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Dragoni G, Innocenti T, Amiot A, Castiglione F, Melotti L, Festa S, Savarino EV, Truyens M, Argyriou K, Noviello D, Molnar T, Bouillon V, Bezzio C, Eder P, Fernandes S, Kagramanova A, Armuzzi A, Oliveira R, Viola A, Ribaldone DG, Drygiannakis I, Viganò C, Calella F, Gravina AG, Pugliese D, Chaparro M, Ellul P, Vieujean S, Milla M, Caprioli F. Rates of Adverse Events in Patients With Ulcerative Colitis Undergoing Colectomy During Treatment With Tofacitinib vs Biologics: A Multicenter Observational Study. Am J Gastroenterol 2024:00000434-990000000-01014. [PMID: 38305302 DOI: 10.14309/ajg.0000000000002676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/17/2023] [Accepted: 12/28/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Patients with ulcerative colitis (UC) receiving immunosuppressive drugs are at substantial risk of colectomy. We aimed to assess the risk of postoperative complications of tofacitinib exposure before colectomy in comparison with biologics. METHODS A multicenter, retrospective, observational study was conducted in patients with UC who underwent total colectomy for medically refractory disease, exposed to tofacitinib or a biologic before surgery. Primary outcome was the occurrence of any complication within 30 (early) and 90 (late) days after surgery. Secondary outcomes were the occurrence of infections, sepsis, surgical site complications, venous thromboembolic events (VTE), hospital readmissions, and redo surgery within the same timepoints. RESULTS Three hundred one patients (64 tofacitinib, 162 anti-tumor necrosis factor-α agents, 54 vedolizumab, and 21 ustekinumab) were included. No significant differences were reported in any outcome, except for a higher rate of early VTE with anti-tumor necrosis factor-α agents ( P = 0.047) and of late VTE with vedolizumab ( P = 0.03). In the multivariate analysis, drug class was not associated with a higher risk of any early and late complications. Urgent colectomy increased the risk of any early (odds ratio [OR] 1.92, 95% confidence interval [CI] 1.06-3.48) complications, early hospital readmission (OR 4.79, 95% CI 1.12-20.58), and early redo surgery (OR 7.49, 95% CI 1.17-47.85). A high steroid dose increased the risk of any early complications (OR 1.96, 95% CI 1.08-3.57), early surgical site complications (OR 2.03, 95% CI 1.01-4.09), and early redo surgery (OR 7.52, 95% CI 1.42-39.82). Laparoscopic surgery decreased the risk of any early complications (OR 0.54, 95% CI 0.29-1.00), early infections (OR 0.39, 95% CI 0.18-0.85), and late hospital readmissions (OR 0.34, 95% CI 0.12-1.00). DISCUSSION Preoperative tofacitinib treatment demonstrated a postoperative safety profile comparable with biologics in patients with UC undergoing colectomy.
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Affiliation(s)
- Gabriele Dragoni
- IBD Referral Centre, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Tommaso Innocenti
- IBD Referral Centre, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Florence, Italy
| | - Aurelién Amiot
- Department of Gastroenterology, Henri Mondor University Hospital, Paris Est-Creteil University, Creteil, France
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Laura Melotti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | | | | | - Marie Truyens
- Department of Gastroenterology, Ghent University Hospital, Ghent, Belgium
| | | | - Daniele Noviello
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Tamas Molnar
- Department of Gastroenterology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Vincent Bouillon
- Department of Gastroenterology, Erasme University Hospital, Brussels, Belgium
| | - Cristina Bezzio
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Piotr Eder
- Department of Gastroenterology, Dietetics and Internal Medicine-Poznań University of Medical Sciences, Heliodor Święcicki University Hospital, Poznań, Poland
| | - Samuel Fernandes
- Department of Gastroenterology and Hepatology, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisboa, Portugal
- Clínica Universitária da Faculdade de Medicina de Lisboa, Lisboa, Portugal
| | - Anna Kagramanova
- Moscow Clinical Scientific Center named after A.S. Loginov, Moscow, Russian Federation
| | | | - Raquel Oliveira
- Gastroenterology Department, Algarve University Hospital Centre-Portimão Unit, Algarve, Portugal
| | - Anna Viola
- IBD-Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Ioannis Drygiannakis
- Department of Gastroenterology, University Hospital of Heraklion, Heraklion, Greece
| | - Chiara Viganò
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italia
| | - Francesca Calella
- SOC Gastroenterologia ed endoscopia digestiva, Azienda USL Toscana Centro, Ospedale "San Giuseppe," Empoli, Italy
| | - Antonietta Gerarda Gravina
- Hepatogastroenterology Unit, Department of Precision Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Daniela Pugliese
- CEMAD, IBD Unit, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - María Chaparro
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Sophie Vieujean
- Hepato-Gastroenterology and Digestive Oncology, University Hospital CHU of Liège, Liège, Belgium
| | - Monica Milla
- IBD Referral Centre, Careggi University Hospital, Florence, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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Abstract
INTRODUCTION Appropriate treatment is critical in elderly inflammatory bowel disease (IBD) subjects since they are at higher risk of complications such as infections, malignancies and mortality. EVIDENCE ACQUISITION We conducted an extensive PubMed search for guidelines, systematic reviews and primary studies to perform a critical analysis of the existing literature on the efficacy and safety of conventional and biological therapies for elderly IBD patients. EVIDENCE SYNTHESIS Due to the exclusion of elderly population from clinical trials, most evidences comes from real-life studies. While aminosalicylates remain a cornerstone treatment of elderly patients with ulcerative colitis (UC), for their effectiveness and safety, their use in Crohn's disease (CD) should not be further supported. Corticosteroid use should be limited for the induction of remission, while as maintenance treatment it should be avoided, due to the low safety profile. Although as efficacious as in the younger population, immunosuppressant use has been associated with higher risk of infective/malignant issues and further use should be carefully evaluated. Biologics have demonstrated high effectiveness in the elderly. However, due to increased morbidity and mortality described in elderly subjects treated with anti-TNF alpha agents, vedolizumab and ustekinumab should be favoured over anti-TNF alpha agents. CONCLUSIONS Treatment of elderly IBD patients remains challenging, since comorbidities and the risk of adverse events can complicate the effectiveness and safety of therapy. Close monitoring of such patients in a multidisciplinary team is advocated to reduce the risk of infections and optimize the treatment, choosing a suitable agent.
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Affiliation(s)
- Fabiana Castiglione
- Unit of Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Nicola Imperatore
- Unit of Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fabiana Zingone
- Department of Surgery, Oncology, and Gastroenterology, University Hospital of Padua, Padua, Italy
| | - Renata D'Incà
- Department of Surgery, Oncology, and Gastroenterology, University Hospital of Padua, Padua, Italy -
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Bergamaschi G, Castiglione F, D'Incà R, Astegiano M, Fries W, Milla M, Ciacci C, Rizzello F, Saibeni S, Ciccocioppo R, Orlando A, Bossa F, Principi M, Vernia P, Ricci C, Scribano ML, Bodini G, Mazzucco D, Bassotti G, Riegler G, Buda A, Neri M, Caprioli F, Monica F, Manca A, Villa E, Fiorino G, Aronico N, Lenti MV, Mengoli C, Testa A, Vecchi M, Klersy C, Di Sabatino A. Follow-up evaluation and management of anemia in inflammatory bowel disease: A study by the Italian Group for Inflammatory Bowel Diseases (IG-IBD). Dig Liver Dis 2024:S1590-8658(24)00193-2. [PMID: 38296690 DOI: 10.1016/j.dld.2024.01.176] [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: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The RIDART I study found a 13.6% prevalence of anemia in Italian patients with inflammatory bowel disease (IBD); most cases were due to iron-deficiency anemia (IDA). AIMS To evaluate changes in hemoglobin concentration during a 24-week follow-up of anemic patients with IBD. METHODS Follow-up laboratory and clinical data were obtained from RIDART I study patients with anemia. Factors affecting hemoglobin concentration, the impact of anemia on fatigue and quality of life (QoL), and its relationship with treatment, disease activity and disease complications were investigated. RESULTS Hemoglobin was 108 g/L at baseline, increased to 121 g/L at follow-up week 12 (p < 0.001) and then stabilized until week 24, but most patients remained anemic, with IDA, throughout the study. Hemoglobin improvement was greater in patients receiving either oral or parenteral iron supplementation. Following hemoglobin normalization, anemia relapse rate during follow-up was 30%. Oral iron did not cause disease reactivation. Lower follow-up hemoglobin was associated with a higher probability of having active disease, clinical complications, increased fatigue and reduced QoL. CONCLUSIONS In anemic patients with IBD, anemia represents a long-lasting problem, in most cases persisting for up to 24 weeks, with high relapse rate and a negative impact on fatigue and QoL.
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Affiliation(s)
- Gaetano Bergamaschi
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy.
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80138 Naples, Italy
| | - Renata D'Incà
- Inflammatory Bowel disease Unit- AO-University of Padua, 35122 Padova, Italy
| | - Marco Astegiano
- Gastroenterology and Digestive Endoscopy Unit, "Città della Salute e della Scienza" Hospital, 10126 Torino, Italy
| | - Walter Fries
- Gastroenterology and Clinical Unit for inflammatory bowel diseases, Dept. of Clinical and Experimental Medicine; University of Messina, 98122 Messina, Italy
| | - Monica Milla
- Unità operativa complessa di Gastroenterologia clinica, Azienda ospedaliero universitaria Careggi- Firenze, 50134 Firenze, Italy
| | - Carolina Ciacci
- Gastroenterology and Endoscopy Unit, AOU San Giovanni di Dio e Ruggi d'Aragona and University of Salerno, 84084 Salerno, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, 20017 Rho (MI), Italy
| | - Rachele Ciccocioppo
- Gastroenterology Unit, Department of Medicine, A.O.U.I. Policlinico G.B. Rossi & University of Verona, 37134 Verona, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", 90146 Palermo Italy
| | - Fabrizio Bossa
- Department of Gastroenterology and Endoscopy, Fondazione "Casa Sollievo della Sofferenza", IRCCS, 71013 San Giovanni Rotondo, Italy
| | | | - Piero Vernia
- Division of Gastroenterology, Department of Translational and Precision Medicine, "Sapienza" University of Rome and Umberto I Hospital, 00161 Rome, Italy
| | - Chiara Ricci
- Dept of Experimental and Clinical Science, University of Brescia, Gastroenterology Unit,Spedali Civili Hospital, 25123 Brescia. Italy
| | - Maria L Scribano
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy; Villa Stuart, Multi-Speciality Clinic, 00135 Rome, Italy
| | - Giorgia Bodini
- Gastroenterology unit, Department of Internal medicine, Policlinico San Martino, Università di Genova, 16132 Genoa, Italy
| | - Dario Mazzucco
- Gastroenterology Unit, ASL TO3, 10097 Rivoli, Torino, Italy
| | - Gabrio Bassotti
- Gastroenterology, Hepatology & Digestive Endoscopy Section, Department of Medicine & Surgery, University of Perugia and Perugia General Hospital, 06129 Perugia, Italy
| | - Gabriele Riegler
- Unit of Gastroenterology - Reference Center for IBD - Second University of Naples, 80138 Naples, Italy
| | - Andrea Buda
- Department of Gastrointestinal Oncological Surgery, Gastroenterology Unit, S. Maria del Prato Hospital, 30032 Feltre, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences and Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66013 Chieti, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, 20122 Milan, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy Unit, Cattinara Academic Hospital, 34149 Trieste, Italy
| | - Aldo Manca
- Department of Gastroenterology and Digestive Endoscopy, S. Croce e Carle Hospital, 12100 Cuneo, Italy
| | - Erica Villa
- UC Gastroenterologia, Dipartimento di Specialità Mediche, Azienda Ospedaliera Universitaria di Modena, 41125 Modena, Italy
| | - Gionata Fiorino
- Department of Gastroenterology and Digestive Endoscopy, San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; IBD Unit, San Camillo-Forlanini Hospital, 00152 Rome, Italy
| | - Nicola Aronico
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy
| | - Marco V Lenti
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy
| | - Caterina Mengoli
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80138 Naples, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, 20122 Milan, Italy
| | - Catherine Klersy
- Servizio di Epidemiologia Clinica & Biometria, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Antonio Di Sabatino
- Medicina Generale I, Fondazione IRCCS Policlinico San Matteo e Università di Pavia, 27100 Pavia, Italy.
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Ardizzone S, Armuzzi A, Caprioli F, Castiglione F, Danese S, Daperno M, Fantini MC, Fries W, Principi MB, Savarino E, Gionchetti P. Timing of proper introduction, optimization and maintenance of anti-TNF therapy in IBD: Results from a Delphi consensus. Dig Liver Dis 2024; 56:98-105. [PMID: 37741750 DOI: 10.1016/j.dld.2023.09.003] [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: 05/11/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBDs) with a rapidly growing worldwide incidence. The last decades presented rapid progress in pharmacological treatment leading in many cases to clinical and endoscopic remission, including biological treatment with anti-TNF agents. AIM The exact timing of introduction, optimization and maintenance of anti-TNF therapy in IBDs is not thoroughly covered in current guidelines. METHODS We used the Delphi panel methodology to gather the IBD experts' views and achieve consensus for clinical recommendations on introducing and maintaining anti-TNF therapy for patients with IBDs. RESULTS Twelve recommendations achieved a high level of consensus in two assessment rounds by 52 (1st round) and 47 (2nd round) IBD experts. CONCLUSION In many clinical situations, the early use of anti-TNF therapy is recommended. Nowadays, the cost-efficacy profile of anti-TNF biosimilars makes them the first-line drug in a substantial proportion of patients, thus providing the opportunity to increase access to biological therapy.
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Affiliation(s)
- Sandro Ardizzone
- Gastrointestinal Unit ASST Fatebenefratelli Sacco-University of Milan, Milan, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy - Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (Milan), Italy
| | - Flavio Caprioli
- Dept. of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Fabiana Castiglione
- Department of clinical medicine and surgery, AOU Federico II hospital, Naples, Italy
| | | | - Marco Daperno
- Gastroenterology Unit, AO Ordine Mauriziano of Turin, Turin, Italy
| | | | - Walter Fries
- Gastroenterology Unit, Dept. of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maria Beatrice Principi
- Gastroenterology Unit, Dept. of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari, Bari, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, AOU University of Padua, Padua, Italy - Dept. of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Paolo Gionchetti
- IBD Unit, IRCCS AOU of Bologna, Bologna, Italy; DIMEC University of Bologna, Bologna, Italy.
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Nardone OM, Calabrese G, La Mantia A, Testa A, Rispo A, Alfonsi L, Pasanisi F, Castiglione F. Effectiveness of Partial Enteral Nutrition as Add-On to Biologics in Patients With Refractory and Difficult-to-Treat Crohn's Disease: A Pilot Study. Crohns Colitis 360 2024; 6:otae011. [PMID: 38464346 PMCID: PMC10923207 DOI: 10.1093/crocol/otae011] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Indexed: 03/12/2024] Open
Abstract
Background Partial enteral nutrition (PEN) is a well-established treatment for children with Crohn's disease (CD). However, its efficacy in adults with CD remains uncertain. We aimed to assess the effectiveness of PEN as an add-on to escalated biological therapy in adults with CD who have lost response to biologics. Methods We conducted a retrospective observational study including patients who had lost response to biologics and received PEN in combination with escalated treatment, compared to those treated only with escalated therapy. The primary endpoint was steroid-free clinical remission (CR) at 24 weeks. Secondary endpoints included transmural healing (TH) and response (TR) rates along with selected clinical outcomes. Results Forty-two patients were screened; 12 (28.6%) were excluded for complicated disease and 30 (71.4%) were included in the final analysis. Fourteen (46.7%) patients completed PEN treatment at 8 weeks, while 16 patients (53.3%) discontinued treatment due to intolerance and continued with escalation of biologic (BT group). At 24 weeks, 9 patients (64.3%) in the PEN group achieved CR, compared to 4 patients (25%) in the BT group (P = .03). The TR rate was 64.9% in the PEN group and 25% in the BT group (P = .03). Patients receiving PEN exhibited an increase in albumin levels compared to those in the BT group (Δ = 0.5; P = .02). A higher rate of therapy changes (68.7%) was observed in the BT group compared to 14.2% in the PEN group (P = .004). Prior failure to 2 lines of biological therapy was associated with adherence to PEN (OR = 1.583; CI = 1.06-2.36; P = .01). Conclusions In patients who had lost response to biologics, PEN in combination with escalated biologics was associated with CR and TR and improved nutritional status. Hence, the addition of PEN should be considered for patients with difficult-to-treat CD.
