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Macaluso FS, Caprioli F, Benedan L, Bezzio C, Caporali R, Cauli A, Chimenti MS, Ciccia F, D'Angelo S, Fantini MC, Festa S, Iannone F, Lubrano E, Mariani P, Papi C, Provenzano G, Pugliese D, Rispo A, Saibeni S, Salvarani C, Variola A, Zenga M, Armuzzi A, Orlando A, Gerli R. The management of patients with inflammatory bowel disease-associated spondyloarthritis: Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) and Italian Society of Rheumatology (SIR) recommendations based on a pseudo-Delphi consensus. Autoimmun Rev 2024:103533. [PMID: 38521214 DOI: 10.1016/j.autrev.2024.103533] [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: 12/31/2023] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
Spondyloarthritis (SpA) is the most frequent extraintestinal manifestation in patients with inflammatory bowel diseases (IBD). When IBD and spondyloarthritis coexist, musculoskeletal and intestinal disease features should be considered when planning a therapeutic strategy. Treatment options for IBD and SpA have expanded enormously over the last few years, but randomized controlled trials with specific endpoints focused on SpA are not available in the IBD setting. To address this important clinical topic, the Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD) and the Italian Society of Rheumatology (SIR) jointly planned to draw updated therapeutic recommendations for IBD-associated SpA using a pseudo-Delphi method. This document presents the official recommendations of IG-IBD and SIR on the management of IBD-associated SpA in the form of 34 statements and 4 therapeutic algorithms. It is intended to be a reference guide for gastroenterologists and rheumatologists dealing with IBD-associated SpA.
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Affiliation(s)
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Italy and Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy.
| | - Laura Benedan
- Bicocca-Applied Statistics Center, Department of Economics, Management and Statistics, University of Milano-Bicocca, Milano, Italy
| | - Cristina Bezzio
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Roberto Caporali
- Rheumatology Unit, Department of Clinical and Community Sciences, University of Milan, ASST Gaetano Pini-CTO, Milan, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medicine and Public Health, AOU and University of Cagliari, Cagliari, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of Systems Medicine, University of Rome Tor Vergata, Italy
| | - Francesco Ciccia
- Department of Precision Medicine, Division of Rheumatology, Università della Campania L. Vanvitelli, Naples, Italy
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
| | - Massimo Claudio Fantini
- Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy; Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | | | | | - Ennio Lubrano
- Dipartimento di Medicina e Scienze della Salute, Università degli Studi del Molise, Campobasso, Italy
| | - Paolo Mariani
- Bicocca-Applied Statistics Center, Department of Economics, Management and Statistics, University of Milano-Bicocca, Milano, Italy
| | | | | | - Daniela Pugliese
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy; IBD Unit, CEMAD, Digestive Diseases Center, Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Antonio Rispo
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Naples, Italy
| | - Simone Saibeni
- IBD Center, Gastroenterology Unit, Rho Hospital ASST Rhodense, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia e Università di Modena e Reggio Emilia, Italy
| | | | - Mariangela Zenga
- Bicocca-Applied Statistics Center, Department of Economics, Management and Statistics, University of Milano-Bicocca, Milano, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Roberto Gerli
- Rheumatology Unit, Department of Medicine & Surgery, University of Perugia, Italy
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Fantini MC, Fiorino G, Colli A, Laharie D, Armuzzi A, Caprioli FA, Gisbert JP, Kirchgesner J, Macaluso FS, Magro F, Ghosh S. Pragmatic trial design to compare real-world effectiveness of different treatments for inflammatory bowel diseases: the PRACTICE-IBD European consensus. J Crohns Colitis 2024:jjae026. [PMID: 38367197 DOI: 10.1093/ecco-jcc/jjae026] [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: 10/11/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND AND AIMS Pragmatic studies designed to test interventions in everyday clinical settings can successfully complement the evidence from registration and explanatory clinical trials. The European consensus project PRACTICE-IBD was developed to identify essential criteria and address key methodological issues needed to design valid comparative pragmatic studies in inflammatory bowel diseases (IBDs). METHODS Statements were issued by a panel of 11 European experts in IBD management and trial methodology on four main topics: (I) study design; (II) eligibility, recruitment and organization, flexibility; (III) outcomes; (IV) analysis. The consensus process followed a modified Delphi approach, involving two rounds of assessment and rating of the level of agreement (1 to 9; cut-off ≥7 for approval) with the statements by 18 additional European experts in IBD. RESULTS At the first voting round, 25 out of the 26 statements reached a mean score ≥7. Following the discussion that preceded the second round of voting, it was decided to eliminate two statements and to split one into two. At the second voting round, 25 final statements were approved: 7 for study design, 6 for eligibility, recruitment and organization, flexibility, 8 for outcomes, and 4 for analysis. CONCLUSIONS Pragmatic randomized clinical trials can address important questions in IBD clinical practice, and may provide complementary high-level evidence, as long as they follow a methodologically rigorous approach. These 25 statements intend to offer practical guidance in the design of high-quality pragmatic clinical trials that can aid decision making in choosing a management strategy for IBDs.
