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Cassinotti A, Mezzina N, De Silvestri A, Di Paolo D, Lenti MV, Bezzio C, Stradella D, Mauri M, Zadro V, Ricci C, Casini V, Radice E, Massari A, Maconi G, Saibeni S, Caprioli F, Tari R, Fichera M, Cortelezzi CC, Parravicini M, Tinelli C, Testoni PA, Pace F, Segato S, Invernizzi P, Occhipinti P, Manes G, Di Sabatino A, Pastorelli L, Vecchi M, Ardizzone S. Continuous clinical remission with biologics in ulcerative colitis: the 'AURORA' comparison study. Eur J Gastroenterol Hepatol 2022; 34:1238-1246. [PMID: 36165081 DOI: 10.1097/meg.0000000000002443] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Comparative trials among biological drugs for the treatment of ulcerative colitis (UC) provided conflicting results. After patent expire of infliximab originator, adalimumab, infliximab biosimilar, golimumab and vedolizumab have been approved in Italy.We compared the efficacy of these four biologics in UC according to the concept of continuous clinical remission (CCR). METHODS In a retrospective, multicentre study, all UC patients treated with adalimumab, infliximab biosimilar, golimumab or vedolizumab between 2014 and 2019 were included. All drugs were compared to each other according to the 1-year CCR rate, defined as Mayo partial score ≤2, with bleeding subscore = 0, without any relapse or optimization with dose escalation, topical treatments or steroid use after first clinical remission. RESULTS Four-hundred sixteen patients (adalimumab = 90, infliximab biosimilar = 105, golimumab = 79, vedolizumab = 142) were included. CCR was achieved in similar percentages among the groups (33%, 37%, 28%, 37%, respectively). All drugs were equivalent in biologic-naive patients, while vedolizumab was better than a second anti-TNFα in prior anti-TNFα agent failures. No differences were found according to type of adverse events or severe adverse events. CONCLUSIONS Based on a strict definition of clinical remission, all biologics appear equally effective at 1 year. Changing to vedolizumab is more effective than switching to another anti-TNFα in TNFα failures.
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Affiliation(s)
- Andrea Cassinotti
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
- Gastroenterology and Digestive Endoscopy Unit, ASST Sette Laghi, Varese
| | - Nicolò Mezzina
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
- Postgraduate School in Gastroenterology, University of Milan, Milan
| | | | - Dhanai Di Paolo
- Postgraduate School in Gastroenterology, University of Milan, Milan
- Gastroenterology Unit, Policlinico San Donato, San Donato Milanese
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
| | | | | | - Martina Mauri
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza
| | - Valentina Zadro
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
- Postgraduate School in Gastroenterology, University of Milan, Milan
| | - Chiara Ricci
- Gastroenterology Unit, ASST Spedali Civili Brescia, Brescia
| | | | | | - Alessandro Massari
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
| | | | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano
| | - Roberto Tari
- Gastroenterology Unit, Ospedale Maggiore della Carità, Novara
| | - Maria Fichera
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza
| | | | - Marco Parravicini
- Gastroenterology and Digestive Endoscopy Unit, ASST Sette Laghi, Varese
| | - Carmine Tinelli
- Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | - Fabio Pace
- Gastroenterology Unit, ASST Bergamo Est, Seriate
| | - Sergio Segato
- Gastroenterology and Digestive Endoscopy Unit, ASST Sette Laghi, Varese
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza
| | | | | | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia
| | - Luca Pastorelli
- Gastroenterology Unit, Policlinico San Donato, San Donato Milanese
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Maurizio Vecchi
- Postgraduate School in Gastroenterology, University of Milan, Milan
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico
| | - Sandro Ardizzone
- Gastroenterology Unit, Department of Biochemical and Clinical Sciences "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan
