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García MJ, Riestra S, Amiot A, Julsgaard M, García de la Filia I, Calafat M, Aguas M, de la Peña L, Roig C, Caballol B, Casanova MJ, Farkas K, Boysen T, Bujanda L, Cuarán C, Dobru D, Fousekis F, Gargallo-Puyuelo CJ, Savarino E, Calvet X, Huguet JM, Kupcinskas L, López-Cardona J, Raine T, van Oostrom J, Gisbert JP, Chaparro M. Effectiveness and safety of a third-line rescue treatment for acute severe ulcerative colitis refractory to infliximab or ciclosporin (REASUC study). Aliment Pharmacol Ther 2024; 59:1248-1259. [PMID: 38445785 DOI: 10.1111/apt.17938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/03/2024] [Accepted: 02/24/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The advent of new therapeutic agents and the improvement of supporting care might change the management of acute severe ulcerative colitis (ASUC) and avoid colectomy. AIMS To evaluate the colectomy-free survival and safety of a third-line treatment in patients with ASUC refractory to intravenous steroids and who failed either infliximab or ciclosporin. METHODS Multicentre retrospective cohort study of patients with ASUC refractory to intravenous steroids who had failed infliximab or ciclosporin and received a third-line treatment during the same hospitalisation. Patients who stopped second-line treatment due to disease activity or adverse events (AEs) were eligible. We assessed short-term colectomy-free survival by logistic regression analysis. Kaplan-Meier curves and Cox regression models were used for long-term assessment. RESULTS Among 78 patients, 32 received infliximab and 46 ciclosporin as second-line rescue treatment. Third-line treatment was infliximab in 45 (58%), ciclosporin in 17 (22%), tofacitinib in 13 (17%) and ustekinumab in 3 (3.8%). Colectomy was performed in 29 patients (37%) during follow-up (median 21 weeks). Of the 78 patients, 32 and 18 were in clinical remission at, respectively, 12 and 52 weeks. At the last visit, 25 patients were still on third-line rescue treatment, while 12 had stopped it due to clinical remission. AEs were reported in 26 (33%) patients. Two patients died (2.6%), including one following colectomy. CONCLUSION Third-line rescue treatment avoided colectomy in over half of the patients with ASUC and may be considered a therapeutic strategy.
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Affiliation(s)
- María José García
- Gastroenterology and Hepatology Department, Hospital Universitario Marqués de Valdecilla, Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Universidad de Cantabria, Santander, Spain
| | - Sabino Riestra
- Gastroenterology Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Aurelien Amiot
- Department of Gastroenterology, CHU Bicêtre, Universite Paris Saclay, Paris, France
| | - Mette Julsgaard
- Department of Gastroenterology and Hepatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Center for Molecular Prediction of Inflammatory Bowel Disease [PREDICT], Aalborg University, Copenhagen, Denmark
| | | | - Margalida Calafat
- Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Mariam Aguas
- Gastroenterology Department, La Fe University and Polytechnic Hospital, Health Research Institute La Fe, Valencia, Spain
| | - Luisa de la Peña
- Gastroenterology Department, Bellvitge University Hospital, Barcelona, Spain
| | - Cristina Roig
- Gastroenterology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Berta Caballol
- Gastroenterology Department, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - María José Casanova
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Klaudia Farkas
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Trine Boysen
- Gastro Unit, Medical Division, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Luis Bujanda
- Department of Gastroenterology, Biodonostia Health Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Universidad del País Vasco (UPV/EHU), San Sebastián, Spain
| | - Camila Cuarán
- Gastroenterology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Daniela Dobru
- Gastroenterology Department, University of Medicine and Pharmacy, Science and Tehnology "G E Palade" Tg.Mures, Târgu-Mureș, Romania
| | - Fotios Fousekis
- Department of Gastroenterology, University Hospital of Ioannina, Ioannina, Greece
| | - Carla Jerusalén Gargallo-Puyuelo
- Department of Gastroenterology, University Clinic Hospital Lozano Blesa, Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology (DiSCOG), Gastroenterology Unit, Azienda Ospedale Università di Padova (AOUP), University of Padua, Padua, Italy
| | - Xavier Calvet
- Gastroenterology Department, Servei d'Aparell Digestiu, Parc Taulí, Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí, Departamento de Medicina, Universitat Autònoma de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Sabadell, Spain
| | - José María Huguet
- Digestive Diseases Department, General University Hospital of Valencia, Valencia, Spain
| | - Limas Kupcinskas
- Institute for Digestive Research, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Tim Raine
- Department of Gastroenterology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Joep van Oostrom
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Javier P Gisbert
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - María Chaparro
- Gastroenterology Department, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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ten Bokkel Huinink S, Thomassen D, Steyerberg EW, Pauwels RWM, Casanova MJ, Bouguen G, Mak JWY, Molnár T, Lobo AJ, Seidelin JB, Amiot A, D’Haens G, Rivière P, Guidi L, Bor R, Lin WC, Peyrin-Biroulet L, Gisbert JP, Janneke van der Woude C, de Vries AC. Discontinuation of Anti-Tumour Necrosis Factor Therapy in Patients with Perianal Fistulizing Crohn's Disease: Individual Participant Data Meta-Analysis of 309 Patients from 12 Studies. J Crohns Colitis 2024; 18:134-143. [PMID: 37437094 PMCID: PMC10821706 DOI: 10.1093/ecco-jcc/jjad118] [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: 02/13/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND The risk of relapse after anti-tumour necrosis factor [TNF] therapy discontinuation in Crohn's disease patients with perianal fistulas [pCD] is unclear. We aimed to assess this risk. METHODS A systematic literature search was conducted to identify cohort studies on the incidence of relapse following anti-TNF discontinuation in pCD patients. Individual participant data were requested from the original study cohorts. Inclusion criteria were age ≥16 years, pCD as a (co)indication for start of anti-TNF therapy, more than three doses, and remission of luminal and pCD at anti-TNF discontinuation. The primary outcome was the cumulative incidence of CD relapse using Kaplan-Meier estimates. Secondary outcomes included response to re-treatment and risk factors associated with relapse as assessed by Cox regression analysis. RESULTS In total, 309 patients from 12 studies in ten countries were included. The median duration of anti-TNF treatment was 14 months [interquartile range 5.8-32.5]. Most patients were treated for pCD without active luminal disease [89%], received first-line anti-TNF therapy [87%], and continued immunomodulatory therapy following anti-TNF discontinuation [78%]. The overall cumulative incidence of relapse was 36% (95% confidence interval [CI] 25-48%) and 42% [95% CI 32-53%] at 1 and 2 years after anti-TNF discontinuation, respectively. Risk factors for relapse included smoking (hazard ratio [HR] 1.5 [1.0, 2.1]) and history of proctitis (HR 1.7 [1.1, 2.5]). The overall re-treatment response rate was 82%. CONCLUSIONS This individual participant data meta-analysis, on predominantly patients with pCD without active luminal disease and first-line anti-TNF therapy, shows that over half of patients remain in remission 2 years after anti-TNF discontinuation. Therefore, anti-TNF discontinuation may be considered in this subgroup.
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Affiliation(s)
| | - Doranne Thomassen
- Leiden UMC, Department of Biomedical Data Sciences, Leiden, The Netherlands
| | - Ewout W Steyerberg
- Leiden UMC, Department of Biomedical Data Sciences, Leiden, The Netherlands
- Erasmus MC, Department of Public Health, Rotterdam, The Netherlands
| | - Renske W M Pauwels
- Erasmus MC, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - Maria J Casanova
- Hospital Universitario de La Princesa, Department of Gastroenterology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Guillaume Bouguen
- University Hospital of Pontchaillou, Department of Gastroenterology and Hepatology, Rennes, France
| | - Joyce W Y Mak
- Chinese University of Hong Kong, Department of Medicine and Therapeutics, Hong Kong, Hong Kong
| | - Tamas Molnár
- University of Szeged, First Department of Medicine, Szeged, Hungary
| | - Alan J Lobo
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Department of Gastroenterology and Hepatology, Sheffield, UK
| | - Jacob B Seidelin
- Herlev Hospital, Department of Gastroenterology, University of Copenhagen, Denmark
| | - Aurelien Amiot
- Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Est Creteil University (UPEC), Department of Gastroenterology, Creteil, France
| | - Geert D’Haens
- Amsterdam UMC, Academic Medical Centre, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Pauline Rivière
- Hospitalier Universitaire, Department of Gastroenterology and Hepatology, Bordeaux, France
| | - Luisa Guidi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Department of Gastroenterology, Rome, Italy
| | - Renata Bor
- University of Szeged, First Department of Medicine, Szeged, Hungary
| | - Wei-Chen Lin
- Mackay Memorial Hospital, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei, Taiwan
| | - Laurent Peyrin-Biroulet
- University Hospital of Nancy, Department of Hepato-Gastroenterology, Vandoeuvre-les-Nancy, France
| | - Javier P Gisbert
- Hospital Universitario de La Princesa, Department of Gastroenterology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM) and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - Annemarie C de Vries
- Erasmus MC, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands
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Hupé M, Streichenberger A, Wils P, Arab N, Serrero M, Amiot A, Bozon A, Vuitton L, Fumery M, Altwegg R, Nachury M, Hébuterne X, Yzet C, Coban D, Dodel M, Bazoge M, Pereira B, Buisson A. Infliximab is an effective option in patients with ulcerative colitis previously exposed to full subcutaneous anti-TNF agent: Results from a real-world multicenter study. Dig Liver Dis 2024:S1590-8658(24)00200-7. [PMID: 38281870 DOI: 10.1016/j.dld.2024.01.181] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Data on infliximab efficacy in bio-exposed patients with ulcerative colitis (UC) are limited. AIMS To evaluate infliximab effectiveness and its predictors in UC patients with prior exposure to subcutaneous (SC) anti-TNF agent. METHODS In this multicenter retrospective study (8 centers), we included all consecutive UC patients with prior exposure to subcutaneous anti-TNF, starting infliximab for symptomatic UC, excluding acute severe colitis. Corticosteroid-free clinical remission (CFREM) was assessed at week 14 (W14) and W52 while endoscopic improvement (CFREM + endoscopic Mayo score≤1) was evaluated at W14. RESULTS Overall, 104 patients were included (pancolitis=54.8%, primary failure to subcutaneous anti-TNF=57.4%, concomitant immunosuppressant=53.8%, median partial Mayo score at baseline=7[5-8]). The rate of CFREM was 33.6% (35/104) at W14 and 40.4% (42/104) at W52. At W14, endoscopic improvement was achieved in 29.8%(31/104). In multivariable analysis, concomitant immunosuppressant was associated with higher rate of CFREM at W14(OR=2.83[1.06-7.54], p = 0.037) and W52(OR=2.68[1.16-6.22];p = 0.021), while primary failure to a previous subcutaneous anti-TNF agent led to lower rate of CFREM at W14 (OR=0.37[0.14-0.98], p = 0.046). After a median follow-up of 20.9 months[11.7-33.7]), 50.0%(52/104) patients had discontinued infliximab. CONCLUSION Infliximab is an effective option in UC patients previously exposed to prior subcutaneous anti-TNF agent and should be used with concomitant immunosuppressant.
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Affiliation(s)
- M Hupé
- Univ. Grenoble Alpes/Hepato-Gastroenterology and Digestive Oncology Department, CHU Grenoble Alpes/Institute for Advanced Biosciences, CNRS UMR 5309-INSERM U1209, Grenoble, France
| | - A Streichenberger
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France
| | - P Wils
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - N Arab
- Gastro-entérologie et Nutrition Clinique, CHU de Nice, Université Côte d'Azur, Nice, France
| | - M Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, Aix-Marseille, Marseille University, Marseille, France
| | - A Amiot
- EC2M3-EA7375, Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, Assistance Publique-Hôpitaux de Paris, University of Paris Est Créteil, Créteil, France
| | - A Bozon
- Department of Hepatogastroenterology, CHU St Eloi Montpellier, Montpellier, France
| | - L Vuitton
- Gastroenterology department, CHU Besançon and UMR 1098, University Bourgogne-Franche-Comté, Besançon, France
| | - M Fumery
- Gastroenterology department, CHU Amiens, Université de Picardie Jules Verne, Unité Peritox, France; Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand, France
| | - R Altwegg
- Department of Hepatogastroenterology, CHU St Eloi Montpellier, Montpellier, France
| | - M Nachury
- Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France
| | - X Hébuterne
- Gastro-entérologie et Nutrition Clinique, CHU de Nice, Université Côte d'Azur, Nice, France
| | - C Yzet
- Gastroenterology department, CHU Amiens, Université de Picardie Jules Verne, Unité Peritox, France
| | - D Coban
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - M Dodel
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - M Bazoge
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - B Pereira
- CHU Amiens, Université de Picardie Jules Verne, Unité Peritox, France
| | - A Buisson
- Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastroentérologie, Clermont-Ferrand, France; Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France.
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Martin A, Jauvain M, Bergsten E, Demontant V, Lehours P, Barau C, Levy M, Rodriguez C, Sobhani I, Amiot A. Gastric microbiota in patients with gastric MALT lymphoma according to Helicobacter pylori infection. Clin Res Hepatol Gastroenterol 2024; 48:102247. [PMID: 37981222 DOI: 10.1016/j.clinre.2023.102247] [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: 09/05/2023] [Revised: 11/12/2023] [Accepted: 11/15/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Gastric Mucosa Associated Lymphoid Tissue lymphoma (GML) development is triggered by Helicobacter pylori (H. pylori) infection. Little is known about the impact of H. pylori infection on gastric microbiota. METHODS The gastric microbiota was retrospectively investigated using 16S rRNA gene sequencing in 32 patients with untreated GML (10 H. pylori-positive and 22 H. pylori-negative), 23 with remitted and 18 refractory GML and 35 controls. Differences in microbial diversity, bacterial composition and taxonomic repartition were assessed. RESULTS There was no change in diversity and bacterial composition between GML and control patients taking into account H. pylori status. Differential taxa analysis identified specific changes associated with H. pylori-negative GML: the abundances of Actinobacillus, Lactobacillus and Chryseobacterium were increased while the abundances of Veillonella, Atopobium, Leptotrichia, Catonella, Filifactor and Escherichia_Shigella were increased in control patients. In patients with remitted GML, the genera Haemophilus and Moraxella were significantly more abundant than in refractory patients, while Atopobium and Actinomyces were significantly more abundant in refractory patients. CONCLUSION Detailed analysis of the gastric microbiota revealed significant changes in the bacterial composition of the gastric mucosa in patients with GML that may have a role in gastric lymphomagenesis but not any new pathobionts.
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Affiliation(s)
- Antoine Martin
- Department of Gastroenterology, Henri-Mondor University Hospital, Universite Paris Est Creteil, AP-HP, EA7375, 51, Avenue du Marechal de Lattre de Tassigny CRETEIL, Creteil F-94010, France
| | - Marine Jauvain
- UMR1312 Bordeaux Institute of Cancer, BRIC, Université de Bordeaux, Bordeaux 33076, France; French National Reference Center for Campylobacters and Helicobacters, Bordeaux Hospital University Center, Bordeaux, France
| | - Emma Bergsten
- Department of Gastroenterology, Henri-Mondor University Hospital, Universite Paris Est Creteil, AP-HP, EA7375, 51, Avenue du Marechal de Lattre de Tassigny CRETEIL, Creteil F-94010, France
| | - Vanessa Demontant
- Genomics Platform and Virology Unit, Henri-Mondor University Hospital, AP-HP, Institut Mondor de Recherche Biomédicale, Universite Paris Est Creteil, INSERM U955, Créteil F-94010 France
| | - Philippe Lehours
- UMR1312 Bordeaux Institute of Cancer, BRIC, Université de Bordeaux, Bordeaux 33076, France; French National Reference Center for Campylobacters and Helicobacters, Bordeaux Hospital University Center, Bordeaux, France
| | - Caroline Barau
- Plateforme de Ressources Biologique, Henri-Mondor University Hospital, AP-HP, University Paris Est Creteil, F-94010, France
| | - Michael Levy
- Department of Gastroenterology, Henri-Mondor University Hospital, Universite Paris Est Creteil, AP-HP, EA7375, 51, Avenue du Marechal de Lattre de Tassigny CRETEIL, Creteil F-94010, France
| | - Christophe Rodriguez
- Genomics Platform and Virology Unit, Henri-Mondor University Hospital, AP-HP, Institut Mondor de Recherche Biomédicale, Universite Paris Est Creteil, INSERM U955, Créteil F-94010 France
| | - Iradj Sobhani
- Department of Gastroenterology, Henri-Mondor University Hospital, Universite Paris Est Creteil, AP-HP, EA7375, 51, Avenue du Marechal de Lattre de Tassigny CRETEIL, Creteil F-94010, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri-Mondor University Hospital, Universite Paris Est Creteil, AP-HP, EA7375, 51, Avenue du Marechal de Lattre de Tassigny CRETEIL, Creteil F-94010, France.
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5
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Bacha RA, Bouhnik Y, Serrero M, Filippi J, Roblin X, Bourrier A, Bouguen G, Franchimont D, Savoye G, Buisson A, Louis E, Nancey S, Abitbol V, Reimund JM, DeWit O, Vuitton L, Mathieu N, Peyrin-Biroulet L, Gilletta C, Allez M, Viennot S, Berre CL, Laharie D, Nachury M, Amiot A. Obesity in adult patients with inflammatory bowel disease: Clinical features and impact on disability. A cross-sectional survey from the GETAID. Dig Liver Dis 2023; 55:1632-1639. [PMID: 37246095 DOI: 10.1016/j.dld.2023.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/26/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND In recent years, an increasing prevalence of obesity in inflammatory bowel disease (IBD) has been observed. However, only a few studies have focused on the impact of overweight and obesity on IBD-related disability. AIMS To identify the factors associated with obese and overweight patients with IBD, including IBD-related disability. PATIENTS AND METHODS In this cross-sectional study, we included 1704 consecutive patients with IBD in 42 centres affiliated with the Groupe d'Etude Therapeutique des Affections Inflammatoires du tube Digestif (GETAID) using a 4-page questionnaire. Factors associated with obesity and overweight were assessed using univariate and multivariate analyses (odds ratios (ORs) are provided with 95% confidence intervals). RESULTS The prevalence rates of overweight and obesity were 24.1% and 12.2%, respectively. Multivariable analyses were stratified by age, sex, type of IBD, clinical remission and age at diagnosis of IBD. Overweight was significantly associated with male sex (OR = 0.52, 95% CI [0.39-0.68], p < 0.001), age (OR = 1.02, 95% CI [1.01-1.03], p < 0.001) and body image subscore (OR = 1.15, 95% CI [1.10-1.20], p < 0.001) (Table 2). Obesity was significantly associated with age (OR = 1.03, 95% CI [1.02-1.04], p < 0.001), joint pain subscore (OR = 1.08, 95% CI [1.02-1.14], p < 0.001) and body image subscore (OR = 1.25, 95% CI [1.19-1.32], p < 0.001) (Table 3). CONCLUSION The increasing prevalence of overweight and obesity in patients with IBD is associated with age and poorer body image. A holistic approach to IBD patient care should be encouraged to improve IBD-related disability and to prevent rheumatological and cardiovascular complications.
