department of Gastroenterology and Hepatology, Zürich, Switzerland
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18
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Miri A, Sato AI, Sewell RK, Huang-Pacheco A. Pott's Puffy Tumor in an Inflammatory Bowel Disease Patient on Anti-TNF Therapy. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929892. [PMID: 34032782 PMCID: PMC8165497 DOI: 10.12659/ajcr.929892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Patient: Male, 14-year-old Final Diagnosis: Pott’s puffy tumor Symptoms: Face swelling Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Infectious Diseases • Otolaryngology • Pediatrics and Neonatology
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Affiliation(s)
- Ahmad Miri
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Alice I Sato
- Department of Pediatrics Infectious Disease, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pediatrics Infectious Disease, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Ryan K Sewell
- Department of Otolaryngology - Head and Neck Surgery, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Ear, Nose and Throat, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Andrew Huang-Pacheco
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital and Medical Center, Omaha, NE, USA
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19
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Chela H, Pasha SB, Wan XF, Ghouri YA. A review on medical management of inflammatory bowel disease during the coronavirus disease 2019 pandemic. J Gastroenterol Hepatol 2021; 36:918-926. [PMID: 32876952 DOI: 10.1111/jgh.15241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/25/2020] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 pandemic has engulfed the world and is the highlight of medical community at this time. As humanity fights the battle against this virus, questions are arising regarding the appropriate management of at risk patient populations. The immunocompromised cohort is particularly susceptible to this infection, and we have tried to explore the medical management of one such group, which is composed of individuals with inflammatory bowel disease (IBD). There is limited data on the management of IBD during the ongoing pandemic. Several medical societies have put forth suggestions on how to manage immunocompromised patients in order to minimize risk of developing coronavirus disease 2019. This review aims to present available recommendations from experts and provides an insight on preventive and therapeutic strategies that can be implemented for the medical management of patients with IBD. We anticipate that as more information arises, new guidelines will emerge.
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Affiliation(s)
- Harleen Chela
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Syed Bilal Pasha
- Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Xiu-Feng Wan
- MU Center for Research on Influenza Systems Biology (CRISB), University of Missouri, Columbia, Missouri, USA.,Department of Molecular Microbiology and Immunology, School of Medicine, University of Missouri, Columbia, Missouri, USA.,Department of Electrical Engineering and Computer Science, College of Engineering, University of Missouri, Columbia, Missouri, USA.,Bond Life Sciences Center, University of Missouri, Columbia, Missouri, USA.,MU Institute for Data Science and Informatics, University of Missouri, Columbia, Missouri, USA
| | - Yezaz A Ghouri
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri, USA
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20
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Calvet X, Carpio D, Rodríguez-Lago I, García-Vicuña R, Barreiro-de-Acosta M, Juanola X, Aguas M, Castillo C, Gratacós J. Risk of infection associated with Janus Kinase (JAK) inhibitors and biological therapies in inflammatory intestinal disease and rheumatoid arthritis. Prevention strategies. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 44:587-598. [PMID: 33640469 DOI: 10.1016/j.gastrohep.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 02/07/2023]
Abstract
Patients with certain immune-mediated inflammatory diseases, such as rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), have an increased risk of severe infectious diseases than the general population, which are mainly associated with the immunosuppressive treatments that they receive. These treatments act on the immune system through different mechanisms, causing different degrees of immunosuppression and a variable risk depending on whether the pathogen is a virus, bacteria or fungus. This article reviews the most relevant literature on the subject, which was selected and discussed by a panel of experts. The aim of this article is to review the risk of infections in patients with IBD and RA, and the potential preventive measures.
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Affiliation(s)
- Xavier Calvet
- Servicio del Aparato Digestivo, Hospital Universitario Parc Taulí, Departamento de Medicina, Universidad Autónoma de Barcelona, CIBERehd, Instituto de Salud Carlos III. Parc Taulí, Sabadell, Barcelona, España.
| | - Daniel Carpio
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, España
| | - Iago Rodríguez-Lago
- Servicio de Aparato Digestivo, Hospital de Galdakao-Usansolo, Instituto de Investigación Sanitaria Biocruces Bizkaia, Galdakao, Bizkaia, España
| | - Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España
| | - Manuel Barreiro-de-Acosta
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, España
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitario de Bellvitge, Universidad de Barcelona, IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Mariam Aguas
- Departamento de Gastroenterología, Servicio de Medicina Digestiva, Hospital Universitario y Politécnico, CIBERehd, Valencia, España
| | - Concepción Castillo
- Sección de Reumatología, Hospital Universitario Torrecárdenas, Almería, España
| | - Jordi Gratacós
- Servicio de Reumatología, Hospital Universitario Parc Taulí, Departamento de Medicina, Universidad Autónoma de Barcelona, Sabadell, Barcelona, España
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21
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Berkovitch G, Cohen S, Lubetzky R, Singer D, Yerushalmy-Feler A. Biologic therapy is associated with a mild decrease in the rate of hospitalizations in pediatric IBD. BMC Pediatr 2021; 21:63. [PMID: 33541320 PMCID: PMC7860024 DOI: 10.1186/s12887-021-02526-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/28/2021] [Indexed: 12/11/2022] Open
Abstract
Background The effect of biologic therapy on the incidence of inflammatory bowel disease (IBD)-related hospitalizations is controversial. The high efficacy of biologic agents is weighted against potential therapy-related adverse events, however, there are no data on the effect of biologic therapy on the indications for hospitalization in IBD. We aimed to evaluate the impact of biologic therapy on the indications and rate of hospitalization in pediatric IBD. Methods This retrospective cohort study included all children (< 18 years of age) with IBD who were hospitalized in our medical center from January 2004 to December 2019. Data on demographics, disease characteristics and course, and therapy were collected, as were the indications for and course of hospitalizations. We evaluated the relationship between therapy with biologic agents, indications and rates of hospitalization. Results Included were 218 hospitalizations of 100 children, of whom 65 (65%) had Crohn’s disease and 35 (35%) had ulcerative colitis. The indications for hospitalization were IBD exacerbations or complications in 194 (89%) and therapy-related adverse events in 24 (11%). The patients of 56 (25.7%) hospitalizations were receiving biologic therapy. In a multivariate analysis, no correlation between therapy and indication for hospitalization was found (p = 0.829). Among children under biologic therapy, a decrease in the rate of hospitalizations from 1.09 (0.11–3.33) to 0.27 (0–0.47) per year was observed for patients that were hospitalized during 2016–2019 (p = 0.043). Conclusion Biologic therapy did not influence the indication for hospitalization, but were associated with a decrease in the rate of hospitalization during 2016–2019 in pediatric IBD.