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Cassinotti A, Batticciotto A, Parravicini M, Lombardo M, Radice P, Cortelezzi CC, Segato S, Zanzi F, Cappelli A, Segato S. Evidence-based efficacy of methotrexate in adult Crohn's disease in different intestinal and extraintestinal indications. Therap Adv Gastroenterol 2022; 15:17562848221085889. [PMID: 35340755 PMCID: PMC8949794 DOI: 10.1177/17562848221085889] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Methotrexate (MTX) is included in the therapeutic armamentarium of Crohn's disease (CD), although its positioning is currently uncertain in an era in which many effective biological drugs are available. No systematic reviews or meta-analysis have stratified the clinical outcomes of MTX according to the specific clinical scenarios of its use. METHODS Medline, PubMed and Scopus were used to extract eligible studies, from database inception to May 2021. A total of 163 studies were included. A systematic review was performed by stratifying the outcomes of MTX according to formulation, clinical indication and criteria of efficacy. RESULTS The use of MTX is supported by randomized clinical trials only in steroid-dependent CD, with similar outcomes to thiopurines. The use of MTX in patients with steroid-refractoriness, failure of thiopurines or in combination with biologics is not supported by high levels of evidence. Combination therapy with biologics can optimize the immunogenic profile of the biological drug, but the impact on long-term clinical outcomes is described only in small series with anti-TNFα. Other off-label uses, such as fistulizing disease, mucosal healing, postoperative prevention and extraintestinal manifestations, are described in small uncontrolled series. The best performance in most indications was shown by parenteral MTX, favouring higher doses (25 mg/week) in the induction phase. DISCUSSION Evidence from high-quality studies in favour of MTX is scarce and limited to the steroid-dependent disease, in which other drugs are the leading players today. Many limitations on study design have been found, such as the prevalence of retrospective underpowered studies and the lack of stratification of outcomes according to specific types of patients and formulations of MTX. CONCLUSION MTX is a valid option as steroid-sparing agent in steroid-dependent CD. Numerous other clinical scenarios require well-designed clinical studies in terms of patient profile, drug formulation and dosage, and criteria of efficacy.
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Affiliation(s)
| | | | | | | | - Paolo Radice
- Ophtalmology Unit, ASST Sette Laghi, Varese, Italy
| | | | - Simone Segato
- Gastroenterology Unit, ASST Sette Laghi, Varese, Italy
| | | | | | - Sergio Segato
- Gastroenterology Unit, ASST Sette Laghi, Varese, Italy
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3
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Ardizzone S, Ferretti F, Monico MC, Carvalhas Gabrielli AM, Carmagnola S, Bezzio C, Saibeni S, Bosani M, Caprioli F, Mazza S, Casini V, Cortelezzi CC, Parravicini M, Cassinotti A, Cosimo P, Indriolo A, Di Sabatino A, Lenti MV, Pastorelli L, Conforti F, Ricci C, Sarzi‐Puttini P, Vecchi M, Maconi G. Lower incidence of COVID-19 in patients with inflammatory bowel disease treated with non-gut selective biologic therapy. J Gastroenterol Hepatol 2021; 36:3050-3055. [PMID: 34159648 PMCID: PMC8447454 DOI: 10.1111/jgh.15591] [Citation(s) in RCA: 15] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/12/2021] [Accepted: 06/15/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM Since the outbreak of COVID-19, concerns have been raised as to whether inflammatory bowel disease (IBD) patients under biologic therapy may be more susceptible to the disease. This study aimed to determine the incidence and outcomes of COVID-19 in a large cohort of IBD patients on biologic therapy. METHODS This observational retrospective multicenter study collected data about COVID-19 in IBD patients on biologic therapy in Italy, between February and May 2020. The main end-points were (i) to assess both the cumulative incidence and clinical outcome of COVID-19, according to different biologic agents and (ii) to compare them with the general population and a cohort IBD patients undergoing non-biologic therapies. RESULTS Among 1816 IBD patients, the cumulative incidence of COVID-19 was 3.9 per 1000 (7/1816) with a 57% hospitalization rate and a 29% case-fatality rate. The class of biologic agents was the only risk factor of developing COVID-19 (P = 0.01). Non-gut selective agents were associated with a lower incidence of COVID-19 cases, related symptoms, and hospitalization (P < 0.05). Compared with the general population of Lombardy, an overall lower incidence of COVID-19 was observed (3.9 vs 8.5 per 1000, P = 0.03). Compared with 565 IBD patients on non-biologic therapies, a lower rate of COVID-19 symptoms was observed in our cohort (7.5% vs 18%, P < 0.001). CONCLUSIONS Compared with the general population, IBD patients on biologic therapy are not exposed to a higher risk of COVID-19. Non-gut selective agents are associated with a lower incidence of symptomatic disease, supporting the decision of maintaining the ongoing treatment.