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Affiliation(s)
- Rose Al Bacha
- Department of Gastroenterology, Bicetre University Hospital, Universite Paris Saclay, Le Kremlin Bicetre, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Anne Bourrier
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, UPMC Université Paris 6, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Denis Franchimont
- Department of Gastroenterology, Hôpital Erasme, Laboratoire de Gastroenterologie experimentale, ULB, Brussels, Belgium
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, CHU Liège, Belgium
| | - Stephane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon and INSERM U1111, University Claude Bernard Lyon 1, Lyon, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin University Hospital, Paris, France
| | - Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg et INSERM U1113, Université de Strasbourg, Strasbourg, France
| | - Olivier DeWit
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Nicolas Mathieu
- Department of Hepato-Gastroenterology and Digestive Oncology, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Catherine Le Berre
- CHU Nantes, Institut des Maladies de l'Appareil Digestif [IMAD], Nantes University, Nantes, France
| | - David Laharie
- Department of HepatoGastroenterology and Digestive Oncology, Centre Medico-chirurgical Magellan, Haut-Leveque Hospital, Université de Bordeaux, Bordeaux, France
| | - Maria Nachury
- Department of Gastroenterology, CHU Lille, Service des Maladies de l'appareil digestif, Lille, France
| | - Aurelien Amiot
- Department of Gastroenterology, Bicetre University Hospital, Universite Paris Saclay, Le Kremlin Bicetre, France.
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Amiot A, Chaibi S, Bouhnik Y, Serrero M, Filippi J, Roblin X, Bourrier A, Bouguen G, Franchimont D, Savoye G, Buisson A, Louis E, Nancey S, Abitbol V, Reimund JM, DeWit O, Vuitton L, Mathieu N, Peyrin-Biroulet L, Gilletta C, Allez M, Viennot S, Le Berre C, Dib N, Brixi H, Painchart C, Plastaras L, Altwegg R, Fumery M, Caillo L, Laharie D, Nachury M. Prevalence and Determinants of Fatigue in Patients with IBD: A Cross-Sectional Survey from the GETAID. J Crohns Colitis 2023; 17:1418-1425. [PMID: 36988620 DOI: 10.1093/ecco-jcc/jjad060] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Indexed: 03/30/2023]
Abstract
BACKGROUND Fatigue is commonly reported by patients with inflammatory bowel disease [IBD], but the determinants of IBD-related fatigue have yet to be determined. AIMS To identify the factors associated with fatigue in a large population of patients with IBD. PATIENTS AND METHODS Fatigue and nine other IBD-related disability dimensions were assessed in a cohort of 1704 consecutive patients with IBD using the IBD-disk questionnaire in a cross-sectional survey of 42 French and Belgian centres. Fatigue and severe fatigue were defined as energy subscores >5 and >7, respectively. Determinants of fatigue were assessed using univariate and multivariate analyses (odds ratios [ORs] are provided with 95% confidence intervals). RESULTS The prevalence rates of fatigue and severe fatigue were 54.1% and 37.1%, respectively. Both fatigue and severe fatigue were significantly higher in patients with active disease than in patients with inactive disease [64.9% vs 44.7% and 47.4% vs 28.6%, respectively; p < 0.001 for both comparisons]. In the multivariate analysis stratified by age, sex, type of IBD and IBD activity, fatigue was associated with age >40 years (OR = 0.71 [0.54-0.93]), female sex (OR = 1.48 [1.13-1.93]) and IBD-related sick leave (OR = 1.61 [1.19-2.16]), and joint pain (OR = 1.60 [1.17-2.18]), abdominal pain (OR = 1.78 [1.29-2.45]), regulating defecation (OR = 1.67 [1.20-2.32]), education and work (OR = 1.96 [1.40-2.75]), body image (OR = 1.38 [1.02-1.86]), sleep (OR = 3.60 [2.66-4.88]) and emotions (OR = 3.60 [2.66-4.88]) subscores >5. CONCLUSION Determinants of fatigue are not restricted to IBD-related factors but also include social factors, sleep and emotional disturbances, thus supporting a holistic approach to IBD patient care.
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Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Hopitaux Universitaires Bicêtre, AP-HP, Université Paris Saclay, INSERM, Centre for Research in Epidemiology and Population Health, Le Kremlin Bicêtre, France
| | - Sayma Chaibi
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Anne Bourrier
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, UPMC Université Paris 6, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Denis Franchimont
- Department of Gastroenterology, Hôpital Erasme, Laboratoire de Gastroenterologie experimentale, ULB, Brussels, Belgium
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, CHU Liège, Belgium
| | - Stephane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon and INSERM U1111, University Claude Bernard Lyon 1, Lyon, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin University Hospital, Paris, France
| | - Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg et INSERM U1113, Université de Strasbourg, Strasbourg, France
| | - Olivier DeWit
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Nicolas Mathieu
- Department of Hepato-Gastroenterology and Digestive Oncology, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Catherine Le Berre
- Hépato-Gastro-Entérologie et Assistance Nutritionnelle, Inserm CIC 1413, Inserm UMR 1235, Institut des Maladies de l'Appareil Digestif (IMAD), Nantes Université, CHU Nantes, Nantes, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | - Hedia Brixi
- Department of GastroEnterology, Reims University Hospital, Rheims, France
| | - Claire Painchart
- Department of Gastroenterology, Valenciennes General Hospital, Valenciennes, France
| | | | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of 28 Montpellier, Montpellier, France
| | - Mathurin Fumery
- Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire Amiens-Picardie Site Sud, Amiens, Hauts-de-France, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nimes, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - Maria Nachury
- Univ. Lille, INSERM, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, F-59000 Lille, France
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7
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Chappe C, Salut C, Amiot A, Gaye D, Frulio N, Lapuyade B, Vuitton L, Altwegg R, Gilletta C, Fumery M, Bouguen G, Serrero M, Nachury M, de Suray N, Caillo L, Simon M, Laharie D, Rivière P, Poullenot F. Preoperative Predictors of Neoplasia in Patients Undergoing Small Bowel Resection for Complicated Crohn’s Disease: A Multicentre Case-Control Study. Cancers (Basel) 2023; 15:cancers15072004. [PMID: 37046666 PMCID: PMC10093720 DOI: 10.3390/cancers15072004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Crohn’s disease (CD) is associated with an increased risk of small bowel neoplasia (SBN). We aimed to assess preoperative predictors of SBN in CD patients. We conducted a retrospective case-control study including CD patients who underwent surgery: cases were diagnosed with SBN on histopathological analysis and controls had no neoplasia. Preoperative cross-sectional imaging was reviewed by a panel of blinded expert radiologists. Fifty cases were matched to one hundred and fifty consecutive controls. In multivariable analysis, predictors of SBN were age ≥ 50 years (OR = 28, 95% CI = 5.05–206), median CD duration ≥ 17.5 years (OR = 4.25, 95% CI = 1.33–14.3), and surgery for stricture (OR = 5.84, 95% CI = 1.27–35.4). The predictors of small bowel adenocarcinoma were age ≥ 50 years (OR = 5.14, 95% CI = 2.12–12.7), CD duration ≥ 15 years (OR = 5.65, 95% CI = 2.33–14.3), and digestive wall thickening > 8 mm (OR = 3.79, 95% CI = 1.45–11.3). A predictive score based on the aforementioned factors was constructed. Almost 73.7% of patients with a high score had SBA. Old age, long small bowel CD duration, and stricture predicted the presence of SBN, particularly adenocarcinoma when patients have digestive wall thickening > 8 mm on preoperative imaging.
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8
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Amiot A, Rahier JF, Baert F, Nahon S, Hart A, Viazis N, Biancone L, Domenech E, Reenears C, Peyrin-Biroulet L, Beaugerie L, Burisch J. The Impact of COVID-19 on Patients with IBD in a Prospective European Cohort Study. J Crohns Colitis 2023; 17:37-48. [PMID: 35767639 PMCID: PMC9384408 DOI: 10.1093/ecco-jcc/jjac091] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND AIMS There are concerns regarding the potential impact of the COVID-19 outbreak on patients with inflammatory bowel disease [IBD]. We report on the impact of the COVID-19 outbreak in a European prospective cohort study of patients with IBD. PATIENTS AND METHODS We prospectively collected data from 5457 patients with IBD nested in the ongoing I-CARE project and still followed up in April 2020, with monthly online monitoring of clinical activity, treatment, imaging and endoscopy. Investigators were also contacted to report incidental cases. RESULTS In total, 233 [4.3%] reported COVID-19 and 12 [0.2%] severe COVID-19, with no COVID-19 deaths. The risk of COVID-19 in patients with IBD was not increased compared to the general population (standardized incidence ratio [SIR]: 1.18, 95% confidence interval [CI] [1.03-1.34], p = 0.009), as well as the risk of severe COVID-19 (SIR: 0.69, 95% CI [0.35-1.20], p = 0.93). We did not observe any negative impact of the different IBD-related medication on the risk of either COVID-19 or severe COVID-19. In 2020, the COVID-19 outbreak resulted in a drastic decrease in endoscopic and imaging procedures from March to May 2020 compared to 2018 and 2019. No impacts on clinical IBD disease activity as well as ongoing treatment were noted. CONCLUSION No increases in either COVID-19 or severe COVID-19 incidences were observed in patients with IBD. There was no impact of COVID-19 on IBD-related medication and clinical activity. Access to endoscopy and imaging was restricted during the first months of the first COVID-19 outbreak.
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Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Henri-Mondor University Hospital, AP-HP, EA7375, Universite Paris Est Creteil, F-94010 Creteil, France
| | - Jean-Francois Rahier
- Department of Gastroenterology, CHU UCL Namur, 1 Av Dr Therasse, 5530 Yvoir, Belgium
| | - Filip Baert
- Division of Gastroenterology, AZ Delta, Roeselare, Belgium
| | | | - Ailsa Hart
- IBD Unit, St Mark’s Hospital and Academic Institute, Harrow, UK
| | - Nikos Viazis
- Gastroenterology Department, Evangelismos-Polykliniki General Hospitals of Athens, Athens, Greece
| | - Livia Biancone
- IBD Unit, Department of Systems Medicine, University ‘Tor Vergata’ of Rome, Via Montpellier, Rome, Italy
| | - Eugeni Domenech
- Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona and Centro de Investigación Biomédicas en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Catherine Reenears
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, and Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Laurent Beaugerie
- Department of Gastroenterology, Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, AP-HP, Saint-Antoine University Hospital, Paris, France
| | - Johan Burisch
- Gastrounit, medical division, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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9
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Amiot A, Meyer A, Carbonnel F. Editorial: ustekinumab during pregnancy - reassuring but still not enough. Aliment Pharmacol Ther 2023; 57:158-159. [PMID: 36480723 DOI: 10.1111/apt.17260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Hôpitaux Universitaires Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin Bicêtre, France.,INSERM, Centre for Research in Epidemiology and Population Health, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Antoine Meyer
- Department of Gastroenterology, Hôpitaux Universitaires Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin Bicêtre, France.,INSERM, Centre for Research in Epidemiology and Population Health, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Franck Carbonnel
- Department of Gastroenterology, Hôpitaux Universitaires Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin Bicêtre, France.,INSERM, Centre for Research in Epidemiology and Population Health, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France
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10
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Amiot A, Bourrier A, Gornet JM, Dewit O, Nancey S, Altwegg R, Abitbol V, Laharie D, Reenaers C, Gagnière C, Buisson A, Nachury M, Viennot S, Vuitton L, Stefanescu C, Marteau P, Bouguen G, Seksik P. Risk of SARS-CoV-2 infection in healthcare workers with inflammatory bowel disease: a case-control study. Infect Prev Pract 2022; 5:100267. [PMID: 36601289 PMCID: PMC9800326 DOI: 10.1016/j.infpip.2022.100267] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 12/06/2022] [Indexed: 01/01/2023] Open
Abstract
Background Whether healthcare workers with inflammatory bowel disease (IBD) are at increased risk of Novel coronavirus disease (COVID-19) due to occupational exposure is unknown. Aim To assess the risk of COVID-19 in healthcare workers with IBD. Methods A case control study enrolled 326 healthcare workers with IBD from 17 GETAID centres and matched non-healthcare workers with IBD controls (1:1) for gender, age, disease subtype and year of diagnosis. The study period was year 2020 during the COVID-19 outbreak. Results In total, 59 COVID-19 were recorded among cases (n = 32) and controls (n = 27), including 2 severe COVID-19 (requiring hospitalization, mechanic ventilation) but no death. No difference was observed between healthcare workers and controls regarding the overall incidence rates of COVID-19 4.9 ± 2.2 vs. 3.8 ± 1.9 per 100 patient-semesters, P = 0.34) and the overall incidence rates of severe COVID-19 (0.6 ± 7.8 vs. 0.3 ± 5.5 per 100 patient-semesters, P = 0.42). In multivariate analysis in the entire study population, COVID-19 was associated with patients with body mass index > 30 kg/m2 (HR = 2.48, 95%CI [1.13-5.44], P = 0.02). Conclusion Healthcare workers with IBD do not have an increased risk of COVID-19 compared with other patients with IBD.
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Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Bicêtre Hospital, AP-HP, Paris Est Creteil University, Le Kremlin Bicêtre, France,Corresponding author. 78 Rue du Général Leclerc, Le Kremlin-Bicêtre F-94270 – France.
| | - Anne Bourrier
- Saint Antoine Hospital, Gastroenterology Unit, Centre de Recherche Saint-Antoine, Sorbonne Université, INSERM 75012, Assistance Publique-Hôpitaux de Paris, France
| | - Jean-Marc Gornet
- Department of Gastroenterology, Saint Louis University Hospital, AP-HP, Paris, France
| | - Olivier Dewit
- Department of HepatoGastroenterology, Catholic University of Leuven, University Hospital of Saint-Luc, Brussels, Belgium
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and Claude Bernard Lyon 1 University, Pierre-Benite, France
| | - Romain Altwegg
- Department of Hepatogastroenterology, Saint-Eloi Hospital, Montpellier, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin University Hospital, University Paris 5 Descartes, Paris, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Catherine Reenaers
- Department of Gastroenterology, University Hospital of Liège, Liège, Belgium
| | - Charlotte Gagnière
- Department of Gastroenterology, Hôpitaux Universitaires Henri Mondor, AP-HP, Créteil, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Maria Nachury
- Department of Gastroenterology, Huriez University Hospital, Université Lille Nord de France, Lille, France
| | - Stephanie Viennot
- Department of Gastroenterology, Besançon University Hospital, Besançon, France
| | - Lucine Vuitton
- Department of Gastroenterology, Caen University Hospital, F-14000, Caen, France
| | - Carmen Stefanescu
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | | | - Guillaume Bouguen
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Philippe Seksik
- Saint Antoine Hospital, Gastroenterology Unit, Centre de Recherche Saint-Antoine, Sorbonne Université, INSERM 75012, Assistance Publique-Hôpitaux de Paris, France
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11
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Meyer A, Fumery M, Peyrin-Biroulet L, Filippi J, Altwegg R, Bouhnik Y, Serrero M, Laharie D, Roblin X, Nachury M, Abitbol V, Cadiot G, Nancey S, Allez M, Gilletta C, Vuitton L, Savoye G, Nahon S, Bourrier A, Buisson A, Bouguen G, Bourreille A, Viennot S, Carbonnel F, Amiot A. Comparative real-world effectiveness of vedolizumab and ustekinumab for patients with ulcerative colitis: a GETAID multicentre cohort study. Scand J Gastroenterol 2022; 57:1454-1462. [PMID: 35819361 DOI: 10.1080/00365521.2022.2095668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION There are currently no comparative data on the efficacy and safety of vedolizumab and ustekinumab in ulcerative colitis (UC) after anti-TNF therapy fails. METHODS We retrieved the full datasets of two observational, multicentre, retrospective studies of patients with UC for whom anti-TNF therapy failed and the patients were then treated with either vedolizumab or ustekinumab. The outcomes included steroid-free clinical remission, clinical remission, treatment persistence, colectomy, hospitalization, and serious and infectious adverse events. Propensity scores weighted comparison was applied. RESULTS In total, 121 patients were included in the vedolizumab group and 97 were included in the ustekinumab group. At week 14 and week 52, in the weighted cohort, no difference was found between vedolizumab and ustekinumab for steroid-free clinical remission (OR = 0.55 [0.21-1.41], p = .21 and 0.94 [0.40-2.22], p = .89, respectively). There was no difference between vedolizumab and ustekinumab for secondary outcomes such as clinical remission, hospitalization, UC-related surgery, treatment persistence and serious and infectious adverse events. CONCLUSION In patients with UC for whom anti-TNF therapy failed, no difference was found between vedolizumab and ustekinumab after propensity scores weighted comparison. Further studies are required to determine predictive factors of the efficacy of both biological agents.