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Affiliation(s)
- Gil Berkovitch
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Shlomi Cohen
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.
| | - Ronit Lubetzky
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dana Singer
- Department of Pediatrics, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Yerushalmy-Feler
- Pediatric Gastroenterology Unit, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel
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22
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Giannotta JA, Fattizzo B, Cavallaro F, Barcellini W. Infectious Complications in Autoimmune Hemolytic Anemia. J Clin Med 2021; 10:E164. [PMID: 33466516 PMCID: PMC7796467 DOI: 10.3390/jcm10010164] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 12/16/2022] Open
Abstract
Autoimmune hemolytic anemia (AIHA) may be frequently challenged by infectious complications, mainly as a result of immunosuppressive treatments administered. Furthermore, infectious agents are known triggers of AIHA onset and relapse. Although being risk factors for mortality, infections are an underestimated issue in AIHA. This review will collect the available evidence on the frequency and type of infectious complications in AIHA, detailing the risk related to each treatment (i.e., steroids, rituximab, splenectomy, classic immunosuppressive agents, and new target drugs). Moreover, we will briefly discuss the infectious complications in AIHA secondary to other diseases that harbor an intrinsic infectious risk (e.g., primary immunodeficiencies, systemic autoimmune diseases, lymphoproliferative disorders, solid organ and hematopoietic stem cell transplants). Finally, viral and bacterial reactivations during immune suppressive therapies will be discussed, along with suggested screening and prophylactic strategies.
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Affiliation(s)
- Juri Alessandro Giannotta
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
| | - Bruno Fattizzo
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
- Department of Oncology and Oncohematology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy
| | - Francesca Cavallaro
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
- Department of Oncology and Oncohematology, University of Milan, Via Festa del Perdono 7, 20100 Milan, Italy
| | - Wilma Barcellini
- Hematology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20100 Milan, Italy; (B.F.); (F.C.); (W.B.)
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23
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Zingone F, Siniscalchi M, Savarino EV, Barberio B, Cingolani L, D'Incà R, De Filippo FR, Camera S, Ciacci C. Perception of the COVID-19 Pandemic Among Patients With Inflammatory Bowel Disease in the Time of Telemedicine: Cross-Sectional Questionnaire Study. J Med Internet Res 2020; 22:e19574. [PMID: 33006945 PMCID: PMC7654503 DOI: 10.2196/19574] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/07/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background After the COVID-19 outbreak, the Italian Government stopped most regular health care activity. As a result, patients with inflammatory bowel disease (IBD) had limited access to outpatient clinics and hospitals. Objective This study aimed to analyze the perception of the COVID-19 emergency among patients with IBD during the early weeks of the lockdown. Methods We invited adult patients with IBD from the University of Salerno (Campania, South Italy) and the University of Padua (Veneto, North Italy) by email to answer an ad hoc anonymous survey about COVID-19. We also collected data on demographic and disease characteristics. Results In total, 167 patients with IBD from Padua and 83 patients from Salerno answered the survey (age: mean 39.7 years, SD 13.9 years; female: n=116, 46.4%). We found that patients with IBD were particularly worried about the COVID-19 pandemic (enough: 77/250, 30.8%; much/very much: 140/250, 56.0%), as they felt more vulnerable to COVID-19 due to their condition (enough: 70/250, 28.0%; much/very much: 109/250, 43.6%). Patients with IBD from the red zone of Veneto were more worried than patients from Campania (P=.001), and men felt more susceptible to the virus than women (P=.05). Additionally, remote medicine was appreciated more by younger patients than older patients (P=.04). Conclusions The results of our survey demonstrate that the lockdown had a significant impact on the psychological aspects of patients with IBD and suggest the need for increasing communication with patients with IBD (eg, through telemedicine) to ensure patients receive adequate health care, correct information, and proper psychological support.