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Affiliation(s)
- Sandro Ardizzone
- Gastroenterology Unit, ASST Fatebenefratelli‐Sacco, L. Sacco University Hospital, Department of Biochemical and Clinical SciencesUniversity of MilanMilanItaly
| | - Francesca Ferretti
- Gastroenterology Unit, ASST Fatebenefratelli‐Sacco, L. Sacco University Hospital, Department of Biochemical and Clinical SciencesUniversity of MilanMilanItaly
| | - Maria Camilla Monico
- Gastroenterology Unit, ASST Fatebenefratelli‐Sacco, L. Sacco University Hospital, Department of Biochemical and Clinical SciencesUniversity of MilanMilanItaly
| | - Anna Maria Carvalhas Gabrielli
- Gastroenterology Unit, ASST Fatebenefratelli‐Sacco, L. Sacco University Hospital, Department of Biochemical and Clinical SciencesUniversity of MilanMilanItaly
| | - Stefania Carmagnola
- Gastroenterology Unit, ASST Fatebenefratelli‐Sacco, L. Sacco University Hospital, Department of Biochemical and Clinical SciencesUniversity of MilanMilanItaly
| | | | - Simone Saibeni
- Gastroenterology Unit, ASST RhodenseRho HospitalRhoItaly
| | | | - Flavio Caprioli
- Gastroenterology and Endoscopy UnitIRCCS Ca' Granda Ospedale Maggiore Policlinico FoundationMilanItaly,Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | - Stefano Mazza
- Gastroenterology and Endoscopy UnitIRCCS Ca' Granda Ospedale Maggiore Policlinico FoundationMilanItaly
| | - Valentina Casini
- UOC Gastroenterology and Digestive EndoscopyASST Bergamo Est, SeriateBergamoItaly
| | | | - Marco Parravicini
- ASST Sette Laghi, Gastroenterology and Endoscopy UnitCircolo Hospital and Macchi FoundationVareseItaly
| | - Andrea Cassinotti
- ASST Sette Laghi, Gastroenterology and Endoscopy UnitCircolo Hospital and Macchi FoundationVareseItaly
| | - Paola Cosimo
- Gastroenterology and Endoscopy UnitPapa Giovanni XXIII HospitalBergamoItaly
| | - Amedeo Indriolo
- Gastroenterology and Endoscopy UnitPapa Giovanni XXIII HospitalBergamoItaly
| | - Antonio Di Sabatino
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, IRCCS San Matteo Hospital FoundationUniversity of PaviaPaviaItaly
| | - Luca Pastorelli
- Gastroenterology UnitIRCCS Policlinico San Donato Research HospitalMilanItaly
| | - Francesco Conforti
- Gastroenterology UnitIRCCS Policlinico San Donato Research HospitalMilanItaly
| | - Chiara Ricci
- Gastroenterology UnitSpedali Civili Hospital, Department of Experimental and Clinical Sciences, University of BresciaBresciaItaly
| | - Piercarlo Sarzi‐Puttini
- Rheumatology UnitASST‐Fatebenefratelli L. Sacco University Hospital, University of MilanMilanItaly
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy UnitIRCCS Ca' Granda Ospedale Maggiore Policlinico FoundationMilanItaly,Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | - Giovanni Maconi
- Gastroenterology Unit, ASST Fatebenefratelli‐Sacco, L. Sacco University Hospital, Department of Biochemical and Clinical SciencesUniversity of MilanMilanItaly
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4
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Saibeni S, Scucchi L, Dragoni G, Bezzio C, Miranda A, Ribaldone DG, Bertani A, Bossa F, Allocca M, Buda A, Mocci G, Soriano A, Mazzuoli S, Bertani L, Baccini F, Loddo E, Privitera AC, Sartini A, Viscido A, Grossi L, Casini V, Gerardi V, Ascolani M, Ruscio MD, Casella G, Savarino E, Stradella D, Pumpo R, Cortelezzi CC, Daperno M, Ciardo V, Nardone OM, Caprioli F, Vitale G, Cappello M, Comberlato M, Alvisi P, Festa S, Campigotto M, Bodini G, Balestrieri P, Viola A, Pugliese D, Armuzzi A, Fantini MC, Fiorino G. Activities related to inflammatory bowel disease management during and after the coronavirus disease 2019 lockdown in Italy: How to maintain standards of care. United European Gastroenterol J 2020; 8:1228-1235. [PMID: 33070758 DOI: 10.1177/2050640620964132] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND AIMS Restructuring activities have been necessary during the lockdown phase of the coronavirus disease 2019 (COVID-19) pandemic. Few data are available on the post-lockdown phase in terms of health-care procedures in inflammatory bowel disease (IBD) care, and no data are available specifically from IBD units. We aimed to investigate how IBD management was restructured during the lockdown phase, the impact of the restructuring on standards of care and how Italian IBD units have managed post-lockdown activities. METHODS A web-based online survey was conducted in two phases (April and June 2020) among