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Affiliation(s)
- Massimo Claudio Fantini
- Departement of Medical Science and Public Health, Gastroenterology Unit, University of Cagliari, Cagliari, Italy; Gastroenterology Unit, Azienda Ospedaliero-Universitaria (AOU) di Cagliari, Cagliari, Italy
| | - Gionata Fiorino
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini, Rome, Italy; Department of Gastroenterology and Digestive Endoscopy, San Raffaele Hospital and Vita-Salute San Raffaele Hospital, Milan, Italy
| | - Agostino Colli
- Department of Transfusion Medicine and Haematology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - David Laharie
- CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie et Oncologie Digestive, Université de Bordeaux, Bordeaux, France
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Flavio Andrea Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Javier P Gisbert
- 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 (CIBEREHD), Madrid, Spain
| | - Julien Kirchgesner
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Department of Gastroenterology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Fernando Magro
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal. Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Clinical Pharmacology, São João University Hospital Center (CHUSJ), Porto, Portugal; Faculty of Medicine, University of Porto, Portugal. Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Subrata Ghosh
- College of Medicine and Health, University College Cork, Cork, Ireland
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Vitello A, Maida M, Shahini E, Macaluso FS, Orlando A, Grova M, Ramai D, Serviddio G, Facciorusso A. Current Approaches for Monitoring of Patients with Inflammatory Bowel Diseases: A Narrative Review. J Clin Med 2024; 13:1008. [PMID: 38398321 PMCID: PMC10888591 DOI: 10.3390/jcm13041008] [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: 01/21/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Patients with inflammatory bowel diseases (IBD) require proactive monitoring both during the active phase to evaluate therapeutic response and during the remission phase to evaluate relapse or colorectal cancer surveillance. However, monitoring may vary between patients with ulcerative colitis (UC) and Crohn's disease (CD), with distinct tools and intervals. METHODS This narrative review aims to focus on modern approaches to IBD monitoring, considering international guidelines and expert consensus. RESULTS The most recent European diagnostic guidelines advocate a combination of clinical, laboratory, endoscopic, and radiological parameters to evaluate the disease course of patients with IBD. Unfortunately, the conventional symptom-based therapeutic approach does not improve long-term outcomes and there is no single ideal biomarker available. Endoscopy plays a key role in evaluating response to therapy as well as monitoring disease activity. Recently, bedside intestinal ultrasound (IUS) has gained increasing interest and diffusion as it appears to offer several advantages including the monitoring of therapeutic response. CONCLUSION In light of growing clinical advances, we present a schematic evidence-based monitoring algorithm that can be easily applied in clinical practice which combines all major monitoring modalities, including noninvasive tools such as IUS and video-capsule endoscopy.
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Affiliation(s)
- Alessandro Vitello
- Gastroenterology and Endoscopy Unit, S. Elia Hospital, 93100 Caltanissetta, Italy; (A.V.); (M.M.)