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Affiliation(s)
- Fabiana Zingone
- Inflammatory Bowel Disease Center, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Monica Siniscalchi
- Inflammatory Bowel Disease Center, Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Edoardo Vincenzo Savarino
- Inflammatory Bowel Disease Center, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Brigida Barberio
- Inflammatory Bowel Disease Center, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Linda Cingolani
- Inflammatory Bowel Disease Center, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Renata D'Incà
- Inflammatory Bowel Disease Center, Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
| | - Francesca Romana De Filippo
- Inflammatory Bowel Disease Center, Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Silvia Camera
- Inflammatory Bowel Disease Center, Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Carolina Ciacci
- Inflammatory Bowel Disease Center, Department of Medicine, Surgery, Dentistry, Scuola Medica Salernitana, University of Salerno, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
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24
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Roberti R, Iannone LF, Palleria C, De Sarro C, Spagnuolo R, Barbieri MA, Vero A, Manti A, Pisana V, Fries W, Trifirò G, Naturale MD, Larussa T, De Francesco AE, Bosco V, Donato di Paola E, Citraro R, Luzza F, Bennardo L, Rodinò S, Doldo P, Spina E, Russo E, De Sarro G. Safety profiles of biologic agents for inflammatory bowel diseases: a prospective pharmacovigilance study in Southern Italy. Curr Med Res Opin 2020; 36:1457-1463. [PMID: 32573307 DOI: 10.1080/03007995.2020.1786681] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Inflammatory bowel diseases (IBDs) are a public health issue with over 3.5 million patients in Europe, but the advent of several biologic agents has completely changed their management. Pharmacovigilance is needed to early detect expected/unexpected adverse events (AEs) to assess the safety of drugs in a real-world setting. Aim of this prospective pharmacovigilance study was to evaluate the occurrence of AEs in patients treated with biologic drugs in gastroenterology units in Southern Italy. METHODS All consecutive patients treated with one biologic drug during a 2-years period (2017-2018) in six gastroenterology tertiary units and satisfying inclusion criteria were enrolled. Demographic and clinical characteristics of patients, type of treatment used, therapy discontinuation, failures, switch/swap to another biologic, and possible onset of AEs were collected. Adverse events have been compared to the number of AEs reported in the same centres in the two years before the protocol. RESULTS Overall, 623 patients (253 females) with Crohn's disease (352; 56.5%) or ulcerative colitis (271; 43.5%) have been included. Infliximab (IFX) was the most commonly used (308, 49.4%), followed by adalimumab (ADA; 215, 34.5%), vedolizumab (VED; 73, 11.7%), golimumab (GOL; 26, 4.2%) and ustekinumab (UST; 0.2%). Ninety-two patients have experienced AEs (14.8%) and 10 serious adverse events (SAEs) (1.6%) were recorded. Adverse events and SAEs have been reported with GOL (7/26; p = .88), IFX (51/308; p = .54), ADA (28/125; p = .40) and VED (6/73; p = .11), no AEs occurred with UST (0/1). CONCLUSION Overall, considering the low rate of AEs reported and discontinuation from therapy, our data seems to confirm the positive beneficial/risk ratio of biologic treatment for IBDs and provide useful data on biologic drugs in gastroenterology.
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Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | | | - Caterina Palleria
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Caterina De Sarro
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Rocco Spagnuolo
- Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
| | | | - Ada Vero
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Antonia Manti
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Valentina Pisana
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Walter Fries
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Diana Naturale
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Tiziana Larussa
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | | | - Vincenzo Bosco
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | | | - Rita Citraro
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Francesco Luzza
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Luigi Bennardo
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Stefano Rodinò
- Division of Gastroenterology, "Ciaccio-Pugliese" Hospital, Catanzaro, Italy
| | - Patrizia Doldo
- Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
| | - Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
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25
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Din H, Anderson AJ, Ramos Rivers C, Proksell S, Koutroumpakis F, Salim T, Babichenko D, Tang G, Koutroubakis IE, Schwartz M, Johnston E, Barrie A, Harrison J, Hashash J, Dunn MA, Hartman DJ, Binion DG. Disease Characteristics and Severity in Patients With Inflammatory Bowel Disease With Coexistent Diabetes Mellitus. Inflamm Bowel Dis 2020; 26:1436-1442. [PMID: 31944255 DOI: 10.1093/ibd/izz305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Given the rising prevalence of diabetes mellitus (DM) and the limited data on its effect on the course of inflammatory bowel disease (IBD), we characterized multiyear patterns of disease severity in a cohort of IBD patients with coexistent DM. METHODS Data of consented IBD patients followed prospectively in a natural history registry at a tertiary center between 2009 and 2017 were analyzed. Patients with ≥3 years of clinical follow-up were included. Patients identified with a diagnosis of DM were compared with 400 consecutive IBD controls without a diagnosis of DM, no laboratory evidence of hyperglycemia, and no history of antihyperglycemic treatment. RESULTS Out of 2810 IBD patients, 141 (5%) had DM (IBD DM; 44% ulcerative colitis, 56% Crohn's disease, 48.2% female). IBD DM had higher use of 5-aminosalicylic acid (5ASA) agents (P = 0.04), narcotics (P < 0.001), and antibiotics (P = 0.007) but not immunomodulators and/or biologics compared with IBD controls. When analyzing biomarkers of severity, IBD DM demonstrated higher frequencies of elevated C-reactive protein (CRP; P = 0.006), elevated erythrocyte sedimentation rate (ESR; P = 0.001), eosinophilia (P = 0.004), monocytosis (P = 0.02), and hypoalbuminemia (P = 0.001). IBD DM had worse quality of life (mean Short Inflammatory Bowel Disease Questionnaire; P < 0.001). IBD DM had increased health care utilization compared with controls (emergency room usage P = 0.008, hospitalizations P < 0.001, gastroenterology clinic visits P < 0.001, and median annual charges P < 0.001). Among IBD DM patients, the use of immunomodulators and/or biologics was not associated with further complications as measured by antibiotic use or hospitalizations. CONCLUSIONS This study of a large IBD cohort suggests that DM in IBD may be associated with increased disease severity and that there may be room for increasing use of highly effective immunomodulator and/or biologic agents in this group.