the Italian Group for IBD affiliated units within the entire country. We investigated preventive measures, the possibility of continuing scheduled visits/procedures/therapies because of COVID-19 and how units resumed activities in the post-lockdown phase. RESULTS Forty-two referral centres participated from all over Italy. During the COVID-19 lockdown, 36% of first visits and 7% of follow-up visits were regularly done, while >70% of follow-up scheduled visits and 5% of first visits were done virtually. About 25% of scheduled endoscopies and bowel ultrasound scans were done. More than 80% of biological therapies were done as scheduled. Compared to the pre-lockdown situation, 95% of centres modified management of outpatient activity, 93% of endoscopies, 59% of gastrointestinal ultrasounds and 33% of biological therapies. Resumption of activities after the lockdown phase may take three to six months to normalize. Virtual clinics, implementation of IBD pathways and facilities seem to be the main factors to improve care in the future. CONCLUSION Italian IBD unit restructuring allowed quality standards of care during the COVID-19 pandemic to be maintained. A return to normal appears to be feasible and achievable relatively quickly. Some approaches, such as virtual clinics and identified IBD pathways, represent a valid starting point to improve IBD care in the post-COVID-19 era.
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Affiliation(s)
- Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Milan, Italy
| | - Ludovica Scucchi
- Department of Systems Medicine, GI Unit, Policlinico Tor Vergata, University of Tor Vergata, Rome, Italy
| | - Gabriele Dragoni
- Gastroenterology Unit, Careggi University Hospital Florence, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Milan, Italy
| | - Agnese Miranda
- Gastroenterology and Endoscopy Unit, University of Campania 'L. Vanvitelli', Naples, Italy
| | | | - Angela Bertani
- Department of Gastroenterology, IBD Unit, Policlinico Hospital, Modena, Italy
| | - Fabrizio Bossa
- Division of Gastroenterology, IRCCS "Casa Sollievo della Sofferenza" Foundation, San Giovanni Rotondo, Italy
| | - Mariangela Allocca
- IBD Centre, Gastroenterology, Humanitas Clinical and Research Centre - IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andrea Buda
- Department of Gastrointestinal Oncological Surgery, Gastroenterology and Endoscopy Unit, S. Maria del Prato Hospital, Feltre, Italy
| | | | - Alessandra Soriano
- Gastroenterology Division, Azienda USL Arcispedale S. Maria Nuova - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Mazzuoli
- Gastroenterology and Artificial Nutrition Unit, Monsignor R. Dimiccoli Hospital, ASL BT, Barletta, Italy
| | - Lorenzo Bertani
- Gastroenterology and Digestive Endoscopy Department of Medical Specialties Apuane Hospital - Tuscany North-West ASL, Massa, Italy
| | - Flavia Baccini
- Digestive Disease Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Erika Loddo
- Gastroenterology Unit, University Hospital, AOU Cagliari, Cagliari, Italy.,Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Alessandro Sartini
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena, AUSL della Romagna, Rimini, Italy
| | - Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Laurino Grossi
- G. D'Annunzio University - Digestive Physiopathology, Ospedale Spirito Santo, Pescara, Italy
| | - Valentina Casini
- A.S.S.T. Bergamo EST, Gastroenterology Unit, Seriate Hospital, Bergamo, Italy
| | - Viviana Gerardi
- Department of Medicine, Gastroenterology and Endoscopy, Poliambulanza foundation, Brescia, Italy
| | - Marta Ascolani
- Gastroenterology Unit, Santa Maria di Ca Foncello Hospital, Treviso, Italy
| | | | | | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Davide Stradella
- Gastroenterology Unit, A.O.U. Maggiore della Caritá, Novara, Italy
| | | | | | - Marco Daperno
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Valeria Ciardo
- Gastroenterology Unit, S. Antonio Hospital, San Daniele del Friuli, Italy
| | - Olga Maria Nardone
- Gastroenterology, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico Foundation, Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giovanna Vitale
- Gastroenterology and Endoscopy Unit, 'San Carlo' Hospital, Potenza, Italy
| | - Maria Cappello
- IBD Clinic, Gastroenterology Section, Promise, University of Palermo, Palermo, Italy
| | | | - Patrizia Alvisi
- Paediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy