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia Hospital, 93100 Caltanissetta, Italy; (A.V.); (M.M.)
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Enna ‘Kore’, 94100 Enna, Italy
| | - Endrit Shahini
- Gastroenterology Unit, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy;
| | - Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Mauro Grova
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. “Villa Sofia-Cervello” Hospital, 90146 Palermo, Italy; (F.S.M.); (A.O.); (M.G.)
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, UT 84132, USA;
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
| | - Antonio Facciorusso
- Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy;
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Macaluso FS, Orlando A. Author's reply: "Tofacitinib in ulcerative colitis-Small molecule but large effect". Dig Liver Dis 2024; 56:373-374. [PMID: 38008695 DOI: 10.1016/j.dld.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/01/2023] [Indexed: 11/28/2023]
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Macaluso FS, D'Antonio E, Fries W, Viola A, Ksissa O, Cappello M, Muscarella S, Belluardo N, Giangreco E, Mocciaro F, Di Mitri R, Ferracane C, Vitello A, Grova M, Renna S, Casà A, De Vivo S, Ventimiglia M, Orlando A. Safety and effectiveness of tofacitinib in ulcerative colitis: Data from TOFA-UC, a SN-IBD study. Dig Liver Dis 2024; 56:15-20. [PMID: 37741749 DOI: 10.1016/j.dld.2023.08.061] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/03/2023] [Accepted: 08/31/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Real-world evidence is needed to determine the value of tofacitinib (TOFA) for the treatment of ulcerative colitis (UC). AIM To assess the safety and effectiveness of TOFA in clinical practice. METHODS TOFA-UC is a multicenter, observational study performed among the Sicilian Network for Inflammatory Bowel Disease (SN-IBD). All consecutive patients with UC starting TOFA from its introduction in Sicily (July 2021) to July 2022 were included. RESULTS 111 patients were included (mean follow-up: 31.7 ± 14.9 weeks; biologic-experienced: 92.8%). Nineteen adverse events were reported (17.1%; incidence rate: 28.2 per 100 patient years), including 11 cases of hypercholesterolemia and 3 infections (no cases of herpes zoster reactivation. At week 8, the rates of clinical response, steroid free clinical remission, and CRP normalization were 74.8%, 45.0%, and 56.9%, respectively, and 68.5%, 51.4%, and 65.2%, respectively, at the end of follow-up. Eighteen patients experienced a loss of response after successful induction (21.7%; incidence rate: 33.2 per 100 patient years). Twenty-six patients (23.4%) discontinued TOFA over time, of whom 3 due to AEs, and 23 to non response or loss of response. CONCLUSIONS TOFA is safe and effective in patients with UC, including those with history of multiple failures to biological therapies.
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Affiliation(s)
| | - Elvira D'Antonio
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Walter Fries
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Anna Viola
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Omar Ksissa
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Maria Cappello
- Gastroenterology & Hepatology Section, PROMISE, University of Palermo, Italy
| | - Stefano Muscarella
- Gastroenterology & Hepatology Section, PROMISE, University of Palermo, Italy
| | | | | | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | | | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Mauro Grova
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Sara Renna
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Simona De Vivo
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy; Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service, Italian Ministry of Health, Rome, Italy
| | - Ambrogio Orlando
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Grova M, Vitello A, Mannino M, Casà A, Renna S, Macaluso FS, Orlando A. Role of ustekinumab in treatment of ulcerative colitis: a narrative review. Immunotherapy 2023; 15:1539-1552. [PMID: 38018475 DOI: 10.2217/imt-2023-0106] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
The therapeutic armamentarium for gastroenterologists in treating ulcerative colitis (UC) has been rapidly growing since the introduction of monoclonal antibodies directed against anti-TNFs. Ustekinumab is a monoclonal antibody binding the shared p40 subunit of IL-12 and IL-23, and the inhibition of these two cytokines, implicated in host response to microbial pathogens, has demonstrated clinical efficacy in different immune-mediated diseases, including moderate-to-severe UC. This narrative review summarizes the newest clinical evidence regarding the efficacy, effectiveness and safety of ustekinumab in moderate-to-severe UC, including specific situations (pregnancy, breastfeeding, elderly/pediatric populations, extraintestinal manifestations, acute severe UC, pouchitis and dual biological therapy). Finally, positioning is discussed in light of the existing evidence.