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Affiliation(s)
- Olga Maria Nardone
- Gastroenterology, Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giulio Calabrese
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Alessia La Mantia
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Lucia Alfonsi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabrizio Pasanisi
- Internal Medicine and Clinical Nutrition Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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6
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Ribaldone DG, Parisio L, Variola A, Bossa F, Castiglione F, Marzo M, Piazza N, Aratari A, Savarino EV, Bodini G, Mastronardi M, Micheli F, Mazzuoli S, Ascolani M, Viganò C, Cappello M, Bezzio C, Ciccocioppo R, Scardino G, Sarli E, Pugliese D, Scaldaferri F, Napolitano D, Todeschini A, Geccherle A, Colaci N, Guerra M, Annese M, Testa A, Caiazzo A, Conforti FS, Festa S, Lorenzon G, Marra A, Magiotta A, Baccini F, Amato A, Poshnjari A, Vernero M, Caprioli F, Caviglia GP. Switching from VEDOlizumab intravenous to subcutaneous formulation in ulcerative colitis patients in clinical remission: The SVEDO Study, an IG-IBD study. Dig Liver Dis 2024; 56:77-82. [PMID: 37474412 DOI: 10.1016/j.dld.2023.07.011] [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: 04/30/2023] [Revised: 07/04/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND The administration of biological drugs in inflammatory bowel diseases (IBD) is increasingly moving from intravenous to subcutaneous formulations. AIMS To evaluate the efficacy and safety of vedolizumab subcutaneous administration after switching from intravenous administration in ulcerative colitis (UC) patients in corticosteroid-free clinical remission. METHODS An observational, multicentre, prospective study was conducted by the Italian Group for the study of IBD (IG-IBD). UC patients in clinical remission (pMAYO < 2) not receiving steroids for > 8 months before the switch, and with at least 6 months of follow-up were included. Switch from intravenous to subcutaneous vedolizumab was defined as successful in patients not experiencing a disease flare (pMAYO ≥ 2) or needing oral steroids or stopping subcutaneous vedolizumab during the 6 months of follow-up after the switch. RESULTS Overall, 168 patients were included. The switch was a success in 134 patients (79.8%). Vedolizumab retention rate was 88.7% at month six. C-reactive protein and faecal calprotectin values did not change after the switch (p = 0.07 and p = 0.28, respectively). Ten of the 19 patients who stopped subcutaneous formulation switched back to intravenous formulation recapturing clinical remission in 80%. Side effects were observed in 22 patients (13.1%). CONCLUSION Effectiveness of switching from intravenous to subcutaneous vedolizumab formulation in UC patients in steroid-free clinical remission is confirmed in a real-world setting.
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Affiliation(s)
| | - Laura Parisio
- CEAMD- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Angela Variola
- IBD Unit - IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Fabrizio Bossa
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - Manuela Marzo
- UOC Gastroenterologia Ospedale Veris delli Ponti, Scorrano, LE, Italy
| | - Nicole Piazza
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
| | | | - Edoardo Vincenzo Savarino
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Giorgia Bodini
- IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | | | - Federica Micheli
- Digestive Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Silvia Mazzuoli
- Gastroenterology and Endoscopy Unit, Ospedale "DiMiccoli" Barletta (BAT), Italy
| | - Marta Ascolani
- UOC Gastroenterologia, ULSS2 Marca Trevigiana, Ospedale Ca'Foncello, Treviso, Italy
| | - Chiara Viganò
- Department of Gastroenterology, and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, University of Milano-Bicocca School of Medicine, Monza, Italy
| | - Maria Cappello
- UOC Gastroenterologia - AOUP P. Giaccone, Palermo, Italy
| | - Cristina Bezzio
- IBD Center, Gastroenterology Unit, Rho Hospital, ASST Rhodense, Milan, Italy
| | - Rachele Ciccocioppo
- Gastroenterology Unit, Department of Medicine, A.O.U.I. Policlinico G.B. Rossi & University of Verona, Verona, Italy
| | - Giulia Scardino
- Gastroenterology Department, "Valduce" Hospital, Como, Italy
| | - Ennio Sarli
- Italian Group for the study of Inflammatory Bowel Disease IG-IBD, Florence, Italy
| | - Daniela Pugliese
- CEAMD- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Franco Scaldaferri
- CEAMD- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Daniele Napolitano
- CEAMD- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Alessia Todeschini
- IBD Unit - IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Andrea Geccherle
- IBD Unit - IRCCS Ospedale Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Nicoletta Colaci
- Unità per la Ricerca Clinica, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Maria Guerra
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Monica Annese
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - Anna Caiazzo
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - Francesco Simone Conforti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
| | | | - Greta Lorenzon
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | | | - Ambra Magiotta
- Digestive Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Flavia Baccini
- Digestive Disease Unit, Sant'Andrea Hospital, Sapienza University of Rome, Italy
| | - Arnaldo Amato
- Digestive Endoscopy and Gastroenterology Department - ASST Lecco, Italy
| | | | - Marta Vernero
- Department of Medical Sciences, University of Turin, Turin, 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 Maggiore Policlinico di Milano, Italy
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7
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Maselli R, de Sire R, Massimi D, Franchellucci G, Busacca A, Castiglione F, Rispo A, Hassan C, Armuzzi A, Repici A. Advancements in Endoscopic Resection for Colitis-Associated Colorectal Neoplasia in Inflammatory Bowel Disease: Turning Visible into Resectable. Diagnostics (Basel) 2023; 14:9. [PMID: 38201318 PMCID: PMC10795709 DOI: 10.3390/diagnostics14010009] [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] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
Patients suffering from inflammatory bowel disease (IBD) face a two to three-fold higher risk of developing colorectal cancer (CRC) compared to the general population. In recent years, significant progress has been made in comprehending the natural history of IBD-associated CRC (IBD-CRC) and refining its treatment strategies. The decreased incidence of IBD-CRC can be attributed to improved therapeutic management of inflammation, advancements in endoscopy, and early detection of precancerous lesions via surveillance programs. Advanced imaging technologies have made previously undetectable dysplasia visible in most cases, allowing for a much more precise and detailed examination of the mucosa. Additionally, new tools have facilitated the endoscopic resection (ER) of visible lesions in IBD. Particularly, the key to effectively manage colitis-associated colorectal neoplasia (CAN) is to first identify it and subsequently guarantee a complete ER in order to avoid surgery and opt for continuing surveillance. Advanced ER techniques for CAN include endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), and hybrid ESD-EMR (h-ESD). This narrative review aims to consolidate the current literature on IBD-CRC, providing an overview of advanced techniques for ER of CAN in IBD, with a particular emphasis on the impact of ESD on the long-term outcomes of IBD patients.
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Affiliation(s)
- Roberta Maselli
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (D.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (G.F.); (A.A.)
| | - Roberto de Sire
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (D.M.); (C.H.); (A.R.)
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (F.C.); (A.R.)
| | - Davide Massimi
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (D.M.); (C.H.); (A.R.)
| | - Gianluca Franchellucci
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (G.F.); (A.A.)
| | - Anita Busacca
- Gastroenterology, IBD Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
| | - Fabiana Castiglione
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (F.C.); (A.R.)
| | - Antonio Rispo
- IBD Unit, Department of Clinical Medicine and Surgery, University Federico II, 80126 Naples, Italy; (F.C.); (A.R.)
| | - Cesare Hassan
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (D.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (G.F.); (A.A.)
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (G.F.); (A.A.)
- Gastroenterology, IBD Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy;
| | - Alessandro Repici
- Gastroenterology, Endoscopy Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (R.M.); (D.M.); (C.H.); (A.R.)
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy; (G.F.); (A.A.)
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8
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Nardone OM, Calabrese G, Barberio B, Giglio MC, Castiglione F, Luglio G, Savarino E, Ghosh S, Iacucci M. Rates of Endoscopic Recurrence In Postoperative Crohn's Disease Based on Anastomotic Techniques: A Systematic Review And Meta-Analysis. Inflamm Bowel Dis 2023:izad252. [PMID: 37931290 DOI: 10.1093/ibd/izad252] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Patients with Crohn's disease (CD) after ileocolic resection may develop an endoscopic postoperative recurrence (ePOR) that reaches 40% to 70% of incidence within 6 months. Recently, there has been growing interest in the potential effect of anastomotic configurations on ePOR. Kono-S anastomosis has been proposed for reducing the risk of clinical and ePOR. Most studies have assessed the association of ileocolonic anastomosis and ePOR individually, while there is currently limited data simultaneously comparing several types of anastomosis. Therefore, we performed a systematic review and meta-analysis to assess the impact of different ileocolonic anastomosis on ePOR in CD. METHODS We searched PubMed and Embase from inception to January 2023 for eligible studies reporting the types of anastomoses and, based on these, the rate of endoscopic recurrence at ≥6 months. Studies were grouped by conventional anastomosis, including side-to-side, end-to-end, and end-to-side vs Kono-S, and comparisons were made between these groups. Pooled incidence rates of ePOR were computed using random-effect modelling. RESULTS Seventeen studies, with 2087 patients who underwent ileocolic resection for CD were included. Among these patients, 369 (17,7%) Kono-S anastomoses were performed, while 1690 (81,0%) were conventional ileocolic anastomosis. Endoscopic postoperative recurrence at ≥6 months showed a pooled incidence of 37.2% (95% CI, 27.7-47.2) with significant heterogeneity among the studies (P < .0001). In detail, patients receiving a Kono-S anastomosis had a pooled incidence of ePOR of 24.7% (95% CI, 6.8%-49.4%), while patients receiving a conventional anastomosis had an ePOR of 42.6% (95% CI, 32.2%-53.4%). CONCLUSIONS Kono-S ileocolic anastomosis was more likely to decrease the risk of ePOR at ≥6 months compared with conventional anastomosis. Our findings highlight the need to implement the use of Kono-S anastomosis, particularly for difficult to treat patients. However, results from larger randomized controlled trials are needed to confirm these data.
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Affiliation(s)
- Olga Maria Nardone
- Gastroenterology, Department of Public Health, School of Medicine, Federico II University of Naples, Naples, Italy
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Giulio Calabrese
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine, Federico II University of Naples, Naples, Italy
| | - Brigida Barberio
- Division of Gastroenterology, Department of Surgery Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Mariano Cesare Giglio
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine, Federico II University of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine, Federico II University of Naples, Naples, Italy
| | - Gaetano Luglio
- Department of Public Health, Endoscopic Surgery Unit, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Edoardo Savarino
- Division of Gastroenterology, Department of Surgery Oncology and Gastroenterology DiSCOG, University of Padova, Padova, Italy
| | - Subrata Ghosh
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, College Road, National University of Ireland, T12 K8AF Cork, Ireland
| | - Marietta Iacucci
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- APC Microbiome Ireland, College of Medicine and Health, University College Cork, College Road, National University of Ireland, T12 K8AF Cork, Ireland
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Cioffi I, Di Vincenzo O, Imperatore N, Fisco M, Testa A, Scialò F, Castiglione F, Ruoppolo M, Pasanisi F, Santarpia L. Amino acid profiles, disease activity, and protein intake in adult patients with Crohn's disease. Front Nutr 2023; 10:1245574. [PMID: 37854352 PMCID: PMC10579601 DOI: 10.3389/fnut.2023.1245574] [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: 06/23/2023] [Accepted: 09/20/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Crohn's disease (CD) is an immune-mediated inflammatory disorder of the gastrointestinal tract with a relapsing-remitting course. Amino acids (AAs) may play critical roles in the intestinal manifestations of disease, due to their involvement in many metabolic and immune functions. The present study aimed to explore serum AA concentrations in adult patients with CD, looking into their variations due to disease activity, surgery and protein content of diet. Eventually, the link between AAs and inflammatory markers was also assessed. Methods Consecutive adult patients aged 18-65 years with diagnosis of CD were recruited. All participants underwent anthropometry and were instructed to fill in a 3-day food record to assess protein intake. Disease activity was clinically defined using the Crohn's Disease Activity Index (CDAI), while blood samples were taken to analyze serum AA profile and inflammatory markers. Results A total of 103 patients with CD (61 men and 42 women; age:39.9 ± 13.9 years, BMI: 23.4 ± 3.51 kg/m2) were included. Tryptophan levels were found to be remarkably decreased in most subjects, unrelated to disease activity. On the contrary, concentration of lysine, leucine, valine and glutamine decreased in active versus quiescent CD patients, while aspartic acid, glutamate and glycine increased. The latter AAs were also directly correlated with CDAI and serum interleukin (IL)- 1β concentration. Considering the total protein intake, expressed as g/kg/body weight, we observed a reduction in some essential AAs in patients with unmet protein requirements compared to patients who met the recommendation. Discussion In conclusion, specific AAs varied according to disease activity and protein intake, adjusted to body weight and disease status. Glu and Asp concentrations raised with increasing IL-1β. However, extensive research is needed to understand the mechanisms underpinning the link between variation in serum AAs, disease activity and protein intake in patients with CD.
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Affiliation(s)
- Iolanda Cioffi
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences - DEFENS, Università degli Studi di Milano, Milan, Italy
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Olivia Di Vincenzo
- Department of Public Health, Federico II University Hospital, Naples, Italy
| | - Nicola Imperatore
- Gastroenterology and Endoscopy Unit, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Mariagrazia Fisco
- CEINGE - Biotecnologie Avanzate F. Salvatore, s.c.ar.l, Napoli, Italy
| | - Anna Testa
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Filippo Scialò
- CEINGE - Biotecnologie Avanzate F. Salvatore, s.c.ar.l, Napoli, Italy
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Naples, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Margherita Ruoppolo
- CEINGE - Biotecnologie Avanzate F. Salvatore, s.c.ar.l, Napoli, Italy
- Department of Molecular Medicine and Medical Biotechnology, University of Naples “Federico II”, Naples, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
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10
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Guarino AD, Luglio G, Imperatore N, Cerciello G, Pugliese N, Castiglione F, Tropeano FP, Testa A, Olmo O, Rispo A. Cyclic Neutropenia Mimicking Crohn's Disease: Two Case Reports and a Narrative Review. J Clin Med 2023; 12:6323. [PMID: 37834967 PMCID: PMC10573598 DOI: 10.3390/jcm12196323] [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] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/15/2023] Open
Abstract
Cyclic neutropenia is a rare hematological condition characterized by periodic fluctuations in neutrophil counts, with a 21-day periodicity. Clinical presentation varies from mild to severe forms of the disease, with the onset of recurrent fever, painful oral ulcers, recurrent bacterial infections, peritonitis, and septic shock. The availability of granulocyte colony-stimulating factor (G-CSF) has revolutionized the management and natural history of this disease, regulating the proliferation, differentiation, and maturation of the progenitor cells, and reducing the duration of neutropenia. Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a group of chronic pathologies that affect the gastrointestinal tract. The onset of both diseases may be at a young age (even during childhood or adolescence), and clinical manifestations may lead to misdiagnosis, due to similar characteristics such as recurrent infections, oral ulcers, perianal abscesses, and infertility. Moreover, the two pathologies are rarely associated, with different management and therapeutic options. Here, we describe two case reports of patients who underwent surgery because of diagnosis of complicated CD. After surgery, due to persistent neutropenia, the hematologist consultant confirmed suspicions of cyclic neutropenia, and G-CSF therapy was started with benefits, underlining the crucial importance of proper differential diagnosis.
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Affiliation(s)
- Alessia Dalila Guarino
- Gastroenterology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (A.D.G.)
| | - Gaetano Luglio
- Endoscopic Surgery, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy
| | - Nicola Imperatore
- Gastroenterology,“Santa Maria Delle Grazie” Hospital, 80078 Pozzuoli, Italy
| | | | - Novella Pugliese
- Hematology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (A.D.G.)
| | - Francesca Paola Tropeano
- Endoscopic Surgery, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (A.D.G.)
| | - Oriana Olmo
- Gastroenterology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (A.D.G.)
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (A.D.G.)
