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Visuri I, Eriksson C, Karlqvist S, Lykiardopoulos B, Karlén P, Grip O, Söderman C, Almer S, Hertervig E, Marsal J, Malmgren C, Delin J, Strid H, Sjöberg M, Bergemalm D, Hjortswang H, Halfvarson J. Long-term outcomes of vedolizumab in inflammatory bowel disease: the Swedish prospective multicentre SVEAH extension study. Therap Adv Gastroenterol 2023; 16:17562848231174953. [PMID: 37274297 PMCID: PMC10236258 DOI: 10.1177/17562848231174953] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
Background Real-world data on long-term outcomes of vedolizumab (VDZ) are scarce. Objective To assess long-term outcomes (up to 3 years) of VDZ in treating inflammatory bowel disease (IBD). Design A nationwide, prospective multicentre extension of a Swedish observational study on VDZ assessing Effectiveness And Healthcare resource utilization in patients with IBD (SVEAH). Methods After re-consent, data of patients with Crohn's disease (CD) (n = 68) and ulcerative colitis (UC) (n = 46) treated with VDZ were prospectively recorded using an electronic case report form integrated with the Swedish IBD Register (SWIBREG). The primary outcome was clinical remission (defined as Harvey-Bradshaw Index ⩽4 in CD and partial Mayo score ⩽2 in UC) at 104 and 156 weeks in patients with a response and/or remission 12 weeks after starting VDZ. Secondary outcomes included health-related quality of life (HRQoL) and biochemical outcomes. Results VDZ continuation rates were high at weeks 104 and 156, 88% and 84%, respectively, for CD and 87% and 78%, respectively, for UC. Of the 53 CD patients with a response/remission at 12 weeks, 40 (75%) patients were in remission at 104 weeks and 42 (79%) patients at 156 weeks. For UC, these numbers were 25/31 (81%) and 22/31 (71%), respectively. Improvements were seen in the Short Health Scale (p < 0.01 for each dimension; CD, n = 51; UC, n = 33) and the EuroQol 5-Dimensions, 5-levels index value (p < 0.01; CD, n = 39; UC, n = 30). Median plasma-C-reactive protein concentrations (mg/L) decreased from 5 at baseline to 4 in CD (p = 0.01, n = 53) and from 5 to 4 in UC (p = 0.03, n = 34) at 156 weeks. Correspondingly, median faecal-calprotectin (µg/g) decreased from 641 to 114 in CD patients (p < 0.01, n = 26) and from 387 to 37 in UC patients (p = 0.02, n = 17). Conclusion VDZ demonstrated high continuation rates and was associated with improvements in clinical outcomes, HRQoL measures and inflammatory markers at 2 and 3 years after treatment initiation in this prospective national SVEAH extension study. Registration ENCePP registration number: EUPAS22735.
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Affiliation(s)
- Isabella Visuri
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Södra Grev Rosengatan 30, Örebro,
SE-70182 Sweden
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of
Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Sara Karlqvist
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
| | - Byron Lykiardopoulos
- Department of Gastroenterology and Hepatology,
Linköping University, Linköping, Sweden
| | - Per Karlén
- Department of Internal Medicine, Danderyd
Hospital, Stockholm, Sweden
| | - Olof Grip
- Department of Gastroenterology, Skåne
University Hospital, Malmö/Lund, Sweden
| | | | - Sven Almer
- Department of Medicine Solna, Division of
Gastroenterolgy, Karolinska Institutet, Stockholm, Sweden
- IBD-Unit, Division of Gastroenterology,
Karolinska University Hospital, Stockholm, Sweden
| | - Erik Hertervig
- Department of Gastroenterology, Skåne
University Hospital, Malmö/Lund, Sweden
| | - Jan Marsal
- Department of Gastroenterology, Skåne
University Hospital, Malmö/Lund, Sweden
| | | | - Jenny Delin
- Department of Gastroenterology, Ersta
Hospital, Stockholm, Sweden
| | - Hans Strid
- Department of Internal Medicine, Södra
Älvsborgs Hospital, Borås, Sweden
| | - Mats Sjöberg
- Department of Internal Medicine, Skaraborgs
Hospital, Lidköping, Sweden
| | - Daniel Bergemalm
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Hepatology,
Linköping University, Linköping, Sweden
- Department of Health, Medicine, and Caring
Sciences, Linköping University, Linköping, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of
Medicine and Health, Örebro University, Örebro, Sweden
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Lykiardopoulos B, Hagström H, Fredrikson M, Ignatova S, Stål P, Hultcrantz R, Ekstedt M, Kechagias S. Development of Serum Marker Models to Increase Diagnostic Accuracy of Advanced Fibrosis in Nonalcoholic Fatty Liver Disease: The New LINKI Algorithm Compared with Established Algorithms. PLoS One 2016; 11:e0167776. [PMID: 27936091 PMCID: PMC5147971 DOI: 10.1371/journal.pone.0167776] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/21/2016] [Indexed: 12/28/2022] Open
Abstract
Background and Aim Detection of advanced fibrosis (F3-F4) in nonalcoholic fatty liver disease (NAFLD) is important for ascertaining prognosis. Serum markers have been proposed as alternatives to biopsy. We attempted to develop a novel algorithm for detection of advanced fibrosis based on a more efficient combination of serological markers and to compare this with established algorithms. Methods We included 158 patients with biopsy-proven NAFLD. Of these, 38 had advanced fibrosis. The following fibrosis algorithms were calculated: NAFLD fibrosis score, BARD, NIKEI, NASH-CRN regression score, APRI, FIB-4, King´s score, GUCI, Lok index, Forns score, and ELF. Study population was randomly divided in a training and a validation group. A multiple logistic regression analysis using bootstrapping methods was applied to the training group. Among many variables analyzed age, fasting glucose, hyaluronic acid and AST were included, and a model (LINKI-1) for predicting advanced fibrosis was created. Moreover, these variables were combined with platelet count in a mathematical way exaggerating the opposing effects, and alternative models (LINKI-2) were also created. Models were compared using area under the receiver operator characteristic curves (AUROC). Results Of established algorithms FIB-4 and King´s score had the best diagnostic accuracy with AUROCs 0.84 and 0.83, respectively. Higher accuracy was achieved with the novel LINKI algorithms. AUROCs in the total cohort for LINKI-1 was 0.91 and for LINKI-2 models 0.89. Conclusion The LINKI algorithms for detection of advanced fibrosis in NAFLD showed better accuracy than established algorithms and should be validated in further studies including larger cohorts.
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Affiliation(s)
- Byron Lykiardopoulos
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Hannes Hagström
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mats Fredrikson
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Simone Ignatova
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Per Stål
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Rolf Hultcrantz
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Mattias Ekstedt
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Stergios Kechagias
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- * E-mail:
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