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Affiliation(s)
- Hassieb Din
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Alyce J Anderson
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Claudia Ramos Rivers
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Siobhan Proksell
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Filippos Koutroumpakis
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tariq Salim
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dmitriy Babichenko
- School of Information Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gong Tang
- University Hospital Heraklion, Crete, Greece
| | | | - Marc Schwartz
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Elyse Johnston
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arthur Barrie
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Janet Harrison
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jana Hashash
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Michael A Dunn
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Douglas J Hartman
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David G Binion
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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26
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Pasha SB, Fatima H, Ghouri YA. Management of inflammatory bowel diseases in the wake of COVID-19 pandemic. J Gastroenterol Hepatol 2020; 35:1449-1450. [PMID: 32246874 DOI: 10.1111/jgh.15056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 03/29/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Syed Bilal Pasha
- Department of Medicine, University of Missouri-School of Medicine at Columbia, Columbia, Missouri, USA
| | | | - Yezaz A Ghouri
- Department of Medicine-Division of Gastroenterology and Hepatology, University of Missouri-School of Medicine at Columbia, Columbia, Missouri, USA
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27
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Iwamoto M, Kato K, Moriyama M. Elderly-onset Crohn's disease remarkably responsive to ustekinumab: a case report. Int J Colorectal Dis 2020; 35:355-359. [PMID: 31848740 DOI: 10.1007/s00384-019-03476-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Crohn's disease is intractable and is frequently diagnosed in younger people. No clear policies exist regarding medical treatment for seniors with this disease, and its diagnosis and treatment are often hindered by difficulties attributable to comorbidities, complex differential diagnoses, and polypharmacy. We describe an elderly-onset Crohn's disease patient showing a marked remission-maintaining effect with no adverse events after administration of ustekinumab. METHODS AND RESULTS A 75-year-old patient with Crohn's disease and a history of pulmonary tuberculosis had first presented to our hospital at age 64 years and was hospitalized. Based on physical examinations, colonoscopy, and blood test results, Crohn's disease was diagnosed. The patient experienced secondary losses of responsiveness to two tumor necrosis factor (TNF)-alpha inhibitors, and after repeated hospital admissions, she was administered ustekinumab. The patient's symptoms, endoscopic findings, Crohn's Disease Activity Index, serum albumin, and physical activity levels improved markedly, and disease remission has been maintained for 2 years to date. CONCLUSION Ustekinumab is an effective treatment option for elderly patients with intractable Crohn's disease when TNF-alpha inhibitors are ineffective.
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Affiliation(s)
- Maho Iwamoto
- Department of Internal Medicine Division of Gastroenterology and Hepatology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Kimitoshi Kato
- Division of Research Planning and Development, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Mitsuhiko Moriyama
- Department of Internal Medicine Division of Gastroenterology and Hepatology, Nihon University School of Medicine, 30-1 Oyaguchi-Kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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28
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Zheng JH, Lin SR, Tseng FJ, Tsai MJ, Lue SI, Chia YC, Woon M, Fu YS, Weng CF. Clerodane Diterpene Ameliorates Inflammatory Bowel Disease and Potentiates Cell Apoptosis of Colorectal Cancer. Biomolecules 2019; 9:biom9120762. [PMID: 31766534 PMCID: PMC6995628 DOI: 10.3390/biom9120762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/20/2019] [Accepted: 11/20/2019] [Indexed: 02/07/2023] Open
Abstract
Inflammatory bowel disease (IBD) is general term for ulcerative colitis and Crohn's disease, which is chronic intestinal and colorectal inflammation caused by microbial infiltration or immunocyte attack. IBD is not curable, and is highly susceptible to develop into colorectal cancer. Finding agents to alleviate these symptoms, as well as any progression of IBD, is a critical effort. This study evaluates the anti-inflammation and anti-tumor activity of 16-hydroxycleroda-3,13-dien-15,16-olide (HCD) in in vivo and in vitro assays. The result of an IBD mouse model induced using intraperitoneal chemical azoxymethane (AOM)/dextran sodium sulfate (DSS) injection showed that intraperitoneal HCD adminstration could ameliorate the inflammatory symptoms of IBD mice. In the in vitro assay, cytotoxic characteristics and retained signaling pathways of HCD treatment were analyzed by MTT assay, cell cycle analysis, and Western blotting. From cell viability determination, the IC50 of HCD in Caco-2 was significantly lower in 2.30 μM at 48 h when compared to 5-fluorouracil (5-FU) (66.79 μM). By cell cycle and Western blotting analysis, the cell death characteristics of HCD treatment in Caco-2 exhibited the involvement of extrinsic and intrinsic pathways in cell death, for which intrinsic apoptosis was predominantly activated via the reduction in growth factor signaling. These potential treatments against colon cancer demonstrate that HCD could provide a promising adjuvant as an alternative medicine in combating colorectal cancer and IBD.