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11
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Resál T, Bacsur P, Keresztes C, Bálint A, Bor R, Fábián A, Farkas B, Katsanos K, Michalopoylos G, Ribaldone DG, Attauabi M, Zhao M, Barak HA, Yanai H, Bezzio C, Rispo A, Castiglione F, Bar-Gil Shitrit A, Pugliese D, Armuzzi A, Savarino EV, Kolar M, Lukáš M, Chashkova E, Filip R, Rozieres A, Nancey S, Krznarić Ž, Schäfer E, Szamosi, Sarlós P, Franko M, Drobne D, Knyazev OV, Kagramanova AV, Limdi J, Wetwittayakhlang P, Lakatos PL, Maharshak N, Bannon L, Nyári T, Szepes Z, Farkas K, Molnár T. Real-Life Efficacy of Tofacitinib in Various Situations in Ulcerative Colitis: A Retrospective Worldwide Multicenter Collaborative Study. Inflamm Bowel Dis 2023:izad135. [PMID: 37542737 DOI: 10.1093/ibd/izad135] [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: 03/14/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND AND AIMS Tofacitinib (TFB) appears to be effective in the treatment of ulcerative colitis (UC); however, available real-world studies are limited by cohort size. TFB could be an option in the treatment of acute severe ulcerative colitis (ASUC). We aimed to investigate efficacy and safety of TFB in moderate-to-severe colitis and ASUC. METHODS This retrospective, international cohort study enrolling UC patients with ≥6-week follow-up period was conducted from February 1 to July 31, 2022. Indications were categorized as ASUC and chronic activity (CA). Baseline demographic and clinical data were obtained. Steroid-free remission (SFR), colectomy, and safety data were analyzed. RESULTS A total of 391 UC patients (median age 38 [interquartile range, 28-47] years; follow-up period 26 [interquartile range, 14-52] weeks) were included. A total of 27.1% received TFB in ASUC. SFR rates were 23.7% (ASUC: 26.0%, CA: 22.8%) at week 12 and 41.1% (ASUC: 34.2%, CA: 43.5%) at week 52. The baseline partial Mayo score (odds ratio [OR], 0.850; P = .006) was negatively associated with week 12 SFR, while biologic-naïve patients (OR, 2.078; P = .04) more likely achieved week 52 SFR. The colectomy rate at week 52 was higher in ASUC group (17.6% vs 5.7%; P < .001) and decreased with age (OR, 0.94; P = .013). A total of 67 adverse events were reported, and 17.9% resulted in cessation of TFB. One case of thromboembolic event was reported. CONCLUSIONS TFB is effective in both studied indications. TFB treatment resulted in high rates of SFR in the short and long terms. Higher baseline disease activity and previous biological therapies decreased efficacy. No new adverse event signals were found.
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Affiliation(s)
- Tamás Resál
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Péter Bacsur
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Csilla Keresztes
- Department for Medical Communication and Translation Studies, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anita Bálint
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Renáta Bor
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Anna Fábián
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Bernadett Farkas
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Kostas Katsanos
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - George Michalopoylos
- Gastroenterology Department, General Hospital of Athens G. Gennimatas, Athens, Greece
| | | | - Mohamed Attauabi
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Mirabella Zhao
- Gastrounit, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | - Hadar Amir Barak
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Cristina Bezzio
- IBD Unit/Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Antonio Rispo
- IBD Unit Department, Clinical Medicine and Surgery, Azienda Ospedaliera Universitaria Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- IBD Unit Department, Clinical Medicine and Surgery, Azienda Ospedaliera Universitaria Federico II of Naples, Naples, Italy
| | - Ariella Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Daniela Pugliese
- IBD Center, Centro Malattie Apparato Digerente, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Martin Kolar
- IVth Medical Department, Charles University in Prague, Prague, Czech Republic
| | - Milan Lukáš
- IVth Medical Department, Charles University in Prague, Prague, Czech Republic
| | - Elena Chashkova
- Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
| | - Rafał Filip
- Department of Gastroenterology with IBD, Unit of Clinical Hospital No. 2 im. Sw. Jadwigi Królowej, Rzeszow, Poland
| | - Aurore Rozieres
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche et Infectologie, INSERM U1111, Lyon, France
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, Lyon, France
- Centre International de Recherche et Infectologie, INSERM U1111, Lyon, France
| | - Željko Krznarić
- Department of Gastroenterology and Hepatology, University Hospital Centre Zagreb, Zagreb, Croatia
- Department of Nutrition, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Eszter Schäfer
- Department of Gastroenterology, Military Hospital Medical Centre, State Health Centre, Budapest, Hungary
| | - Szamosi
- Department of Gastroenterology, Military Hospital Medical Centre, State Health Centre, Budapest, Hungary
| | - Patrícia Sarlós
- Division of Gastroenterology, First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Matej Franko
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - David Drobne
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Department of Gastroenterology, University Medical Centre Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Oleg V Knyazev
- Moscow Clinical Scientific Center named after A. S. Loginov, Moscow, Russia
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Anna V Kagramanova
- Moscow Clinical Scientific Center named after A. S. Loginov, Moscow, Russia
- Research Institute of Health Organization and Medical Management, Moscow, Russia
| | - Jimmy Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, United Kingdom
| | - Panu Wetwittayakhlang
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Peter L Lakatos
- Division of Gastroenterology, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, Budapest, Hungary
| | - Nitsan Maharshak
- National Medical Research Сenter of Coloproctology named after A. N. Ryzhykh, Moscow, Russia
| | - Lian Bannon
- Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tibor Nyári
- Department of Medical Physics and Informatics, Albert Szent-Györgyi Medical School University of Szeged, Szeged, Hungary
| | - Zoltán Szepes
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Klaudia Farkas
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Tamás Molnár
- Division of Gastroenterology, Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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12
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Bezzio C, Vernero M, Costa S, Armuzzi A, Fiorino G, Ardizzone S, Roselli J, Carparelli S, Orlando A, Caprioli FA, Castiglione F, Viganò C, Ribaldone DG, Zingone F, Monterubbianesi R, Imperatore N, Festa S, Daperno M, Scucchi L, Ferronato A, Pastorelli L, Alimenti E, Balestrieri P, Ricci C, Cappello M, Felice C, Coppini F, Alvisi P, Di Luna I, Gerardi V, Variola A, Mazzuoli S, Lenti MV, Saibeni S. SARS-CoV-2 infection in patients with inflammatory bowel disease: comparison between the first and second pandemic waves. BMC Gastroenterol 2023; 23:230. [PMID: 37407913 DOI: 10.1186/s12876-023-02841-0] [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: 09/28/2022] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND In Italy, the incidence of SARS-CoV-2 infection peaked in April and November 2020, defining two pandemic waves of coronavirus disease 2019 (COVID-19). This study compared the characteristics and outcomes of patients with inflammatory bowel disease (IBD) and SARS-CoV-2 infections between pandemic waves. METHODS Observational longitudinal study of IBD patients with SARS-CoV-2 infection. Patients with established diagnoses of IBD and of SARS-CoV-2 infection were consecutively enrolled in two periods: (i) first wave, from 1 March 2020 to 31 May 2020; and (ii) second wave, from 15 September to 15 December 2020. RESULTS We enrolled 937 IBD patients (219 in the first wave, 718 in the second wave). Patients of the first wave were older (mean ± SD: 46.3 ± 16.2 vs. 44.1 ± 15.4 years, p = 0.06), more likely to have ulcerative colitis (58.0% vs. 44.4%, p < 0.001) and comorbidities (48.9% vs. 38.9%; p < 0.01), and more frequently residing in Northern Italy (73.1% vs. 46.0%, p < 0.001) than patients of the second wave. There were no significant differences between pandemic waves in sex (male: 54.3% vs. 53.3%, p = 0.82) or frequency of active IBD (44.3% vs. 39.0%, p = 0.18). The rates of negative outcomes were significantly higher in the first than second wave: pneumonia (27.8% vs. 11.7%, p < 0.001), hospital admission (27.4% vs. 9.7%, p < 0.001), ventilatory support (11.9% vs. 5.4%, p < 0.003) and death (5.5% vs. 1.8%, p < 0.007). CONCLUSION Between the first and second SARS-CoV-2 pandemic waves, demographic, clinical and geographical features of IBD patients were different as were the symptoms and outcomes of infection. These differences are likely due to the different epidemiological situations and diagnostic possibilities between the two waves.
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Affiliation(s)
- Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017, Rho, MI, Italy.
| | - Marta Vernero
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Stefania Costa
- Department of Medical Sciences, University of Turin, Turin, Italy
- , UO Gastroenterology, ASST Milano Ovest, Legnano (MI), Legnano, Italy
| | - Alessandro Armuzzi
- IBD Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Gionata Fiorino
- Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Sandro Ardizzone
- Gastroenterology Unit, ASST Fatebenefratelli Sacco, Milan, Italy
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Jenny Roselli
- Gastroenterology Department, IBD Referral Center, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Sonia Carparelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Casa Sollievo Della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Flavio Andrea Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Chiara Viganò
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Davide G Ribaldone
- Division of Gastroenterology, Department of Medical Sciences, Università Di Torino, Turin, Italy
| | - Fabiana Zingone
- Department of Surgical, Oncological and Gastroenterological Sciences - DISCOG, University Hospital, Padua, Italy
| | - Rita Monterubbianesi
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Nicola Imperatore
- Gastroenterology and Endoscopy Unit, P.O. Santa Maria delle Grazie, Pozzuoli, Naples, Italy
| | | | - Marco Daperno
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Ludovica Scucchi
- Department of Systems Medicine, University Tor Vergata, Rome, Italy
| | - Antonio Ferronato
- UOSD Endoscopia Digestiva, Ospedale Alto Vicentino, AULSS 7 Pedemontana, Santorso, VI, Italy
| | - Luca Pastorelli
- Gastroenterology and Liver Unit, School of Medicine at Ospedale San Paolo, Department of Health Sciences, ASST Santi Paolo E Carlo, University of Milan, Milan, Italy
| | | | - Paola Balestrieri
- Gastroenterology and Endoscopy Unit, Policlinico Campus Bio Medico, Rome, Italy
| | - Chiara Ricci
- Gastroenterology Unit, Clinical and Experimental Sciences Department, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Carla Felice
- Medicine 1 Unit, Ca' Foncello University Hospital, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Francesca Coppini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Patrizia Alvisi
- Pediatric Gastroenterology Unit, Maggiore Hospital, Bologna, Italy
| | - Imma Di Luna
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Viviana Gerardi
- Medicine, Gastroenterology and Digestive Endoscopy Department, Fondazione Poliambulanza, Brescia, Italy
| | - Angela Variola
- IBD Unit, IRCCS Sacro Cuore Don Calabria, Negrar, VR, Italy
| | - Silvia Mazzuoli
- Gastroenterology and Artificial Nutrition Department, Ospedale Monsignor Raffaele Dimiccoli, Barletta, BT, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; First Department of Internal Medicine, San Matteo Hospital Foundation, Pavia, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017, Rho, MI, Italy
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13
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Macaluso FS, Principi M, Facciotti F, Contaldo A, Todeschini A, Saibeni S, Bezzio C, Castiglione F, Nardone OM, Spagnuolo R, Fantini MC, Riguccio G, Conforti S, Caprioli F, Viganò C, Felice C, Fiorino G, Correale C, Bodini G, Milla M, Scardino G, Vernero M, Desideri F, Bossa F, Guerra M, Ventimiglia M, Casà A, Rizzo G, Orlando A. Lack of Seroconversion Following COVID-19 Vaccination Is an Independent Risk Factor for SARS-CoV-2 Infection in Patients With Inflammatory Bowel Disease: Data from ESCAPE-IBD, an IG-IBD Study. Inflamm Bowel Dis 2023:izad118. [PMID: 37390400 DOI: 10.1093/ibd/izad118] [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: 01/22/2023] [Indexed: 07/02/2023]
Abstract
This prospective study reported 2 key results: (1) lack of seroconversion following 2 doses of COVID-19 vaccines is an independent predictor of SARS-CoV-2 infection; (2) treatments for IBD were not associated with increased risk of SARS-CoV-2 infection.
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Affiliation(s)
| | | | - Federica Facciotti
- Istituto Europeo di Oncologia IRCCS, Dipartimento di Oncologia Sperimentale, Milan, Italy
| | - Antonella Contaldo
- Gastroenterology 2 Unit, IRCCS "S. De Bellis", Castellana Grotte, Bari, Italy
| | - Alessia Todeschini
- IBD Unit, IRCCS Sacro Cuore Don Calabria, Negrar di Valpolicella, Verona, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Milan, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Milan, Italy
| | - Fabiana Castiglione
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - Olga Maria Nardone
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Naples, Italy
| | - Rocco Spagnuolo
- U.O. Gastroenterologia ed Endoscopia Digestiva, A.O.U. "Mater Domini," Catanzaro, Italy
- Dipartimento di Medicina Sperimentale e Clinica, Università "Magna Graecia" Catanzaro, Italy
| | - Massimo Claudio Fantini
- AOU Policlinico Monserrato, Dipartimento di Scienze Mediche e Sanità Pubblica, Università di Cagliari, Italy
| | - Gaia Riguccio
- UOSD Malattie Infiammatorie Croniche intestinali, Ospedale Santa Maria del Prato, Feltre, Italy
| | - Simone Conforti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Carla Felice
- UOC Gastroenterologia, Ospedale Ca'Foncello, Treviso, Italy
| | - Gionata Fiorino
- Dipartimento di Gastroenterologia ed Endoscopia Digestiva, IRCCS Ospedale San Raffaele e Università Vita-Salute San Raffaele, Milano, Italia
| | - Carmen Correale
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Giorgia Bodini
- IRCCS Policlinico San Martino, Università di Genova, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Scardino
- Dipartimento di Gastroenterologia, Ospedale Valduce, Como, Italy
| | - Marta Vernero
- Gastroenterology Unit, Department of Medical Sciences, University of Pavia, Pavia, Italy
| | | | - Fabrizio Bossa
- Division of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Maria Guerra
- Division of Gastroenterology, "Casa Sollievo della Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service; Italian Ministry of Health, Rome, Italy
| | - Angelo Casà
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Giuseppe Rizzo
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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14
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Principi M, Macaluso FS, Todeschini A, Facciotti F, Contaldo A, Castiglione F, Nardone OM, Spagnuolo R, Doldo P, Riguccio G, Conforti FS, Viganò C, Ascolani M, Fiorino G, Correale C, Bodini G, Milla M, Scardino G, Vernero M, Desideri F, Caprioli F, Mannino M, Rizzo G, Orlando A. Safety, hesitancy of coronavirus disease 2019 vaccination and pandemic burden in patients with inflammatory bowel disease: data of a national study (ESCAPE-IBD). Eur J Gastroenterol Hepatol 2023; 35:629-634. [PMID: 37115976 DOI: 10.1097/meg.0000000000002550] [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] [Indexed: 04/30/2023]
Abstract
BACKGROUND AND AIMS The purpose of this study was to present data on the safety of anti- severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in a cohort of inflammatory bowel disease (IBD) patients of an ongoing multicenter study (ESCAPE-IBD) sponsored by the Italian Group for the study of Inflammatory Bowel Disease (ClinicalTrials.gov Identifier: NCT04769258). METHODS Anti-SARS-CoV-2 vaccination was administrated to 809 IBD patients. Interviews were conducted to report adverse events related to vaccination. Of these 809, 346 patients were surveyed on the pandemic burden and the main reason for hesitancy in coronavirus disease 2019 vaccination. The chi-square test was used to compare categorical variables. Logistic regression was used to assess the relationship between disease-related characteristics and the onset of adverse events. RESULTS About 45% of patients had at least one side effect, following the first dose (10%), the second (15%), and both doses (19%). All the adverse events were mild and lasted only a few days. Logistic regression analysis revealed that female sex ( P < 0.001), younger age ( P = 0.001), seroconversion ( P = 0.002), and comorbidity ( P < 0.001) were significantly associated with adverse events. The survey showed that the main concerns were the possibility of adverse event (33%). Almost all patients (99%) felt safer having been vaccinated at their IBD reference center. CONCLUSION The vaccine reactions experienced in IBD patients were mostly self-limited. We found high acceptance and good safety of SARS-CoV-2 vaccination in our cohort.
