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Chaparro M, Garre A, Iborra M, Sierra M, Barreiro-de Acosta M, Fernández-Clotet A, de Castro L, Boscá-Watts M, Casanova MJ, López-García A, Lorente R, Rodríguez C, Carbajo AY, Arroyo MT, Gutiérrez A, Hinojosa J, Martínez-Pérez T, Villoria A, Bermejo F, Busquets D, Camps B, Cañete F, Manceñido N, Monfort D, Navarro-Llavat M, Pérez-Calle JL, Ramos L, Rivero M, Angueira T, Camo P, Carpio D, García-de-la-Filia I, González-Muñoza C, Hernández L, Huguet JM, Morales VJ, Sicilia B, Vega P, Vera I, Zabana Y, Nos P, Suárez Álvarez P, Calviño-Suarez C, Ricart E, Hernández V, Mínguez M, Márquez L, Hervías Cruz D, Rubio Iturria S, Barrio J, Gargayo-Puyuelo C, Francés R, Hinojosa E, del Moral M, Calvet X, Algaba A, Aldeguer X, Guardiola J, Mañosa M, Pajares R, Piqueras M, García-Bosch O, Lopez Serrano P, Castro B, Lucendo AJ, Montoro M, Castro Ortiz E, Mesonero F, García-Planella E, Fuentes DA, Bort I, Delgado-Guillena P, Arias L, Iglesias A, Calvo M, Esteve M, Domènech E, Gisbert JP. Effectiveness and Safety of Ustekinumab in Ulcerative Colitis: Real-world Evidence from the ENEIDA Registry. J Crohns Colitis 2021; 15:1846-1851. [PMID: 33860795 PMCID: PMC8083263 DOI: 10.1093/ecco-jcc/jjab070] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS The development programm UNIFI has shown promising results of ustekinumab in ulcerative colitis [UC] treatment which should be confirmed in clinical practice. We aimed to evaluate the durability, effectiveness, and safety of ustekinumab in UC in real life. METHODS Patients included in the prospectively maintained ENEIDA registry, who received at least one intravenous dose of ustekinumab due to active UC [Partial Mayo Score [PMS]>2], were included. Clinical activity and effectiveness were defined based on PMS. Short-term response was assessed at Week 16. RESULTS A total of 95 patients were included. At Week 16, 53% of patients had response [including 35% of patients in remission]. In the multivariate analysis, elevated serum C-reactive protein was the only variable significantly associated with lower likelihood of achieving remission. Remission was achieved in 39% and 33% of patients at Weeks 24 and 52, respectively; 36% of patients discontinued the treatment with ustekinumab during a median follow-up of 31 weeks. The probability of maintaining ustekinumab treatment was 87% at Week 16, 63% at Week 56, and 59% at Week 72; primary failure was the main reason for ustekinumab discontinuation. No variable was associated with risk of discontinuation. Three patients reported adverse events; one of them had a fatal severe SARS-CoV-2 infection. CONCLUSIONS Ustekinumab is effective in both the short and the long term in real life, even in a highly refractory cohort. Higher inflammatory burden at baseline correlated with lower probability of achieving remission. Safety was consistent with the known profile of ustekinumab.
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Affiliation(s)
- María Chaparro
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain,CORRESPONDENCE: María Chaparro, M.D., Ph.D, Inflammatory Bowel Disease Unit, Department of Gastroenterology, Hospital Universitario de La Princesa, Diego de León, 62. 28006 Madrid, Spain, Tel.: 34-913093911; Fax: 34-915204013, e-mail:
| | - Ana Garre
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain
| | - Marisa Iborra
- Hospital Universitario y Politécnico La Fe and CIBERehd, Valencia, Spain
| | - Mónica Sierra
- Complejo Asistencial Universitario de León, León, Spain
| | | | | | - Luisa de Castro
- Xerencia Xestion Integrada de Vigo, SERGAS. Vigo. Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO. Spain
| | - Maia Boscá-Watts
- Hospital Clinico de Valencia. Universitat de València, Valencia, Spain
| | - María José Casanova
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain
| | - Alicia López-García
- Hospital del Mar and Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | - Rufo Lorente
- Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | | | - Ana Y Carbajo
- Hospital Universitario Río Hortega. Gerencia Regional de Salud de Castilla y León (SACYL). Valladolid, Spain
| | | | - Ana Gutiérrez
- Hospital General Universitario de Alicante and CIBERehd, IIS ISABIAL Alicante, Spain
| | | | | | - Albert Villoria
- Hospital Parc Taulí, Sabadell. Depàrtament de Medicina. Universitat Autònoma de Barcelona and CIBERehd, Spain
| | - Fernando Bermejo
- Hospital Universitario Fuenlabrada and Instituto de Investigación Sanitaria del Hospital La Paz (IdiPAZ), Madrid, Spain
| | - David Busquets
- Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain
| | - Blau Camps
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Fiorella Cañete
- Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Spain
| | | | | | | | | | - Laura Ramos
- Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Montserrat Rivero
- Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | - Teresa Angueira
- Hospital General de Tomelloso and CIBERehd, Ciudad Real, Spain
| | | | - Daniel Carpio
- Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | | | | | | | - José M Huguet
- Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Pablo Vega
- Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Isabel Vera
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Yamile Zabana
- Hospital Universitario Mútua Terrassa and CIBERehd, Terrassa, Spain
| | - Pilar Nos
- Hospital Universitario y Politécnico La Fe and CIBERehd, Valencia, Spain
| | | | | | - Elena Ricart
- Hospital Clìnic i Provincial and CIBERehd, IDIBAPS, Barcelona, Spain
| | - Vicent Hernández
- Xerencia Xestion Integrada de Vigo, SERGAS. Vigo. Research Group in Digestive Diseases, Galicia Sur Health Research Institute (IIS Galicia Sur). SERGAS-UVIGO. Spain
| | - Miguel Mínguez
- Hospital Clinico de Valencia. Universitat de València, Valencia, Spain
| | - Lucía Márquez
- Hospital del Mar and Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain