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Affiliation(s)
- Mauro Grova
- Digestive Endoscopy Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
| | - Alessandro Vitello
- Gastroenterology & Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, 93100, Italy
| | - Mariella Mannino
- Inflammatory Bowel Disease Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
| | - Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Department of Medicine, "Villa Sofia-Cervello" Hospital, Palermo, 90100, Italy
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Costantino A, Michelon M, Noviello D, Macaluso FS, Leone S, Bonaccorso N, Costantino C, Vecchi M, Caprioli F. Attitudes towards Vaccinations in a National Italian Cohort of Patients with Inflammatory Bowel Disease. Vaccines (Basel) 2023; 11:1591. [PMID: 37896993 PMCID: PMC10611209 DOI: 10.3390/vaccines11101591] [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] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The vaccination status of patients with inflammatory bowel disease (IBD) should be investigated before starting any treatment, and patients should eventually be vaccinated against vaccine-preventable diseases (VPDs). Patients with IBD may have suboptimal vaccination rates. The aim of this study was to evaluate the vaccination coverage, attitude towards vaccinations, and determinants among an Italian cohort of patients with IBD. METHODS AMICI, the Italian IBD patients' association, sent an anonymous web-based questionnaire in February 2021. Previous vaccination status and patients' attitudes towards vaccinations were recorded. We examined the factors influencing their attitudes using crude and adjusted odds ratios (adjORs) with 95% confidence intervals (CIs). RESULTS Among the 4039 patients invited, 1252 patients (including 729 women, median age 47.7 [37-58]) completed the questionnaire, with a response rate of 25.3%. Respondents declared being vaccinated against tetanus (74.1%), flu (67.7%; last season), MMR (43.3%), HBV (37.1%), pneumococcus (29.1%), meningitis (20%), HAV (16%), VZV (15.3%), and HPV (7.6%). Complete vaccination history was not remembered by 20.7% of the patients. One thousand one hundred and twelve (88.8%) expressed a positive attitude towards vaccination, 91 (7.3%) were indifferent, and 49 (3.9%) reported being opposed to vaccinations. The belief of a possible return of VPDs with a decline in vaccination coverage rates was the factor most strongly related to a positive attitude towards vaccinations (adjOR 5.67, 95% CI 3.45-9.30, p-value < 0.001). CONCLUSIONS A low vaccination rate against some VPDs was found among a national cohort of patients with IBD, despite a generally positive attitude towards vaccinations.
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Affiliation(s)
- Andrea Costantino
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.V.); (F.C.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (M.M.); (D.N.)
| | - Marco Michelon
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (M.M.); (D.N.)
| | - Daniele Noviello
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (M.M.); (D.N.)
| | | | | | - Nicole Bonaccorso
- Department of Health Promotion Sciences—Maternal and Infant Care—Internal Medicine and Excellence Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (N.B.); (C.C.)
| | - Claudio Costantino
- Department of Health Promotion Sciences—Maternal and Infant Care—Internal Medicine and Excellence Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (N.B.); (C.C.)
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.V.); (F.C.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (M.M.); (D.N.)
| | - Flavio Caprioli
- Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (M.V.); (F.C.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy; (M.M.); (D.N.)