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Affiliation(s)
| | | | | | - Federica Facciotti
- Dipartimento di Oncologia Sperimentale, Istituto Europeo di Oncologia IRCCS, Milan
| | | | - Fabiana Castiglione
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Napoli
| | - Olga Maria Nardone
- Dipartimento di Medicina Clinica e Chirurgia, Università Federico II di Napoli, Napoli
| | - Rocco Spagnuolo
- Dipartimento di Medicina Sperimentale e Clinica, Università 'Magna Graecia' Catanzaro, U.O. Gastroenterologia ed Endoscopia Digestiva, A.O.U. 'Mater Domini', Catanzaro
| | - Patrizia Doldo
- Dipartimento di Medicina Sperimentale e Clinica, Università 'Magna Graecia' Catanzaro, U.O. Gastroenterologia ed Endoscopia Digestiva, A.O.U. 'Mater Domini', Catanzaro
| | - Gaia Riguccio
- UOSD Malattie Infiammatorie Croniche intestinali, Ospedale Santa Maria del Prato, Feltre
| | - Francesco Simone Conforti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan
| | - Chiara Viganò
- Department of Medicine and Surgery, Division of Gastroenterology and Center for Autoimmune Liver Diseases, University of Milano-Bicocca, Monza
| | | | - Gionata Fiorino
- Dipartimento di Gastroenterologia ed Endoscopia Digestiva, IRCCS Ospedale San Raffaele e Università Vita-Salute San Raffaele, Milano
| | | | - Giorgia Bodini
- IRCCS Policlinico San Martino, Università di Genova, Genoa
| | - Monica Milla
- IBD Referral Center, Gastroenterology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence
| | | | - Marta Vernero
- Department of Medical Sciences, Gastroenterology Unit, University of Pavia, Pavia
| | | | - Flavio Caprioli
- Department of Medicine and Surgery, Division of Gastroenterology and Center for Autoimmune Liver Diseases, University of Milano-Bicocca, Monza
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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15
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Cioffi I, Scialò F, Di Vincenzo O, Gelzo M, Marra M, Testa A, Castiglione F, Vitale M, Pasanisi F, Santarpia L. Serum Interleukin 6, Controlling Nutritional Status (CONUT) Score and Phase Angle in Patients with Crohn's Disease. Nutrients 2023; 15:nu15081953. [PMID: 37111172 PMCID: PMC10146872 DOI: 10.3390/nu15081953] [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] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Crohn's disease (CD) is a chronic inflammatory disorder that may occur in any segment of the gastrointestinal tract. Asymptomatic or untreated inflammation along with malnutrition can often coexist in patients with CD, impairing clinical outcomes, therefore the aim of this study was to assess the relationship between inflammation, malnutrition risk and nutritional status in CD patients. Consecutive adult CD outpatients aged 18-65 years were recruited. Disease activity was clinically defined by the Crohn's Disease Activity Index (CDAI), whilst anthropometry and phase angle (PhA) were measured. The Controlling Nutritional Status (CONUT) score was retrospectively calculated for screening malnutrition risk and blood samples were taken. A total of 140 CD patients with a mean age of 38.8 ± 13.9 years and an average weight of 64.9 ± 12.0 kg were included. Serum interleukin (IL)-6 concentration was increased in active-CD patients, unrelated to medical treatment, which was associated with CDAI and PhA. Based on the CONUT score, the prevalence of patients with moderate/severe malnutrition risk (score ≥ 5) was 10%, showing lower age, body mass index and fat mass, but higher IL-6 and IL-1β levels than subjects classified as not at risk (score 0-1). Finally, increased IL-6 levels and reduced PhA values were identified as independent predictors of moderate/severe malnutrition risk (p < 0.05). In conclusion, IL-6 increased in active-CD patients, which was inversely correlated with PhA. Although the CONUT score might be helpful for identifying CD patients at moderate/severe risk of malnutrition, larger studies are needed to verify these results in different settings.
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Affiliation(s)
- Iolanda Cioffi
- Department of Food, Environmental and Nutritional Sciences-DEFENS, Division of Human Nutrition, Università degli Studi di Milano, Celoria 2, 20133 Milan, Italy
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Filippo Scialò
- CEINGE-Biotecnologie Avanzate F. Salvatore, s.c.ar.l, 80145 Napoli, Italy
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, 80138 Naples, Italy
| | - Olivia Di Vincenzo
- Department of Public Health, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Monica Gelzo
- CEINGE-Biotecnologie Avanzate F. Salvatore, s.c.ar.l, 80145 Napoli, Italy
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Maurizio Marra
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Anna Testa
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Maria Vitale
- CEINGE-Biotecnologie Avanzate F. Salvatore, s.c.ar.l, 80145 Napoli, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Lidia Santarpia
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
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16
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Caiazzo G, Caiazzo A, Napolitano M, Megna M, Potestio L, Fornaro L, Parisi M, Luciano MA, Ruggiero A, Testa A, Castiglione F, Patruno C, Quaranta M, Fabbrocini G. The Use of JAK/STAT Inhibitors in Chronic Inflammatory Disorders. J Clin Med 2023; 12:jcm12082865. [PMID: 37109202 PMCID: PMC10142234 DOI: 10.3390/jcm12082865] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/21/2023] [Accepted: 04/05/2023] [Indexed: 04/29/2023] Open
Abstract
The Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway plays a critical role in orchestrating immune and inflammatory responses, and it is essential for a wide range of cellular processes, including differentiation, cell growth, and apoptosis. Over the years, this pathway has been heavily investigated due to its key role in the pathogeneses of several chronic inflammatory conditions, e.g., psoriasis, atopic dermatitis (AD), and inflammatory bowel diseases (IBDs). Nevertheless, the impact of this pathway on the pathogenesis of inflammatory conditions remains unclear. This review describes the role of the JAK/STAT signaling pathway in the pathogenesis of inflammatory diseases such as psoriasis (Pso), psoriatic arthritis (PsA), AD, and IBD with a focus on ulcerative colitis (UC) and briefly resumes the use of JAK inhibitors in their clinical management.
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Affiliation(s)
- Giuseppina Caiazzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Anna Caiazzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, 86100 Cambobasso, Italy
| | - Matteo Megna
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Luca Potestio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Luigi Fornaro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Melania Parisi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Maria Antonietta Luciano
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Angelo Ruggiero
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Anna Testa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Maria Quaranta
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
| | - Gabriella Fabbrocini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy
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17
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Dragoni G, Castiglione F, Bezzio C, Pugliese D, Spagnuolo R, Viola A, Cocomazzi F, Aratari A, Savarino EV, Balestrieri P, Onali S, Viganò C, Ribaldone DG, Innocenti T, Testa A, Saibeni S, Privitera G, Milla M, Armuzzi A, Fantini MC, Fiorino G. Comparison of two strategies for the management of postoperative recurrence in Crohn's disease patients with one clinical risk factor: A multicentre IG-IBD study. United European Gastroenterol J 2023; 11:271-281. [PMID: 36942657 PMCID: PMC10083469 DOI: 10.1002/ueg2.12367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 10/26/2022] [Accepted: 02/01/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The management of postoperative recurrence (POR) in Crohn's disease (CD) after ileo-colonic resection is a highly debated topic. Prophylactic immunosuppression after surgery is currently recommended in the presence of at least one clinical risk factor. OBJECTIVE Our aim was to determine whether early immunosuppression can be avoided and guided by endoscopy in CD patients with only one risk factor. METHODS CD patients with only one risk factor for POR, including previous intestinal resection, extensive small intestine resection (>50 cm), fistulising phenotype, history of perianal disease, and active smoking, were retrospectively included. Two groups were formed based on whether immunosuppression was started immediately after surgery ("prophylaxis group") or guided by endoscopy ("endoscopy-driven group"). Primary endpoints were rates of any endoscopic recurrence (Rutgeerts ≥ i2a) and severe endoscopic recurrence (i4) within 12 months after surgery. Secondary outcomes were clinical recurrence rates at 6, 12 and 24 months after surgery. RESULTS A total of 195 patients were enroled, of whom 61 (31.3%) received immunoprophylaxis. No differences between immunoprophylaxis and the endoscopy-driven approach were found regarding any endoscopic recurrence (36.1% vs. 45.5%, respectively, p = 0.10) and severe endoscopic recurrence (9.8% vs. 15.7%, respectively, p = 0.15) at the first endoscopic evaluation. Clinical recurrence rates were also not statistically different (p = 0.43, p = 0.09, and p = 0.63 at 6, 12, and 24 months, respectively). CONCLUSIONS In operated CD patients with only one risk factor for POR, immediate immunoprophylaxis does not decrease the rate of early clinical and endoscopic recurrence. Prospective studies are needed to confirm our results.
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Affiliation(s)
- Gabriele Dragoni
- IBD Referral Center, Department of Gastroenterology, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, AOU Federico II Napoli, Napoli, Italy
| | - Cristina Bezzio
- IBD Center, Gastroenterology Unit, Rho Hospital, ASST Rhodense, Milan, Italy
| | - Daniela Pugliese
- CEMAD - IBD UNIT, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Rocco Spagnuolo
- Department of Health Science, Magna Graecia University, Catanzaro, Italy
| | - Anna Viola
- IBD-Unit, Department. of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Cocomazzi
- Department of Gastroenterology and Endoscopy, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | | | | | | | - Sara Onali
- Department of Medical Science and Public Health, Gastroenterology Unit, University of Cagliari, Cagliari, Italy
| | - Chiara Viganò
- Department of Gastroenterology and Center for Autoimmune Liver Diseases, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Tommaso Innocenti
- IBD Referral Center, Department of Gastroenterology, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, AOU Federico II Napoli, Napoli, Italy
| | - Simone Saibeni
- IBD Center, Gastroenterology Unit, Rho Hospital, ASST Rhodense, Milan, Italy
| | - Giuseppe Privitera
- CEMAD - IBD UNIT, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Monica Milla
- IBD Referral Center, Department of Gastroenterology, Careggi University Hospital, Florence, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Massimo Claudio Fantini
- Department of Medical Science and Public Health, Gastroenterology Unit, University of Cagliari, Cagliari, Italy
| | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
- BD Unit, Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, I, Rome, Italy
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18
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Rispo A, Calabrese G, Testa A, Imperatore N, Patturelli M, Allocca M, Guarino AD, Cantisani NM, Toro B, Castiglione F. Hocus Pocus: The Role Of Handheld Ultrasonography In Predicting Disease Extension And Endoscopic Activity In Ulcerative Colitis. J Crohns Colitis 2023:7043220. [PMID: 36795070 DOI: 10.1093/ecco-jcc/jjad024] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 11/24/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND Ulcerative colitis (UC) assessment still requires ileocolonoscopy (IC). Intestinal ultrasound (IUS) has emerged as a non-invasive assessment tool, and the Milan Ultrasound Criteria (MUC) score has been validated to estimate and grade UC disease activity. Recently, handheld IUS (HHIUS) has been used in several clinical settings, but data about its use in UC are limited. We aimed to evaluate the diagnostic accuracy of HHIUS compared to conventional (IUS) in detecting UC extension and activity. PATIENTS AND METHODS From November 2021 to September 2022, we prospectively enrolled UC patients afferent to our third-level IBD Unit for IC evaluation. Patients underwent IC, HHIUS, and IUS. Ultrasound activity was defined by MUC > 6.2, while endoscopic activity was defined by a Mayo endoscopic score (MES) > 1. Cohen's k test was applied to test the concordance between IUS-MUC and HHIUS-MUC after MUC dichotomization (MUC>6.2, yes/no). RESULTS 86 patients with UC were enrolled. No significant difference was recorded between IUS and HHIUS at the per-segment extension (p=N.S.), and both procedures were comparable in terms of results of bowel wall thickness (BWT) and bowel wall stratification (BWS) assessment (p=N.S.). IUS and HHIUS displayed excellent agreement when the MUC score system was applied (k = 0.86, p<0.01). CONCLUSION Handheld intestinal ultrasound and IUS are comparable in UC extension definition and MUC evaluation. HHIUS could be reliable for detecting disease activity and estimating its extension, providing close monitoring. It also represents a non-invasive, easily practicable investigation, allowing immediate medical decisions with significant time and cost advantages.
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Affiliation(s)
- A Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - G Calabrese
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - A Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - N Imperatore
- Gastroenterology, P.O. "Santa Maria Delle Grazie", Pozzuoli (Na), Italy
| | - M Patturelli
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - M Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital "San Raffaele" and University Vita-Salute San Raffaele, Milan, Italy
| | - A D Guarino
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - N M Cantisani
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - B Toro
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
| | - F Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy
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19
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Macaluso FS, Principi M, Facciotti F, Contaldo A, Todeschini A, Saibeni S, Bezzio C, Castiglione F, Nardone OM, Spagnuolo R, Fantini MC, Riguccio G, Caprioli F, Viganò C, Felice C, Fiorino G, Correale C, Bodini G, Milla M, Scardino G, Vernero M, Desideri F, Mannino M, Rizzo G, Orlando A. Reduced humoral response to two doses of COVID-19 vaccine in patients with inflammatory bowel disease: Data from ESCAPE-IBD, an IG-IBD study. Dig Liver Dis 2023; 55:154-159. [PMID: 36127228 PMCID: PMC9420701 DOI: 10.1016/j.dld.2022.08.027] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patients on immunosuppressive drugs have been excluded from COVID-19 vaccines trials, creating concerns regarding their efficacy. AIMS To explore the humoral response to COVID-19 vaccines in patients with inflammatory bowel disease (IBD) METHODS: Effectiveness and Safety of COVID-19 Vaccine in Patients with Inflammatory Bowel Disease (IBD) Treated with Immunomodulatory or Biological Drugs (ESCAPE-IBD) is a prospective, multicentre study promoted by the Italian Group for the study of Inflammatory Bowel Disease. We present data on serological response eight weeks after the second dose of COVID-19 vaccination in IBD patients and healthy controls (HCs). RESULTS 1076 patients with IBD and 1126 HCs were analyzed. Seropositivity for anti-SARS-CoV-2 IgG was reported for most IBD patients, even if with a lesser rate compared with HCs (92.1% vs. 97.9%; p<0.001). HCs had higher antibody concentrations (median OD 8.72 [IQR 5.2-14-2]) compared to the whole cohort of IBD patients (median OD 1.54 [IQR 0.8-3.6]; p<0.001) and the subgroup of IBD patients (n=280) without any treatment or on aminosalicylates only (median OD 1.72 [IQR 1.0-4.1]; p<0.001). CONCLUSIONS Although most IBD patients showed seropositivity after COVID-19 vaccines, the magnitude of the humoral response was significantly lower than in HCs. Differently from other studies, these findings seem to be mostly unrelated to the use of immune-modifying treatments (ClinicalTrials.govID:NCT04769258).
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Affiliation(s)
| | | | - Federica Facciotti
- Department of Experimental Oncology, Istituto Europeo di Oncologia IRCCS, Milan, Italy
| | - Antonella Contaldo
- Gastroenterology 2 Unit, IRCCS "S. De Bellis", Castellana Grotte, Bari, Italy
| | | | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Milan, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Milan, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Olga Maria Nardone
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rocco Spagnuolo
- Gastroenterology and Endoscopy Unit, "Mater Domini" University Hospital, Catanzaro, Italy; Department of Experimental Medicine and Clinic, "Magna Graecia" University, Catanzaro, Italy
| | - Massimo Claudio Fantini
- Policlinico Monserrato University Hospital, Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Gaia Riguccio
- IBD Unit, "Santa Maria del Prato" Hospital, Feltre, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Carla Felice
- GastroenterologY Unit, "Ca'Foncello" Hospital, Treviso, Italy
| | - Gionata Fiorino
- Department of Gastroenterology and Endoscopy, IRCCS "San Raffaele" Hospital and "Università Vita-Salute San Raffaele", Milan, Italia
| | - Carmen Correale
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | - Giorgia Bodini
- IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Unit, University Hospital "Careggi", Florence, Italy
| | - Giulia Scardino
- Gastroenterology Department, "Valduce" Hospital, Como, Italy
| | - Marta Vernero
- Gastroenterology Unit, Department of Medical Sciences, University of Pavia, Pavia, Italy
| | | | | | - Giuseppe Rizzo
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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20
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Bergamaschi G, Castiglione F, D'Incà R, Astegiano M, Fries W, Milla M, Ciacci C, Rizzello F, Saibeni S, Ciccocioppo R, Orlando A, Bossa F, Principi M, Vernia P, Ricci C, Scribano ML, Bodini G, Mazzucco D, Bassotti G, Riegler G, Buda A, Neri M, Caprioli F, Monica F, Manca A, Villa E, Fiorino G, Comberlato M, Aronico N, Della Corte C, Caccaro R, Gionchetti P, Giuffrida P, Iovino P, Lenti MV, Mengoli C, Pellegrini L, Pieraccini A, Ribaldone D, Testa A, Ubezio C, Viola A, Vecchi M, Klersy C, Di Sabatino A. Prevalence, Pathogenesis and Management of Anemia in Inflammatory Bowel Disease: An IG-IBD Multicenter, Prospective, and Observational Study. Inflamm Bowel Dis 2023; 29:76-84. [PMID: 35366312 DOI: 10.1093/ibd/izac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/13/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Anemia is a common extraintestinal manifestation of inflammatory bowel disease (IBD), with a 6% to 74% prevalence and a negative impact on patient survival and quality of life, although the prevalence is apparently declining due to improved disease treatment. We aimed to investigate the prevalence, pathogenesis, and clinical correlates of anemia in Italian patients with IBD. METHODS A multicenter, prospective, observational study, involving 28 Italian gastroenterology centers, was conducted to investigate the epidemiology and consequences of IBD-associated anemia. Clinical and laboratory data of anemic patients were obtained at study enrolment. RESULTS Anemia was diagnosed in 737 of 5416 adult IBD outpatients (prevalence 13.6%); females were more commonly affected than males (odds ratio, 1.5; 95% confidence interval [CI], 1.2-1.7) and had more severe anemia. In the majority of cases, anemia was due to iron deficiency (62.5% of cases; 95% CI, 58.3%-66.6%), either isolated or in association with inflammation and/or vitamin deficiencies; anemia of inflammation accounted for only 8.3% of cases. More severe anemia was associated with increasing fatigue and worse quality of life. Only 68.9% of anemic patients with iron deficiency (95% CI, 63.4%-73.8%) and 34.6% of those with vitamin deficiencies (95% CI, 26.2%-44.2%) were properly treated with supplementation therapy. CONCLUSIONS In Italy, the prevalence of IBD-associated anemia is lower than previously reported. Anemia of IBD is most commonly due to iron deficiency and contributes to fatigue and poor quality of life, but remains untreated in a large proportion of patients with iron and/or vitamin deficiencies. This study is registered at clinicaltrials.gov as NCT02872376.