| | | | | | - Jesús Barrio
- Hospital Universitario Río Hortega. Gerencia Regional de Salud de Castilla y León (SACYL). Valladolid, Spain
| | | | - Rubén Francés
- Hepatic and intestinal Immunobiology group Clinical Medicina, Department Miguel Hernández University, IIS ISABIAL, Hospital General Universitario de Alicante and CIBERehd, Alicante, Spain
| | | | | | - Xavier Calvet
- Hospital Parc Taulí, Sabadell. Depàrtament de Medicina. Universitat Autònoma de Barcelona and CIBERehd, Spain
| | - Alicia Algaba
- Hospital Universitario Fuenlabrada and Instituto de Investigación Sanitaria del Hospital La Paz (IdiPAZ), Madrid, Spain
| | - Xavier Aldeguer
- Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain
| | | | - Miriam Mañosa
- Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Spain
| | - Ramón Pajares
- Hospital Infanta Sofía, San Sebastián de los Reyes, Spain
| | | | | | | | - Beatriz Castro
- Hospital Universitario Marqués de Valdecilla and IDIVAL, Santander, Spain
| | | | | | | | | | | | | | | | | | - Lara Arias
- Hospital Universitario de Burgos, Burgos, Spain
| | - Agueda Iglesias
- Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - Marta Calvo
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Maria Esteve
- Hospital Universitario Mútua Terrassa and CIBERehd, Terrassa, Spain
| | - Eugeni Domènech
- Hospital Universitari Germans Trials i Pujol and CIBERehd, Badalona, Spain
| | - Javier P Gisbert
- Gastroenterology Departments of: Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid. Spain
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Huang W, de la Iglesia-García D, Baston-Rey I, Calviño-Suarez C, Lariño-Noia J, Iglesias-Garcia J, Shi N, Zhang X, Cai W, Deng L, Moore D, Singh VK, Xia Q, Windsor JA, Domínguez-Muñoz JE, Sutton R. Exocrine Pancreatic Insufficiency Following Acute Pancreatitis: Systematic Review and Meta-Analysis. Dig Dis Sci 2019; 64:1985-2005. [PMID: 31161524 PMCID: PMC6584228 DOI: 10.1007/s10620-019-05568-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [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: 10/23/2018] [Accepted: 02/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/OBJECTIVES The epidemiology of exocrine pancreatic insufficiency (EPI) after acute pancreatitis (AP) is uncertain. We sought to determine the prevalence, progression, etiology and pancreatic enzyme replacement therapy (PERT) requirements for EPI during follow-up of AP by systematic review and meta-analysis. METHODS Scopus, Medline and Embase were searched for prospective observational studies or randomized clinical trials (RCTs) of PERT reporting EPI during the first admission (between the start of oral refeeding and before discharge) or follow-up (≥ 1 month of discharge) for AP in adults. EPI was diagnosed by direct and/or indirect laboratory exocrine pancreatic function tests. RESULTS Quantitative data were analyzed from 370 patients studied during admission (10 studies) and 1795 patients during follow-up (39 studies). The pooled prevalence of EPI during admission was 62% (95% confidence interval: 39-82%), decreasing significantly during follow-up to 35% (27-43%; risk difference: - 0.34, - 0.53 to - 0.14). There was a two-fold increase in the prevalence of EPI with severe compared with mild AP, and it was higher in patients with pancreatic necrosis and those with an alcohol etiology. The prevalence decreased during recovery, but persisted in a third of patients. There was no statistically significant difference between EPI and new-onset pre-diabetes/diabetes (risk difference: 0.8, 0.7-1.1, P = 0.33) in studies reporting both. Sensitivity analysis showed fecal elastase-1 assay detected significantly fewer patients with EPI than other tests. CONCLUSIONS The prevalence of EPI during admission and follow-up is substantial in patients with a first attack of AP. Unanswered questions remain about the way this is managed, and further RCTs are indicated.
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Affiliation(s)
- Wei Huang
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Daniel de la Iglesia-García
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Iria Baston-Rey
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Cristina Calviño-Suarez
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jose Lariño-Noia
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Julio Iglesias-Garcia
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Na Shi
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoying Zhang
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China ,0000 0004 1936 8470grid.10025.36Liverpool Pancreatitis Research Group, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Wenhao Cai
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Lihui Deng
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - Danielle Moore
- 0000 0004 1936 8470grid.10025.36Liverpool Pancreatitis Research Group, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Vikesh K. Singh
- 0000 0001 2171 9311grid.21107.35Pancreatitis Center, Division of Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Qing Xia
- 0000 0004 1770 1022grid.412901.fDepartment of Integrated Traditional Chinese and Western Medicine, Sichuan Provincial Pancreatitis Center and West China-Liverpool Biomedical Research Center, West China Hospital, Sichuan University, Chengdu, China
| | - John A. Windsor
- 0000 0004 0372 3343grid.9654.eSurgical and Translational Research Center, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - J. Enrique Domínguez-Muñoz
- 0000 0000 8816 6945grid.411048.8Department of Gastroenterology and Hepatology, Health Research Institute of Santiago (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Robert Sutton
- 0000 0004 1936 8470grid.10025.36Liverpool Pancreatitis Research Group, Royal Liverpool University Hospital, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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