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Affiliation(s)
- Jia-Huei Zheng
- Department of Life Science and Institute of Biotechnology, National Dong Hwa University, Hualien 97401, Taiwan; (J.-H.Z.); (S.-R.L.); (F.-J.T.); (S.-I.L.)
| | - Shian-Ren Lin
- Department of Life Science and Institute of Biotechnology, National Dong Hwa University, Hualien 97401, Taiwan; (J.-H.Z.); (S.-R.L.); (F.-J.T.); (S.-I.L.)
| | - Feng-Jen Tseng
- Department of Life Science and Institute of Biotechnology, National Dong Hwa University, Hualien 97401, Taiwan; (J.-H.Z.); (S.-R.L.); (F.-J.T.); (S.-I.L.)
- Department of Orthopedics, Hualien Armed Force General Hospital, Hualien 97144, Taiwan
| | - May-Jywan Tsai
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei City 11217, Taiwan;
| | - Sheng-I Lue
- Department of Life Science and Institute of Biotechnology, National Dong Hwa University, Hualien 97401, Taiwan; (J.-H.Z.); (S.-R.L.); (F.-J.T.); (S.-I.L.)
- Department of Physiology & Master’s Program, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Yi-Chen Chia
- Department of Food Science & Technology, Tajen University, Pingtung 90741, Taiwan;
| | - Mindar Woon
- Department of Radiation Oncology, Yeezen Hospital, Taoyuan 32645, Taiwan;
| | - Yaw-Syan Fu
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Institute of Respiratory Disease, Department of Basic Medical Science, Xiamen Medical College, Xiamen 361023, China
| | - Ching-Feng Weng
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Institute of Respiratory Disease, Department of Basic Medical Science, Xiamen Medical College, Xiamen 361023, China
- Correspondence: or ; Tel.: +886-3-8903609
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29
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Lin E, Lin K, Katz S. Serious and Opportunistic Infections in Elderly Patients With Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2019; 15:593-605. [PMID: 31802985 PMCID: PMC6883733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Inflammatory bowel disease (IBD) is often treated with biologics and immunomodulators, which can place elderly IBD patients at risk for serious and opportunistic infections. This article provides an updated account of research on therapies in IBD that are associated with an increased infection risk. Relevant serious and opportunistic infections in the elderly population are discussed along with methods for prevention and treatment. The incidence of infection increases with age and the degree of immunosuppression. Emphasis should be placed on performing vaccinations at the time of IBD diagnosis. Additionally, patients receiving immunosuppressive therapy should avoid live vaccines. Physicians should have a greater awareness of the increased risk of infection in elderly adults and the need for screening for infection prior to initiation of immunosuppressive IBD therapies.
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Affiliation(s)
- Elissa Lin
- Dr Elissa Lin is a resident in the Department of Internal Medicine at NYU Langone Medical Center in New York, New York
- Mr Kevin Lin is a medical student and Dr Katz is a clinical professor of medicine at NYU School of Medicine in New York, New York
| | - Kevin Lin
- Dr Elissa Lin is a resident in the Department of Internal Medicine at NYU Langone Medical Center in New York, New York
- Mr Kevin Lin is a medical student and Dr Katz is a clinical professor of medicine at NYU School of Medicine in New York, New York
| | - Seymour Katz
- Dr Elissa Lin is a resident in the Department of Internal Medicine at NYU Langone Medical Center in New York, New York
- Mr Kevin Lin is a medical student and Dr Katz is a clinical professor of medicine at NYU School of Medicine in New York, New York
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30
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Zabana Y, Rodríguez L, Lobatón T, Gordillo J, Montserrat A, Mena R, Beltrán B, Dotti M, Benitez O, Guardiola J, Domènech E, Garcia-Planella E, Calvet X, Piqueras M, Aceituno M, Fernández-Bañares F, Esteve M. Relevant Infections in Inflammatory Bowel Disease, and Their Relationship With Immunosuppressive Therapy and Their Effects on Disease Mortality. J Crohns Colitis 2019; 13:828-837. [PMID: 30668662 DOI: 10.1093/ecco-jcc/jjz013] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/12/2019] [Accepted: 01/17/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS There is controversy as to whether the risk of relevant infection in IBD is related to immunosuppressants or the disease itself. The aims of this study were to evaluate: [1] the life-long prevalence and types of relevant infections in patients with IBD related to immunosuppressive treatment, and [2] the relationship of both infection and patient comorbidity to mortality. METHODS Observational multicentre retrospective study of IBD patients that presented a relevant infection. For each case, four periods of infection exposure were analysed: P1: pre-IBD diagnosis, P2: from IBD diagnosis to immunosuppressant initiation, P3: during immunosuppressant therapy, and P4: after treatment withdrawal. RESULTS The life-long prevalence of relevant infection in the total cohort of patients [6914] was 3%, and 5% in immunosuppressed patients [4202]. 366 relevant infections were found in 212 patients [P1: 9, P2: 17, P3: 334, and P4: 6]. Differences between periods were significant [p < 0.0001]. The most frequent types of infection were respiratory, intestinal and urinary. The most frequent opportunistic infections were tuberculosis [prevalence: 2.6/1000] and herpes zoster [prevalence: 3.9/1000]. Herpes zoster infection was associated with thiopurines alone or in combination with anti-TNF in 75% of the cases, whereas tuberculosis was associated with anti-TNF in 94% of patients. The overall mortality was 4.2%. Infection-related mortality was 2.8% and it was not influenced by comorbidity. CONCLUSIONS Relevant infections in IBD patients are rare and appear to be related to immunosuppression. Relevant infection is a major cause of death in IBD.