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Affiliation(s)
- Gaetano Bergamaschi
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Renata D'Incà
- Inflammatory Bowel Disease Unit-Azienda Ospedaliera-University of Padua, Padua, Italy
| | - Marco Astegiano
- Gastroenterology and Digestive Endoscopy Unit, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Walter Fries
- Gastroenterology and Clinical Unit for Inflammatory Bowel Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Monica Milla
- Unità Operativa Complessa di Gastroenterologia Cinica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Carolina Ciacci
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona and University of Salerno, Salerno, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, Azienda Socio-Sanitaria Territoriale Rhodense, Rho (MI), Italy
| | - Rachele Ciccocioppo
- Unità Operativa Complessa Gastroenterologia B, Azienda Ospedaliera Universitaria Integrata Policlinico G.B. Rossi & Dipartimento di Medicina, Università di Verona, Verona, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Azienda Ospedaliera Ospedali Riuniti "Villa Sofia-Cervello" Palermo, Palermo, Italy
| | - Fabrizio Bossa
- Department of Gastroenterology and Endoscopy, Fondazione "Casa Sollievo della Sofferenza", IRCCS, San Giovanni Rotondo, Italy
| | - Mariabeatrice Principi
- Gastroenterology Unit (Department of Emergency and Organ transplantation), University of Bari, Bari, Italy
| | - Piero Vernia
- Division of Gastroenterology, Department of Translational and Precision Medicine, "Sapienza" University of Rome and Umberto I Hospital, Rome, Italy
| | - Chiara Ricci
- Gastroenterology Unit, Spedali Civili di Brescia and Department of Clinical and Sperimental Sciences, University of Brescia, Brescia, Italy
| | - Maria L Scribano
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, Policlinico San Martino, Università di Genova, Genoa, Italy
| | - Dario Mazzucco
- Gastroenterology Unit, ASL Torino 3, Rivoli, Torino, Italy
| | - Gabrio Bassotti
- Gastroenterology & Hepatology Unit, Perugia General Hospital and University of Perugia, Perugia, Italy
| | - Gabriele Riegler
- Unit of Gastroenterology-Reference Center for IBD-Second University of Naples, Naples, Italy
| | - Andrea Buda
- Unità Operativa Complessa Gastroenterologia, Ospedale S. Maria del Prato, Azienda - Unità Locale Socio Sanitaria 1 Dolomiti, Feltre, Italy
| | - Matteo Neri
- Department of Medicine and Ageing Sciences and Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Fabio Monica
- Gastroenterology and Digestive Endoscopy Unit, Azienda sanitaria universitaria Giuliano Isontina, Cattinara Academic Hospital, Trieste, Italy
| | - Aldo Manca
- Department of Gastroenterology and Digestive Endoscopy, S. Croce e Carle Hospital, Cuneo, Italy
| | - Erica Villa
- UC Gastroenterologia, Dipartimento di Specialità Mediche, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Gionata Fiorino
- Istituto di Ricovero e Cura a Carattere Scientifico Humanitas Research Hospital, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Michele Comberlato
- Gastroenterologia, Fisiopatologia ed Endoscopia Digestiva, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Nicola Aronico
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Cristina Della Corte
- Gastroenterology Unit, Rho Hospital, Azienda Socio-Sanitaria Territoriale Rhodense, Rho (MI), Italy
| | - Roberta Caccaro
- Inflammatory Bowel Disease Unit-Azienda Ospedaliera-University of Padua, Padua, Italy
| | - Paolo Gionchetti
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paolo Giuffrida
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Paola Iovino
- Gastroenterology and Endoscopy Unit, Azienda Ospedaliera Universitaria San Giovanni di Dio e Ruggi d'Aragona and University of Salerno, Salerno, Italy
| | - Marco V Lenti
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Caterina Mengoli
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Lucienne Pellegrini
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Alberto Pieraccini
- Unità Operativa Complessa di Gastroenterologia Cinica, Azienda Ospedaliero Universitaria Careggi, Firenze, Italy
| | - Davide Ribaldone
- Gastroenterology and Digestive Endoscopy Unit, "Città della Salute e della Scienza" Hospital, Torino, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Cristina Ubezio
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
| | - Anna Viola
- Gastroenterology and Clinical Unit for Inflammatory Bowel Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Milan, Italy
| | - Catherine Klersy
- Servizio di Epidemiologia Clinica & Biometria, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Sabatino
- Medicina Generale I, Fondazione stituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo e Università di Pavia, Pavia, Italy
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21
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Yanai H, Kagramanova A, Knyazev O, Sabino J, Haenen S, Mantzaris GJ, Mountaki K, Armuzzi A, Pugliese D, Furfaro F, Fiorino G, Drobne D, Kurent T, Yassin S, Maharshak N, Castiglione F, de Sire R, Nardone OM, Farkas K, Molnar T, Krznaric Z, Brinar M, Chashkova E, Livne Margolin M, Kopylov U, Bezzio C, Bar-Gil Shitrit A, Lukas M, Chaparro M, Truyens M, Nancey S, Lobaton T, Gisbert JP, Saibeni S, Bacsúr P, Bossuyt P, Schulberg J, Hoentjen F, Viganò C, Palermo A, Torres J, Revés J, Karmiris K, Velegraki M, Savarino E, Markopoulos P, Tsironi E, Ellul P, Calviño Suárez C, Weisshof R, Ben-Hur D, Naftali T, Eriksson C, Koutroubakis IE, Foteinogiannopoulou K, Limdi JK, Liu E, Surís G, Calabrese E, Zorzi F, Filip R, Ribaldone DG, Snir Y, Goren I, Banai-Eran H, Broytman Y, Amir Barak H, Avni-Biron I, Ollech JE, Dotan I, Aharoni Golan M. Endoscopic Postoperative Recurrence in Crohn's Disease After Curative Ileocecal Resection with Early Prophylaxis by Anti-TNF, Vedolizumab or Ustekinumab: A Real-World Multicentre European Study. J Crohns Colitis 2022; 16:1882-1892. [PMID: 35895074 DOI: 10.1093/ecco-jcc/jjac100] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 12/14/2022]
Abstract
BACKGROUND Endoscopic-post-operative-recurrence [ePOR] in Crohn's disease [CD] after ileocecal resection [ICR] is a major concern. We aimed to evaluate the effectiveness of early prophylaxis with biologics and to compare anti-tumour necrosis factor [anti-TNF] therapy to vedolizumab [VDZ] and ustekinumab [UST] in a real-world setting. METHODS A retrospective multicentre study of CD-adults after curative ICR on early prophylaxis was undertaken. ePOR was defined as a Rutgeerts score [RS] ≥ i2 or colonic-segmental-SES-CD ≥ 6. Multivariable logistic regression was used to evaluate risk factors, and inverse probability treatment weighting [IPTW] was applied to compare the effectiveness between agents. RESULTS The study included 297 patients (53.9% males, age at diagnosis 24 years [19-32], age at ICR 34 years [26-43], 18.5% smokers, 27.6% biologic-naïve, 65.7% anti-TNF experienced, 28.6% two or more biologics and 17.2% previous surgery). Overall, 224, 39 and 34 patients received anti-TNF, VDZ or UST, respectively. Patients treated with VDZ and UST were more biologic experienced with higher rates of previous surgery. ePOR rates within 1 year were 41.8%. ePOR rates by treatment groups were: anti-TNF 40.2%, VDZ 33% and UST 61.8%. Risk factors for ePOR at 1 year were: past-infliximab (adjusted odds ratio [adj.OR] = 1.73 [95% confidence interval, CI: 1.01-2.97]), past-adalimumab [adj.OR = 2.32 [95% CI: 1.35-4.01] and surgical aspects. After IPTW, the risk of ePOR within 1 year of VDZ vs anti-TNF or UST vs anti-TNF was comparable (OR = 0.55 [95% CI: 0.25-1.19], OR = 1.86 [95% CI: 0.79-4.38]), respectively. CONCLUSION Prevention of ePOR within 1 year after surgery was successful in ~60% of patients. Patients treated with VDZ or UST consisted of a more refractory group. After controlling for confounders, no differences in ePOR risk were seen between anti-TNF prophylaxis and other groups.
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Affiliation(s)
- Henit Yanai
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Anna Kagramanova
- Moscow Clinical Scientific Centre named after. A.S. Loginov, Moscow, Russian Federation
| | - Oleg Knyazev
- Moscow Clinical Scientific Centre named after. A.S. Loginov, Moscow, Russian Federation.,State Scientific Centre of Coloproctology named after A.N. Ryzhyh, Moscow, Russian Federation.,Research Institute of Health Organization and Medical Management, Moscow, Russian Federation
| | - João Sabino
- Department of Gastroenterology, University Hospitals of Leuven, Leuven, Belgium
| | - Shana Haenen
- Department of Gastroenterology, University Hospitals of Leuven, Leuven, Belgium
| | - Gerassimos J Mantzaris
- Department of Gastroenterology, GHA 'Evaggelismos-Ophthalmiatreion Athinon-Polykliniki', Athens, Greece
| | - Katerina Mountaki
- Department of Gastroenterology, GHA 'Evaggelismos-Ophthalmiatreion Athinon-Polykliniki', Athens, Greece
| | | | - 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
| | | | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - David Drobne
- Department of Internal Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.,Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tina Kurent
- Department of Gastroenterology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sharif Yassin
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nitsan Maharshak
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Roberto de Sire
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Olga Maria Nardone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Klaudia Farkas
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Tamas Molnar
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre, Zagreb, Croatia
| | - Marko Brinar
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre, Zagreb, Croatia
| | - Elena Chashkova
- Irkutsk Scientific Center of Surgery and Traumatology, Russia
| | - Moran Livne Margolin
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Uri Kopylov
- Sackler Faculty of Medicine, Tel Aviv University, Israel.,Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho (MI), Italy
| | - Ariella Bar-Gil Shitrit
- Digestive Diseases Institute, Shaare Zedek Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Milan Lukas
- Clinical and Research Centre for Inflammatory Bowel Disease, ISCARE Clinical Centre, Prague, Czech Republic.,Institute of Medical Biochemistry and Laboratory Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - María Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS- Princesa), Universidad Autónoma de Madrid (UAM), Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Marie Truyens
- IBD unit, Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Stéphane Nancey
- Department of Gastroenterology, Lyon-Sud hospital, Hospices Civils de Lyon, Lyon and INSERM U1111, CIRI, Lyon, France
| | - Triana Lobaton
- IBD unit, Department of Gastroenterology, University Hospital Ghent, Ghent, Belgium.,Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS- Princesa), Universidad Autónoma de Madrid (UAM), Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho (MI), Italy
| | - Péter Bacsúr
- Department of Medicine, University of Szeged, Szeged, Hungary
| | - Peter Bossuyt
- Imelda GI clinical Research Center, Department of Gastroenterology, Imelda General Hospital, Bonheiden, Belgium
| | - Julien Schulberg
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia.,Department of Gastroenterology, Austin Hospital, Melbourne, VIC, Australia
| | - Frank Hoentjen
- Inflammatory Bowel Disease Center, Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands and Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Chiara Viganò
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Andrea Palermo
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.,European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Joana Torres
- Division of Gastroenterology, Hospital da Luz Lisboa, Portugal.,Division of Gastroenterology, Hospital Beatriz Ângelo, Loures, Lisbon, Portugal
| | - Joana Revés
- Division of Gastroenterology, Hospital Beatriz Ângelo, Loures, Lisbon, Portugal
| | - Konstantinos Karmiris
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Magdalini Velegraki
- Department of Gastroenterology, Venizeleio General Hospital, Heraklion, Crete, Greece
| | - Edoardo Savarino
- Department of Surgical Oncological & Gastroenterological Sciences (DiSCOG), Gastroenterology Unit, Padua University, Padua, Italy
| | | | - Eftychia Tsironi
- Department of Gastroenterology, Metaxa Memorial General Hospital, Piraeus, Greece
| | - Pierre Ellul
- Division of Gastroenterology Mater Dei Hospital, Msida, Malta
| | - Cristina Calviño Suárez
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Roni Weisshof
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, The Technion - Israel Institute of Technology, Haifa, Israel
| | - Dana Ben-Hur
- Department of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, The Technion - Israel Institute of Technology, Haifa, Israel
| | - Timna Naftali
- Institute of Gastroenterology, Meir Hospital Sapir Medical Center, Kfar Saba, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Carl Eriksson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | | | - Jimmy K Limdi
- Department of Gastroenterology, The Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences, University of Manchester, Manchester, UK
| | - Eleanor Liu
- Department of Gastroenterology, The Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Sciences, University of Manchester, Manchester, UK
| | - Gerard Surís
- Gastroenterology Department, Hospital de Bellvitge and IDIBELL, L'Hospitalet, Spain
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Francesca Zorzi
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Rafał Filip
- Department of Gastroenterology with IBD Unit, Clinical Hospital No. 2, Rzeszów, Poland
| | | | - Yifat Snir
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Idan Goren
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Hagar Banai-Eran
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yelena Broytman
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Hadar Amir Barak
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Irit Avni-Biron
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Jacob E Ollech
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Iris Dotan
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Maya Aharoni Golan
- Department of Gastroenterology and Hepatology, Kaplan Medical Center, Rehovot, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Concord Medical Center, Clalit Health Services, Bnei Brak, Israel
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22
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Mahajna H, Verstockt B, Bergemalm D, Castiglione F, Rodríguez-Moranta F, Savarino EV, Hoentjen F, Bessissow T, Pokryszka J, Cremer A, Eder P, Truyens M, Yerushalmy-Feler A, Garcia MJ, Kopylov U. Idiopathic Thrombocytopenic Purpura associated with Inflammatory Bowel Disease: a multi-centre ECCO CONFER case series. J Crohns Colitis 2022; 17:722-727. [PMID: 36455965 DOI: 10.1093/ecco-jcc/jjac179] [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: 08/23/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Idiopathic Thrombocytopenic Purpura (ITP) is an acquired haematological disorder with an incidence of 1 to 6 per 100,000/year. ITP and inflammatory bowel disease (IBD) comorbidity has been reported in the literature, but insights regarding the course, outcome and optimal management are limited by its rarity. The current study aimed to evaluate the clinical presentation and outcome of ITP in patients with IBD. METHODS This multicentre retrospective case series was performed as part of the ECCO Collaborative Network of Exceptionally Rare case reports (CONFER) project. Cases of patients with ITP and IBD were collected by participating investigators. Clinical data were recorded in a standardised collection form. RESULTS This report includes 32 patients with concurrent ITP and IBD:10 were females, median age was 32.0 [interquartile range (IQR) 20.5-39.5]. 14 patients had a diagnosis of Crohn's disease (CD) and the other 18 had of ulcerative colitis (UC). The diagnosis of IBD preceded the ITP in 26 patients (median time between diagnoses was 7.0 years [IQR, 1.5-9.5]). Among those patients, 17 patients were in clinical remission at ITP diagnosis. 13 patients were treated with mesalamine, 4 with oral corticosteroids, 1 with rectal corticosteroids, 2 with azathioprine, and 5 with anti-TNF agents. The median platelet count was 35,000/mmc (IQR, 10,000-70,000). 8 patients had rectal bleeding, 13 had skin purpura, 3 had epistaxis, 6 had mucosal petechiae, and 13 were asymptomatic. Regarding ITP treatment, 19 were treated with corticosteroids, 1 with Anti-RhD immunoglobulin, 12 with intravenous immunoglobulins (IVIG), 4 with thrombopoietin, 3 with rituximab and 6 patients eventually required splenectomy. 10 patients needed no treatment directed to the ITP.Three patients required colectomy during term long follow-up, due to IBD or cancer and not to massive bleeding as a complication of ITP. One patient of eight patients who presented with rectal bleeding required splenectomy, and none required urgent colectomy. Two patients died during the follow-up, one of them due to bleeding complication located in the upper gastrointestinal tract.Median follow-up time was 6.5 years [IQR, 3-10]. With long-term follow-up, all patients had platelet count above 50,000/mmc, and 24 were in IBD clinical remission. CONCLUSION Most ITP cases in this case series occurred after the IBD diagnosis and responded well to regular ITP treatment. The course of the ITP in the IBD patients follows an expected course, including response to medical therapy and low rates of splenectomy.