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Macaluso FS, Grova M, Mocciaro F, Di Mitri R, Privitera AC, Distefano ME, Vitello A, Camilleri S, Ferracane C, Pluchino D, Belluardo N, Giangreco E, Fries W, Viola A, Cappello M, D'Amato L, Bertolami C, Ventimiglia M, Renna S, Casà A, D'Antonio E, De Vivo S, Orlando A. Ustekinumab is a promising option for the treatment of postoperative recurrence of Crohn's disease. J Gastroenterol Hepatol 2023; 38:1503-1509. [PMID: 37148148 DOI: 10.1111/jgh.16208] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/05/2023] [Accepted: 04/20/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND AIM Postoperative recurrence (POR) following ileocolonic resection is a major concern in patients with Crohn's disease (CD). The role of ustekinumab (UST) in this setting is poorly known. METHODS All consecutive CD patients with a baseline colonoscopy at 6-12 months from ileocolonic resection showing POR (Rutgeerts score ≥ i2) who were treated with UST after the baseline colonoscopy and with an available post-treatment endoscopy, were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). The primary outcome was endoscopic success, defined as reduction of at least one point of Rutgeerts score. The secondary outcome was clinical success, assessed at the end of follow-up. Reasons for clinical failure included mild clinical relapse (Harvey-Bradshaw index 5-7), clinically relevant relapse (Harvey-Bradshaw index > 7), and need for new resection. RESULTS Forty-four patients were included (mean follow-up: 17.8 ± 8.4 months). The baseline postoperative colonoscopy showed severe POR (Rutgeerts score i3 or i4) in 75.0% of patients. The post-treatment colonoscopy was performed after a mean of 14.5 ± 5.5 months following initiation of UST. Endoscopic success was reported in 22 out of 44 (50.0%) patients, of whom 12 (27.3%) achieved a Rutgeerts score i0 or i1. Clinical success at the end of follow-up was reported in 32 out of 44 patients (72.7%); none of the 12 patients with clinical failure had achieved endoscopic success at post-treatment colonoscopy. CONCLUSIONS Ustekinumab could be a promising option for the treatment of POR of CD.
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Affiliation(s)
| | - Mauro Grova
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | | | | | - Alessandro Vitello
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Salvatore Camilleri
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | | | - Dario Pluchino
- Gastroenterology Unit, "Vittorio Emanuele" Hospital, Catania, Italy
| | | | | | - Walter Fries
- Inflammatory Bowel Disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, University of Palermo, Palermo, Italy
| | - Livia D'Amato
- Gastroenterology and Hepatology Section, University of Palermo, Palermo, Italy
| | | | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service; Italian Ministry of Health, Rome, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Elvira D'Antonio
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Simona De Vivo
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Macaluso FS, Ventimiglia M, Orlando A. Effectiveness and Safety of Vedolizumab in Inflammatory Bowel Disease: A Comprehensive Meta-analysis of Observational Studies. J Crohns Colitis 2023; 17:1217-1227. [PMID: 36913311 DOI: 10.1093/ecco-jcc/jjad043] [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: 11/15/2022] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND AIMS Many observational studies on the use of vedolizumab [VDZ] in patients with Crohn's disease [CD] and ulcerative colitis [UC] have been published in the past few years. We aimed to comprehensively summarise its effectiveness and safety by pooling data only from observational studies. METHODS PubMed/Medline and Embase were systematically searched for observational studies on patients with CD and UC treated with VDZ through December 2021. The rates of clinical remission and overall adverse events were the primary outcomes. The rates of steroid-free clinical remission, clinical response, mucosal healing, C-reactive protein normalisation, loss of response, VDZ dose escalation, colectomy, serious adverse events, infections, and malignancies were considered as secondary outcomes. RESULTS In all, 88 studies comprising 25 678 patients [13 663 with CD and 12 015 with UC] met the inclusion criteria. In patients with CD, the pooled estimate rates of clinical remission were 36% at induction and 39% at maintenance. In patients with UC, the pooled estimate rates of clinical remission were 40% at induction and 45% at maintenance. The pooled estimate of incidence rate of adverse events was 34.6 per 100 person-years. At multivariable meta-regression analysis, studies with increased male proportion were independently associated with higher rates of clinical remission and steroid-free clinical remission at both induction and maintenance, and clinical response at maintenance in patients with CD. Studies with increased disease duration were independently associated with higher mucosal healing rates at maintenance in patients with UC. CONCLUSIONS Observational studies demonstrated extensively the effectiveness of VDZ, with a reassuring safety profile.