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Affiliation(s)
- Yamile Zabana
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain
| | | | - Triana Lobatón
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Raquel Mena
- Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Belén Beltrán
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain.,Hospital Universitari i Policlínic La Fe, Valencia, Spain
| | - Marina Dotti
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | - Olga Benitez
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain
| | | | - Eugeni Domènech
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Xavier Calvet
- Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain.,Corporació Sanitària Parc Taulí, Sabadell, Spain
| | | | - Montserrat Aceituno
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain
| | - Fernando Fernández-Bañares
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain
| | - Maria Esteve
- Gastroenterology and Inflammatory Bowel Disease Unit, Hospital Universitari Mútua Terrassa, Barcelona, Spain.,Centro de Investigación Biomédica en Red de enfermedades hepáticas y digestivas [CIBEREhd], Madrid, Spain
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31
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Franca R, Curci D, Lucafò M, Decorti G, Stocco G. Therapeutic drug monitoring to improve outcome of anti-TNF drugs in pediatric inflammatory bowel disease. Expert Opin Drug Metab Toxicol 2019; 15:527-539. [PMID: 31177858 DOI: 10.1080/17425255.2019.1630378] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Medical treatment of pediatric inflammatory bowel diseases (IBD) has been greatly changed by the introduction of a number of biologic agents that are able to target various players of the immune response. In particular, monoclonal antibodies against the pro-inflammatory cytokine TNF-alpha (TNF) such as infliximab, adalimumab, and golimumab are now in the clinics both in induction and maintenance therapy, and several efforts are currently ongoing to optimize the use of these drugs in children. Areas covered: This review focuses on therapeutic drug monitoring (TDM) of anti-TNF levels and antidrug antibodies (ADAs), in IBD children. A revision of the analytical assays used for assessing anti-TNF plasma levels is also provided. Expert opinion: Although there is a consensus across studies that higher anti-TNF trough levels are associated with a better clinical outcome, and that early anti-TNF serum measurements could be predictive of long-term response, it is still not clear what the best predictive time of sampling is and what the ideal target drug plasma concentration to achieve. Indeed, there are a number of published studies, particularly in pediatric cohorts, limited by the population size analyzed and more prospective large studies are needed to examine the value of these predictive markers.
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Affiliation(s)
- Raffaella Franca
- a University of Trieste, Department of Medical , Surgical and Health Sciences , Trieste , Italy
| | - Debora Curci
- b University of Trieste, PhD Course in Reproductive and Developmental Sciences , Trieste , Italy
| | - Marianna Lucafò
- c Centro di Riferimento Oncologico (CRO) , Aviano , Italy.,d Institute for Maternal and Child Health I.R.C.C.S. Burlo Garofolo , Trieste , Italy
| | - Giuliana Decorti
- a University of Trieste, Department of Medical , Surgical and Health Sciences , Trieste , Italy.,d Institute for Maternal and Child Health I.R.C.C.S. Burlo Garofolo , Trieste , Italy
| | - Gabriele Stocco
- e University of Trieste , Department of Life Sciences , Trieste , Italy
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32
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Ciccocioppo R, Baumgart DC, Dos Santos CC, Galipeau J, Klersy C, Orlando G. Perspectives of the International Society for Cell & Gene Therapy Gastrointestinal Scientific Committee on the Intravenous Use of Mesenchymal Stromal Cells in Inflammatory Bowel Disease (PeMeGi). Cytotherapy 2019; 21:824-839. [PMID: 31201092 DOI: 10.1016/j.jcyt.2019.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 05/17/2019] [Accepted: 05/25/2019] [Indexed: 02/06/2023]
Abstract
Inflammatory bowel disease (IBD), namely, Crohn's disease and ulcerative colitis, remains a grievous and recalcitrant problem incurring significant human and health care costs, even in consideration of the growing incidence. Initial goals of care aimed to achieve the induction and maintenance of clinical remission. The advent of novel treat-to-target approaches using patient stratification, early introduction of immunosuppressants and rapid escalation to biologics or early use of combination therapy has refocused the goals of care toward the achievement of mucosal healing. This is in an attempt to preserve intestinal function, decrease hospitalization and surgery rates and improve the quality of life of affected patients. Cellular therapeutics for the treatment of IBD offers an unprecedented opportunity to change the current paradigm from single-targeted to systems-targeted therapy, trying to dampen the whole inflammatory cascade instead of a only molecule. Therefore, as we move forward, the importance of designing informative and possibly adaptive trial designs, standardizing methodologies, harmonizing goals of therapy and evaluating methods cannot be underemphasized. In this article, we review the current literature on the application of mesenchymal stromal cells for the treatment of IBD in an effort to establish a consensus on designing efficient and consistent clinical trials for the intravenous use of this cellular therapy in IBD.