| | | | - Michele Campigotto
- Academic Surgical and Health Sciences Department, Trieste University, Trieste, Italy
| | - Giorgia Bodini
- Gastroenterology chair, Internal Medicine Department, Genoa University, Italy
| | - Paola Balestrieri
- Unit of Digestive Disease of Campus Bio Medico, University of Rome, Rome, Italy
| | - Anna Viola
- IBD Unit, Department Clinical and experimental Medicine, Policlinico Messina, Messina, Italy
| | - Daniela Pugliese
- CEMAD - IBD Unit, Internal and Gastroenterology Unit, Academic Policlinic Foundation 'A. Gemelli' IRCCS, Rome, Italy
| | - Alessandro Armuzzi
- CEMAD - IBD Unit, Internal and Gastroenterology Unit, Academic Policlinic Foundation 'A. Gemelli' IRCCS, Rome, Italy
| | - Massimo C Fantini
- Gastroenterology Unit, University Hospital, AOU Cagliari, Cagliari, Italy.,Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | - Gionata Fiorino
- IBD Centre, Gastroenterology, Humanitas Clinical and Research Centre - IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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5
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Fantini MC, Biancone L, Dragoni G, Bezzio C, Miranda A, Ribaldone DG, Bertani A, Bossa F, Allocca M, Buda A, Mocci G, Soriano A, Guglielmi FW, Bertani L, Baccini F, Loddo E, Privitera AC, Sartini A, Viscido A, Grossi L, Casini V, Gerardi V, Ascolani M, Di Ruscio M, Casella G, Savarino E, Stradella D, Pumpo R, Cortelezzi CC, Daperno M, Ciardo V, Nardone OM, Caprioli F, Vitale G, Cappello M, Comberlato M, Alvisi P, Festa S, Campigotto M, Bodini G, Balestrieri P, Viola A, Pugliese D, Armuzzi A, Saibeni S, Fiorino G. Telemedicine and Remote Screening for COVID-19 in Inflammatory Bowel Disease Patients: Results From the SoCOVID-19 Survey. Inflamm Bowel Dis 2020; 26:e134-e136. [PMID: 33029612 PMCID: PMC7797727 DOI: 10.1093/ibd/izaa254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Massimo Caludio Fantini
- Gastroenterology Unit, University Hospital, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy,Address correspondence to: Massimo C. Fantini, MD, PhD, Department of Medical Sciences and Public Health, University of Cagliari, Italy; AOU Cagliari Presidio Ospedaliero Monserrato, Cagliari, Italy. E-mail:
| | - Livia Biancone
- Gastroenterology Unit, Policlinico Tor Vergata. Department of Systems Medicine, University of Rome, Rome, Italy
| | - Gabriele Dragoni
- Gastroenterology Unit, Azienda Ospedaliero Universitaria Careggi, Firenze, Toscana, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
| | - Agnese Miranda
- Gastroenterology and Endoscopy Unit, University of Campania “L. Vanvitelli” Naples, Italy
| | | | - Angela Bertani
- Department of Gastroenterology, IBD Unit, Policlinico Hospital, Modena, Italy
| | - Fabrizio Bossa
- Division of Gastroenterology, IRCCS Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Puglia, Italy
| | - Mariangela Allocca
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Andrea Buda
- Department of Gastrointestinal Oncological Surgery, Gastroenterology and Endoscopy Unit, S. Maria del Prato Hospital, Feltre, Italy
| | | | - Alessandra Soriano
- Gastroenterology Division, Azienda USL Arcispedale S. Maria Nuova, IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Lorenzo Bertani
- Gastroenterology and Digestive Endoscopy Department of Medical Specialties Apuane Hospital, Tuscany North-West ASL, Massa, Italy
| | - Flavia Baccini
- Digestive Disease Unit, Sant’Andrea University Hospital, Rome, Italy
| | - Erica Loddo
- Gastroenterology Unit, University Hospital, AOU Cagliari, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Alessandro Sartini
- Gastroenterology and Digestive Endoscopy Unit, Forlì-Cesena, AUSL della Romagna, Italy
| | - Angelo Viscido
- Gastroenterology Unit, Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Laurino Grossi
- G. D’Annunzio University-Digestive Physiopathology Ospedale Spirito Santo Pescara, Pescara, Italy
| | - Valentina Casini
- ASST BERGAMO EST, Ospedale Seriate, UOC Gastroenterologia ed Endoscopia Digestiva, Bergamo, Italy
| | - Viviana Gerardi
- Department of Medicine, Gastroenterology and Endoscopy, Fondazione Poliambulanza, Brescia, Italy
| | - Marta Ascolani
- Gastroenterology Unit, Ospedale Santa Maria di Ca Foncello, Treviso, Veneto, Italy
| | - Mirko Di Ruscio
- IBD Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Giovanni Casella
- Gastroenterologist, General Practitioner, Limbiate (Monza Brianza), ATS Lecco Brianza, Lombardia, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Davide Stradella