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Affiliation(s)
- Antoine Meyer
- Department of Gastroenterology, Bicêtre University Hospital, AP-HP, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, and PeriTox, Université de Picardie, Amiens, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, Nancy University Hospital, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Jérôme Filippi
- Department of Gastroenterology, Archet 2 University Hospital, Nice, France
| | - Romain Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, University Hospital of Montpellier, Montpellier, France
| | - Yoram Bouhnik
- IBD Unit, Department of Gastroenterology, Beaujon Hospital, AP-HP, Clichy, France
| | - Melanie Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, Aix-Marseille, Marseille University, Marseille, France
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-Gastroentérologie et Oncologie Digestive - Université de Bordeaux, Bordeaux, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Maria Nachury
- Department of Gastroenterology and Hepatology, Lille University, Inserm, CHU Lille, U1286 - INFINITE - Institute for Translational Research in Inflammation, Lille, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin Hospital, AP-HP, Paris, France
| | | | | | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis Hospital, AP-HP, Paris, France
| | | | | | | | | | - Anne Bourrier
- Department of Gastroenterology, Saint-Antoine Hospital, AP-HP, UPMC Université Paris 6, Paris, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Arnaud Bourreille
- CHU Nantes, Institut des Maladies de l'Appareil Digestif [IMAD], Nantes University, Nantes, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicêtre University Hospital, AP-HP, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Aurelien Amiot
- Department of Gastroenterology, Bicêtre University Hospital, AP-HP, Paris-Saclay University, Le Kremlin Bicêtre, France.,Department of Gastroenterology, Hopitaux Universitaires Henri Mondor, AP-HP, EA7375, Universite Paris Est Creteil, Créteil, France
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12
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Poullenot F, Amiot A, Nachury M, Viennot S, Altwegg R, Bouhnik Y, Abitbol V, Nancey S, Vuitton L, Peyrin-Biroulet L, Biron A, Fumery M, Picon L, Vidon M, Reenaers C, Serrero M, Savoye G, Beaugerie L, Rivière P, Laharie D. Comparative Risk of Incident Cancer in Patients with Inflammatory Bowel Disease with Prior Non-digestive Malignancy According to Immunomodulator: a Multicentre Cohort Study. J Crohns Colitis 2022; 16:1523-1530. [PMID: 35512337 DOI: 10.1093/ecco-jcc/jjac061] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/27/2022] [Accepted: 05/03/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Knowledge about the cancer risk when initiating a biologic in inflammatory bowel disease [IBD] patients with prior malignancy remains scarce, especially for vedolizumab. Our aim was to evaluate the rate of incident cancer in a cohort of IBD patients with prior non-digestive malignancy, according to the subsequent treatment given. METHODS A multicentre retrospective study included consecutive IBD patients with prior non-digestive malignancy. Inclusion date corresponded to the diagnosis of index malignancy. Patients were categorized into different cohorts according to the first treatment [none, conventional immunosuppressant, anti-TNF, or vedolizumab] to which they were exposed after inclusion and before incident cancer [recurrent or new cancer]. RESULTS Among the 538 patients {58% female; mean (standard deviation [SD]) age inclusion: 52 [15] years} analyzed, the most frequent malignancy was breast cancer [25%]. The first immunomodulator given after inclusion was a conventional immunosuppressant in 27% of patients, anti-TNF in 21%, or vedolizumab in 9%. With a median (interquartile range [IQR]) follow-up duration of 55 [23-100] months, 100 incident cancers were observed. Crude cancer incidence rates per 1000 person-years were 47.0 for patients receiving no immunomodulator, 36.6 in the anti-TNF cohort, and 33.6 in the vedolizumab cohort [p = 0.23]. Incident-cancer free survival rates were not different between patients receiving anti-TNF and those receiving vedolizumab [p = 0.56]. After adjustment, incidence rates were not different between patients receiving no immunomodulator, anti-TNF, or vedolizumab. CONCLUSIONS In this large multicentre cohort study, there was no difference of cancer incidence in those IBD patients with prior non-digestive malignancy, treated with vedolizumab or anti-TNF.
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Affiliation(s)
- F Poullenot
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
| | - A Amiot
- Département de Gastroentérologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
| | - M Nachury
- Univ. Lille, Institute for Translational Research in Inflammation, France
| | - S Viennot
- Hepato-gastroenterology Department, CHU Caen, Caen, France
| | - R Altwegg
- Department of Gastroenterology, Saint-Eloi Hospital, Montpellier, France
| | - Y Bouhnik
- Gastroenterology and Nutrition Support Department, Department of Gastroenterology, Beaujon Hospital, Clichy, France
| | - V Abitbol
- Hôpital Cochin AP-HP Gastro-entérologie, and Université de Paris, Paris, France
| | - S Nancey
- Department of Gastroenterology, CHU, Lyon, France
| | - L Vuitton
- Department of Gastroenterology, CHRU, Besançon, France
| | - L Peyrin-Biroulet
- Gastroenterology Department, Nancy University Hospital, Université de Lorraine, Nancy, France
| | - A Biron
- CHU Reims, Hôpital Robert Debré. Service Hépato-gastroentérologie et cancérologie digestive, Reims, France
| | - M Fumery
- Department of Gastroenterology, CHU, Amiens, France
| | - L Picon
- Hepato-gastroenterology Department, CHRU Tours-TROUSSEAU Hospital, Tours, France
| | - M Vidon
- Departement of Gastroenterology, Hôpital Intercommunal de Créteil, Créteil, France
| | - C Reenaers
- Hepato-gastroenterology Department, CHU Sart Tilman, Liège University, Liège, Belgium
| | - M Serrero
- Hepato-gastroenterology Department, APHM Hôpital Nord, Marseille, France
| | - G Savoye
- Department of Gastroenterology, Normandie University, Rouen University Hospital-Charles Nicolle, Rouen, France
| | - L Beaugerie
- Sorbonne Université, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Saint-Antoine, Department of Gastroenterology, Paris, France
| | - P Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
| | - D Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive, Bordeaux, France
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Bresteau C, Martin A, Amiot A. Letter: to switch or not to switch, that is the question. Aliment Pharmacol Ther 2022; 56:920-921. [PMID: 35934860 DOI: 10.1111/apt.17112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Clément Bresteau
- Department of Gastroenterology, Hopitaux Universitaires Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Antoine Martin
- Department of Gastroenterology, Hopitaux Universitaires Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin Bicêtre, France
| | - Aurelien Amiot
- Department of Gastroenterology, Hopitaux Universitaires Bicêtre, AP-HP, Université Paris Saclay, Le Kremlin Bicêtre, France.,INSERM, Centre for Research in Epidemiology and Population Health, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France
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14
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Amiot A, Laharie D, Malamut G, Serrero M, Poullenot F. Management of immune checkpoint inhibitor in patients with cancer and pre-existing inflammatory bowel disease: Recommendations from the GETAID. Dig Liver Dis 2022; 54:1162-1167. [PMID: 35842365 DOI: 10.1016/j.dld.2022.06.020] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/30/2022] [Accepted: 06/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS There is no consensus on the management of immune checkpoint inhibitor (ICI) for treating cancer in patients with pre-existing inflammatory bowel disease (IBD). The Groupe d'Étude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID) aimed to provide recommendations on this topic. METHODS A dedicated working group performed a comprehensive expert-based review of the literature, generated clinical key question and shaped recommendations that were further voted for approval by the educational and scientific committees of the GETAID. Using consensus methods, treatment modalities were defined by vote. RESULTS Majority of patients with IBD in clinical remission can be treated with ICI after cancer diagnosis. The rate of relapse or immune-related diarrhoea or colitis upon ICI treatment is up to 39.8% and is maximal with ICI combination therapy compared to monotherapies. When starting ICI in a patient with IBD, it is recommended to assess disease activity and pursue ongoing maintenance therapy. In case of relapse or immune-related diarrhoea or colitis upon ICI treatment, treatment depends on grading of diarrhoea or colitis and may include corticosteroid therapy, infliximab and/or vedolizumab. CONCLUSIONS In the present publication, we provided recommendations, which may assist gastroenterologists, haematologists, and oncologists for a better management of patients with pre-existing IBD before and during cancer treatment with ICI.
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Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Hopitaux Universitaires Bicêtre, AP-HP, Universite Paris Est Creteil, Le Kremlin Bicêtre, France; INSERM, Centre for Research in Epidemiology and Population Health, Institut Gustave Roussy, Université Paris Saclay, Villejuif, France.
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - Georgia Malamut
- Department of Gastroenterology, AP-HP-Centre, Université de Paris, Hôpital Cochin, Paris, France
| | - Melanie Serrero
- Department of Gastroenterology, University Hospital of Marseille Nord, Aix-Marseille, Marseille University, Marseille, France
| | - Florian Poullenot
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
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15
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Cottron C, Treton X, Altwegg R, Reenaers C, Amiot A, Fumery M, Vuitton L, Peyrin-Biroulet L, Bouguen G, Dewit O, Nancey S, Caillo L, Roblin X, Beylot-Barry M, Rivière P, Laharie D. How to Manage Inflammatory Bowel Disease Patients When They Withdraw Anti-Tumour Necrosis Factor [Anti-TNF] Due to Severe Anti-TNF-Induced Skin Lesions? A Multicentre Cohort Study. J Crohns Colitis 2022; 16:1202-1210. [PMID: 35218189 DOI: 10.1093/ecco-jcc/jjac035] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/01/2022] [Accepted: 02/24/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Optimal management of patients with inflammatory bowel disease [IBD] after anti-tumour necrosis factor [TNF] discontinuation due to severe induced skin lesions is unclear. Our study aimed to describe dermatological and IBD evolution after anti-TNF discontinuation for this side effect. METHODS We conducted a multicentre retrospective study including consecutive IBD patients who discontinued anti-TNF due to severe induced skin lesions. Our objectives were to determine factors associated with dermatological remission [complete disappearance of skin lesions] and with IBD relapse in patients with inactive disease at inclusion, notably the impact of an early switch to another biological agent within 3 months of anti-TNF discontinuation. RESULTS Among the 181 patients [134 women, 160 Crohn's disease] included in the 13 participating centres, dermatological remission occurred in 110 [62%] patients with a median [interquartile range, IQR] interval of 8.0 [6.8-11.0] months. Scalp location was independently associated with less remission of skin lesions (hazard ratio [HR] = 0.64 [95% CI 0.43-0.94], p = 0.02) while early switch was independently associated with a higher probability of remission of skin lesions (HR = 1.64 [95% CI 1.1-2.5], p = 0.02). Among the 148 patients with inactive IBD at inclusion, disease relapse occurred in 75 [51%] patients with a median [IQR] interval of 26.0 [23.0-39.1] months. Survival rates without IBD relapse at 1 year were 85.8% [95% CI 77.5-94.9] in the early switch group and 59.3% [95% CI 48.9-71.9] in the other group [p < 0.01]. CONCLUSIONS Early switch to a new biological is associated with a higher probability of healing of anti-TNF-induced skin lesions and significantly reduces the risk of IBD relapse.
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Affiliation(s)
- C Cottron
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - X Treton
- Department of Gastroenterology, IBD and Nutrition, Beaujon Hospital, APHP, Paris, France
| | - R Altwegg
- Department of Hepatogastroenterology, Saint Eloi Hospital, CHU de Montpellier, Montpellier, France
| | - C Reenaers
- Department of Gastroenterology, CHU Sart Tilman, Liège, Belgium
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Creteil, France
| | - M Fumery
- Department of Gastroenterology, CHU de Amiens, and Peritox, UMR I-01, France
| | - L Vuitton
- Department of Hepatogastroenterology, CHRU de Besançon, Besançon, France
| | - L Peyrin-Biroulet
- Department of Hepatogastroenterology, Nancy University Hospital, Vandoeuvre les Nancy, France
| | - G Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolism and Cancer), F-35000 Rennes, France
| | - O Dewit
- Department of Gastroenterology, Université Catholique de Louvain Saint Luc, Brussels, Belgium
| | - S Nancey
- Department of Gastroenterology, CHU de Lyon, Lyon Sud Hospital, University Claude Bernard Lyon 1, INSERM U1111, Lyon, France
| | - L Caillo
- Department of Hepatogastroenterology, CHU de Nîmes, Nîmes, France
| | - X Roblin
- Department of Hepatogastroenterology, CHU de Saint-Etienne, Hôpital Nord, Université Jean Monnet, Saint-Etienne, France
| | - M Beylot-Barry
- Department of Dermatology, Saint-André Hospital, CHU de Bordeaux, France
| | - P Rivière
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
| | - D Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive - Université de Bordeaux, F-33000 Bordeaux, France
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16
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Pauwels RWM, van der Woude CJ, Nieboer D, Steyerberg EW, Casanova MJ, Gisbert JP, Kennedy NA, Lees CW, Louis E, Molnár T, Szántó K, Leo E, Bots S, Downey R, Lukas M, Lin WC, Amiot A, Lu C, Roblin X, Farkas K, Seidelin JB, Duijvestein M, D'Haens GR, de Vries AC. Prediction of Relapse After Anti-Tumor Necrosis Factor Cessation in Crohn's Disease: Individual Participant Data Meta-analysis of 1317 Patients From 14 Studies. Clin Gastroenterol Hepatol 2022; 20:1671-1686.e16. [PMID: 33933376 DOI: 10.1016/j.cgh.2021.03.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Tools for stratification of relapse risk of Crohn's disease (CD) after anti-tumor necrosis factor (TNF) therapy cessation are needed. We aimed to validate a previously developed prediction model from the diSconTinuation in CrOhn's disease patients in stable Remission on combined therapy with Immunosuppressants (STORI) trial, and to develop an updated model. METHODS Cohort studies were selected that reported on anti-TNF cessation in 30 or more CD patients in remission. Individual participant data were requested for luminal CD patients and anti-TNF treatment duration of 6 months or longer. The discriminative ability (concordance-statistic [C-statistic]) and calibration (agreement between observed and predicted risks) were explored for the STORI model. Next, an updated prognostic model was constructed, with performance assessment by cross-validation. RESULTS This individual participant data meta-analysis included 1317 patients from 14 studies in 11 countries. Relapses after anti-TNF cessation occurred in 632 of 1317 patients after a median of 13 months. The pooled 1-year relapse rate was 38%. The STORI prediction model showed poor discriminative ability (C-statistic, 0.51). The updated model reached a moderate discriminative ability (C-statistic, 0.59), and included clinical symptoms at cessation (hazard ratio [HR], 2.2; 95% CI, 1.2-4), younger age at diagnosis (HR, 1.5 for A1 (age at diagnosis ≤16 years) vs A2 (age at diagnosis 17 - 40 years); 95% CI, 1.11-1.89), no concomitant immunosuppressants (HR, 1.4; 95% CI, 1.18-172), smoking (HR, 1.4; 95% CI, 1.15-1.67), second line anti-TNF (HR, 1.3; 95% CI, 1.01-1.69), upper gastrointestinal tract involvement (HR, 1.3 for L4 vs non-L4; 95% CI, 0.96-1.79), adalimumab (HR, 1.22 vs infliximab; 95% CI, 0.99-1.50), age at cessation (HR, 1.2 per 10 years younger; 95% CI, 1-1.33), C-reactive protein (HR, 1.04 per doubling; 95% CI, 1.00-1.08), and longer disease duration (HR, 1.07 per 5 years; 95% CI, 0.98-1.17). In subanalysis, the discriminative ability of the model improved by adding fecal calprotectin (C-statistic, 0.63). CONCLUSIONS This updated prediction model showed a reasonable discriminative ability, exceeding the performance of a previously published model. It might be useful to guide clinical decisions on anti-TNF therapy cessation in CD patients after further validation.
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Affiliation(s)
- Renske W M Pauwels
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - C Janneke van der Woude
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - María J Casanova
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Nick A Kennedy
- Exeter Inflammatory Bowel Disease Research Group, University of Exeter, Exeter, United Kingdom; Department of Gastroenterology and Hepatology, Western General Hospital, Edinburgh, United Kingdom
| | - Charlie W Lees
- Department of Gastroenterology and Hepatology, Western General Hospital, Edinburgh, United Kingdom
| | - Edouard Louis
- Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Tamás Molnár
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Kata Szántó
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Eduardo Leo
- Department of Digestive Diseases, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Steven Bots
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Academic Medical Centre, Amsterdam, The Netherlands
| | - Robert Downey
- Department of Gastroenterology and Hepatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, National Health Service Foundation Trust, Sheffield, United Kingdom
| | - Milan Lukas
- Inflammatory Bowel Disease Clinical and Research Centre, Iscare a.s, Prague, Czech Republic; Institute of Medical Biochemistry and Laboratory Diagnostics, First Medical Faculty, General Teaching Hospital, Prague, Czech Republic
| | - Wei C Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Aurelien Amiot
- Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris, Paris Est Creteil University, Henri Mondor Hospital, Paris Est Creteil University; Department of Gastroenterology, Paris Est-Créteil Val de Marne University, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, Creteil, France
| | - Cathy Lu
- Division of Gastroenterology, Zeidler Ledcor Center, University of Alberta, Edmonton, Alberta, Canada; Division of Gastroenterology, Calgary, Alberta, Canada
| | - Xavier Roblin
- Department of Gastro-Enterology, INSERM CIC 1408, Paris, France; Department of Gastroenterology, University of Saint Etienne, Centre Hospitalier Universitaire Hopital Nord, Saint Etienne, France
| | - Klaudia Farkas
- First Department of Medicine, University of Szeged, Szeged, Hungary
| | - Jakob B Seidelin
- Department of Gastroenterology, Herlev Hospital, Herlev, Denmark
| | - Marjolijn Duijvestein
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Geert R D'Haens
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annemarie C de Vries
- Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Lévy M, Dupuis J, Charpy C, Martin A, Itti E, Sobhani I, Haioun C, Amiot A. Rituximab or rituximab plus chlorambucil for translocation (11;18)-negative gastric mucosa-associated lymphoid tissue lymphoma: a monocentric non-randomized observational study. Leuk Lymphoma 2022; 63:2597-2603. [DOI: 10.1080/10428194.2022.2086248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Michaël Lévy
- Department of Gastroenterology, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Jehan Dupuis
- Universite Paris Est Creteil, Creteil, France
- Lymphoid Malignancies Unit, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Cecile Charpy
- Department of Pathology, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Antoine Martin
- Department of Gastroenterology, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Emmanuel Itti
- Universite Paris Est Creteil, Creteil, France
- Department of Nuclear Medicine, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Iradj Sobhani
- Department of Gastroenterology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Universite Paris Est Creteil, Creteil, France
| | - Corinne Haioun
- Universite Paris Est Creteil, Creteil, France
- Lymphoid Malignancies Unit, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Aurelien Amiot
- Department of Gastroenterology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Universite Paris Est Creteil, Creteil, France
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18
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Kharoubi M, Bodez D, Bézard M, Zaroui A, Galat A, Guendouz S, Gendre T, Hittinger L, Attias D, Mohty D, Bergoend E, Itti E, Lebras F, Hamon D, Poullot E, Molinier-Frenkel V, Lellouche N, Deux JF, Funalot B, Fannen P, Oghina S, Arrouasse R, Lecorvoisier P, Souvannanorath S, Amiot A, Teiger E, Bougouin W, Damy T. Describing mode of death in three major cardiac amyloidosis subtypes to improve management and survival. Amyloid 2022; 29:79-91. [PMID: 35114877 DOI: 10.1080/13506129.2021.2013193] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The three main cardiac amyloidosis (CA) types have different progression and prognosis. Little is known about the mode of death (MOD) which is commonly attributed to cardiovascular causes in CA. Improving MOD's knowledge could allow to adapt patient care. OBJECTIVE This retrospective study describes the MOD that occurred during long-term follow-up in CA patients in light-chain (AL), transthyretin hereditary (ATTRv) or wild-type (ATTRwt). MATERIAL AND METHODS Patients referred to and cared for, at the French referral centre for CA, Henri Mondor Hospital, Créteil between 2010 and 2016 were included. Clinical information surrounding patient deaths were investigated and centrally evaluated by two blinded clinical committees which classified MOD as cardiovascular, non-cardiovascular or unknown and sub-classified it depending on its subtype. RESULTS From the 566 patients included, 187 had AL, 206 ATTRv and 173 ATTRwt. During the 864 patient-year follow-up, 160 (28%) deaths occurred, with median survival time of 17.3 months (interquartile range 5.1-35.4). The most frequent MOD was cardiovascular (64%) of which worsening heart failure occurred most frequently and for which, 69% were of AL subtype, 79% ATTRv and 76% ATTRwt. Sudden death also occurred more frequently in AL subtype accounting for 29% of AL deaths. Non-cardiovascular MOD occurred in 26% of patients overall. Among these, infection was the most common non-cardiovascular MOD in any type of CA (80%). CONCLUSIONS Mortality is high during natural course of CA and differs between subtypes. The main MOD were worsening heart failure, sudden death and infection, opening room to optimise management.