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Affiliation(s)
- R Ciccocioppo
- Gastroenterology Unit, Department of Medicine, AOUI Policlinico G.B. Rossi and University of Verona, Verona, Italy.
| | - D C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, Canada and Department of Gastroenterology and Hepatology, Charité Medical School, Humboldt University of Berlin, Berlin, Germany
| | - C C Dos Santos
- Interdepartmental Division of Critical Care Medicine, Keenan Research Centre for Biomedical Science and St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - J Galipeau
- Director of the Program for Advanced Cell Therapy, University of Wisconsin in Madision, Madision, Wisconsin, USA
| | - C Klersy
- Service of Clinical Epidemiology & Biostatistics, I.R.C.C.S Policlinico San Mateo Foundation, Pavia, Italy
| | - G Orlando
- Wake Forest Institute for Regenerative Medicine, Wake Forest University School of Medicine, Winston Salem, North Carolina, USA
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33
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Sparrow MP, Melmed GY, Devlin S, Kozuch P, Raffals L, Loftus Jr EV, Rubin DT, Spiegel B, Baidoo L, Bressler B, Cheifetz A, Irving P, Jones J, Kaplan GG, Velayos F, Siegel CA. De‐escalating medical therapy in Crohn’s disease patients who are in deep remission: A RAND appropriateness panel. ACTA ACUST UNITED AC 2019. [DOI: 10.1002/ygh2.337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Miles P. Sparrow
- The BRIDGe Group
- The Alfred Hospital Melbourne Victoria Australia
| | - Gil Y. Melmed
- The BRIDGe Group
- Cedars‐Sinai Medical Center Los Angeles California
| | - Shane Devlin
- The BRIDGe Group
- University of Calgary Calgary Alberta Canada
| | - Patricia Kozuch
- The BRIDGe Group
- Jefferson University Philadelphia Pennsylvania
| | | | | | | | | | | | - Brian Bressler
- The BRIDGe Group
- University of British Columbia Vancouver British Columbia Canada
| | - Adam Cheifetz
- The BRIDGe Group
- Beth Israel Deaconess Medical Center Boston Massachusetts
| | - Peter Irving
- The BRIDGe Group
- Guy's and St. Thomas' Hospitals London UK
| | - Jennifer Jones
- The BRIDGe Group
- Dalhousie University Halifax Nova Scotia Canada
| | | | | | - Corey A. Siegel
- The BRIDGe Group
- Dartmouth‐Hitchcock IBD Center Lebanon New Hampshire
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34
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Shivaji UN, Sharratt CL, Thomas T, Smith SCL, Iacucci M, Moran GW, Ghosh S, Bhala N. Review article: managing the adverse events caused by anti-TNF therapy in inflammatory bowel disease. Aliment Pharmacol Ther 2019; 49:664-680. [PMID: 30735257 DOI: 10.1111/apt.15097] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/12/2018] [Accepted: 11/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Biological therapy is currently widely used to treat IBD. Infliximab, adalimumab and golimumab are currently licensed anti-TNF therapies. Biosimilar anti-TNF monoclonal antibodies are increasingly used. Anti-TNF therapies are widely used and their adverse effects are well characterised, and may cause significant morbidity and mortality in a small proportion of exposed patients. Gastroenterologists need to understand the mechanisms for these effects, recognise these swiftly and manage such events appropriately. AIM To cover the range of potential adverse reactions as a result of biologic therapy and specifically management of these events. METHODS A Medline and Pubmed search was undertaken. Search terms included were "anti-TNF," "infliximab" or "adalimumab" or "golimumab" combined with the keywords "ulcerative colitis" or "Crohn's disease" or "inflammatory bowel disease" and then narrowed to articles containing the keywords "complications," "side effects" or "adverse events" or "safety profile." International guidelines were also reviewed where relevant. RESULTS Adverse events discussed in this review include infusion reactions, blood disorders and infections (including bacterial, viral, fungal and opportunistic infections) as well as autoimmune, dermatological disorders, cardiac and neurological conditions. Malignancies including solid organ, haematological and those linked to viral disease are discussed. CONCLUSIONS Anti-TNF therapy has wide-ranging effects on the immune system resulting in a spectrum of potential adverse events in a small proportion of patients. Research advances are improving the understanding, recognition and management of these adverse events.
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Affiliation(s)
- Uday N Shivaji
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Caroline L Sharratt
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK.,Nottingham Digestive Diseases Centre, Nottingham University Hospitals, Nottingham, UK
| | - Tom Thomas
- Department of Gastroenterology, University Hospitals Birmingham, Birmingham, UK
| | | | - Marietta Iacucci
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Institute of Translational Medicine, Edgbaston, UK
| | - Gordon W Moran
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK.,Nottingham Digestive Diseases Centre, Nottingham University Hospitals, Nottingham, UK
| | - Subrata Ghosh
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Institute of Translational Medicine, Edgbaston, UK
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospitals Birmingham, Birmingham, UK.,University of Birmingham, Birmingham, UK
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35
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Sharifi L, Moshiri M, Dallal MM, Asgardoon MH, Nourizadeh M, Bokaie S, Mirshafiey A. The Inhibitory Role of M2000 (β-D-Mannuronic Acid) on Expression of Toll-like Receptor 2 and 4 in HT29 Cell Line. RECENT PATENTS ON INFLAMMATION & ALLERGY DRUG DISCOVERY 2019; 13:57-65. [PMID: 30539708 PMCID: PMC6778985 DOI: 10.2174/1872213x13666181211160238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Anti-inflammatory agents play a crucial role in controlling inflammatory diseases such as Inflammatory Bowel Disease (IBD) but their use is restricted due to their vast side effects. M2000 (β-D-mannuronic acid) is a new immunomodulatory drug. According to the capacity of M2000 in suppressing some molecules involved in Toll Like Receptors (TLRs) signaling and reducing oxidative stress we hypothesize that, this molecule may have a potential role in decreasing inflammatory responses in IBD. The aim of this study was to evaluate the cytotoxicity of M2000 and its effect on the gene expression of TLR2 and TLR4. METHODS HEK293 cell line was grown and divided into 96-well cell plate and MTT assay was performed. HT29 cells were cultured and treated with low and high doses of M2000. Total RNA was extracted and cDNA synthesized and quantitative real-time PCR was done to quantify the TLR2 and TLR4 mRNA expression. RESULTS We found that M2000 at the concentration of ≤ 1000µg/ml had no obvious cytotoxicity effect on the HEK293 cells. Also, low and high doses of M2000 could significantly down-regulate both TLR2 and TLR4 mRNA expression. Moreover, a significant reduction in gene expression of TLR2 and TLR4 in an inflammatory condition resulted in high doses of M2000 in the presence of LPS. CONCLUSION Our study which was conducted in colonic epithelial cell model, shows that M2000 can be considered as a new anti-inflammatory agent in IBD. However, more comprehensive experimental and clinical studies are required to recognize the molecular mechanism of M2000 and also its safety and efficacy.