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Affiliation(s)
- Hussein Mahajna
- Department of Gastroenterology, Sheba Medical Center, Ramat-Gan, Israel
| | - Bram Verstockt
- Dpt. Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.,Dpt. Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Daniel Bergemalm
- Department of Gastroenterology, Faculty of Medicine, and Health, Örebro University, Örebro, Sweden
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | | | - Edoardo Vincenzo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Italy.,Gastroenterology Unit, Azienda Ospedale Università di Padova, Padua, Italy
| | - Frank Hoentjen
- Department of Gastroenterology, Radboud University Medical Center, Nijmegen, The Netherlands.,Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Talat Bessissow
- Department of Gastroenterology, Royal Victoria Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Jagoda Pokryszka
- Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Anneline Cremer
- Department of Gastroenterology, Erasme University Hospital, ULB, Brussels, Belgium
| | - Piotr Eder
- Department of Gastroenterology, Dietetics, and Internal Medicine, Poznań University of Medical Sciences, Poland
| | - Marie Truyens
- IBD Unit, Department of Gastroenterology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Anat Yerushalmy-Feler
- Paediatric Gastroenterology Institute, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maria Jose Garcia
- IBD Unit. Gastroenterology and Hepatology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Uri Kopylov
- Department of Gastroenterology, Tel-Hashomer Sheba Medical Center, Ramat Gan, and Sackler Medical School, Tel Aviv, Israel
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23
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Del Mastro L, Poggio F, Blondeaux E, De Placido S, Giuliano M, Forestieri V, De Laurentiis M, Gravina A, Bisagni G, Rimanti A, Turletti A, Nisticò C, Vaccaro A, Cognetti F, Fabi A, Gasparro S, Garrone O, Alicicco MG, Urracci Y, Mansutti M, Poletti P, Correale P, Bighin C, Puglisi F, Montemurro F, Colantuoni G, Lambertini M, Boni L, Venturini M, Abate A, Pastorino S, Canavese G, Vecchio C, Guenzi M, Lambertini M, Levaggi A, Giraudi S, Accortanzo V, Floris C, Aitini E, Fornari G, Miraglia S, Buonfanti G, Cherchi M, Petrelli F, Vaccaro A, Magnolfi E, Contu A, Labianca R, Parisi A, Basurto C, Cappuzzo F, Merlano M, Russo S, Mansutti M, Poletto E, Nardi M, Grasso D, Fontana A, Isa L, Comandè M, Cavanna L, Iacobelli S, Milani S, Mustacchi G, Venturini S, Scinto A, Sarobba M, Pugliese P, Bernardo A, Pavese I, Coccaro M, Massidda B, Ionta M, Nuzzo A, Laudadio L, Chiantera V, Dottori R, Barduagni M, Castiglione F, Ciardiello F, Tinessa V, Ficorella A, Moscetti L, Vallini I, Giardina G, Silva R, Montedoro M, Seles E, Morano F, Cruciani G, Adamo V, Pancotti A, Palmisani V, Ruggeri A, Cammilluzzi E, Carrozza F, D'Aprile M, Brunetti M, Gallotti P, Chiesa E, Testore F, D'Arco A, Ferro A, Jirillo A, Pezzoli M, Scambia G, Iacono C, Masullo P, Tomasello G, Gandini G, Zoboli A, Bottero C, Cazzaniga M, Genua G, Palazzo S, D'Amico M, Perrone D. Fluorouracil and dose-dense adjuvant chemotherapy in patients with early-stage breast cancer (GIM2): end-of-study results from a randomised, phase 3 trial. Lancet Oncol 2022; 23:1571-1582. [DOI: 10.1016/s1470-2045(22)00632-5] [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] [Received: 08/16/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022]
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24
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Kravvas G, Muneer A, Watchorn R, Castiglione F, Haider A, Freeman A, Hadway P, Alnajjar H, Lynch M, Bunker C. 234 Male genital lichen sclerosus, micro incontinence and occlusion: Mapping the disease across the prepuce. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.241] [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: 10/17/2022]
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25
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Castiglione F, Imperatore N, Testa A, de Sire R, Nardone OM, Ricciolino S, Di Luna I, Patturelli M, Villani GD, Olmo O, Rispo A. Exploring the concept of deep remission in Crohn's disease: correlation between transmural healing and biomarkers. Therap Adv Gastroenterol 2022; 15:17562848221110643. [PMID: 35898191 PMCID: PMC9310328 DOI: 10.1177/17562848221110643] [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: 02/16/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND While mucosal healing (MH) and transmural healing (TH) predict relevant clinical outcomes in Crohn's disease (CD), little is known about the real significance and clinical impact of deep remission (DR). OBJECTIVES To better explore the concept of DR, toward a direct correlation between MH, TH, and biomarkers. DESIGN Real-world observational longitudinal study to evaluate the rate of clinical remission (CR), MH and TH, and the fecal calprotectin (FC)/C-reactive protein (CRP) levels in all consecutive CD patients on biologics. METHODS A receiver operating characteristic (ROC) curve was constructed to define the best FC and CRP cut-offs associated with MH and TH. Finally, patients achieving CR, MH, and TH, in association with the target FC/CRP values, were considered in DR. RESULTS Among 118 CD patients, CR, MH, and TH were achieved in 62.7, 44.1, and 32.2%, respectively. After 2 years, the mean FC levels decreased from 494 ± 15.4 μg/g to 260 ± 354.9 μg/g (p < 0.01). Using the ROC curve analysis, an FC cut-off value of 94 μg/g was associated with both MH [sensitivity: 94.2%, specificity: 84.8%, positive predictive value (PPV): 83.05%, negative predictive value (NPV): 94.92%, area under the curve (AUC): 0.95] and TH (sensitivity: 92.1%, specificity: 70%, PPV: 64.4%, NPV: 94.9%, AUC: 0.88). CRP < 5 mg/L was associated with both MH (sensitivity: 96.1%, specificity: 62.1%, PPV: 66.7%, NPV: 95.35%, AUC: 0.85) and TH (sensitivity: 97.4%, specificity: 52.5%, PPV: 52%, NPV: 95.35%, AUC: 0.78). When considering CD patients with concomitant CR, MH, and TH associated with an FC < 94 μg/g and CRP < 5 mg/L, this association was found identified in 33 patients (27.9%). CONCLUSION An FC < 94 μg/g and a normal CRP are associated with CR, MH, and TH and could be included in the definition of DR in association. So by definition, DR could be achieved in approximately 30% of CD patients during maintenance treatment with biologics.
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Affiliation(s)
| | - Nicola Imperatore
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Anna Testa
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, ‘Federico II’ School of Medicine, Naples, Italy
| | - Roberto de Sire
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, ‘Federico II’ School of Medicine, Naples, Italy
| | - Olga Maria Nardone
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, ‘Federico II’ School of Medicine, Naples, Italy
| | - Simona Ricciolino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, ‘Federico II’ School of Medicine, Naples, Italy
| | - Imma Di Luna
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, ‘Federico II’ School of Medicine, Naples, Italy
| | - Marta Patturelli
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, ‘Federico II’ School of Medicine, Naples, Italy
| | - Guido Daniele Villani
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, ‘Federico II’ School of Medicine, Naples, Italy
| | - Oriana Olmo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, ‘Federico II’ School of Medicine, Naples, Italy
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, ‘Federico II’ School of Medicine, Naples, Italy
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26
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Pugliese D, Privitera G, Crispino F, Mezzina N, Castiglione F, Fiorino G, Laterza L, Viola A, Bertani L, Caprioli F, Cappello M, Barberio B, Ricci C, Balestrieri P, Daperno M, Pluchino D, Rizzello F, Scribano ML, Sablich R, Pastorelli L, Manguso F, Variola A, Di Sario A, Grossi L, Armuzzi A, Biscaglia G, Buda A, Mocci G, Viscido A, Di Paolo MC, Onali S, Rodino S, Coletta M, Principi M, Miranda A, Amato A, Bezzio C, Petruzzellis C, Mazzuoli S, Festa S, Sartini A, Checchin D, Fanigliulo L, Gallina S, Cesarini M, Bodini G, Stradella D, Spagnuolo R, Guidi L, Savarino E, Scrivo B, Soru P, Costa F, Fries W, Scaldaferri F, Allocca M, Pellegrini L, Massari A, Orlando A. Effectiveness and safety of vedolizumab in a matched cohort of elderly and nonelderly patients with inflammatory bowel disease: the IG-IBD LIVE study. Aliment Pharmacol Ther 2022; 56:95-109. [PMID: 35876062 PMCID: PMC9324100 DOI: 10.1111/apt.16923] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 11/19/2021] [Revised: 12/13/2022] [Accepted: 03/25/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vedolizumab registration trials were the first to include elderly patients with moderate-to-severe ulcerative colitis (UC) or Crohn's disease (CD), but few real-life data have been reported in this population. AIMS We investigated the effectiveness and safety of vedolizumab in matched cohorts of elderly and nonelderly UC and CD patients. METHODS The Long-term Italian Vedolizumab Effectiveness (LIVE) study is a retrospective-prospective study including UC and CD patients who started vedolizumab from April 2016 to June 2017. Elderly patients (≥65 years) were matched clinically 1:2 to nonelderly patients (18-64 years); the 2 groups were followed until drug discontinuation or June 2019. RESULTS The study included 198 elderly (108 UC, 90 CD) and 396 matched nonelderly patients (205 UC, 191 CD). Nonelderly UC patients had a significantly higher persistence on vedolizumab compared to elderly patients (67.6% vs. 51.4%, p = 0.02). No significant difference in effectiveness was observed between elderly and nonelderly CD patients (59.4% vs. 52.4%, p = 0.32). Age ≥65 years was associated with lower persistence in UC; for CD, previous exposure to anti-TNF-α agents, Charlson comorbidity index >2 and moderate-to-severe clinical activity at baseline were associated with lower persistence. There were recorded 130 adverse events, with comparable rates between the two groups. A Charlson comorbidity index >2 was associated with an increased risk of adverse events. CONCLUSION Vedolizumab can be considered a safe option in elderly IBD patients. Its effectiveness in elderly UC patients may be reduced, while no age-dependent effect on effectiveness was observed in CD.
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Affiliation(s)
- Daniela Pugliese
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCSRomeItaly
| | - Giuseppe Privitera
- Dipartimento Universitario di Medicina e Chirurgia TraslazionaleUniversità Cattolica del Sacro CuoreRomeItaly
| | - Federica Crispino
- Riuniti Villa Sofia–Cervello Hospital, Internal Medicine e 2IBD Unit PalermoPalermoItaly
| | - Nicolò Mezzina
- Department of Biochemical and Clinical Science “L. Sacco” ASST Fatebenefratelli Sacco–University of MilanMilanItaly
| | | | - Gionata Fiorino
- IBD Center, Gastroenterology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy¸ Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Lucrezia Laterza
- CEMAD – IBD UNIT, Unità Operativa Complessa di Medicina Interna e GastroenterologiaDipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCSRomeItaly
| | - Anna Viola
- UOSD Malattie Intestinali Croniche, Dip. di Medicina Clinica e SperimentalePoliclinico MessinaSicilyItaly
| | - Lorenzo Bertani
- Gastroenterology and Digestive Endoscopy Department of Medical Specialties Apuane HospitalTuscany North‐West ASLMassaItaly
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, La Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano Policlinico, Department of Pathophysiology and TransplantationUniversity of MilanMilanLombardiaItaly
| | - Maria Cappello
- Head IBD Clinic, Gastroenterology Section, PromiseUniversity of PalermoSicilyItaly
| | - Brigida Barberio
- Gastroenterology Unit, Department of Surgery, Oncology and GastroenterologyUniversity of PaduaPaduaItaly
| | - Chiara Ricci
- Gastroenterology Unit, Spedali Civili Hospital, Department of Experimental and Clinical SciencesUniversity of BresciaBresciaItaly
| | - Paola Balestrieri
- Unit of Digestive Disease of Campus Bio Medico University of RomeItaly
| | - Marco Daperno
- Gastroenterology UnitAzienda Ospedaliera Ordine Mauriziano di TorinoTorinoPiemonteItaly
| | - Dario Pluchino
- Gastroenterology UnitA.O.U. Policlinico "Vittorio Emanuele"CataniaItaly
| | - Fernando Rizzello
- Department of Internal Medicine and GastroenterologyPoliclinico Sant’Orsola MalpighiBolognaItaly
| | | | - Renato Sablich
- Gastroenterology UnitSanta Maria degli Angeli HospitalPordenoneItaly
| | - Luca Pastorelli
- Gastroenterology UnitIRCCS Policlinico San Donato Research HospitalMilanItaly
| | - Francesco Manguso
- Gastoenterology UnitAO A. CardarelliVia A. Cardarelli, 5Naples80131Italy
| | - Angela Variola
- IBD Unit, IRCCS Sacro Cuore Don CalabriaNegrar di ValpolicellaVeronaItaly
| | - Antonio Di Sario
- Clinica di GastroenterologiaUniversità Politecnica delle MarcheAnconaItaly,IBD‐UNIT, and Dipartimento Gastroenterologico e dei TrapiantiPolo Ospedaliero‐Universitario "Umberto I‐G.M. Lancisi‐ G. Salesi"AnconaItaly
| | - Laurino Grossi
- G. D’Annunzio University‐Digestive Physiopathology Ospedale Spirito Santo PescaraPescaraItaly
| | - Alessandro Armuzzi
- IBD CenterIRCCS Humanitas Research HospitalMilanItaly,Department of Biomedical Sciences, Humanitas UniversityPieve EmanueleMilanItaly
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27
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Rispo A, de Sire R, Mainenti PP, Imperatore N, Testa A, Maurea S, Ricciolino S, Nardone OM, Olmo O, Castiglione F. David Against Goliath: Direct Comparison of Handheld Bowel Sonography and Magnetic Resonance Enterography for Diagnosis of Crohn's Disease. Inflamm Bowel Dis 2022; 29:563-569. [PMID: 35666249 DOI: 10.1093/ibd/izac116] [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: 02/28/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Diagnosis of Crohn's disease (CD) requires ileo-colonoscopy (IC) and cross-sectional evaluation. Recently, "echoscopy" has been used effectively in several settings, although data about its use for CD diagnosis are still limited. Our aim was to evaluate the diagnostic accuracy of handheld bowel sonography (HHBS) in comparison with magnetic resonance enterography (MRE) for CD diagnosis. METHODS From September 2019 to June 2021, we prospectively recruited consecutive subjects attending our third level IBD Unit for suspected CD. Patients underwent IC, HHBS, and MRE in random order with operators blinded about the result of the other procedures. Bivariate correlation between MRE and HHBS was calculated by Spearman coefficient (r). To test the consistency between MRE and HHBS for CD location and complications, the Cohen's k measure was applied. RESULTS Crohn's disease diagnosis was made in 48 out of 85 subjects (56%). Sensitivity, specificity, positive predictive values, and negative predictive values for CD diagnosis were 87.50%, 91.89%, 93.33%, and 85% for HHBS; and 91.67%, 94.59%, 95.65%, and 89.74% for MRE, without significant differences in terms of diagnostic accuracy (89.41% for HHBS vs 92.94% for MRE, P = NS). Magnetic resonance enterography was superior to HHBS in defining CD extension (r = 0.67; P < .01) with a better diagnostic performance than HHBS for detecting location (k = 0.81; P < .01), strictures (k = 0.75; P < .01), abscesses (k = 0.68; P < .01), and fistulas (k = 0.65; P < .01). CONCLUSION Handheld bowel sonography and MRE are 2 accurate and noninvasive procedures for diagnosis of CD, although MRE is more sensitive in defining extension, location, and complications. Handheld bowel sonography could be used as effective ambulatory (or out-of-office) screening tool for identifying patients to refer for MRE examination due to high probability of CD diagnosis.