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Affiliation(s)
- Mounira Kharoubi
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Diane Bodez
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France.,Centre Cardiologique du Nord, Saint Denis, France
| | - Mélanie Bézard
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Amira Zaroui
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Arnault Galat
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Soulef Guendouz
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Thierry Gendre
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Neurology, Henri Mondor University Hospital, Creteil, France
| | - Luc Hittinger
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - David Attias
- Centre Cardiologique du Nord, Saint Denis, France
| | - Dania Mohty
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.,AL Amyloidosis Referral Center, Dupuytren University Hospital, Limoges, France
| | - Eric Bergoend
- AP-HP, Department of Cardiac Surgery, Henri Mondor University Hospital, Creteil, France
| | - Emmanuel Itti
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Nuclear Medicine, Henri Mondor University Hospital, Creteil, France
| | - Fabien Lebras
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Lymphoid Malignancy Unit, Henri Mondor University Hospital, Creteil, France
| | - David Hamon
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Elsa Poullot
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Biology-Pathology, Henri Mondor Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
| | - Valérie Molinier-Frenkel
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Biology-Pathology, Henri Mondor Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.,AP-HP, Department of Immunobiology, Henri Mondor University Hospital, Créteil, France
| | - Nicolas Lellouche
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Jean-François Deux
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Radiology, Henri Mondor University Hospital, Créteil, France
| | - Benoit Funalot
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Genetic, Henri Mondor Teaching Hospital, Créteil, France
| | - Pascale Fannen
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Genetic, Henri Mondor Teaching Hospital, Créteil, France
| | - Silvia Oghina
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Raphael Arrouasse
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,Inserm, Clinical Investigations Center 1430, AP-HP, DMU Saphire, Henri Mondor University Hospital, Creteil, France
| | - Philippe Lecorvoisier
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,Inserm, Clinical Investigations Center 1430, AP-HP, DMU Saphire, Henri Mondor University Hospital, Creteil, France
| | - Sarah Souvannanorath
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Referral Center for Neuromuscular Disease Department, Henri Mondor University Hospital, Créteil, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor University Hospital, AP-HP, EA7375, University Paris-Est Creteil, Creteil, France
| | - Emmanuel Teiger
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France
| | - Wulfran Bougouin
- AP-HP, Centre de Recherche Cardiovasculaire de Paris (PARCC), INSERM U970, Centre d'Expertise Mort Subite (CEMS), Paris Descartes University, Paris, France.,Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Thibaud Damy
- National Referral Center for Cardiac Amyloidosis, Creteil, France.,GRC Amyloid Research Institute University Paris-Est Creteil INSERM, IMRB, Creteil, France.,AP-HP, Department of Cardiology, Henri Mondor University Hospital, Creteil, France.,Inserm U955, IMRB, Creteil, France.,Inserm, Clinical Investigations Center 1430, AP-HP, DMU Saphire, Henri Mondor University Hospital, Creteil, France
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19
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Fumery M, Filippi J, Abitbol V, Biron A, Laharie D, Serrero M, Altwegg R, Bouhnik Y, Peyrin-Biroulet L, Gilletta C, Roblin X, Pineton de Chambrun G, Vuitton L, Bourrier A, Nancey S, Gornet JM, Nahon S, Bouguen G, Viennot S, Nachury M, Amiot A. Effectiveness and safety of ustekinumab maintenance therapy in 103 patients with ulcerative colitis: a GETAID cohort study. Aliment Pharmacol Ther 2021; 54:944-951. [PMID: 34296456 DOI: 10.1111/apt.16544] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/10/2021] [Accepted: 07/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Phase III trials have demonstrated the efficacy and safety of ustekinumab in ulcerative colitis (UC), but few real-life long-term data are currently available. AIMS To assess the real-world effectiveness and safety of ustekinumab in patients with UC. METHODS From January to September 2019, all consecutive patients with active UC treated with ustekinumab in a GETAID centre were included. Patients were evaluated at week 52. Remission was defined as a partial Mayo Clinic score ≤2. RESULTS We included 103 patients with UC (62 men; mean age: 41.2 ± 16.2 years; 52% pancolitis E3) with an insufficient response to immunosuppressants, anti-TNFs and/or vedolizumab. At week 52, 45 (44%) patients had discontinued ustekinumab mainly due to lack of effectiveness (n = 41). The cumulative probabilities of ustekinumab persistence were 96.1%, 81.6%, 71.7% and 58.4% after 3, 6, 9 and 12 months respectively. The overall steroid-free clinical remission rate at week 52 was 32% of whom 71% had subscores of null for rectal bleeding and stool frequency. Ten patients underwent colectomy within a median of 6.7 [4.3-10.6] months. Adverse effects were observed in 15 (16.9%) patients; 4 (4.5%) were severe, including one patient who died from a myocardial infarction. CONCLUSION After 52 weeks, over one-half of patients with refractory UC were still treated by ustekinumab and one-third were in steroid-free clinical remission.
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20
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Amiot A. Editorial: a long way to go before precision medicine. Aliment Pharmacol Ther 2021; 54:187. [PMID: 34170547 DOI: 10.1111/apt.16391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EA7375, Paris Est-Créteil Univeristy (UPEC), Creteil, France
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21
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de'Angelis N, Notarnicola M, Martínez-Pérez A, Memeo R, Charpy C, Urciuoli I, Maroso F, Sommacale D, Amiot A, Canouï-Poitrine F, Levesque E, Brunetti F. Robotic Versus Laparoscopic Partial Mesorectal Excision for Cancer of the High Rectum: A Single-Center Study with Propensity Score Matching Analysis. World J Surg 2021; 44:3923-3935. [PMID: 32613345 DOI: 10.1007/s00268-020-05666-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The role of robotic surgery for partial mesorectal excision (PME) in patients with high rectal cancer (RC) remains unexplored. This study aimed to compare the operative and postoperative outcomes of robotic (R-PME) versus laparoscopic (L-PME) PME for high RC. METHODS This was a single-center propensity score cohort study of consecutive patients diagnosed with RC in the high rectum (>10 to 15 cm from the anal verge) who underwent surgery between September 2012 and May 2019. RESULTS Of 131 selected patients (50 R-PME and 81 L-PME), 88 were matched using propensity score (44 per group). Operative and postoperative variables were similar between R-PME and L-PME patients, except for operative time (220 min and 190 min, respectively; p < 0.0001). No conversion was needed. Overall morbidity was 15.9%; 4 patients (4.5%) developed anastomotic leakage. The mean hospital stay was 7.25 days for R-PME vs. 7.64 days for L-PME (p = 0.597). R0 resection was achieved in 100% of R-PME and 90.9% of L-PME (p = 0.116). Only 3 patients (1 R-PME, 2 L-PME) received a permanent stoma (p = 1). No group differences were observed for overall or disease-free survival rates at 5 years. The costs of R-PME were significantly higher than those of L-PME. CONCLUSION Minimally invasive surgery can be performed safely for PME in high RC. No difference can be detected between R-PME and L-PME for both short- and long-term outcomes, leaving the choice of the surgical approach to the surgeon's experience. Specific health economic studies are needed to evaluate the cost-effectiveness of robotic surgery for RC.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France. .,EA7375 (EC2M3 Research Team), Université Paris Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.
| | - Margerita Notarnicola
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Aleix Martínez-Pérez
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, 90, Av. de Gaspar Aguilar, 46017, Valencia, Spain
| | - Riccardo Memeo
- Department of Emergency and Organ Transplantation, University Aldo Moro of Bari, Piazza Umberto I, 1, 70121, Bari, Italy
| | - Cecile Charpy
- Department of Pathology, Henri Mondor Hospital, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Irene Urciuoli
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Fabio Maroso
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Daniele Sommacale
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Aurelien Amiot
- EA7375 (EC2M3 Research Team), Université Paris Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France.,Department of Gastroenterology, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Florence Canouï-Poitrine
- Department of Public Health L, Henri Mondor University Hospital, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.,University of Paris Est, Creteil (UPEC), IMRB-U955 INSERM, CEPiA, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Eric Levesque
- Department of Anesthesia and Liver Intensive Care Unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris-Est, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Francesco Brunetti
- Unit of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, University of Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
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22
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Buisson A, Filippi J, Amiot A, Cadiot G, Allez M, Marteau P, Bouhnik Y, Pineton de Chambrun G, Pelletier AL, Nancey S, Moussata D, Attar A, Blain A, Vuitton L, Vernier-Massouille G, Seksik P, Nachury M, Dupas JL, Laharie D, Peyrin-Biroulet L, Louis E, Mary JY. Defining and Assessing the Reproducibility of Crohn's Disease Endoscopic Lesions: A Delphi-like Method from the GETAID. J Crohns Colitis 2021; 15:1000-1008. [PMID: 33313808 DOI: 10.1093/ecco-jcc/jjaa250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Defining and assessing the reproducibility of Crohn's disease [CD] endoscopic lesions is essential in assessing endoscopic healing. METHODS Twelve endoscopic CD experts from the GETAID defined aphthoid erosions [AE], superficial ulcerations [SU], deep ulcerations [DU], stenosis, and fistulas according to a Delphi-like method. Thirty different GETAID physicians declared if they found acceptable each definition. Intra- and inter-observer agreements were investigated using 100 videos with one tagged specific lesion [AE, SU, DU, or sham lesion] read by 15 independent endoscopists at baseline and 1 month later in a randomised order. Video quality was determined by an external reader. According to kappa estimate [κ ±standard error], intra or inter-observer agreement was qualified as 'moderate' [0.4-0.6], 'substantial' [0.6-0.8], or 'almost perfect' [0.8-1.0]. RESULTS Among 30 different experts, 83% to 97% found acceptable the definitions retrieved from the Delphi-like method. Intra-observer κ was 0.717 [±0.019] for SU, 0.681 [±0.027] for AE, 0.856 [±0.014] for DU, showing 'substantial' agreement. It was 0.801 [±0.016] for any ulceration [DU or SU]. There was a high variability across readers from 'moderate' to 'almost perfect' agreement. Inter-observer κ was 0.548 [±0.042] for SU, 0.554 [±0.028] for AE 0.694 [±0.041] for DU, and 0.705 [±0.042] for any ulceration. Inter-observer agreement increased when reading the 53 high-quality videos: 0.787 [±0.064] [p = 0.001], 0.607 [±0.043] [p = 0.001], and 0.782 [±0.064][p = 0.001] for DU, AE, and any ulceration, respectively. CONCLUSIONS Despite variable intra-agreement level across readers, the GETAID definitions for CD endoscopic lesions provided 'substantial' inter-observer agreements, especially in case of high-quality videos.
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Affiliation(s)
- A Buisson
- Université Clermont Auvergne, Inserm, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, Inserm U1071, Clermont-Ferrand, France
| | - J Filippi
- Archet 2 University Hospital, Department of Gastroenterology, Nice, France
| | - A Amiot
- Hospital Henri-Mondor, Department of Gastroenterology, Creteil, France
| | - G Cadiot
- University Hospital of Reims, Gastroenterology, Reims, France
| | - M Allez
- APHP, Hopital Saint Louis, Department of Gastroenterology, Paris, France
| | - P Marteau
- Hopital Lariboisiere, Gastroenterologie, Paris, France
| | - Y Bouhnik
- Beaujon Hospital, Department of Gastroenterology, Clichy la Garenne, France
| | | | - A L Pelletier
- APHP, Bichat Hospital, Gastroenterology Department, Paris, France
| | - S Nancey
- Hospices Civils de Lyon, Lyon-Sud Hospital, Gastroenterology, Pierre Benite, France
| | - D Moussata
- Hospices Civils de Lyon, Lyon-Sud Hospital, Gastroenterology, Pierre Benite, France
| | - A Attar
- Beaujon Hospital, Department of Gastroenterology, Clichy la Garenne, France
| | - A Blain
- APHP-IMM, Gastroenterology Department, Paris, France
| | - L Vuitton
- University Hospital of Besançon, Gastroenterology, Besançon, France
| | | | - P Seksik
- University Hospital of Saint Antoine, APHP, Gastroenterology, Paris, France
| | - M Nachury
- University Hospital of Lille, Gastroenterology, Lille, France
| | - J L Dupas
- Amiens University Hospital, Gastroenterology, Amiens, France
| | - D Laharie
- University Hospital Haut Levesque, Gastroenterology, Pessac, France
| | - L Peyrin-Biroulet
- Nancy University Hospital, Inserm NGERE U1256, Department of Gastroenterology, Vandoeuvre les Nancy, France
| | - E Louis
- Liège University Hospital, Department of Gastroenterology, Liege, Belgium
| | - J Y Mary
- Centre de Recherche Epidémiologie et Statistiques, Equipe ECSTRRA, Université de Paris, Hôpital Saint-Louis, Paris, France
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23
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Laharie D, Bourreille A, Branche J, Allez M, Bouhnik Y, Filippi J, Zerbib F, Savoye G, Vuitton L, Moreau J, Amiot A, Beaugerie L, Ricart E, Dewit O, Lopez-Sanroman A, Fumery M, Carbonnel F, Buisson A, Coffin B, Roblin X, van Assche G, Esteve M, Farkkila M, Gisbert JP, Marteau P, Nahon S, de Vos M, Peyrin-Biroulet L, Mary JY. Evolution of Endoscopic Lesions in Steroid-Refractory Acute Severe Ulcerative Colitis Responding to Infliximab or Cyclosporine. Clin Gastroenterol Hepatol 2021; 19:1180-1188.e4. [PMID: 32777552 DOI: 10.1016/j.cgh.2020.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/04/2020] [Accepted: 08/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND/AIMS Few data on the evolution of endoscopic findings are available in patients with acute severe ulcerative colitis (ASUC). The aim of this study was to describe this evolution in a prospective cohort. METHODS Patients admitted for a steroid-refractory ASUC and included in a randomized trial comparing infliximab and cyclosporine were eligible if they achieved steroid-free clinical remission at day 98. Flexible sigmoidoscopies were performed at baseline, days 7, 42 and 98. Ulcerative colitis endoscopic index of severity (UCEIS) and its sub-scores - vascular pattern, bleeding and ulceration/erosion - were post-hoc calculated. Global endoscopic remission was defined by a UCEIS of 0, and partial endoscopic remission by any UCEIS sub-score of 0. RESULTS Among the 55 patients analyzed (29 infliximab and 26 cyclosporine), 49 (83%) had UCEIS ≥6 at baseline at baseline. Partial endoscopic remission rates were higher for bleeding than for vascular pattern and for ulcerations/erosions at day 7 (20% vs. 4% and 5% (n = 55); p = .004 and p=.04), for bleeding and ulceration/erosion than for vascular pattern at day 42 [63% and 65% vs. 33% (n=54); p<.001 for both] and at day 98 [78% and 92% vs. 56% (n = 50); p = .007 and p < .001]. Global endoscopic remission rates at day 98 were higher in patients treated with infliximab than with cyclosporine [73% vs. 25% (n = 26 and 24); p < .001]. CONCLUSION In steroid-refractory ASUC patients responding to a second-line medical therapy, endoscopic remission process started with bleeding remission and was not achieved in half the patients at day 98 for vascular pattern. Infliximab provided a higher endoscopic remission rate than cyclosporine at day 98.