- Gastroenterologia, A.O.U Maggiore della Caritá di Novara, Piemonte, University of Eastern Piedmont Amedeo Avogadro, Italy
| | - Rossella Pumpo
- Endoscopia Digestiva, P.O. S.G. Bosco, ASLNA1, Napoli, Campania, Italy
| | - Claudio Camillo Cortelezzi
- SC di Gastroneterologia ed Endoscopia Digestiva Ospedale di Circolo Fondazione Macchi ASST Sette Laghi Varese, Italy
| | - Marco Daperno
- Gastroenterology Unit, Azienda Ospedaliera Ordine Mauriziano di Torino, Torino, Piemonte, Italy
| | - Valeria Ciardo
- Struttura Operativa Semplice Dipartimentale (SOSD) di Gastroenterologia, AAS3 Alto Friuli Collinare e Medio Friuli, Ospedale di San Daniele del Friuli, Italy
| | - Olga Maria Nardone
- Gastroenterology, Federico II University Hospital, Napoli, Campania, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Department of Pathophysiology and Transplantation, University of Milan, Milano, Lombardia, Italy
| | - Giovanna Vitale
- Gastroenterology and Endoscopy Unit, “San Carlo” Hospital, Potenza, Italy
| | - Maria Cappello
- Head IBD Clinic, Gastroenterology Section, Promise, University of Palermo, Sicily, Italy
| | - Michele Comberlato
- Divisione di Gastrenterologia e Servizio di Fisiopatologia ed Endoscopia digestiva Ambulatorio interdisciplinare per le malattie infiammatorie croniche intestinali, Ospedale provinciale – Bolzano, Italy
| | | | - Stefano Festa
- S. Filippo Neri Hospital, IBD Unit, Rome, Lazio, Italy
| | - Michele Campigotto
- Diparimento Universitario Clinico di Scienze Mediche, Chirurgiche e della Salute, Università degli Studi di Trieste, Trieste, Italy
| | - Giorgia Bodini
- Cattedra di Gastroenterologia, Diparti-mento di Medicina Interna, Universita`di Genova, Genova, Italy
| | - Paola Balestrieri
- Unit of Digestive Disease of Campus Bio Medico University of Rome, Italy
| | - Anna Viola
- UOSD Malattie Intestinali Croniche, Dip. di Medicina Clinica e Sperimentale, Policlinico Messina, Sicily, Italy
| | - Daniela Pugliese
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Alessandro Armuzzi
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, Rho (MI), ASST Rhodense, Garbagnate Milanese, Lombardia, Italy
| | - Gionata Fiorino
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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Fiorino G, Caprioli F, Daperno M, Mocciaro F, Principi M, Viscido A, Fantini MC, Orlando A, Papi C, Annese V, Danese S, Vecchi M, Rizzello F, Armuzzi A, Previtali E, Aloi M, Alvisi P, Antonelli E, Ardizzone S, Astegiano M, Baldoni M, Beltrami M, Biancone L, Bodini G, Buda A, Bossa F, Bracci F, Calabrese E, Cappello M, Castiglione F, Ciacci C, Cicala M, Ciccocioppo R, Comberlato M, Cortelezzi CC, Cosintino R, Costa F, Costantino G, Cucchiara S, Cuomo A, D’Incà R, Di Paolo MC, Di Sabatino A, Di Sario A, Frieri G, Fries W, Gasbarrini A, Geccherle A, Gionchetti P, Graziani MG, Grossi L, Guidi L, Imperiali G, Latella G, Lionetti P, Inserra G, Maconi G, Manguso F, Marino M, Mastronardi M, Mazzuoli S, Meucci G, Mendolaro M, Milla M, Mocci G, Monteleone G, Bortoluzzi FN, Pagnini C, Pastorelli L, Pica R, Piergallini S, Privitera A, Renna S, Ribaldone DG, Ricci C, Rispo A, Rocca R, Romano C, Romano M, Russo G, Sablich R, Saibeni S, Savarino E, Scribano ML, Spagnuolo R, Stasi E, Terpin MM, Testa A, Valpiani D, Variola A, Vernia P, Vitale G, Zoli G. Use of biosimilars in inflammatory bowel disease: a position update of the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Dig Liver Dis 2019; 51:632-639. [PMID: 30872085 DOI: 10.1016/j.dld.2019.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 01/16/2019] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
The first infliximab biosimilar for the treatment of inflammatory bowel disease (IBD) was introduced in 2013, and today eight anti-TNF alpha biosimilars (three for infliximab and five for adalimumab) have been approved and licensed by the European Medicines Agency. Biosimilars present great potential in terms of cost saving and possible consequential reinvestment in the health care system. The increasing knowledge about the process of biosimilar development and use in IBD and the publication of many prospective clinical studies and real-life clinical experiences have progressively changed the point of view of IBD physicians. In the present position paper, the Italian Group for the Study of Inflammatory Bowel Disease present and discuss their updated statements and positions on this topic, with emphasis on the concepts of biosimilarity and extrapolation across indications, safety and immunogenicity, interchangeability and switching, automatic substitution, and, finally, patient education about biosimilars.