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Affiliation(s)
- Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Roberto de Sire
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Pier Paolo Mainenti
- Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy
| | - Nicola Imperatore
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli of Naples, Naples, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Simone Maurea
- Radiology, Department of Advanced Biochemical Sciences, University Federico II of Naples, Naples, Italy
| | - Simona Ricciolino
- Gastroenterology, Hospital of Ariano Irpino Sant'Ottone-Frangipane, Avellino, Italy
| | - Olga Maria Nardone
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Oriana Olmo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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Nardone OM, Calabrese G, Testa A, Caiazzo A, Fierro G, Rispo A, Castiglione F. The Impact of Intestinal Ultrasound on the Management of Inflammatory Bowel Disease: From Established Facts Toward New Horizons. Front Med (Lausanne) 2022; 9:898092. [PMID: 35677820 PMCID: PMC9167952 DOI: 10.3389/fmed.2022.898092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Intestinal ultrasound (IUS) plays a crucial role as a non-invasive and accurate tool to diagnose and assess inflammatory bowel disease (IBD). The rationale for using IUS in Crohn’s disease (CD), a transmural disease, is widely acknowledged. While the use of IUS in ulcerative colitis (UC), a mucosal disease, is often underestimated, but, recently, it is increasingly expanding. In the context of a treat-to-target approach, the role of IUS is shifting toward a monitoring tool for predicting response to therapy. Hence, adjusting therapeutic strategies based on IUS response could reduce the burden related to endoscopy and speed the decision process with the ultimate goal to alter the natural course of IBD. Assessment of bowel wall thickness (BWT) is the most reliable IUS measure. However, the development of validated and reproducible sonographic scores to measure disease activity and the identification of parameters of therapeutic response remain relevant issues to implement the daily adoption of IUS in clinical practice. Accordingly, this review focuses on the current literature investigating the impact of IUS on CD with emphasis on the concept of transmural healing (TH) and the main related advantages. We further explore new insights on the role of IUS in UC and its clinical implications.
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Affiliation(s)
- Olga Maria Nardone
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giulio Calabrese
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Testa
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Anna Caiazzo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Giuseppe Fierro
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Antonio Rispo
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- *Correspondence: Fabiana Castiglione,
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de Sire R, Rispo A, Compare D, Tortora F, Nardone G, Castiglione F. Wernicke Encephalopathy in Ulcerative Colitis. Inflamm Bowel Dis 2022; 28:e70-e71. [PMID: 35512144 DOI: 10.1093/ibd/izab296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Roberto de Sire
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Debora Compare
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Fabio Tortora
- Radiology Unit, Department of Advanced Biomedical Sciences, University Federico II of Naples, Naples, Italy
| | - Gerardo Nardone
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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Calabrese E, Rispo A, Zorzi F, De Cristofaro E, Testa A, Costantino G, Viola A, Bezzio C, Ricci C, Prencipe S, Racchini C, Stefanelli G, Allocca M, Scotto di Santolo S, D'Auria MV, Balestrieri P, Ricchiuti A, Cappello M, Cavallaro F, Guarino AD, Maconi G, Spagnoli A, Monteleone G, Castiglione F. Ultrasonography Tight Control and Monitoring in Crohn's Disease During Different Biological Therapies: A Multicenter Study. Clin Gastroenterol Hepatol 2022; 20:e711-e722. [PMID: 33775896 DOI: 10.1016/j.cgh.2021.03.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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] [Received: 02/19/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Bowel ultrasonography (BUS) is a noninvasive tool for evaluating bowel activity in Crohn's disease (CD) patients. Aim of our multicenter study was to assess whether BUS helps to monitor intestinal activity improvement/resolution following different biological therapies. METHODS Adult CD patients were prospectively enrolled at 16 sites in Italy. Changes in BUS parameters [i.e. bowel wall thickening (BWT), lesion length, echo pattern, blood flow changes and transmural healing (TH: normalization of all BUS parameters)] were analyzed at baseline and after 3, 6 and 12 months of different biological therapies. RESULTS One hundred eighty-eight out of 201 CD patients were enrolled and analyzed (116 males [62%]; median age 36 years). Fifty-five percent of patients were treated with adalimumab, 16% with infliximab, 13% with vedolizumab and 16% with ustekinumab. TH rates at 12 months were 27.5% with an NNT of 3.6. TH at 12 months after adalimumab was 26.8%, 37% after infliximab, 27.2% after vedolizumab and 20% after ustekinumab. Mean BWT improvement from baseline was statistically significant at 3 and 12 months (P < .0001). Median Harvey-Bradshaw index, C-reactive protein and fecal calprotectin decreased after 12 months from baseline (P < .0001). Logistic regression analysis showed colonic lesion was associated with a higher risk of TH at 3 months and a greater BWT at baseline was associated with a lower risk of TH at 3 months [P = .03 (OR 0.70, 95% CI 0.50-0.97)] and 12 months [P = .01 (OR 0.58, 95% CI 0.38-0.89)]. At 3 months therapy optimization during the study was the only independent factor associated with a higher risk of no ultrasonographic response [P = .02 (OR 3.34, 95% CI 1.18-9.47)] and at 12 months disease duration [P = .02 (OR 3.03, 95% CI 1.15-7.94)]. CONCLUSIONS Data indicate that BUS is useful to monitor biologics-induced bowel activity improvement/resolution in CD.
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Affiliation(s)
- Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome.
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, Federico II, School of Medicine, Naples
| | - Francesca Zorzi
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome
| | - Elena De Cristofaro
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, Federico II, School of Medicine, Naples
| | - Giuseppe Costantino
- Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina
| | - Anna Viola
- Clinical Unit for Chronic Bowel Disorders, Department of Clinical and Experimental Medicine, University of Messina, Messina
| | | | - Chiara Ricci
- Gastroenterology Unit, University and Spedali Civili of Brescia, Brescia
| | | | | | - Gianpiero Stefanelli
- Department of Life, Health and Environmental Sciences, Gastroenterology Unit, University of L'Aquila, L'Aquila
| | - Mariangela Allocca
- Humanitas Clinical and Research Center, Humanitas University, Department of Biomedical Sciences, Milan
| | | | | | - Paola Balestrieri
- Unit of Digestive Disease, Campus Bio Medico University of Rome, Rome
| | - Angelo Ricchiuti
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, Cisanello University Hospital of Pisa, Pisa
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, AOU Policlinico "P. Giaccone", Palermo
| | - Flaminia Cavallaro
- Gastroenterology and Digestive Endoscopy, IRCCS Policlinico San Donato, San Donato Milanese, Milano
| | - Alessia Dalila Guarino
- Gastroenterology, Department of Clinical Medicine and Surgery, Federico II, School of Medicine, Naples
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, FBF-Sacco University Hospital, Milan
| | - Alessandra Spagnoli
- Department of Public Health and Infectious Diseases, Sapienza, University of Rome, Rome
| | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, Federico II, School of Medicine, Naples
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de Sire A, de Sire R, Curci C, Castiglione F, Wahli W. Role of Dietary Supplements and Probiotics in Modulating Microbiota and Bone Health: The Gut-Bone Axis. Cells 2022; 11:cells11040743. [PMID: 35203401 PMCID: PMC8870226 DOI: 10.3390/cells11040743] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 02/04/2023] Open
Abstract
Osteoporosis is characterized by an alteration of bone microstructure with a decreased bone mineral density, leading to the incidence of fragility fractures. Around 200 million people are affected by osteoporosis, representing a major health burden worldwide. Several factors are involved in the pathogenesis of osteoporosis. Today, altered intestinal homeostasis is being investigated as a potential additional risk factor for reduced bone health and, therefore, as a novel potential therapeutic target. The intestinal microflora influences osteoclasts’ activity by regulating the serum levels of IGF-1, while also acting on the intestinal absorption of calcium. It is therefore not surprising that gut dysbiosis impacts bone health. Microbiota alterations affect the OPG/RANKL pathway in osteoclasts, and are correlated with reduced bone strength and quality. In this context, it has been hypothesized that dietary supplements, prebiotics, and probiotics contribute to the intestinal microecological balance that is important for bone health. The aim of the present comprehensive review is to describe the state of the art on the role of dietary supplements and probiotics as therapeutic agents for bone health regulation and osteoporosis, through gut microbiota modulation.
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Affiliation(s)
- Alessandro de Sire
- Physical Medicine and Rehabilitation Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy
- Correspondence: (A.d.S.); (W.W.)
| | - Roberto de Sire
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80126 Naples, Italy; (R.d.S.); (F.C.)
| | - Claudio Curci
- Physical Medicine and Rehabilitation Unit, Department of Neurosciences, ASST Carlo Poma, 46100 Mantova, Italy;
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University Federico II of Naples, 80126 Naples, Italy; (R.d.S.); (F.C.)
| | - Walter Wahli
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, Singapore 308232, Singapore
- Toxalim Research Center in Food Toxicology (UMR 1331), French National Research Institute for Agriculture, Food, and the Environment (INRAE), F-31300 Toulouse, France
- Center for Integrative Genomics, University of Lausanne, Le Génopode, CH-1015 Lausanne, Switzerland
- Correspondence: (A.d.S.); (W.W.)
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Schifano N, Castiglione F, Rewhorn M, Hadway P, Nigam R, Rees R, Alnajjar H, Muneer A. Inguinal lymphadenectomy for penile cancer using a fascial sparing technique -outcomes from a single centre. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00767-9] [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: 11/04/2022]
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Luglio G, Pellegrini L, Rispo A, Tropeano FP, Imperatore N, Pagano G, Amendola A, Testa A, De Palma GD, Castiglione F. Post-operative morbidity in Crohn's disease: what is the impact of patient-, disease- and surgery-related factors? Int J Colorectal Dis 2022; 37:411-419. [PMID: 35013822 DOI: 10.1007/s00384-021-04076-5] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Over 50% of patients suffering from Crohn's disease (CD) require surgery in their lifetime. Predictors/risk factors of post-operative morbidity and mortality in CD are poorly investigated. We aimed to assess the risk factors of post-operative morbidity/mortality in CD. METHODS We performed a retrospective cohort study in which all CD patients operated and followed up at our tertiary Inflammatory Bowel Disease Centre from 2014 to 2019 were enrolled. For each patient, we evaluated patient-dependent, disease-dependent and surgery-dependent variables. All patients underwent small bowel and/or colic resections. RESULTS Of the 165 operated patients, forty-two (25.5%) developed post-operative complications (major complication rate = 9.8%) including wound infection (12.1%), respiratory complications (4.8%), prolonged ileum (4.2%), anastomotic leak (3.6%), urinary infections (3%), abdominal abscess (2.4%), anastomotic bleeding (3.6%), abdominal bleeding (1.2%) and obstruction (0.6%). Two subjects (1.2%) required re-operation within 30 days, and one died. A surgery duration < 141 min was predictive of a better post-operative outcome (sensitivity 80.9%, specificity 43.1%, PPV 32.7%, NPV 86.9%). The multivariable analysis showed stricturing/fistulizing behaviour (OR 3.7, 95% CI 1.6-6.4, p = 0.02), need for total parenteral nutrition (OR 4.1, 95% CI 2.4-9.2, p = 0.01), pre-operative bowel cleansing (OR 0.6, 95% CI 0.41-0.83, p = 0.01) and surgery duration < 141 min (OR 0.2, 95% CI 0.08-0.7, p = 0.03) as the only risk factors associated with post-operative morbidities. CONCLUSIONS About 25% of CD patients develop post-operative complications. Several patient-related, disease-related and surgery-related factors should be considered risk factors for post-operative morbidity. The recognition of these factors, as well as a multidisciplinary approach to the pre-operative management of CD, could reduce post-operative complications.
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Affiliation(s)
- G Luglio
- Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy.
| | - L Pellegrini
- Gastroenterology Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Naples, Italy
| | - A Rispo
- Gastroenterology Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Naples, Italy
| | - F P Tropeano
- Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - N Imperatore
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy
| | - G Pagano
- Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - A Amendola
- Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - A Testa
- Gastroenterology Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Naples, Italy
| | - G D De Palma
- Endoscopic Surgery Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Via Sergio Pansini 5, 80131, Naples, Italy
| | - F Castiglione
- Gastroenterology Unit, Integrated Department of Gastrointestinal Disease, School of Medicine, University of Naples Federico II, Naples, Italy
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Armuzzi A, Bortoli A, Castiglione F, Contaldo A, Daperno M, D'Incà R, Labarile N, Mazzuoli S, Onali S, Milla M, Orlando A, Principi M, Pugliese D, Renna S, Rizzello F, Scribano ML, Todeschini A. Female reproductive health and inflammatory bowel disease: A practice-based review. Dig Liver Dis 2022; 54:19-29. [PMID: 34120858 DOI: 10.1016/j.dld.2021.05.020] [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: 03/17/2021] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel diseases, namely ulcerative colitis and Crohn's disease, occur worldwide and affect people of all ages, with a high impact on their quality of life. Sex differences in incidence and prevalence have been reported, and there are also gender-specific issues that physicians should recognize. For women, there are multiple, important concerns regarding issues of body image and sexuality, menstruation, contraception, fertility, pregnancy, breastfeeding and menopause. This practice-based review focuses on the main themes that run through the life of women with inflammatory bowel diseases from puberty to menopause. Gastroenterologists who specialize in inflammatory bowel diseases and other physicians who see female patients with inflammatory bowel diseases should provide support for these problems and offer adequate therapy to ensure that their patients achieve the same overall well-being and health as do women without inflammatory bowel diseases.
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Affiliation(s)
| | - Alessandro Armuzzi
- CEMAD - IBD Unit, Department of Medical and Surgical Sciences, A Gemelli University Hospital, Rome, Italy
| | | | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Antonella Contaldo
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy
| | - Marco Daperno
- Gastroenterology and Endoscopic Unit, Umberto I Mauriziano Hospital, Turin, Italy
| | - Renata D'Incà
- Gastroenterology Unit, Padua University Hospital, Padua, Italy
| | - Nunzia Labarile
- Gastroenterology Unit, Ospedale Santissima Annunziata, Taranto, Italy
| | - Silvia Mazzuoli
- Gastroenterology and Artificial Nutrition Department, "Mons. Dimiccoli " Barletta, Italy
| | - Sara Onali
- Gastroenterology Unit, Department of Science and Public Health, University Hospital of Cagliari, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Clinic, Careggi University Hospital, Florence, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Mariabeatrice Principi
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy.
| | - Daniela Pugliese
- CEMAD - IBD Unit, Department of Medical and Surgical Sciences, A Gemelli University Hospital, Rome, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Alessia Todeschini
- Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy
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de Sire R, Nardone OM, Testa A, Calabrese G, Caiazzo A, Castiglione F. Exclusive Enteral Nutrition in Adult Crohn's Disease: an Overview of Clinical Practice and Perceived Barriers. Clin Exp Gastroenterol 2021; 14:493-501. [PMID: 35002274 PMCID: PMC8720860 DOI: 10.2147/ceg.s267172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/07/2021] [Accepted: 12/10/2021] [Indexed: 12/11/2022] Open
Abstract
Recently, the role of nutrition in the management of Crohn's disease (CD) is of increasing interest and the exploration of novel nutritional interventions to improve long-term management of the disease is challenging. So far, the majority of the studies on the role of exclusive enteral nutrition (EEN) in CD are conducted in the pediatric population and have highlighted the efficacy of EEN for achieving mucosal healing. This implicates that a similar approach would be beneficial in adult patients. However, the evidence for EEN in adults is heterogeneous, with meta-analyses reporting it as inferior to steroids while growing data demonstrate improvement in complicated CD. Currently, EEN is less used in adult patients with IBD. Indeed, the lack of palatability of enteral formula leads to difficulties in acceptance and compliance. The search for more tolerable and still effective diets has become an intense area of research aiming to explore the potential role of diet to control inflammation in patients with CD. Thus, this narrative review provides the state-of-the-art on the use of EEN treatment in CD and highlights the perceived barriers to its implementation in adult CD patients.