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Affiliation(s)
- David Laharie
- INSERM CIC 1401, Service d'hépato-gastroentérologie et oncologie digestive, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France.
| | - Arnaud Bourreille
- Institut des Maladies de l'Appareil Digestif, Hépato-Gastroentérologie, Hôtel-Dieu, CHU de Nantes, Nantes, France
| | - Julien Branche
- Service des maladies de l'appareil digestif-Endoscopie digestive, Hôpital Claude Huriez, CHRU de Lille, Lille, France
| | - Matthieu Allez
- Service d'Hépato-Gastroentérologie, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Paris, France
| | - Yoram Bouhnik
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Clichy, France
| | - Jerome Filippi
- Service de Gastroentérologie et Nutrition Clinique, Hôpital de l'Archet 2, CHU de Nice, Nice, France
| | - Frank Zerbib
- INSERM CIC 1401, Service d'hépato-gastroentérologie et oncologie digestive, Centre Medico-chirurgical Magellan, Hôpital Haut-Lévêque, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Guillaume Savoye
- UMR 1073, Service de Gastroentérologie, Hôpital Charles Nicolle, CHU de Rouen, Normandie Université-Rouen, Rouen, France
| | - Lucine Vuitton
- Service de Gastroentérologie, Hôpital Jean Minjoz, CHU de Besançon, Besançon, France
| | - Jacques Moreau
- Service de Gastro-entérologie et Nutrition, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Aurelien Amiot
- Service d'Hépato-gastroentérologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Créteil, Créteil, France
| | - Laurent Beaugerie
- Department of Gastroenterology, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Elena Ricart
- Gastroenterology Department, Hospital Clínic, Augus Pi i Sunyer Biomedical Research Institute, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona, Spain
| | - Olivier Dewit
- Service d'Hépato-Gastroentérologie, UCL Saint Luc, Brussels, Belgium
| | - Antonio Lopez-Sanroman
- Unidad de EII / IBD Unit, Servicio de Gastroenterología y Hepatología, Hospital Ramón y Cajal, Madrid, Spain
| | - Mathurin Fumery
- Peritox UMR I-01, Service d'Hépato-Gastroentérologie, CHU Amiens, Amiens, France
| | - Franck Carbonnel
- Service d'Hépato-Gastroentérologie, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris Sud 11, Le Kremlin-Bicêtre, France
| | - Anthony Buisson
- INSERM U1071, M2iSH, USC-INRA 2018, 3iHP, Service d'Hépato-Gastroentérologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Benoit Coffin
- Pôle Maladie Appareil Digestif, Service d'Hépato-Gastroentérologie, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris, Université Paris VII, Colombes, France
| | - Xavier Roblin
- Service de Gastro-entérologie et Hépatologie, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Gert van Assche
- Division of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
| | - Maria Esteve
- Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Terrassa, Spain
| | - Martti Farkkila
- Clinic of Gastroenterology, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland
| | - Javier P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Universidad Autónoma de Madrid, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Philippe Marteau
- Service Hépato-gastroentérologie, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris Sorbonne Université, Paris, France
| | - Stephane Nahon
- Service d'Hépato-gastroentérologie, CHI Le Raincy Montfermeil, Montfermeil, France
| | - Martine de Vos
- Gastroenterology unit, Ghent University Hospital, Gent, Belgium
| | - Laurent Peyrin-Biroulet
- INSERM U1256 NGERE, Department of Hepato-Gastroenterology, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Jean-Yves Mary
- INSERM UMR-S-1153, Equipe ECSTRA, Hôpital Saint-Louis, Paris Diderot University, Paris, France
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24
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Affiliation(s)
- Jenny Tannoury
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Paris Est-Créteil University (UPEC), Creteil, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Paris Est-Créteil University (UPEC), Creteil, France
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25
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Tadbiri S, Nachury M, Bouhnik Y, Serrero M, Hébuterne X, Roblin X, Kirchgesner J, Bouguen G, Franchimont D, Savoye G, Buisson A, Louis E, Nancey S, ABitbol V, Reimund JM, DeWit O, Vuitton L, Matthieu N, Peyrin-Biroulet L, Gilletta C, Allez M, Viennot S, Trang-Poisson C, Dib N, Brixi H, Boualit M, Plastaras L, Boivineau L, Fumery M, Caillo L, Laharie D, Amiot A. The IBD-disk Is a Reliable Tool to Assess the Daily-life Burden of Patients with Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:766-773. [PMID: 33246337 DOI: 10.1093/ecco-jcc/jjaa244] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The inflammatory bowel disease [IBD]-disk is a 10-item self-questionnaire that is used to assess IBD-related disability. The aim of the present study was to evaluate this tool in the assessment of IBD daily-life burden. METHODS A 1-week cross-sectional study was conducted in 42 centres affiliated in France and Belgium. Patients were asked to complete the IBD-disk [best score: 0, worst score: 100] and a visual analogue scale [VAS] of IBD daily-life burden [best score: 0, worst score: 10]. Analyses included internal consistency, correlation analysis, and diagnostic performance assessment. RESULTS Among the 2011 IBD outpatients who responded to the survey [67.8% of the patients had Crohn's disease], 49.9% were in clinical remission. The IBD-disk completion rate was 73.8%. The final analysis was conducted in this population [n = 1455 patients]. The mean IBD-disk score and IBD daily-life burden VAS were 39.0 ± 23.2 and 5.2 ± 2.9, respectively. The IBD-disk score was well correlated with the IBD daily-life burden VAS [r = 0.67; p <0.001]. At an optimal IBD-disk cut-off of 40, the area under the receiver operating characteristic curve [AUROC] for high IBD daily-life burden [VAS >5] was 0.81 (95% confidence interval [CI]: 0.79-0.83; p <0.001). CONCLUSIONS In a large cohort of patients, the IBD-disk score was well correlated with IBD daily-life burden, and it could be used in clinical practice.
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Affiliation(s)
- Sara Tadbiri
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, CHU Lille, Service des Maladies de l'appareil digestif, Lille, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Xavier Hébuterne
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Julien Kirchgesner
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, , UPMC Université Paris 6, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Denis Franchimont
- Department of Gastroenterology, Hôpital Erasme, Laboratoire de Gastroenterologie experimentale, ULB, Brussels, Belgium
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - Edouard Louis
- Department of Gastroenterology, Liège University Hospital, CHU Liège, Belgium
| | - Stephane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon and INSERM U1111, University Claude Bernard Lyon 1, Lyon, France
| | - Vered ABitbol
- Department of Gastroenterology, Cochin University Hospital, Paris, France
| | - Jean-Marie Reimund
- Service d'Hépato-Gastroentérologie et d'Assistance Nutritive, Hôpitaux Universitaires de Strasbourg et INSERM U1113, Université de Strasbourg, Strasbourg, France
| | - Olivier DeWit
- Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium
| | - Lucine Vuitton
- Department of Gastroenterology, Besancon University Hospital, Besancon, France
| | - Nicolas Matthieu
- Department of Hepato-Gastroenterology and Digestive Oncology, Grenoble Alpes University Hospital, Grenoble, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Caroline Trang-Poisson
- CHU Nantes, Institut des Maladies de l'Appareil Digestif [IMAD], Nantes University, Nantes, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | - Hedia Brixi
- Department of GastroEnterology, Reims University Hospital, Rheims, France
| | - Medina Boualit
- Department of Gastroenterology, Valenciennes General Hospital, Valenciennes, France
| | | | - Lucile Boivineau
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nimes, France
| | - David Laharie
- Department of HepatoGastroenterology and Digestive Oncology, Centre Medico-chirurgical Magellan, Haut-Leveque Hospital, Université de Bordeaux, Bordeaux, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
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Tannoury J, Nachury M, Martins C, Serrero M, Filippi J, Roblin X, Bourrier A, Bouguen G, Franchimont D, Savoye G, Buisson A, Louis E, Nancey S, Abitbol V, Reimund JM, DeWitt O, Vuitton L, Mathieu N, Peyrin-Biroulet L, Gilletta C, Allez M, Viennot S, Trang-Poisson C, Laharie D, Amiot A. Determinants of IBD-related disability: a cross-sectional survey from the GETAID. Aliment Pharmacol Ther 2021; 53:1098-1107. [PMID: 33817819 DOI: 10.1111/apt.16353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/26/2021] [Accepted: 03/15/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND The burden of inflammatory bowel disease (IBD) is rising worldwide. The goal of IBD treatment is to achieve clinical and endoscopic remission but also prevent disability. AIMS To identify the predictive factors of disability in a large population of patients with IBD. PATIENTS AND METHODS We conducted a cross-sectional survey in 42 tertiary centres in France and Belgium. A self-administered questionnaire was designed to explore patients and their IBD characteristics. IBD-disk is a validated tool to measure disability in patients with IBD. The IBD-disk score was then calculated for each patient. Based on a previous study, an overall IBD-disk score ≥40 was associated with moderate-to-severe disability. RESULTS Among the 2011 patients, 1700 were analysed, including 746 (44%) in self-reported clinical remission and 752 (44.2%) declaring clinical activity. The patient global assessment of global remission was missing in 200 (11.8%) of 1700 patients. Moderate-to-severe disability was significantly increased in patients with BMI >25 kg/m2 (OR = 1.66; 95% CI [1.29-2.14]), in those having perception of need for a psychotherapist (OR = 2.24; 95% CI [1.79-3.05]) and social worker (OR = 1.54; 95% CI [1.08-2.21]). Conversely, male gender (OR = 0.83; 95% CI [0.69-0.99]), ulcerative colitis (OR = 0.69; 95% CI [0.53-0.92]), self-reported clinical remission (OR = 0.59; 95% CI [0.46-0.77]) and employed or student occupational status (OR = 0.69; 95% CI [0.52-0.92]) were inversely correlated with disability. Overall, 257 (34.5%) patients who declared being in clinical remission had disability. CONCLUSION Determinants of IBD-related disability include IBD-related factors but also psychological and social factors. This highlights the importance of a multidisciplinary team in the management of patients with IBD.
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Bataille P, Layese R, Amiot A, Claudepierre P, Sbidian E. Incidence des réactions paradoxales chez les patients débutant un biomédicament : étude de cohorte de 9303 patients. Ann Dermatol Venereol 2020. [DOI: 10.1016/j.annder.2020.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bataille P, Amiot A, Claudepierre P, Paris N, Neuraz A, Lerner I, Garcelon N, Rance B, Grisel O, Moreau T, Bernaux M, Audureau E, Sbidian E. Infection à SARS-CoV-2 et biomédicaments : une étude multicentrique française de 7808 patients. Revue du Rhumatisme 2020. [PMCID: PMC7700096 DOI: 10.1016/j.rhum.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction Les formes sévères d’infection à COVID-19 sont liées à une importante réponse inflammatoire. Certains biomédicaments (BM) sont en cours d’évaluation dans des essais thérapeutiques avec pour rationnel cet orage cytokinique. À l’inverse, nous pouvons nous interroger sur le risque d’infections à COVID-19 chez les patients sous BM au long cours. L’objectif principal de notre étude était de déterminer l’impact de la prise d’un BM sur le taux d’hospitalisation, de passage en réanimation (ICU) et de décès chez les patients sous BM atteints d’une infection à COVID-19. Matériels et méthodes Étude de cohorte rétrospective multicentrique à partir des données médico-administratives de l’Entrepôt de Données de Santé (EDS) de l’APHP. L’ensemble des patients recevant un BM (anti-TNF, anti-IL-12/23, anti-IL-17 ou anti-intégrine) étaient inclus. Les événements d’intérêt étaient la survenue d’une hospitalisation, d’un séjour en ICU ou d’un décès dans le cadre d’une infection à COVID-19 (confirmée par RT-PCR ou TDM thoracique) entre le 01/02 et le 22/04/20. Le risque d’hospitalisation/ICU/décès était évalué selon la méthodologie du Ratio de Morbidité/Mortalité Standardisé (SMR) en calculant le rapport entre le nombre observé et le nombre attendu. Le nombre attendu d’hospitalisation/ICU/décès était calculé en appliquant le taux d’hospitalisation/ICU/décès à COVID-19 de la population d’Ile-de-France (par tranche d’âge de 20 ans et par sexe) au nombre de personnes sous BM dans la sous-classe correspondante de la même source de données (données EDS de l’APHP). Résultats Un total de7808 patients (âge médian 45 ans, 51 % de femmes) étaient inclus ; dont 48 avec un diagnostic d’infection à COVID-19 : 19 (40 %) hospitalisés, 4 (8 %) en ICU et 1 décès. En comparaison avec la population d’Ile-de-France, les taux d’hospitalisation et d’ICU étaient significativement élevés chez les patients sous BM avec SMR 2,19, IC95 % 1,32-3,42, p < 0,001 et SMR 6,04, IC95 % 1,62-15,45, p < 0,001 respectivement, significativement observés chez les [20-40[. Cependant, une analyse post-hoc suggérait que les SMR d’hospitalisation et d’ICU étaient surestimés, un retour aux compte-rendus mettant en évidence une poussée de la pathologie sous-jacente comme principal motif d’hospitalisation chez les [20-40[et non une infection à COVID-19 nécessitant une hospitalisation ou un passage en ICU. Aucun sur-risque de mortalité était mis en évidence. Discussion À partir d’une large base de données, notre étude a permis de confirmer que les taux d’hospitalisation, de passage en réanimation et de mortalité n’étaient pas augmentés chez les patients sous BM. Nos résultats sont concordants avec les différentes études publiées dans la littérature (Haberman et al., Favalli et al. ou Sanchez-Piedra et al.). Conclusion Ces résultats plaident pour un maintien des BM en période d’épidémie du virus COVID-19 pour éviter la rechute des pathologies inflammatoires de fond.
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Bataille P, Amiot A, Claudepierre P, Paris N, Neuraz A, Lerner I, Garcelon N, Rance B, Grisel O, Moreau T, Berneaux M, Audureau E, Sbidian E. Infection à SARS-CoV-2 et biomédicaments : étude multicentrique française de 7808 patients. Ann Dermatol Venereol 2020. [PMCID: PMC7688288 DOI: 10.1016/j.annder.2020.09.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Amiot A, Salameh R. Letter: long-term outcomes of patients with acute severe ulcerative colitis after intravenous steroid therapy-authors' reply. Aliment Pharmacol Ther 2020; 52:1252. [PMID: 33016556 DOI: 10.1111/apt.16003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EA7375, Paris Est-Créteil Univeristy (UPEC), Creteil, France
| | - Robert Salameh
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EA7375, Paris Est-Créteil Univeristy (UPEC), Creteil, France
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Severyns T, Kirchgesner J, Lambert J, Thieblemont C, Amiot A, Abitbol V, Treton X, Cazals-Hatem D, Malamut G, Coppo P, Galicier L, Walter-Petrich A, Deau-Fischer B, Besson C, Aparicio T, Beaugerie L, Allez M, Gornet JM. Prognosis of Lymphoma in Patients With Known Inflammatory Bowel Disease: A French Multicentre Cohort Study. J Crohns Colitis 2020; 14:1222-1230. [PMID: 32161943 DOI: 10.1093/ecco-jcc/jjaa048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND AIMS The prognosis of lymphoma that occurs in patients with inflammatory bowel disease [IBD] is poorly known. METHODS A multicentre retrospective cohort analysis was done in seven French tertiary centres from 1999 to 2019. Only lymphoma occurring in patients with previous established diagnosis of IBD were analysed. The primary outcome was progression-free survival at 3 years. RESULTS A total of 52 patients [male 65%, Crohn's disease 79%, median age 48.3 years, median duration of IBD 10.1 years] were included, of whom 37 had been previously exposed to immunosuppressants and/or biologics for at least 3 months and 20 had primary intestinal lymphomas. The lymphoma histological types were: diffuse large B cell lymphomas [N = 17], Hodgkin lymphomas [N = 17], indolent B cell lymphomas [N = 12], and others including T cell lymphomas, mantle cell lymphomas, and unclassifiable B cell lymphoma [N = 6]. The median follow-up after lymphoma was 5.1 years (interquartile range [IQR] 4-7.8). Progression-free survival at 3 years was 85% in the overall population (95% confidence interval [CI] 75%-96%) with no significant difference between the exposed and unexposed group, 79% for patients exposed to immunosuppressants and/or biologics [95% CI 67%-94%], and 83% for patients diagnosed with primary intestinal lymphoma [95% CI 67%-100%]. No relapse of IBD has been observed during chemotherapy. The IBD relapse rate at the end of the last chemotherapy cycle was 23% at 3 years [95% CI 11%-39%] in the overall population. CONCLUSIONS In this large cohort, the prognosis for lymphomas occurring in IBD appears to be good and similar to what is expected, irrespective of the exposure to biologics and/or immunosuppressants.
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Affiliation(s)
- T Severyns
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - J Kirchgesner
- Service de Gastroentérologie, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - J Lambert
- Service de Biostatistiques et Information Médicale, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - C Thieblemont
- Service d'Hémato-oncologie, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - A Amiot
- Service de Gastroentérologie, Hôpital Henri Mondor, UPEC, Créteil, France
| | - V Abitbol
- Service de Gastroentérologie, Hôpital Cochin, Université de Paris, Paris, France
| | - X Treton
- Service de Gastroentérologie, Hôpital Beaujon, Université de Paris, Clichy La Garenne, France
| | - D Cazals-Hatem
- Département de Pathologie, Hôpital Beaujon, Université de Paris, Clichy La Garenne. France
| | - G Malamut
- Service de Gastroentérologie, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - P Coppo
- Service d'Hématologie, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - L Galicier
- Service d'Immunohématologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - A Walter-Petrich
- Service de Biostatistiques et Information Médicale, Hôpital Saint-Louis, Université de Paris, Paris, France
| | - B Deau-Fischer
- Service d'Hématologie, Hôpital Cochin, Université de Paris, Paris, France
| | - C Besson
- Service d'Hématologie-Oncologie, Centre Hospitalier de Versailles, Université Versailles Saint Quentin en Yvelines, Université de Paris-Saclay, Le Chesnay, France
| | - T Aparicio
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - L Beaugerie
- Service de Gastroentérologie, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - M Allez
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
| | - J M Gornet
- Service de Gastroentérologie, Hôpital Saint Louis, Université de Paris, Paris, France
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Petitdidier N, Beaugerie L, Carbonnel F, Bourrier A, Treton X, Rajca S, Malamut G, Abitbol V, Allez M, Pelletier AL, Marthey L, Jouet P, Benamouzig R, Amiot X, Bouhnik Y, Amiot A. Real-world use of therapeutic drug monitoring of CT-P13 in patients with inflammatory bowel disease: A 12-month prospective observational cohort study. Clin Res Hepatol Gastroenterol 2020; 44:609-618. [PMID: 31924554 DOI: 10.1016/j.clinre.2019.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/18/2019] [Accepted: 11/27/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Whether therapeutic drug monitoring (TDM) of infliximab should be implemented in daily practice is an ongoing controversy. AIMS To assess the real-world use of TDM in an observational multicentre cohort study with consecutive patients with inflammatory bowel disease (IBD) treated with CT-P13. METHODS Between September 2015 and December 2016, 364 patients with IBD were treated with CT-P13 in 13 gastroenterology departments and were followed up for 54 weeks. Disease activity, CT-P13 trough concentration and anti-CT-P13 antibody (ACA) were recorded. RESULTS Steroid-free clinical remission rates at week 54 were 67.0% and 56.4% in patients with CD and UC, respectively. CT-P13 trough concentrations were measured in 70.7% of the patients. The mean CT-P13 trough concentration was 4.2±4.3μg/mL. The presence of ACA was observed in 53 (15.9%) patients. CT-P13 trough concentration was collected in a proactive approach in 62.8% of cases and in a reactive approach in 37.2%. Among patients who submitted to TDM, CT-P13 therapy was optimized in 88.7% of the reactive group and in 22.5% of the proactive group (P<0.001). CONCLUSION In a real-world cohort of patients with IBD treated with CT-P13, more than two-thirds of the patients underwent TDM. CT-P13 optimization was much less common in the proactive approach than in the reactive approach.