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Affiliation(s)
- Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | - Marco Daperno
- Division of Gastroenterology, Ospedale Ordine Mauriziano di Torino, Turin, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | - Mariabeatrice Principi
- Gastroenterology Unit, Department of Organ Transplantation (DETO), Policlinico Universitario, Bari, Italy
| | - Angelo Viscido
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Ambrogio Orlando
- IBD Unit, A.O. Osp. Riuniti "Villa Sofia-Cervello", Palermo, Italy
| | - Claudio Papi
- IBD Unit, San Filippo Neri Hospital, Rome, Italy
| | | | - Silvio Danese
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - Maurizio Vecchi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy, and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy
| | | | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
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Bolzacchini E, Chini C, Cortelezzi CC, Vallini I, Pinotti G, La Rosa S, Uccella S. Poorly Differentiated Neuroendocrine Carcinoma of the Sigmoid Tract in Long-Standing Ulcerative Colitis: Report of a Case and Review of the Literature. Int J Surg Pathol 2018; 26:479-483. [DOI: 10.1177/1066896917752443] [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] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 37-year-old male with long-standing and extensive ulcerative pancolitis developed a rapidly lethal poorly differentiated neuroendocrine carcinoma (NEC) in the sigmoid colon. Prior biopsies obtained from multiple sites of the colon during endoscopic surveillance showed minimal inflammatory changes and no sign of dysplasia. Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal malignancies, and adenocarcinoma is the most common type of colorectal neoplasm associated with ulcerative colitis and Crohn’s disease, but other types of epithelial and nonepithelial tumors have also been described in IBD. NECs arising in the setting of ulcerative colitis are very rare and are reported as anecdotic findings. We describe the clinicopathological features of an IBD-related NEC and review the previously reported cases.
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Daperno M, Bortoli A, Kohn A, Politi P, Marconi S, Ardizzone S, Cortelezzi CC, Grasso G, Ferraris L, Milla M, Spina L, Guidi L, Losco A, Inserra G, Sablich R, Morganti D, Bodini G, Comberlato M. Patient and physician views on the quality of care for inflammatory bowel disease after one-year follow-up: Results from SOLUTION-2, a prospective IG-IBD study. Dig Liver Dis 2017; 49:997-1002. [PMID: 28595949 DOI: 10.1016/j.dld.2017.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 04/08/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Perception of quality of care is important in the management of patients with chronic diseases, particularly inflammatory bowel disease. AIMS AND METHODS This longitudinal study aimed to investigate variations of the Quality of Care through the Patients' Eyes (QUOTE-IBD) questionnaire scores one year after the basal evaluation in the Studio Osservazionale quaLità cUre malatTIe crOniche intestiNali (SOLUTION-1) study. RESULTS Of the cohort of 992 patients, 936 were evaluable. The QUOTE-IBD score overcame satisfactory levels of more than the 80%, overall and in all subdomains except for the "Continuity of Care" sub-dimension (mean, 8.3; standard deviation, 1.49), scored satisfactory only by 34% of the patients. No significant changes in satisfaction were recorded overall, or considering patients subgroups. Significant differences were found at the end of the follow-up between physicians' and patients' perceptions of quality of care, with the former over-rating their performance in "Continuity of Cares" and under-rating "Costs", "Competence", and "Accessibility" sub-domains of the score (p<0.05 for all). CONCLUSION Perceived quality of care in a large cohort of Italian patients with inflammatory bowel disease remains unchanged after one-year follow-up and was not significantly affected by disease activity or therapeutic interventions. Differences between physicians' and patients' perceptions of quality of care should be taken into account.