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Affiliation(s)
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service, Italian Ministry of Health, Rome, Italy
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10
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Saibeni S, Zanetti M, Bezzio C, Pironi L, Armuzzi A, Riso S, Caprioli F, Lezo A, Macaluso FS, Pugliese D, Daperno M, Giorgetti GM. Nutritional care at centres managing patients with inflammatory bowel disease: A nationwide survey in Italy. Dig Liver Dis 2023; 55:1028-1033. [PMID: 37355395 DOI: 10.1016/j.dld.2023.05.029] [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: 02/25/2023] [Revised: 04/28/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) are at risk of malnutrition, but little is known about how IBD centres provide nutritional care. AIM To assess how nutritional care is delivered at IBD centres across Italy. METHODS 120 IBD centres were invited to answer a web-based questionnaire. RESULTS 76 questionnaires (63.3%) were completed. An IBD-dedicated nutritionist is present in 27 centres (35.5%). Fifty-two centres (68.4%) have an IBD multidisciplinary team, and 22 of these include a nutritionist. In the outpatient setting, malnutrition risk is evaluated at each visit in 23 centres (30.3%), while nutritional status is assessed at each visit in 21 centres (27.6%). These assessments are performed by a gastroenterologist in almost all centres (93.4% and 88.2%, respectively) and more rarely by a nutritionist (32.9% and 36.9%), dietician (7.9% and 2.6%) or nurse (3.9% and 9.2%). The decision to offer oral nutritional support is made by a gastroenterologist alone (35.5%), a nutritionist alone (23.7%), or a team of the two (38.2%). CONCLUSIONS Nutritional care for IBD patients appears quite far from satisfactory in the Italian reality. Educational and structural interventions are urgently needed to improve assessment and treatment of malnutrition in everyday clinical practice.
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Affiliation(s)
- Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho (MI), Italy.
| | - Michela Zanetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy; Geriatrics Unit, Azienda Sanitaria-Universitaria Giuliano Isontina, Trieste, Italy
| | - Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho (MI), Italy
| | - Loris Pironi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Centre for Chronic Intestinal Failure, IRCCS AOUBO, Bologna, Italy
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Sergio Riso
- Clinical Nutrition and Dietetics Unit, Ospedale Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
| | - Flavio 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
| | - Antonella Lezo
- Dietetic and Clinical Nutrition Unit, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza, Turin, Italy
| | | | - Daniela Pugliese
- Digestive Disease Center (CEMAD), IBD Unit, Internal Medicine and Gastroenterology Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Gemelli IRCCS, Rome, Italy
| | - Marco Daperno
- Gastroenterology Unit, Mauriziano Hospital, Turin, Italy
| | - Gian Marco Giorgetti
- Clinical and Artificial Nutrition Unit, Department of Medicine, Sant'Eugenio Hospital, Rome, Italy
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Bonovas S, Macaluso FS, Piovani D, Papi C, Orlando A, Armuzzi A. Author's Reply: ``Use of biologics for the management of Crohn's disease''. Dig Liver Dis 2023; 55:990. [PMID: 37380281 DOI: 10.1016/j.dld.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Claudio Papi
- Inflammatory bowel disease Unit, "San Filippo Neri" Hospital, Rome, Italy
| | - Ambrogio Orlando
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
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12
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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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13
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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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14
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Macaluso FS, Orlando A. Editorial: adjuvanted recombinant zoster vaccine in adults with inflammatory bowel disease-time for universal recommendation? Aliment Pharmacol Ther 2023; 57:1343-1344. [PMID: 37161634 DOI: 10.1111/apt.17490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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15
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Bonovas S, Piovani D, Pansieri C, Macaluso FS, Orlando A, Festa S, Papi C, Pugliese D, Armuzzi A. Use of biologics for the management of Crohn's disease: IG-IBD technical review based on the GRADE methodology. Dig Liver Dis 2023; 55:695-703. [PMID: 36964060 DOI: 10.1016/j.dld.2023.02.019] [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: 09/06/2022] [Revised: 12/20/2022] [Accepted: 02/18/2023] [Indexed: 03/26/2023]
Abstract
The therapeutic armamentarium for the management of Crohn's disease (CD) is rapidly expanding. Several biologic therapies (e.g. infliximab, adalimumab, vedolizumab, and ustekinumab) have been regulatory approved, and there is considerable practice variability in the treatment of patients with CD. This technical review systematically searched and identified the current evidence, synthesized it using meta-analytic methodology, appraised its quality, and concisely presented it, thus forming the basis for developing clinical practice recommendations on the use of biologic treatments in adult patients with CD.