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Affiliation(s)
- Nicolas Petitdidier
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Laurent Beaugerie
- Department of Gastroenterology, Saint Antoine Hospital, Paris 6 Pierre et Marie Curie University, Paris, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre Hospital, Paris Sud University, Kremlin-Bicetre, France
| | - Anne Bourrier
- Department of Gastroenterology, Saint Antoine Hospital, Paris 6 Pierre et Marie Curie University, Paris, France
| | - Xavier Treton
- Department of Gastroenterology, Beaujon Hospital, Paris 7 Denis Diderot University, Clichy, France
| | - Sylvie Rajca
- Department of Gastroenterology, Louis Mourier Hospital, Paris 7 Denis Diderot University, Colombes, France
| | - Georgia Malamut
- Department of Gastroenterology, European Georges Pompidou Hospital, Paris 5 Rene Descartes University, Paris, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin Hospital, Paris 5 Rene Descartes University, Paris, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis, Paris 7 Denis Diderot University, Paris, France
| | - Anne-Laure Pelletier
- Department of Gastroenterology, Bichat Hospital, Paris 7 Denis Diderot University, Paris, France
| | - Lysiane Marthey
- Department of Gastroenterology, Antoine Beclere Hospital, Paris Sud University, Clamart, France
| | - Pauline Jouet
- Department of Gastroenterology, Ambroise Pare Hospital, Paris Ouest University, Boulogne-Billancourt, France
| | - Robert Benamouzig
- Department of Gastroenterology, Avicenne Hospital, Paris Nord University, Bobigny, France
| | - Xavier Amiot
- Department of Gastroenterology, Tenon Hospital, Paris 6 Pierre et Marie Curie University, Paris, France
| | - Yoram Bouhnik
- Department of Gastroenterology, Beaujon Hospital, Paris 7 Denis Diderot University, Clichy, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France.
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Rotkopf H, Lévy M, Copie-Bergman C, Dupuis J, Verlinde-Carvalho M, Itti E, Gagniere C, Belhadj K, Tannoury J, Le Bras F, Sobhani I, Haioun C, Amiot A. Effectiveness and Safety of Subcutaneous Rituximab for Patients With Gastric MALT Lymphoma: A Case-Control Comparison With Intravenous Rituximab. Clin Lymphoma Myeloma Leuk 2020; 21:e32-e38. [PMID: 32921592 DOI: 10.1016/j.clml.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/15/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rituximab is a standard treatment for gastric mucosa-associated lymphoid tissue (MALT) lymphoma (GML). We sought to compare the effectiveness and safety of subcutaneous and intravenous rituximab in a retrospective case-control study. PATIENTS AND METHODS All consecutive patients with GML treated with subcutaneous rituximab between January 2017 and December 2018 were included and compared to 3 matched control patients (based on Ann Arbor classification, presence of t(11;18) translocation, history of treatment, and type of current treatment) treated with intravenous rituximab between January 2000 and December 2018. Patients with t(11;18) translocation were treated with rituximab in combination with chlorambucil; the other patients were treated with rituximab alone. Effectiveness was assessed at week 52, and safety was assessed through weeks 0 to 52 and compared by the chi-square test. RESULTS Twenty-five patients were included in the subcutaneous rituximab group and 75 in the intravenous group. There was no difference between the groups in complete remission (78% vs. 76%, P = .99) or overall response rates (91% vs. 89%, P = .99) at week 52. Safety profiles were similar in both groups, with a significant decrease in postinduction grade 2 injection-related reactions and outpatient hospital length of stay in the subcutaneous rituximab group. CONCLUSION In a small case-control study, we did not find any difference in the effectiveness or safety profiles between subcutaneously and intravenously delivered rituximab for the treatment of patients with GML. We found a decrease in postinduction grade 2 injection-related reactions and outpatient hospital length of stay in the subcutaneous rituximab group.
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Affiliation(s)
- Hugo Rotkopf
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, Université Paris Est Créteil, Creteil, France
| | - Michaël Lévy
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, Université Paris Est Créteil, Creteil, France
| | - Christiane Copie-Bergman
- Department of Pathology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, INSERM UMR-S 955, Université Paris Est Créteil, Creteil, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France
| | - Muriel Verlinde-Carvalho
- Department of Pharmacy, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France
| | - Charlotte Gagniere
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, Université Paris Est Créteil, Creteil, France
| | - Karim Belhadj
- Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France
| | - Jenny Tannoury
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, Université Paris Est Créteil, Creteil, France
| | - Fabien Le Bras
- Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France
| | - Iradj Sobhani
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, Université Paris Est Créteil, Creteil, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, Université Paris Est Créteil, Creteil, France
| | - Aurelien Amiot
- Department of Gastroenterology, Groupe Hospitalier Henri Mondor-Albert Chennevier, APHP, EC2M3-EA7375, Université Paris Est Créteil, Creteil, France.
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Martin A, Nachury M, Peyrin-Biroulet L, Bouhnik Y, Nancey S, Bourrier A, Serrero M, Fumery M, Buisson A, Laharie D, Gilletta C, Filippi J, Allez M, Bouguen G, Roblin X, Altwegg R, Dib N, Pineton de Chambrun G, Savoye G, Carbonnel F, Viennot S, Amiot A, Martin A, Gagnière C, Nachury M, Pariente B, Wils P, Peyrin-Biroulet L, Zallot C, Bouhnik Y, Treton X, Stefanescu C, Nancey S, Boschetti G, Seksik P, Beaugerie L, Kirchgesner J, Bourrier A, Sokol H, Serrero M, Fumery M, Yzet C, Brazier F, Laharie D, Rivière P, Poullenot F, Buisson A, Gilletta C, Filippi J, Hebuterne X, Allez M, Gornet JM, Bouguen G, Siproudhis L, Roblin X, Altwegg R, Pineton de Chambrun G, Dib N, Savoye G, Carbonnel F, Meyer A, Viennot S, Lebaut G. Maintenance of Remission Among Patients With Inflammatory Bowel Disease After Vedolizumab Discontinuation: A Multicentre Cohort Study. J Crohns Colitis 2020; 14:896-903. [PMID: 31930285 DOI: 10.1093/ecco-jcc/jjaa005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM It is unclear whether vedolizumab therapy can be discontinued in patients with inflammatory bowel disease [IBD] after achieving steroid-free clinical remission. The aim was to assess the risk of relapse after vedolizumab therapy was discontinued. METHODS This was a retrospective observational study, collecting data from 21 tertiary centres affiliated with the GETAID from January 2017 to April 2019. Consecutive patients with IBD, who were in steroid-free clinical remission for at least 3 months and were treated with vedolizumab for at least 6 months, were included at the time of vedolizumab discontinuation. RESULTS A total of 95 patients [58 with Crohn's disease] discontinued vedolizumab after a median duration of therapy of 17.5 [10.6-25.4] months. After a median follow-up period of 11.2 [5.8-17.7] months, 61 [64%] patients experienced disease relapse. The probabilities of relapse-free survival were 83%, 59%, and 36% at 6, 12, and 18 months, respectively. According to the multivariate analysis, a C-reactive protein level less than 5 mg/L at vedolizumab discontinuation (hazard ratio [HR] = 0.56, 95% confidence interval [CI] [0.33-0.95], p = 0.03) and discontinuation due to patients' elective choice (HR = 0.41, 95% CI [0.21-0.80], p = 0.009) were significantly associated with a lower risk of relapse. Re-treatment with vedolizumab was noted in 24 patients and provided steroid-free clinical remission in 71% and 62.5% at Week 14 and after a median follow-up of 11.0 [5.4-13.3] months, respectively, without any infusion reactions. CONCLUSIONS In this retrospective study, two-thirds of patients with IBD treated with vedolizumab experienced relapse within the first year after vedolizumab discontinuation. Re-treatment with vedolizumab was effective in two-thirds of patients.
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Affiliation(s)
- Antoine Martin
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | | | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Anne Bourrier
- Department of Gastroenterology, Sorbonne Univeristé, Centre de Recherche Saint-Antoine, Paris, France
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Mathurin Fumery
- Department of Gastroenterology, Peritox UMRI-01, Amiens University Hospital, Amiens, France
| | - Anthony Buisson
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, CHU Rennes and University of Rennes, NUMECAN Institute, Rennes, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Nina Dib
- Department of HepatoGastroenterology, Angers University Hospital, Angers, France
| | | | - Guillaume Savoye
- Department of Gastroenterology, Bicetre University Hospital, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre University Hospital, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, Paris Est-Créteil Val de Marne University, Creteil, France
| | | | - Antoine Martin
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA7375, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Charlotte Gagnière
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA7375, Paris Est-Créteil Val de Marne University, Creteil, France
| | - Maria Nachury
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | - Benjamin Pariente
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | - Pauline Wils
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | | | - Camille Zallot
- INSERM U954 and Department of Gastroenterology, Université de Lorraine, Nancy, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Xavier Treton
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Carmen Stefanescu
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Gilles Boschetti
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Philippe Seksik
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Laurent Beaugerie
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Julien Kirchgesner
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Anne Bourrier
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Harry Sokol
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, F-75012, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Melanie Serrero
- Hôpital Nord, Centre d’investigation clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Clara Yzet
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Franck Brazier
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Pauline Rivière
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Florian Poullenot
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Anthony Buisson
- Department of Gastroenterology, University of Clermont Ferrand, Clermont-Ferrand, France
| | - Cyrielle Gilletta
- Department of Gastroenterology, Toulouse University Hospital, Toulouse, France
| | - Jérôme Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Xavier Hebuterne
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Matthieu Allez
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Jean-Marc Gornet
- Department of Gastroenterology, Saint-Louis University Hospital, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Laurent Siproudhis
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Xavier Roblin
- Department of Gastroenterology, Saint-Etienne University Hospital, Saint-Etienne, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | | | - Nina Dib
- Department of Gastroenterology, Angers University Hospital, Angers, France
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University Hospital, Rouen, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - Antoine Meyer
- Department of Gastroenterology, Bicetre University Hospital, Le Kremlin-Bicetre, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Guillaume Lebaut
- Department of Gastroenterology, Caen University Hospital, Caen, France
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Beghdadi N, Reitano E, Cochennec F, Desgranges P, Amiot A, Sobhani I, Mongardon N, Langeron O, Notarnicola M, Mulé S, Luciani A, Canoui-Poitrine F, Laurent A, Sommacale D, Brunetti F, De' Angelis N. Predictors of mortality following emergency open colectomy for ischemic colitis: a single-center experience. World J Emerg Surg 2020; 15:40. [PMID: 32600341 PMCID: PMC7325045 DOI: 10.1186/s13017-020-00321-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/17/2020] [Indexed: 11/20/2022] Open
Abstract
Background Ischemic colitis (IC) is a severe emergency in gastrointestinal surgery. The aim of the present study was to identify the predictors of postoperative mortality after emergent open colectomy for IC treatment. Additionally, we compared postoperative outcomes of patients undergoing emergent colectomy due to aortic surgery-related IC (AS-IC group) vs. other IC etiologies (Other-IC group). Methods We analyzed records of consecutive patients who underwent emergency open colectomy for IC between 2008 and 2019. Logistic regression analysis was performed to identify clinical and operative parameters associated with postoperative mortality. The AS-IC and Other-IC groups were compared for mortality, morbidity, ICU stay, hospital stay, and survival. Results During the study period, 94 patients (mean age, 67.4 ± 13.7 years) underwent emergent open colectomy for IC. In the majority of cases, IC involved the entire colon (53.2%) and vasopressor agents were required preoperatively (63.8%) and/or intraoperatively (78.8%). Thirty-four patients underwent surgery due to AS-IC, whereas 60 due to Other-IC causes. In the AS-IC group, 9 patients had undergone endovascular aortic repair and 25 open aortic surgery; 61.8% of patients needed aortic surgery for ruptured abdominal aortic aneurism (AAA). Overall, 66 patients (70.2%) died within 90 days from surgery. The AS-IC and Other-IC groups showed similar operative outcomes and postoperative complication rates. However, the duration of the ICU stay (19 days vs. 11 days; p = 0.003) and of the total hospital stay (22 days vs. 16 days; p = 0.016) was significantly longer for the AS-IC group than for the Other-IC group. The rate of intestinal continuity restoration at 1 year after surgery was higher for the Other-IC group than for the AS-IC group (58.8% vs. 22.2%; p = 0.05). In the multivariate model, preoperative increased lactate levels, a delay between signs/symptoms’ onset and surgery > 12 h, and the occurrence of postoperative acute kidney injury were statistically associated with postoperative mortality. Neither IC etiology (aortic surgery vs. other etiology) nor ruptured AAA was associated with postoperative mortality. Conclusion Emergency open colectomy for IC is associated with high postoperative mortality, which appears to be unrelated to the IC etiology. Preoperative lactate levels, > 12-h delay to surgery, and postoperative acute kidney injury are independent predictors of postoperative mortality.
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Affiliation(s)
- Nassiba Beghdadi
- Unit of Digestive and HPB surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Elisa Reitano
- Unit of Digestive and HPB surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Frederic Cochennec
- Unit of vascular surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, Créteil, France
| | - Pascal Desgranges
- Unit of vascular surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, Créteil, France
| | - Aurelien Amiot
- Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, Créteil, France
| | - Iradj Sobhani
- Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, Créteil, France
| | - Nicolas Mongardon
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France.,Université Paris Est Creteil, Faculté de Santé, 94010, Créteil, France
| | - Olivier Langeron
- Service d'anesthésie-réanimation chirurgicale, DMU CARE, DHU A-TVB, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, 94010, Créteil, France.,Université Paris Est Creteil, Faculté de Santé, 94010, Créteil, France
| | - Margherita Notarnicola
- Unit of Digestive and HPB surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Sébastien Mulé
- Unit of Radiology, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, Créteil, France.,Inserm U955, Team 18, Créteil, France
| | - Alain Luciani
- Unit of Radiology, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, Créteil, France.,Inserm U955, Team 18, Créteil, France
| | - Florence Canoui-Poitrine
- Clinical Epidemiology and Ageing Unit, Henri Mondor Hospital, APHP, EA 7376, CEpiA-IMRB, Université Paris Est, Créteil, France
| | - Alexis Laurent
- Unit of Digestive and HPB surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Daniele Sommacale
- Unit of Digestive and HPB surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Francesco Brunetti
- Unit of Digestive and HPB surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France
| | - Nicola De' Angelis
- Unit of Digestive and HPB surgery, CARE Department, Henri Mondor Hospital, AP-HP, and Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Créteil, France.
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Salameh R, Kirchgesner J, Allez M, Carbonnel F, Meyer A, Gornet JM, Beaugerie L, Amiot A. Long-term outcome of patients with acute severe ulcerative colitis responding to intravenous steroids. Aliment Pharmacol Ther 2020; 51:1096-1104. [PMID: 32342994 DOI: 10.1111/apt.15751] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 11/28/2019] [Accepted: 04/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The long-term outcome of patients with acute severe ulcerative colitis (ASUC) responding to intravenous steroids (IVS) has been poorly reported. AIMS To assess relapse-free survival in patients with ASUC responding to IVS. METHODS Between January 2006 and December 2017, 142 consecutive patients with ASUC (according to modified Truelove-and-Witts criteria) responding to IVS were included in this multicentre retrospective study. Relapse was defined by a partial Mayo Clinic score >4 and/or the need for another maintenance therapy. RESULTS Among the 142 included patients (100 naïve of immunomodulator and/or biological agent) hospitalised for ASUC, 59 (41.5%) were treated at discharge with 5-aminosalicylic acid, 60 (42%) with immunomodulators, 18 (13%) with anti-tumour necrosis factor (TNF) agents and 5 (3.5%) with vedolizumab. After a median follow-up of 4.8 (2.6-7.3) years, 90 (63.4%) had relapsed and 12 (8.5%) had required colectomy. The probabilities of relapse-free survival were 58%, 48% and 40% at 1, 2 and 5 years respectively. The multivariate analysis demonstrated that patients with <6 liquid stools per day at day 3 (hazard ratio 0.56, 95%CI [0.34-0.91]), a partial Mayo Clinic score <2 at day 5 (0.41 [0.21-0.80]) and anti-TNF maintenance therapy (0.37 [0.16-0.87]) were less likely to relapse. The probabilities of colectomy-free survival were 96%, 95% and 91% at 1, 2 and 5 years respectively. CONCLUSION Despite a high relapse rate, patients with ASUC responding to IVS had a low rate of colectomy after 5 years of follow-up. Early response to IVS and maintenance therapy with biological agents were associated with a lower rate of relapse.