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Affiliation(s)
| | | | | | | | | | | | - Abbas Mirshafiey
- Address correspondence to this author at the Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Tel/Fax: +98 (21) 88954913; E-mail:
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36
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Matsumoto S, Mashima H. Efficacy of ustekinumab against infliximab-induced psoriasis and arthritis associated with Crohn's disease. Biologics 2018; 12:69-73. [PMID: 30050284 PMCID: PMC6055910 DOI: 10.2147/btt.s169326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Anti-TNFα drugs have been shown to be effective for maintaining stable remission in patients with Crohn's disease. However, some problems have been identified during clinical use of this class of drugs, such as secondary treatment failure, in which the drugs become progressively less effective with time, and the development of paradoxical reactions such as psoriatic skin symptoms. Thus, while anti-TNFα drugs are used to treat psoriasis, they can sometimes also cause paradoxical psoriasis, characterized by the appearance of psoriasis-like eruptions, which has recently begun to attract attention. Furthermore, inflammatory bowel disease is not only associated with intestinal lesions, but also with a variety of extraintestinal manifestations, of which arthritis is relatively common. We encountered a case of Crohn's disease with arthritis, as an extraintestinal manifestation, and paradoxical psoriasis caused by infliximab treatment, in which ustekinumab proved extremely effective, not only for alleviating the arthritis, but also against the skin manifestations. To the best of our knowledge, this is the first reported case of the efficacy of ustekinumab against paradoxical psoriasis and arthritis in a patient with Crohn's disease.
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Affiliation(s)
- Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, Saitama, Japan,
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37
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McConachie SM, Wilhelm SM, Bhargava A, Kale-Pradhan PB. Biologic-Induced Infections in Inflammatory Bowel Disease: The TNF-α Antagonists. Ann Pharmacother 2018; 52:571-579. [DOI: 10.1177/1060028018754896] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: To review the mechanism and association of infectious risk among the tumor-necrosis factor α (TNF-α) antagonists used in inflammatory bowel disease. Data Sources: A PubMed literature search was performed using the following search terms: infliximab, adalimumab, certolizumab, golimumab, inflammatory bowel disease, crohn’s, ulcerative colitis, adverse effects, adverse events, safety, and infection. Study Selection and Data Extraction: Meta-analyses and cohort studies with outcomes pertaining to quantitative infectious risk were reviewed. Case reports and case series describing association between TNF-α inhibitors and infection were also reviewed. Data Synthesis: A total of 7 recent meta-analyses of randomized trials demonstrate inconclusive association of infection with TNF-α antagonists. Registry data suggest that medications carry an independent risk of opportunistic infections. Risk factors for infection include older age, malnutrition, diabetes, and possibly combination therapy. Reported infections vary widely but include intracellular and granulomatous bacteria, viruses, and fungi. Conclusion: TNF-α antagonists are associated with an increased risk of opportunistic infection, although this risk has not been demonstrated conclusively in randomized controlled trials. Knowledge of concomitant risk factors, mechanism of infectious risk, and available treatment options can improve patient care in the clinical setting.
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Affiliation(s)
- Sean M. McConachie
- Wayne State University, Detroit, MI, USA
- Harper University Hospital, Detroit, MI, USA
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38
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Hindryckx P, Novak G, Bonovas S, Peyrin-Biroulet L, Danese S. Infection Risk With Biologic Therapy in Patients With Inflammatory Bowel Disease. Clin Pharmacol Ther 2017; 102:633-641. [DOI: 10.1002/cpt.791] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 07/07/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Pieter Hindryckx
- Department of Gastroenterology; University of Ghent; Ghent Belgium
| | - Gregor Novak
- Department of Gastroenterology; Ljubljana University Medical Centre; Ljubljana Slovenia
| | - Stefanos Bonovas
- Department of Gastroenterology; IBD Center, Humanitas Clinical and Research Center; Milan Italy
| | | | - Silvio Danese
- Department of Gastroenterology; IBD Center, Humanitas Clinical and Research Center; Milan Italy
- Department of Biomedical Sciences; Humanitas University; Milan Italy
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