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Tepeš K, Hanžel J, Štubljar D, Strmšek K, Erjavec L, Supovec E, Jagodic Z, Končan M, Grosek J, Košir JA, Tomažič A, Kogovšek U, Norčič G, Šibli R, Žnidaršič M, Pačnik Vižintin T, Sodin B, Breznik J, Hribar VA, Ocepek A, Pernat Drobež C, Bukovnik N, Zafošnik A, Marušič T, Jurečič Brglez N, Denkovski M, Smrekar N, Novak G, Koželj M, Kurent T, Simonič J, Pintar Š, Štabuc B, Drobne D. Biological treatment approach to inflammatory bowel disease is similar in academic and nonacademic centres - prime time for decentralisation of inflammatory bowel disease care? Eur J Gastroenterol Hepatol 2024; 36:728-734. [PMID: 38625825 PMCID: PMC11045401 DOI: 10.1097/meg.0000000000002771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/08/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND With the increasing number of inflammatory bowel disease (IBD) patients, it is difficult to manage them within specialised IBD teams in academic medical centres: many are therefore treated in nonacademic IBD centres. It is unclear whether the time to introducing biologics is the same in both settings. AIM We aimed to compare treatment approach with biologics in academic vs. nonacademic centres. METHODS We analysed Slovenian national IBD registry data (UR-CARE Registry, supported by the European Crohn's and Colitis Organisation), which included 2 academic (2319 patients) and 4 nonacademic IBD (429 patients) centres. RESULTS The disease phenotype was similar in both settings. In total, 1687 patients received 2782 treatment episodes with biologics. We observed no differences in treatment episodes with TNF-alpha inhibitors (60% vs. 61%), vedolizumab (24% vs. 23%), or ustekinumab (17% vs. 16%) in academic compared to nonacademic centres ( P = 0.949). However, TNF inhibitors were less often the first biologic in academic centres (TNF inhibitors: 67.5% vs. 74.0%, vedolizumab: 20.3% vs. 17.9%, ustekinumab: 12.1% vs. 8.1%; P = 0.0096). Consequently, more patients received ustekinumab (29.8% vs. 18.3%) and vedolizumab (17.4% vs. 13.5%) and fewer TNF inhibitors (52.7% vs. 68.2%) for Crohn's disease in academic compared to nonacademic centres, with no such differences for ulcerative colitis. The time to initiation of the first biologic from diagnosis was short and similar in both settings (11.3 vs. 10.4 months, P = 0.2). CONCLUSION In this nationwide registry analysis, we observed that biological treatment choice was similar in academic and nonacademic settings. These findings support the decentralisation of IBD care.
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Affiliation(s)
- Katja Tepeš
- Department of Gastroenterology, General Hospital Celje, Celje
| | - Jurij Hanžel
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - David Štubljar
- In-Medico, Department of Research and Development, Metlika, Slovenia
| | - Karin Strmšek
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Luka Erjavec
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Eva Supovec
- Faculty of Medicine, University of Ljubljana
| | | | | | - Jan Grosek
- Department of Abdominal Surgery, University Medical Centre Ljubljana
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Jurij Aleš Košir
- Department of Abdominal Surgery, University Medical Centre Ljubljana
| | - Aleš Tomažič
- Department of Abdominal Surgery, University Medical Centre Ljubljana
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Urška Kogovšek
- Department of Abdominal Surgery, University Medical Centre Ljubljana
| | - Gregor Norčič
- Department of Abdominal Surgery, University Medical Centre Ljubljana
- Department of Surgery, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Renata Šibli
- Department of Gastroenterology, General Hospital Celje, Celje
| | | | | | - Barbara Sodin
- Department of Gastroenterology, General Hospital Celje, Celje
| | - Janez Breznik
- Department of Gastroenterology, General Hospital Jesenice, Jesenice
| | | | - Andreja Ocepek
- Department of Gastroenterology, University Medical Centre Maribor, Maribor
| | | | - Nejc Bukovnik
- Department of Gastroenterology, University Medical Centre Maribor, Maribor
| | - Andrej Zafošnik
- Department of Gastroenterology, University Medical Centre Maribor, Maribor
| | - Tamara Marušič
- Department of Gastroenterology, General Hospital Izola, Izola
| | | | | | - Nataša Smrekar
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Gregor Novak
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - Matic Koželj
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Tina Kurent
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Jože Simonič
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Špela Pintar
- Department of Gastroenterology, University Medical Centre Ljubljana
| | - Borut Štabuc
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
| | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana
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Pintar Š, Hanžel J, Drobne D, Koželj M, Kurent T, Smrekar N, Novak G. Remission Is Maintained after Switch from Dose-Optimised Intravenous Treatment to Subcutaneous Treatment with Vedolizumab in Inflammatory Bowel Disease. Medicina (Kaunas) 2024; 60:296. [PMID: 38399583 PMCID: PMC10890533 DOI: 10.3390/medicina60020296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The subcutaneous (SC) formulation of vedolizumab has proven to be effective for the maintenance of remission after intravenous induction. Little is known about the efficacy of switching from intravenous maintenance treatment to SC. We aimed to assess the real-world efficacy of switching to SC treatment and to assess the impact of a baseline treatment regimen. Materials and Methods: In this observational cohort study, adult patients with inflammatory bowel disease who were switched to SC vedolizumab maintenance treatment were enrolled. Patients after intravenous induction and patients who switched from intravenous maintenance treatment (every 8 weeks or every 4 weeks) were included. The SC vedolizumab dosing was 108 mg every 2 weeks, regardless of the previous regimen. The clinical, biochemical, and endoscopic disease activity parameters and vedolizumab serum concentrations at the time of the switch and at the follow-up were assessed. Results: In total, 135 patients (38% Crohn's disease, 62% ulcerative colitis) were switched to SC vedolizumab treatment. The median time to the first follow-up (FU) was 14.5 weeks (IQR 12-26), and the median time to the second FU was 40 weeks (IQR 36-52). Nine patients (7%) discontinued SC vedolizumab treatment, with two-thirds of them discontinuing due to active disease. In all dosing regimens, there were no significant changes in the clinical scores and CRP at the baseline and first and second FUs. Clinical and biochemical remission appeared to be maintained irrespective of the previous dosing regimen. Conclusions: The results of this real-world study suggest that the maintenance of clinical and biomarker remission can be achieved in patients who switched from intravenous to SC vedolizumab. The baseline vedolizumab dosing regimen (every 4 weeks versus every 8 weeks) did not have an impact on outcomes.
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Affiliation(s)
- Špela Pintar
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
| | - Jurij Hanžel
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Matic Koželj
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
| | - Tina Kurent
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
| | - Nataša Smrekar
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
| | - Gregor Novak
- Department of Gastroenterology, University Medical Centre Ljubljana, Japljeva 2, 1000 Ljubljana, Slovenia; (Š.P.); (J.H.); (D.D.); (M.K.); (T.K.); (N.S.)
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
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