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Affiliation(s)
- Marco Daperno
- Department of Gastroenterology, Mauriziano Hospital, Turin, Italy.
| | | | - Anna Kohn
- Department of Gastroenterology, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Stefano Marconi
- Medical Department, Chiesi Italian Pharmaceutical Group, Parma, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, L. Sacco University Hospital, Milan, ASST Fatebenefratelli Sacco, Italy
| | | | - Gianalberto Grasso
- Gastroenterology Unit, Carlo Ondoli Hospital, Angera, ASST Valle Olona, Italy
| | - Luca Ferraris
- Gastroenterology Unit, Gallarate Hospital, ASST Valleolona, Italy
| | - Monica Milla
- Gastroenterology Unit, University Hospital Careggi, Florence, Italy
| | - Luisa Spina
- Gastroenterology Department, IRCCS Policlinico San Donato Milanese, Italy
| | - Luisa Guidi
- Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, Presidio Columbus, Rome, Italy
| | - Alessandra Losco
- Hepatology and Gastroenterology Department, San Paolo Hospital, Milan, ASST Santi Paolo e Carlo, Italy; Division of Internal Medicine, Liver and Gastroenterology Unit, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Gaetano Inserra
- Internal Medicine Unit, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico", Catania, Italy
| | - Renato Sablich
- Gastroenterology Unit, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Daniela Morganti
- Gastroenterology Unit, Garbagnate Milanese Hospital, ASST Rhodense, Italy
| | | | - Michele Comberlato
- Gastroenterology and Digestive Endoscopy Department, Bolzano Central Hospital, Italy
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Rondonotti E, Soncini M, Girelli CM, Russo A, Ballardini G, Bianchi G, Cantù P, Centenara L, Cesari P, Cortelezzi CC, Gozzini C, Lupinacci G, Maino M, Mandelli G, Mantovani N, Moneghini D, Morandi E, Putignano R, Schalling R, Tatarella M, Vitagliano P, Villa F, Zatelli S, Conte D, Masci E, de Franchis R. Can we improve the detection rate and interobserver agreement in capsule endoscopy? Dig Liver Dis 2012; 44:1006-11. [PMID: 22858420 DOI: 10.1016/j.dld.2012.06.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [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: 04/03/2012] [Revised: 05/15/2012] [Accepted: 06/20/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data about strategies for improving the diagnostic ability of capsule endoscopy readers are lacking. AIM (1) To evaluate the detection rate and the interobserver agreement among readers with different experience; (2) to verify the impact of a specific training (hands-on training plus expert tutorial) on these parameters. METHODS 17 readers reviewed 12 videos twice; between the two readings they underwent the training. The identified small bowel findings were described by a simplified version of Structured Terminology and classifies as clinically significant/non-significant. Findings identified by the readers were compared with those identified by three experts (Reference Standard). RESULTS The Reference Standard identified 26 clinically significant findings. The mean detection rate of overall readers for significant findings was low (about 50%) and did not change after the training (46.2% and 46.4%, respectively). There was no difference in the detection rate among readers with different experience. The interobserver agreement with the Reference Standard in describing significant findings was moderate (k = 0.44; CI95%: 0.39-0.50) and did not change after the training (k = 0.44; CI95%: 0.38-0.49) or stratifying readers according to their experience. CONCLUSIONS Both the interobserver agreement and the detection rate of significant findings are low, regardless of the readers' experience. Our training did not significantly increase the performance of readers with different experience.
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Casella G, Spreafico C, Costantini M, Pagni F, Cortelezzi CC, Baldini V, DeLodovici ML, Bono G. Cerebral sinus thrombosis in ulcerative colitis. Inflamm Bowel Dis 2011; 17:2214-6. [PMID: 21351209 DOI: 10.1002/ibd.21659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Accepted: 12/27/2010] [Indexed: 01/02/2023]
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