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Affiliation(s)
- Robert Salameh
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-Equipe, Universitaire, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Julien Kirchgesner
- Department of Gastroenterology, Sorbonne Univeristé, INSERM, Centre de Recherche Saint-Antoine, CRSA, Paris, France
| | - Matthieu Allez
- Department of Gastroenterology, APHP, Saint-Louis hospital, Paris, France
| | - Franck Carbonnel
- Department of Gastroenterology, APHP, Bicêtre Hospital, Kremlin Bicêtre, France
| | - Antoine Meyer
- Department of Gastroenterology, APHP, Bicêtre Hospital, Kremlin Bicêtre, France
| | - Jean-Marc Gornet
- Department of Gastroenterology, APHP, Saint-Louis hospital, Paris, France
| | - Laurent Beaugerie
- Department of Gastroenterology, Sorbonne Univeristé, INSERM, Centre de Recherche Saint-Antoine, CRSA, Paris, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-Equipe, Universitaire, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
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Bergsten E, Mestivier D, Amiot A, DeAngelis N, Khazaie K, Sobhani I. Immune tolerance to colon cancer is mediated by colon dysbiosis: Human results and experimental In Vivo validation. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e16062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16062 Background: Lynch syndrome (Ly) but not Sporadic (Sp) CRC patients are responsive to immunotherapies. We have shown micorbiota from CRC patients induces precancerous colonic lesions in germ-free mice. The aim was to investigate microbiota linked compromised anti tumor immune response. Methods: We compared 1) Whole metagenomic fecal microbiotas of CRC patients [Sp, n = 53+Ly, n = 19] to controls (n = 90) or being first degree relatives of Ly patients (n = 14), respectively; 2) Tumoral to normal mucosa-adherent microbiota (16sRNA sequences); 3) Normal to tumoral tissues’ mRNA RT-PCRs of IL1b, IL4, IL6, IL8, IL17, TNFa, TGFb, FasL, Granzyme A&B, Thy1; 4) CD3, CD4, CD8, Granzym, KL1, FoxP3, RORgT, MastCell, cells in tumor tissues quantified by immunohistochemistry (IHC), between subgroups. Associations between bacteria, tissue immune cell infiltrates and clinical data (3-yrs follow up or death) were established by using unsupervised Systems Biology and Bioinformatics analyses (Institut Pasteur Shaman platform and Qlucor program). Anti tumoral immune response links with bacteria were based on differences between Ly and Sp CRC patients. Tumor tolerance links with bacteria were identified using germ-free mice (n = 185) who orally received microbiota (9 Sp CRC patients vs 9 controls) with colonic mucosa examined 3 months after human fecal transfer (whole exome sequencing, methylchips, IHC for CD3, CD11b, FoxP3, RORgT, ILC3). Results: Enrichment in Peptostreptococcus, Thermodesulfovibrio and diminution in Ruminococcus, Eubacterium, Coprococcus were linked with FoxP3 and IL-17 over expressions in tumor tissues. Enrichment in Escherichia, Enterobacter, Thioalkalimicrobium, and diminution in Eubacterium, Faecalibacterium and Butyrovibrio were associated with higher FoxP3, FasL, Granzyms A&B, Perforin, Thy1 mRNAs/mRNACD3. Diminution of Eubacterium, Dorea, Faecalibacterium genera and enrichment in Fusobacterium, E. Coli/Shigella were associated with higher CD3, FoxP3, GranzymA and B and FOXP3-RORgT cells in tumor tissues. Higher fecal enrichments in oral bacteria (parvimonas micra) and lack of Thermodesulfovibrio enrichment were associated with higher FoxP3-RORgt cells and short survival; in mice ILC3 and FoxP3-RORgT cells were linked with Sp CRC dysbiosis. Species linked with immunotolerance are identified. Conclusions: Fecal and tissue microbiota can impact failure of anti tumoral immune response in sporadic CRC patients by enhancing overexpression of IL-17 and reducing cytotoxic T-cell infiltration in tumors. Clinical trial information: NCT01270360 .
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Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EA7375, Est-Créteil Univeristy (UPEC), Creteil, France
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Amiot A. Letter: new insights on tofacitinib dose de-escalation. Aliment Pharmacol Ther 2020; 51:578. [PMID: 32048759 DOI: 10.1111/apt.15638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EA7375, Paris Est-Créteil Univeristy (UPEC), Creteil, France
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Dulai PS, Amiot A, Peyrin‐Biroulet L, Jairath V, Serrero M, Filippi J, Singh S, Pariente B, Loftus EV, Roblin X, Kane S, Buisson A, Siegel CA, Bouhnik Y, Sandborn WJ, Lasch K, Rosario M, Feagan BG, Bojic D, Trang‐Poisson C, Shen B, Altwegg R, Sands BE, Colombel J, Carbonnel F. A clinical decision support tool may help to optimise vedolizumab therapy in Crohn's disease. Aliment Pharmacol Ther 2020; 51:553-564. [PMID: 31867766 PMCID: PMC7028036 DOI: 10.1111/apt.15609] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/21/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND A clinical decision support tool (CDST) has been validated for predicting treatment effectiveness of vedolizumab (VDZ) in Crohn's disease. AIM To assess the utility of this CDST for predicting exposure-efficacy and disease outcomes. METHODS Using data from three independent datasets (GEMINI, GETAID and VICTORY), we assessed clinical remission rates and measured VDZ exposure, rapidity of onset of action, response to dose optimisation and progression to surgery by CDST-defined response groups (low, intermediate and high). RESULTS A linear relationship existed between CDST-defined groups, measured VDZ exposure, rapidity of onset of action and efficacy in GEMINI through week 52 (P < 0.001 at all time points across three CDST-defined groups). In GETAID, CDST predicted differences in clinical remission at week 14 (AUC = 0.68) and rapidity of onset of action (P = 0.04) between probability groups. The high-probability patients did not benefit from shortening of infusion intervals, and differences in onset of action between the high-intermediate and low-probability groups within GETAID were no longer significant when including low-probability patients who received a week 10 infusion. CDST predicted a twofold increase in surgery risk over 12 months of VDZ therapy among low- to intermediate-probability vs high-probability patients (adjusted HR 2.06, 95% CI 1.33-3.21). CONCLUSIONS We further extended the clinical utility of a previously validated VDZ CDST, which accurately predicts at baseline exposure-efficacy relationships and rapidity of onset of action and could be used to help identify patients who would most benefit from interval shortening and those most likely to require surgery while on active therapy.
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Petitdidier N, Tannoury J, de'Angelis N, Gagniere C, Hulin A, Rotkopf H, Mesli F, Brunetti F, Sobhani I, Amiot A. Patients' perspectives after switching from infliximab to biosimilar CT-P13 in patients with inflammatory bowel disease: A 12-month prospective cohort study. Dig Liver Dis 2019; 51:1652-1660. [PMID: 31718934 DOI: 10.1016/j.dld.2019.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/17/2019] [Accepted: 08/19/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Patients' perspectives after switching from infliximab to a biosimilar have yet to be assessed. AIM To assess patients' perspectives in a prospective manner after switching from infliximab to CT-P13. METHODS 113 consecutive patients with inflammatory bowel disease (IBD) on maintenance therapy with infliximab were switched to CT-P13. Patients' perspectives were assessed by questionnaires, including the Beliefs about Medicines Questionnaire (BMQ) and FACIT-F (questionnaire regarding fatigue), and patient-reported outcomes (IBD disability index) at the inclusion and after the fourth CT-P13 infusion. RESULTS After one year, the patients' perspectives did not change after the switch according to BMQ-general, BMQ-specific necessity and BMQ-specific concerns subscales. No difference was observed in the mean IBD-DI score, while a significant improvement in fatigue was observed according to the FACIT-F questionnaire. Patients' concerns were raised about the use of biosimilars and the risks of switching with a significant improvement after switching (65% vs. 42%, respectively, p = 0.01). Fourteen (12.4%) patients experienced loss of response to CT-P13, including 12 with restoration of steroid-free clinical remission after CT-P13 dose optimization. CONCLUSION Although some concerns were reported, no difference was observed in patients' perspectives after switching from infliximab to CT-P13.
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Affiliation(s)
- Nicolas Petitdidier
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Jenny Tannoury
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Nicola de'Angelis
- Department of Digestive Surgery, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Charlotte Gagniere
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Anne Hulin
- Laboratory of Pharmacology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Hugo Rotkopf
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Farida Mesli
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Francesco Brunetti
- Department of Digestive Surgery, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Iradj Sobhani
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA 7375, Paris Est-Créteil (UPEC) Val de Marne University, Creteil, France.
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Caron B, Peyrin-Biroulet L, Pariente B, Bouhnik Y, Seksik P, Bouguen G, Caillo L, Laharie D, Carbonnel F, Altwegg R, Reenaers C, Serrero M, Trang-Poisson C, Nancey S, Filippi J, Abitbol V, Savoye G, Vuitton L, Viennot S, Fumery M, Reymond M, Bronowicki JP, Reimund JM, Amiot A. Vedolizumab Therapy is Ineffective for Primary Sclerosing Cholangitis in Patients With Inflammatory Bowel Disease: A GETAID Multicentre Cohort Study. J Crohns Colitis 2019; 13:1239-1247. [PMID: 31056693 DOI: 10.1093/ecco-jcc/jjz088] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Whether vedolizumab may be effective as a treatment for primary sclerosing cholangitis [PSC] in patients with inflammatory bowel disease [IBD] remains controversial. METHODS We performed a retrospective observational study of consecutive patients with IBD and PSC, treated with vedolizumab for at least 30 weeks in 22 centres of GETAID from January 2015 to June 2016. The outcomes included a decrease in the serum alkaline phosphatase [ALP] concentration of at least 50% from baseline to Week 30 or 54, a change in any serum liver enzymes concentrations, and an assessment of the efficacy and safety of vedolizumab in IBD. RESULTS Among 75 patients with active IBD and PSC treated with vedolizumab, 21 patients discontinued vedolizumab before Week 30 [due to lack of efficacy in 19 and malignancy in two patients]. In the remaining 54 patients, a decrease in the serum ALP concentration of at least 50% from baseline to Weeks 30 and 54 was observed in four [7%] and four [11%] patients, respectively. No significant change was observed in serum liver enzyme concentrations at week 30 or 54. After a median follow-up period of 19.4 [14.0-29.9] months, nine cases of digestive neoplasia [colorectal neoplasia in seven and cholangiocarcinoma in two] were reported. CONCLUSIONS In patients with IBD and PSC, vedolizumab did not improve serum liver enzyme concentrations at week 30 or 54. Nine cases of digestive cancer occurred during the follow-up period, confirming the need for a tight surveillance programme in this population.
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Affiliation(s)
- Benedicte Caron
- Department of Gastroenterology, Hôpitaux Universitaires de Strasbourg [Hôpital de Hautepierre] and INSERM U1113 IRFAC, Université de Strasbourg [Faculté de Médecine], Strasbourg, France
| | | | - Benjamin Pariente
- Department of Gastroenterology, Huriez Hospital, Université of Lille, Lille, France
| | - Yoram Bouhnik
- Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France
| | - Philippe Seksik
- Department of Gastroenterology, AP-HP, Hôpital Saint-Antoine, ERL 1057 INSERM/UMRS 7203, UPMC Université Paris 6, Paris, France
| | - Guillaume Bouguen
- Department of Gastroenterology, Pontchaillou Hospital and Rennes University, Rennes, France
| | - Ludovic Caillo
- Department of Gastroenterology, Nimes University Hospital, Nimes, France
| | - David Laharie
- Department of Hepato-Gastroenterology, University Hospital of Bordeaux, Hôpital Haut-Lévêque, Bordeaux, France
| | - Franck Carbonnel
- Department of Gastroenterology, Bicetre University Hospital, APHP, Université Paris Sud, le Kremlin Bicêtre, Paris, France
| | - Romain Altwegg
- Department of Gastroenterology, Hôpital Saint-Eloi, University Hospital of Montpellier, Montpellier, France
| | - Catherine Reenaers
- Department of Gastroenterology, Liege University Hospital, Liege, Belgium
| | - Melanie Serrero
- Hôpital Nord, Centre d'investigation clinique Marseille Nord, Université Méditerranée, Marseille, France
| | - Caroline Trang-Poisson
- Department of Gastroenterology, Institut des Maladies de l'appareil Digestif [IMAD], University Hospital of Nantes, Nantes University, Nantes, France
| | - Stephane Nancey
- Department of Gastroenterology, Hospices Civils de Lyon and University Claude Bernard Lyon 1, Pierre-Benite, France
| | - Jerome Filippi
- Department of Gastroenterology and Clinical Nutrition, Nice University Hospital, University of Nice Sophia-Antipolis, Nice, France
| | - Vered Abitbol
- Department of Gastroenterology, Cochin Hospital, University Paris 5 Descartes, Paris, France
| | - Guillaume Savoye
- Department of Gastroenterology, Rouen University and Hospital, Rouen, France
| | - Lucine Vuitton
- Department of Gastroenterology, Besançon University Hospital, Besançon, France
| | - Stephanie Viennot
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University Hospital, Amiens, France
| | - Maud Reymond
- Department of Hepato-Gastroenterology, University Hospital Estaing of Clermont-Ferrand, Université d'Auvergne, Clermont-Ferrand, France
| | | | - Jean-Marie Reimund
- Department of Gastroenterology, Hôpitaux Universitaires de Strasbourg [Hôpital de Hautepierre] and INSERM U1113 IRFAC, Université de Strasbourg [Faculté de Médecine], Strasbourg, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, EC2M3-EA7375, Paris Est-Créteil Val de Marne University, Creteil, France
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Briot C, Faure P, Parmentier AL, Nachury M, Trang C, Viennot S, Altwegg R, Bulois P, Thomassin L, Serrero M, Ah-Soune P, Gilletta C, Plastaras L, Simon M, Dray X, Caillo L, Del Tedesco E, Abitbol V, Zallot C, Degand T, Rossi V, Bonnaud G, Colin D, Morel B, Winkfield B, Danset JB, Filippi J, Amiot A, Attar A, Levy J, Peyrin-Biroulet L, Vuitton L. Efficacy, Tolerability, and Safety of Low-Volume Bowel Preparations for Patients with Inflammatory Bowel Diseases: The French Multicentre CLEAN Study. J Crohns Colitis 2019; 13:1121-1130. [PMID: 30785181 DOI: 10.1093/ecco-jcc/jjz040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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] [Indexed: 02/08/2023]
Abstract
BACKGROUND Standard high-volume polyethylene glycol [PEG] bowel preparations [PEG-4L] are recommended for patients with inflammatory bowel disease [IBD] undergoing colonoscopy. However, low-volume preparations [≤2 L of active volume] are often used in clinical practice. The aim of this study was to evaluate the efficacy, tolerability, and safety of the various bowel preparations for patients with IBD, including low-volume preparations. METHODS We conducted a French prospective multicentre observational study over a period of 1 month. Patients aged 18-75 years with IBD with an indication of colonoscopy independent of the study were enrolled. The choice of the preparation was left to the investigators, as per their usual protocol. The patients' characteristics, disease, and colonoscopy characteristics were recorded, and they were given self-reported questionnaires. RESULTS Twenty-five public and private hospitals enrolled 278 patients. Among them, 46 had a disease flare and 41 had bowel stenoses. Bowel preparations for colonoscopy were as follows: 42% received PEG-2L, 29% received sodium picosulfate [Pico], 15% received PEG-4L, and 14% had other preparations. The preparation did not reach the Boston's score efficacy outcome in the PEG-4L group in 51.2% of the patients [p = 0.0011]. The preparation intake was complete for 59.5% in the PEG-4L group, compared with 82.9% in the PEG-2L group and 93.8% in the Pico group [p < 0.0001]. Tolerability, as assessed by the patients' VAS, was significantly better for both Pico and PEG-2L compared with PEG-4L, and better for Pico compared with PEG-2L [p = 0.008; p = 0.0003]. In multivariate analyses, low-volume preparations were independent factors of efficacy and tolerability. Adverse events occurred in 4.3% of the patients. CONCLUSIONS Preparations with PEG-2L and Pico were equally safe, with better efficacy and tolerability outcomes compared with PEG-4L preparations. The best efficacy/tolerance/safety profile was achieved with the Pico preparation.