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Affiliation(s)
- Roberto de Sire
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Olga Maria Nardone
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Anna Testa
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Giulio Calabrese
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Anna Caiazzo
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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Cioffi I, Di Vincenzo O, Morlino D, Santarpia L, Pagano C, Alfonsi L, Imperatore N, Castiglione F, Pasanisi F. Prevalence of Vitamin D deficiency and its association with disease activity in adult patients with Crohn’s disease. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.262] [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: 11/26/2022]
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Bezzio C, Armuzzi A, Furfaro F, Ardizzone S, Milla M, Carparelli S, Orlando A, Caprioli FA, Castiglione F, Viganò C, Ribaldone DG, Zingone F, Monterubbianesi R, Imperatore N, Festa S, Daperno M, Scucchi L, Ferronato A, Pastorelli L, Balestrieri P, Ricci C, Cappello M, Felice C, Fiorino G, Saibeni S. Therapies for inflammatory bowel disease do not pose additional risks for adverse outcomes of SARS-CoV-2 infection: an IG-IBD study. Aliment Pharmacol Ther 2021; 54:1432-1441. [PMID: 34694009 PMCID: PMC8653024 DOI: 10.1111/apt.16663] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 09/10/2021] [Accepted: 10/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Older age and comorbidities are the main risk factors for adverse COVID-19 outcomes in patients with inflammatory bowel disease (IBD). The impact of IBD medications is still under investigation. AIMS To assess risk factors for adverse outcomes of COVID-19 in IBD patients and use the identified risk factors to build risk indices. METHODS Observational cohort study. Univariable and multivariable logistic regression was used to identify risk factors associated with pneumonia, hospitalisation, need for ventilatory support, and death. RESULTS Of the 937 patients (446 with ulcerative colitis [UC]) evaluated, 128 (13.7%) had asymptomatic SARS-CoV-2 infection, 664 (70.8%) had a favourable course, and 135 (15.5%) had moderate or severe COVID-19. In UC patients, obesity, active disease and comorbidities were significantly associated with adverse outcomes. In patients with Crohn's disease (CD), age, obesity, comorbidities and an additional immune-mediated inflammatory disease were identified as risk factors. These risk factors were incorporated into two indices to identify patients with UC or CD with a higher risk of adverse COVID-19 outcomes. In multivariable analyses, no single IBD medication was associated with poor COVID-19 outcomes, but anti-TNF agents were associated with a lower risk of pneumonia in UC, and lower risks of hospitalisation and severe COVID-19 in CD. CONCLUSION The course of COVID-19 in patients with IBD is similar to that in the general population. IBD patients with active disease and comorbidities are at greater risk of adverse COVID-19 outcomes. IBD medications do not pose additional risks. The risk indices may help to identify patients who should be prioritised for COVID-19 re-vaccination or for therapies for SARS-CoV-2 infection.
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Cioffi I, Fisco M, Santarpia L, Di Vincenzo O, Caterino M, Morlino D, Imperatore N, Castiglione F, Ruoppolo M, Pasanisi F. Assessment of serum amino acids profile in adult patients with Crohn’s disease. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.254] [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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Fankhauser C, M. De Vries H, Roussel E, Jakobsen J, Issa A, Lee E, Schifano N, Alnajjar H, Castiglione F, Pedro O, Lau M, Parnham A, Maarten A, Watkin N, Muneer A, Ayres B, Brouwer O, Sangar V. Risk factors for inguinal lymph node metastases in men with T1G2 penile cancer: a multi centre collaborative study. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)03080-9] [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: 12/01/2022] Open
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Rubba F, Luglio G, Castiglione F, Rispo A, Tropeano FP, Pagano G, Vozzella EA, De Palma GD. In Silico Preliminary evaluation of Cx601 as new therapeutic approach in hospital clinical paths. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Crohn's disease is a chronic inflammatory bowel disease characterized by transmural inflammation and fistula formation. Perianal fistulas are a common complication of Crohn's disease and are estimated to affect up to 28% of patients in the first two decades after diagnosis, particularly those with colonic disease and rectal involvement. Complex perianal fistulas in Crohn's disease are challenging to treat, severely impair patients' quality of life and cause substantial morbidity. Allogeneic, expanded, adipose-derived stem cells (Cx601) are a promising new therapeutic approach, although their high cost is often discouraging. We aimed at assessing the safety and efficacy of this treatment in patients with complex perianal fistulas in patients with Crohn's disease. Therefore, we conducted a meta-analysis in order to evaluate this new therapeutic approach before introducing it as standard of care. We examined 8 studies published in the last 10 years, 5 of which were selected for the final analysis. The primary outcome assessed was the combined fistula remission (clinical + imaging) assessed through the clinical examination and MRI, the control being the traditional medical strategies (ie, antibiotics, immunomodulators and anti-tumour necrosis factor agents). We registered a total of 128 events (lack of remission) in the control group vs 94 in the experimental one (Confidence Interval for OR of 0,12-0,31, P < 0,001). Our “in silico” assessment is reliable, being the introduction of (Cx601) an innovative and effective treatment. Further insights will be provided by the INSPIRE registry, a multinational post-marketing study whose main objective is the evaluation of the real-world clinical effectiveness and safety of (Cx601) in patients affected by Crohn's disease with complex perianal fistulas for a duration of 36 months, to which our University “Federico II” is actively taking part.
Key messages
Disability reduction is an important goal in cronh therapeutic path of care. Our “in silico” assessment may support the introduction of (Cx601) an innovative and effective treatment.
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Affiliation(s)
- F Rubba
- Public Health Department, AOU Federico II, Naples, Italy
| | - G Luglio
- Department of Medical and Surgical Gastrointestinal Disease, AOU Federico II, Naples, Italy
| | - F Castiglione
- Department of Medical and Surgical Gastrointestinal Disease, AOU Federico II, Naples, Italy
| | - A Rispo
- Department of Medical and Surgical Gastrointestinal Disease, AOU Federico II, Naples, Italy
| | - FP Tropeano
- Department of Medical and Surgical Gastrointestinal Disease, AOU Federico II, Naples, Italy
| | - G Pagano
- Department of Medical and Surgical Gastrointestinal Disease, AOU Federico II, Naples, Italy
| | - EA Vozzella
- Public Health Department, AOU Federico II, Naples, Italy
| | - GD De Palma
- Department of Medical and Surgical Gastrointestinal Disease, AOU Federico II, Naples, Italy
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Schifano N, Capogrosso P, Boeri L, Pozzi E, Belladelli F, Chiappini S, Castiglione F, Deho’ F, Schifano F, Montorsi F, Salonia A. Medications mostly associated with priapism events: assessment of the 2015–2020 food and drug administration (FDA) pharmacovigilance database entries. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00721-7] [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: 10/20/2022] Open
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42
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Schifano N, Capogrosso P, Boeri L, Pozzi E, Belladelli F, Chiappini S, Castiglione F, Deho’ F, Montorsi F, Salonia A, Schifano F. Is finasteride intake associated with penile curvature/peyronie’s disease? Assessment of both the food and drug administration (FDA) and the European Medicines Agency (EMA) pharmacovigilance databases. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00727-8] [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: 11/26/2022] Open
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43
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Guarino AD, Testa A, Mormile I, Imperatore N, Granata F, Rispo A, De Paulis A, Castiglione F. Crohn's disease and Takayasu's arteritis: are they associated? Eur Rev Med Pharmacol Sci 2021; 25:1472-1484. [PMID: 33629317 DOI: 10.26355/eurrev_202102_24855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Different types of vasculitis can occur in patients with inflammatory bowel disease [IBD], but large vessels vasculitis seems to be the most prevalent. Indeed, the presence of both Crohn's disease [CD] and Takayasu's arteritis [TAK] has previously been reported, with higher prevalence in young women between the second and the third decade of life. This article aims to provide clinicians with an accurate picture of the most common clinical features and current treatment strategy for patients with both CD and TAK. PATIENTS AND METHODS We described the coexistence of CD and TAK in three young women and also performed an extensive literature review about the association of these two immune-related disorders. Research on PubMed server was performed typing the terms "Takayasu's arteritis and inflammatory bowel disease", "Takayasu's arteritis and Crohn's disease", and "Takayasu's arteritis and Ulcerative colitis". RESULTS Although the association of CD with TAK is uncommon, due to the severity of both diseases, concomitance in the same patient may significantly complicate the diagnostic and therapeutic work-up. In addition, since TAK can compromise intestinal vasculature, it may possibly exacerbate the clinical course of patients with IBD. All patients we reported underwent surgery due to IBD complications and two of them started biological therapy with different outcomes. CONCLUSIONS Early detention of these conditions has a great importance for both gastroenterologists and immunologists, for ensuring a tailored multidisciplinary management, possibly in order to identify a common therapy for these two immune-related disorders.
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Affiliation(s)
- A D Guarino
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy.
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Nardone OM, de Sire R, Petito V, Testa A, Villani G, Scaldaferri F, Castiglione F. Inflammatory Bowel Diseases and Sarcopenia: The Role of Inflammation and Gut Microbiota in the Development of Muscle Failure. Front Immunol 2021; 12:694217. [PMID: 34326845 PMCID: PMC8313891 DOI: 10.3389/fimmu.2021.694217] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/28/2021] [Indexed: 12/13/2022] Open
Abstract
Sarcopenia represents a major health burden in industrialized country by reducing substantially the quality of life. Indeed, it is characterized by a progressive and generalized loss of muscle mass and function, leading to an increased risk of adverse outcomes and hospitalizations. Several factors are involved in the pathogenesis of sarcopenia, such as aging, inflammation, mitochondrial dysfunction, and insulin resistance. Recently, it has been reported that more than one third of inflammatory bowel disease (IBD) patients suffered from sarcopenia. Notably, the role of gut microbiota (GM) in developing muscle failure in IBD patient is a matter of increasing interest. It has been hypothesized that gut dysbiosis, that typically characterizes IBD, might alter the immune response and host metabolism, promoting a low-grade inflammation status able to up-regulate several molecular pathways related to sarcopenia. Therefore, we aim to describe the basis of IBD-related sarcopenia and provide the rationale for new potential therapeutic targets that may regulate the gut-muscle axis in IBD patients.
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Affiliation(s)
- Olga Maria Nardone
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Roberto de Sire
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Valentina Petito
- Department of Medicine and Translational Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, University Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Testa
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Guido Villani
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Franco Scaldaferri
- Department of Medicine and Translational Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, University Cattolica del Sacro Cuore, Rome, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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Imperatore N, Foggia M, Patturelli M, Rispo A, Calabrese G, Testa A, Pellegrini L, Tosone G, Di Luna I, Nardone OM, Ricciolino S, Castiglione F. Treatment-based risk stratification of infections in inflammatory bowel disease: A comparison between anti-tumor necrosis factor-α and nonbiological exposure in real-world setting. J Gastroenterol Hepatol 2021; 36:1859-1868. [PMID: 33283312 DOI: 10.1111/jgh.15367] [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: 10/20/2020] [Revised: 11/21/2020] [Accepted: 11/29/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM Infective issues about anti-tumor necrosis factor (TNF)-α agents in inflammatory bowel disease (IBD) remain controversial, especially when compared with nonbiological treatments. This study aimed to evaluate the incidence and prevalence of several infections in anti-TNF-α-exposed patients compared with nonbiological treatments. METHODS All naïve IBD subjects treated with anti-TNF-α and matched nonbiologic-exposed patients were included. RESULTS Among 3453 patients in the database, 288 anti-TNF-α-exposed subjects and 288 nonbiologic-exposed IBD controls met inclusion criteria. Fifty-eight infections (20.1%) occurred during anti-TNF-α treatment versus 23 (8%) in the matched group (odds ratio [OR] 2.9, P < 0.001) (incidence 5.72 vs 0.96/100 patient-years, incidence ratio [IR] 6, P < 0.001). IR was higher for anti-TNF-α versus mesalamine/sulfasalazine (IR 40.8, P < 0.001), similar to azathioprine/6-mercaptopurine/methotrexate (IR 0.78, P = 0.32) and lower than corticosteroids (IR 0.05, P < 0.001). The incidence rate of serious infections was 1.3 in the anti-TNF-α-exposed versus 0.38/100 patient-years in nonexposed subjects (IR 3.44, P = 0.002), without significant difference between anti-TNF-α and azathioprine/6-mercaptopurine/methotrexate (1.3 vs 3.03/100 patient-years, IR 0.43, P = 0.1). Predictors of infections in anti-TNF-α-exposed patients were concomitant use of systemic steroids (OR 1.9, P = 0.02) or azathioprine (OR 2.6, P = 0.01) and a body mass index < 18.5 at time of infection (OR 2.2, P = 0.01). CONCLUSIONS The risk of developing infections during anti-TNF-α therapy remains high, although not dissimilar to that found for other immunosuppressants, while concomitant immunosuppression and malnutrition appear the most important causes of infection.
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Affiliation(s)
- Nicola Imperatore
- Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy.,Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Maria Foggia
- Department of Infectious Diseases, School of Medicine Federico II of Naples, Naples, Italy
| | - Marta Patturelli
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Giulio Calabrese
- Department of Infectious Diseases, School of Medicine Federico II of Naples, Naples, Italy
| | - Anna Testa
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Lucienne Pellegrini
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Grazia Tosone
- Department of Infectious Diseases, School of Medicine Federico II of Naples, Naples, Italy
| | - Imma Di Luna
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Olga Maria Nardone
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Simona Ricciolino
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Naples, Italy
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Orlando A, Mocciaro F, Ventimiglia M, Renna S, Rispo A, Scribano ML, Testa A, Aratari A, Bossa F, Angelucci E, Onali S, Cappello M, Giunta M, Scimeca D, Macaluso FS, Castiglione F, Papi C, Annese V, Biancone L, Kohn A, Di Mitri R, Cottone M. Azathioprine for prevention of clinical recurrence in Crohn's disease patients with severe endoscopic recurrence: an IG-IBD randomized double-blind trial. Eur Rev Med Pharmacol Sci 2021; 24:11356-11364. [PMID: 33215456 DOI: 10.26355/eurrev_202011_23627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The recurrence of Crohn's Disease after ileo-colonic resection is a crucial issue. Severe endoscopic lesions increase the risk of developing early symptoms. Prevention and treatment of post-operative Endoscopic Recurrence (ER) have been studied with conflicting results. We compare effi cacy of azathioprine (AZA) vs. high-dose 5-aminosalicylic acid (5-ASA) in preventing clinical recurrence and treating severe post-operative ER. PATIENTS AND METHODS We performed a 1-year multicenter randomized double-blind double-dummy trial. Primary end-points were endoscopic improvement and therapeutic failure (clinical recurrence or drug discontinuation due to lack of efficacy or adverse events) 12 months after randomization. We also performed a post-trial analysis on symptomatic and endoscopic outcomes 10 years after the beginning of the trial, with a median follow-up of 60 months. RESULTS Therapeutic failure occurred in 8 patients (17.4%) within 12 months from randomization, with no significant difference between patients treated with 5-ASA (20.8%, 5 patients) and those with AZA (13.6%, 3 patients). Therapeutic failure was due to clinical recurrence in the 5-ASA group and to adverse events in the AZA group. Endoscopic improvement at 12 months was observed in 8 patients, 2 (11.8%) in the 5-ASA group and 6 (30%) in the AZA group. No serious adverse event was recorded. At the post-trial analysis (median follow-up 60 months), 47.8% (22/46) of patients experienced clinical recurrence: 54.2% (13/24) in the 5-ASA group and 40.9% (9/22) in the AZA group, p=0.546. Patients treated with AZA had lower risk of drug escalation. Clinical recurrence was associated with smoking (p=0.031) and previous surgery (p=0.003). CONCLUSIONS Our trial indicates that there was no difference in terms of treatment failure between 5-ASA and AZA in patients with severe ER. The main limit of AZA is its less favorable safety profile.
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Affiliation(s)
- A Orlando
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy.
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de Sire R, Castiglione F, Picardi M, Mascolo M, Di Luna I, Corcione F, D'Ambra M, Travaglino A, Rispo A. Chemotherapy-Induced Remission of Steroid-Dependent Ulcerative Colitis Associated With Rectal Hodgkin Lymphoma. Inflamm Bowel Dis 2021; 27:e81-e82. [PMID: 33501977 DOI: 10.1093/ibd/izab010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Roberto de Sire
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Marco Picardi
- Hematology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Massimo Mascolo
- Pathology, Department of Advanced Biomedical Sciences, University Federico II of Naples, Naples, Italy
| | - Imma Di Luna
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
| | - Francesco Corcione
- General Surgery, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Michele D'Ambra
- General Surgery, Department of Public Health, University Federico II of Naples, Naples, Italy
| | - Antonio Travaglino
- Pathology, Department of Advanced Biomedical Sciences, University Federico II of Naples, Naples, Italy
| | - Antonio Rispo
- Gastroenterology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy
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Wardak S, Castiglione F, Lindsay J, Alifrangis C, Walkden M, Hadway P, Nigam R, Rees R, Alnajjar H, Muneer A. Management of indeterminate Small Testis Masses (STMs): A 10-year single centre experience. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01031-9] [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: 11/17/2022]
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Campos Juanatey F, Fes Ascanio E, Rosenbaum C, Adamowicz J, Castiglione F, Waterloos M, Kluth L. Contemporary management of male anterior urethral strictures by reconstructive urology experts. Results from EAU-YAU survey among ESGURS members. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00766-1] [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: 10/20/2022]
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Schifano N, Capogrosso P, Boeri L, Pozzi E, Belladelli F, Chiappini S, Cakir O, Rewhorn M, Castiglione F, Alnajjar H, Muneer A, Deho’ F, Schifano F, Montorsi F, Salonia A. Medications mostly associated with priapism events: Assessment of the 2015-2020 Food and Drug Administration (FDA) pharmacovigilance database entries. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00857-5] [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: 11/28/2022]
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