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Affiliation(s)
- C Briot
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
| | - P Faure
- Department of Gastroenterology, Clinique Pasteur, Toulouse, France
| | - A L Parmentier
- Centre de Méthodologie Clinique, University Hospital of Besançon, Besançon, France
| | - M Nachury
- Gastroenterology Department, University Hospital of Lille, Lille, France
| | - C Trang
- Department of Hepatology and Gastroenterology, University Hospital Hotel Dieu, Nantes, France
| | - S Viennot
- Gastroenterology Department, University Hospital of Caen, Caen, France
| | - R Altwegg
- Department of Hepatology and Gastroenterology, University Hospital of St Eloi, Montpellier, France
| | - P Bulois
- Department of Gastroenterology, Hôpital Privé la Louvière, Ramsay Générale de Santé, Lille, France
| | - L Thomassin
- Department of Gastroenterology, University Hospital Charles Nicolle, Rouen, France
| | - M Serrero
- Department of Gastroenterology, APHM, Hopital Nord, Marseille, France
| | - P Ah-Soune
- Department of Hepatology and Gastroenterology, Toulon - La Seyne-sur-Mer Hospital, Toulon, France
| | - C Gilletta
- Department of Gastroenterology, University Hospital Rangueuil, Toulouse, France
| | - L Plastaras
- Department of Hepato-Gastroenterology, Hospital Pasteur, Colmar, France
| | - M Simon
- Gastroenterology Department, Institut Mutualiste Montsouris, Paris, France
| | - X Dray
- Department of Gastroenterology, Sorbonne University & APHP, Hôpital Saint-Antoine, Paris, France
| | - L Caillo
- Department of Gastroenterology and Hepatology, University Hospital Caremeau, Nimes, France
| | - E Del Tedesco
- Department of Gastroenterology, University Hospital of Saint-Etienne, Saint Priest en Jarez, France
| | - V Abitbol
- Department of Gastroenterology, University Hospital Cochin, Paris, France
| | - C Zallot
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - T Degand
- Department of Gastroenterology, University Hospital Le Bocage, Dijon, France
| | - V Rossi
- Department of Gastroenterology, Hospital Haut Anjou, Château Gontier, France
| | - G Bonnaud
- Clinique Ambroise Paré, Toulouse, France
| | - D Colin
- Department of Gastroenterology, Clinique de la Miotte, Belfort, France
| | - B Morel
- Department of Gastroenterology, Centre Hospitalier de Villefranche-sur-Saône, Gleizé, France
| | - B Winkfield
- Department of Hepatology and Gastroenterology, Hôpital Nord Franche-Comté, Trevenans, France
| | - J B Danset
- Department of HepatoGastroenterology, European Georges-Pompidou Hospital, APHP, Paris, France
| | - J Filippi
- Department of Gastroenterology, University Hospital L'Archet, Nice, France
| | - A Amiot
- Department of Gastroenterology, Henri Mondor Hospital, APHP, Creteil, France
| | - A Attar
- Gastroenterology Department, Beaujon University Hospital, Clichy, France
| | - J Levy
- Department of Gastroenterology, Clinique des Cèdres, Cornebarrieu, France
| | - L Peyrin-Biroulet
- Department of Gastroenterology, Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - L Vuitton
- Department of Gastroenterology, University Hospital of Besançon, University Bourgogne Franche-Comté, Besançon, France
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Amiot A, Serrero M, Peyrin-Biroulet L, Filippi J, Pariente B, Roblin X, Buisson A, Stefanescu C, Trang-Poisson C, Altwegg R, Marteau P, Vaysse T, Bourrier A, Nancey S, Laharie D, Allez M, Savoye G, Moreau J, Vuitton L, Viennot S, Bouguen G, Abitbol V, Fumery M, Gagniere C, Bouhnik Y. Three-year effectiveness and safety of vedolizumab therapy for inflammatory bowel disease: a prospective multi-centre cohort study. Aliment Pharmacol Ther 2019; 50:40-53. [PMID: 31165509 DOI: 10.1111/apt.15294] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/23/2019] [Accepted: 04/19/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cohort studies have described the short-term effectiveness and safety of vedolizumab in treating patients with Crohn's disease (CD) and ulcerative colitis (UC), but data beyond 1 year are lacking. AIM To assess the effectiveness and safety of vedolizumab after 162 weeks in patients with UC and CD. METHODS Between June and December 2014, 294 patients including 173 patients with CD and 121 with UC were treated with vedolizumab induction therapy. Among them, 149 continued to be treated with vedolizumab beyond week 54 (78 patients with CD and 71 with UC). Disease activity was assessed using the Harvey-Bradshaw Index for CD and the partial Mayo Clinic score for UC. The primary outcome was steroid-free clinical remission at week 162, computed for the whole population included at week 0. RESULTS Steroid-free clinical remission rates at week 162 were 19.9% and 36.1% in patients with CD and UC respectively. Vedolizumab dose optimisation to 300 mg every 4 weeks instead of 300 mg every 8 weeks was at investigator's discretion and occurred in 58.7% and 52.1% of patients with CD and UC respectively. The 1-, 2- and 3-year persistence rates of vedolizumab were 48.5%, 31.4% and 26.3% respectively, in patients with CD and 61.0%, 49.9% and 42.9% respectively, in patients with UC. No new safety signal was identified. CONCLUSION Vedolizumab is able to maintain steroid-free clinical remission in patients with UC and CD up to week 162. Loss of response resulting in discontinuation of vedolizumab occurred in 10% of patients per year.
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Gendreau S, Amiot A, Le Baleur Y, Charpy C, Wolkenstein P, Chosidow O, Mekontso Dessap A, Ingen‐Housz‐Oro S, Prost N. Gastrointestinal involvement in Stevens–Johnson syndrome and toxic epidermal necrolysis: a retrospective case series. Br J Dermatol 2019; 180:1234-1235. [DOI: 10.1111/bjd.17428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- S. Gendreau
- Service de Réanimation Médicale Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
| | - A. Amiot
- Service de Gastro‐entérologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
| | - Y. Le Baleur
- Service de Gastro‐entérologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
| | - C. Charpy
- Département de pathologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
| | - P. Wolkenstein
- Service de Dermatologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) Créteil France
- Reference Center for Toxic Bullous Diseases Créteil France
| | - O. Chosidow
- Service de Dermatologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) Créteil France
- Reference Center for Toxic Bullous Diseases Créteil France
| | - A. Mekontso Dessap
- Service de Réanimation Médicale Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
- Groupe de Recherche Clinique CARMAS Université Paris Est‐Créteil Créteil France
| | - S. Ingen‐Housz‐Oro
- Service de Dermatologie Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) Créteil France
- Reference Center for Toxic Bullous Diseases Créteil France
| | - N. Prost
- Service de Réanimation Médicale Hôpitaux Universitaires Henri Mondor – Albert Chenevier, Assistance Publique – Hôpitaux de Paris (AP‐HP) CréteilFrance
- Reference Center for Toxic Bullous Diseases Créteil France
- Groupe de Recherche Clinique CARMAS Université Paris Est‐Créteil Créteil France
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Gendreau S, Amiot A, Wolkenstein P, Chosidow O, Mekontso Dessap A, Oro S, de Prost N. Atteinte digestive au cours des nécrolyses épidermiques. Ann Dermatol Venereol 2018. [DOI: 10.1016/j.annder.2018.09.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gagnière C, Bourrier A, Seksik P, Gornet JM, DeWit O, Nancey S, Altwegg R, Abitbol V, Laharie D, Reenaers C, Buisson A, Pariente B, Viennot S, Vuitton L, Stefanescu C, Marteau P, Bouguen G, Cosnes J, Amiot A. Risk of serious infection in healthcare workers with inflammatory bowel disease: a case-control study of the Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID). Aliment Pharmacol Ther 2018; 48:713-722. [PMID: 30069921 DOI: 10.1111/apt.14926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 03/10/2018] [Accepted: 07/07/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Whether healthcare workers with inflammatory bowel disease (IBD) are at increased risk of severe infection due to daily pathogen exposure is controversial. AIM To assess the risk of severe infection in healthcare workers with IBD in a large multicentre case-control study. METHODS The study population comprised 482 healthcare workers with IBD from 17 centres who were matched for gender, age, disease subtype and year of diagnosis to 482 controls (non-healthcare workers with IBD). The study period was between the date of diagnosis of IBD and June 2016. Severe infection was defined as any community-acquired infection that required hospitalisation. RESULTS With a median follow-up of 9.3 years, 139 severe infections were recorded among cases and controls, including 30 Clostridium difficile infections, 33 severe viral infections, nine tuberculosis infections, 21 community-acquired pneumonia and 46 others. No difference was observed between healthcare workers and controls regarding the overall incidence rates of severe infection. An increased risk of tuberculosis was noted in healthcare workers. In multivariate analysis in the entire study population, severe infection was associated with current exposure to corticosteroids (OR = 3.05, 95% CI [2.06-4.52], P < 0.001), immunosuppressants (OR = 1.98, 95% CI [1.38-2.84], P < 0.001) and anti-TNF agents (OR = 2.93, 95% CI [2.02-4.27], P < 0.001) and reduced with Crohn's disease (OR = 0.63, 95% CI [0.43-0.91], P = 0.01). CONCLUSIONS Healthcare workers with IBD do not have an increased risk of severe infection compared with other patients with IBD, except for tuberculosis. Screening for tuberculosis exposure should be assessed in this high-risk population when treated with anti-TNF agents.
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48
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Wils P, Bouhnik Y, Michetti P, Flourie B, Brixi H, Bourrier A, Allez M, Duclos B, Serrero M, Buisson A, Amiot A, Fumery M, Roblin X, Peyrin-Biroulet L, Filippi J, Bouguen G, Abitbol V, Coffin B, Simon M, Laharie D, Pariente B. Long-term efficacy and safety of ustekinumab in 122 refractory Crohn's disease patients: a multicentre experience. Aliment Pharmacol Ther 2018; 47:588-595. [PMID: 29315694 DOI: 10.1111/apt.14487] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 10/19/2017] [Accepted: 12/05/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term outcome of ustekinumab in Crohn's disease (CD) has not been evaluated. AIM To evaluate the long-term efficacy and safety of ustekinumab and identify the predictive factors of ustekinumab failure-free persistence in a cohort of anti-TNF refractory CD patients. METHODS We performed a retrospective multicentre cohort study including all consecutive CD patients who began subcutaneous ustekinumab and presented a clinical response (defined as a significant improvement of CD-related clinical symptoms assessed by the patient's physician leading to continued ustekinumab) during the first year of treatment. Primary outcome was treatment failure defined as withdrawal of treatment due to loss of response, intolerance or need for surgery. RESULTS Eighty-eight of the 122 (72%) CD patients beginning ustekinumab from March 2011 to December 2014, responded to ustekinumab and were followed up until November 2016. Median time on ustekinumab was 26.6 (13.4-34.4) months. Forty-seven patients (54%) continued ustekinumab with a clinical response and 38 (43%) stopped treatment (32 for failure, five for remission and one for pregnancy). Endoscopic response was observed in 82% of patients with endoscopic evaluation and mucosal healing in 39%. Ustekinumab failure-free persistence rates were 78% at 12 months, 66% at 24 months and 55% at 36 months. No predictive factor of ustekinumab failure-free persistence was identified. One severe adverse event was observed (anal adenocarcinoma). CONCLUSION In this cohort of refractory CD patients receiving long-term ustekinumab therapy, more than 50% of patients continued ustekinumab treatment with no loss of response, intolerance or surgery and with a good safety profile.
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49
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Laharie D, Bourreille A, Branche J, Allez M, Bouhnik Y, Filippi J, Zerbib F, Savoye G, Vuitton L, Moreau J, Amiot A, Cosnes J, Ricart E, Dewit O, Lopez-Sanroman A, Fumery M, Carbonnel F, Bommelaer G, Coffin B, Roblin X, van Assche G, Esteve M, Farkkila M, Gisbert JP, Marteau P, Nahon S, de Vos M, Lambert J, Mary JY, Louis E. Long-term outcome of patients with steroid-refractory acute severe UC treated with ciclosporin or infliximab. Gut 2018; 67:237-243. [PMID: 28053054 DOI: 10.1136/gutjnl-2016-313060] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 12/09/2016] [Accepted: 12/11/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Ciclosporin and infliximab have demonstrated short-term similar efficacy as second-line therapies in patients with acute severe UC (ASUC) refractory to intravenous steroids. The aim of this study was to assess long-term outcome of patients included in a randomised trial comparing ciclosporin and infliximab. DESIGN Between 2007 and 2010, 115 patients with steroid-refractory ASUC were randomised in 29 European centres to receive ciclosporin or infliximab in association with azathioprine. Patients were followed until death or last news up to January 2015. Colectomy-free survival rates at 1 and 5 years and changes in therapy were estimated through Kaplan-Meier method and compared between initial treatment groups through log-rank test. RESULTS After a median follow-up of 5.4 years, colectomy-free survival rates (95% CI) at 1 and 5 years were, respectively, 70.9% (59.2% to 82.6%) and 61.5% (48.7% to 74.2%) in patients who received ciclosporin and 69.1% (56.9% to 81.3%) and 65.1% (52.4% to 77.8%) in those who received infliximab (p=0.97). Cumulative incidence of first infliximab use at 1 and 5 years in patients initially treated with ciclosporin was, respectively, 45.7% (32.6% to 57.9%) and 57.1% (43.0% to 69.0%). Only four patients from the infliximab group were subsequently switched to ciclosporin. Three patients died during the follow-up, none directly related to UC or its treatment. CONCLUSIONS In this cohort of patients with steroid-refractory ASUC initially treated by ciclosporin or infliximab, long-term colectomy-free survival was independent from initial treatment. These long-term results further confirm a similar efficacy and good safety profiles of both drugs and do not favour one drug over the other. TRIAL REGISTRATION NUMBER EudraCT: 2006-005299-42; ClinicalTrials.gouv number: NCT00542152; post-results.
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Affiliation(s)
- D Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive-Université de Bordeaux, Bordeaux, France
| | - A Bourreille
- CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, Nantes, France
| | - J Branche
- CHRU de Lille, Hôpital Claude Huriez, Service des maladies de l'appareil digestif-Endoscopie digestive, Lille, France
| | - M Allez
- Hôpital Saint-Louis, service d'Hépato-Gastroentérologie, APHP-Université Paris VII, Paris, France
| | - Y Bouhnik
- Hôpital Beaujon, Gastroentérologie, MICI et Assistance Nutritive, APHP-Université Paris VII, Clichy, France
| | - J Filippi
- CHU de Nice, Hôpital de l'Archet 2, Service de Gastroentérologie et Nutrition Clinique, Nice, France
| | - F Zerbib
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et oncologie digestive-Université de Bordeaux, Bordeaux, France
| | - G Savoye
- CHU de Rouen, Hôpital Charles Nicolle, service de Gastroentérologie, UMR 1073″, Normandie Université-Rouen, Rouen, France
| | - L Vuitton
- CHU de Besançon, Hôpital Jean Minjoz, Service de Gastroentérologie, Besançon, France
| | - J Moreau
- CHU de Toulouse, Hôpital Rangueil, Service de Gastro-entérologie et Nutrition, Toulouse, France
| | - A Amiot
- Hôpital Henri Mondor, Service d'Hépato-gastroentérologie, APHP-Université Créteil, Créteil, France
| | - J Cosnes
- Hôpital St-Antoine, service de Gastroentérologie, Paris, France
| | - E Ricart
- Gastroenterology Department, Hospital. Clinic, IDIBAPS, CIBEREHD, Barcelona, Spain
| | - O Dewit
- UCL Saint Luc, Service d'Hépato-Gastroentérologie, Brussels, Belgium
| | - A Lopez-Sanroman
- Hospital Ramon y Cajal, Unidad de EII/IBD Unit, Servicio de Gastroenterología y Hepatología, Madrid, Spain
| | - M Fumery
- CHU Amiens, Hôpital Nord, service d'Hépato-Gastroentérologie, Amiens, France
| | - F Carbonnel
- Hôpital Bicêtre, service d'Hépato-Gastroentérologie, APHP-Université Paris Sud 11,Le Kremlin Bicêtre, France
| | - G Bommelaer
- CHU Clermont-Ferrand, Service Hépatologie-Gastro-entérologie, Clermont-Ferrand, France
| | - B Coffin
- Hôpital Louis Mourier, service d'Hépato-Gastroentérologie, Pôle Maladie Appareil Digestif, APHP-Université Paris VII, Colombes, France
| | - X Roblin
- CHU de Saint-Etienne, Hôpital Nord, Service de Gastro-entérologie et Hépatologie, Saint-Etienne, France
| | - G van Assche
- Division of Gastroenterology, University Hospital of Leuven, Leuven, Belgium
| | - M Esteve
- Department of Gastroenterology, Hospital Universitari Mútua de Terrassa, University of Barcelona, Terrassa. CIBEREHD, Catalonia, Spain
| | - M Farkkila
- Helsinki University, and Helsinki University Central Hospital, Clinic of Gastroenterology, HUS, Finland
| | - J P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP) y Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - P Marteau
- Hôpital St-Antoine, service de Gastroentérologie, Paris, France
| | - S Nahon
- CHI Le Raincy Montfermeil, Service d'Hépato-gastroentérologie, Montfermeil, France
| | - M de Vos
- Ghent University Hospital, Gent, Belgium
| | - J Lambert
- UMR-S- 1153 Inserm, Equipe ECSTRA, Denis Diderot-Paris 7 University, Hôpital Saint-Louis, Paris, France
| | - J Y Mary
- UMR-S- 1153 Inserm, Equipe ECSTRA, Denis Diderot-Paris 7 University, Hôpital Saint-Louis, Paris, France
| | - E Louis
- Department of Gastroenterology, University Hospital CHU of Liège, Liège, Belgium
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Rentien AL, Lévy M, Copie-Bergman C, Gagniere C, Dupuis J, Le Baleur Y, Belhadj K, Sobhani I, Haioun C, Delchier JC, Amiot A. Long-term course of precancerous lesions arising in patients with gastric MALT lymphoma. Dig Liver Dis 2018; 50:181-188. [PMID: 29102522 DOI: 10.1016/j.dld.2017.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/11/2017] [Accepted: 10/13/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS To evaluate the prevalence and the long-term course of gastric precancerous lesions in patients with GML. PATIENTS AND METHODS In this retrospective single-centre study, we included 179 patients with GML, 70 with gastric diffuse large B-cell lymphoma (GDLBCL) and 152 with Helicobacter pylori-associated gastritis (HpG), from January 1995 to January 2014. The presence of atrophic gastritis, intestinal metaplasia and neoplastic lesion has been assessed at baseline and during follow-up. RESULTS Atrophic gastritis was more frequent in the GML group whereas there was also a trend for intestinal metaplasia and gastric dysplasia. In patients with GML, atrophic gastritis, intestinal metaplasia and gastric dysplasia were more frequent in the GML area than in other part of the stomach. During follow-up, the prevalence of atrophic gastritis remained stable overtime whereas intestinal metaplasia and dysplasia tend to increase overtime. In multivariate analysis, the occurrence of dysplasia or carcinoma was associated with the presence of intestinal metaplasia at baseline and male gender. CONCLUSION GML is associated with gastric precancerous lesion to a higher extent than GDLBCL and HpG. Those precancerous lesions do not regress despite achievement of complete remission of GML and tend to increase overtime.
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Affiliation(s)
- Anne-Laure Rentien
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France; Paris Est-Creteil University (UPEC), Creteil F-94010, France; EC2M3-EA7375 Unit, Creteil, France
| | - Michaël Lévy
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Christiane Copie-Bergman
- Paris Est-Creteil University (UPEC), Creteil F-94010, France; Department of Pathology, Henri Mondor University Hospital, APHP, Creteil F-94010, France; Unit UMR-S 955, INSERM, Creteil F-94010, France
| | - Charlotte Gagniere
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France; Paris Est-Creteil University (UPEC), Creteil F-94010, France; EC2M3-EA7375 Unit, Creteil, France
| | - Jehan Dupuis
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Yann Le Baleur
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Karim Belhadj
- Lymphoid Malignancies Unit, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Iradj Sobhani
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Corinne Haioun
- Paris Est-Creteil University (UPEC), Creteil F-94010, France; Unit UMR-S 955, INSERM, Creteil F-94010, France; Lymphoid Malignancies Unit, Henri Mondor University Hospital, APHP, Creteil F-94010, France
| | - Jean-Charles Delchier
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France; Paris Est-Creteil University (UPEC), Creteil F-94010, France
| | - Aurelien Amiot
- Department of Gastroenterology, Henri Mondor University Hospital, APHP, Creteil F-94010, France; Paris Est-Creteil University (UPEC), Creteil F-94010, France; EC2M3-EA7375 Unit, Creteil, France.
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