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Affiliation(s)
- Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Claudia Pansieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | | | - Claudio Papi
- IBD Unit, "San Filippo Neri" Hospital, Rome, Italy
| | - Daniela Pugliese
- Division of Internal Medicine and Gastroenterology, Department of Medical and Surgical Sciences, Policlinico Universitario "A. Gemelli" IRCCS Foundation, Rome, Italy
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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16
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Grova M, Crispino F, Maida M, Vitello A, Renna S, Casà A, Tesè L, Macaluso FS, Orlando A. Sarcopenia is a negative predictive factor for endoscopic remission in patients with Crohn's disease treated with biologics. Dig Liver Dis 2023:S1590-8658(23)00482-6. [PMID: 36925319 DOI: 10.1016/j.dld.2023.02.017] [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: 08/12/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Sarcopenia has been associated with poor prognosis in chronic diseases. AIMS To investigate the role of sarcopenia in predicting clinical and endoscopic outcomes in patients with Crohn's disease (CD). METHODS Consecutive CD patients who started biologics between 2014 and 2020 and underwent abdominal magnetic resonance or computed tomography within 6 months from the beginning of the biological therapy were enroled. Sarcopenia was defined as Psoas Muscle Index (PMI) lower than 5.4 cm²/m² (men) and 3.56 cm²/m² (women). Univariate and multivariate analyses were used to evaluate whether sarcopenia could predict steroid-free clinical remission (SFCR), endoscopic remission (ER), hospitalisation and surgery after 12 months of therapy. RESULTS 358 patients were included. Sarcopenia was found in 18.2% of patients, and it was associated with a lower rate of ER (14.8% vs 47.7%; p = 0.002) after 12 months of therapy, while it was not associated with SFCR (65.1% vs 70.1%; p = 0.435), hospitalisation (9.2% vs 7.8%; p = 0.801) and surgery (3.1% vs 6.1%; p = 0.549). Sarcopenia was identified as a predictor of lack of ER (odds ratio [OR]=5.2; p = 0.006), as well as smoking (OR=2.5; p = 0.028) and perianal disease (OR=2.6; p = 0.020). CONCLUSION Sarcopenia is a negative prognostic factor for ER in CD patients treated with biologics.
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Affiliation(s)
- Mauro Grova
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy; Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
| | - Federica Crispino
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy; Section of Gastroenterology and Hepatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Marcello Maida
- Section of Gastroenterology, "S. Elia-Raimondi" Hospital", Caltanissetta, Italy
| | - Alessandro Vitello
- Section of Gastroenterology, "S. Elia-Raimondi" Hospital", Caltanissetta, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Lorenzo Tesè
- Radiology Unit, A.O.O.R. "Villa Sofia-Cervello Hospital", Palermo, Italy
| | - Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, Department of Medicine, A.O.O.R. "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Macaluso FS, Casà A, Renna S, Grova M, Mannino M, Orlando A. Switching from SB2 to PF-06438179/GP1111 and back in inflammatory bowel disease: "The Superswitchers". Dig Liver Dis 2023; 55:424-425. [PMID: 36609013 DOI: 10.1016/j.dld.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 01/09/2023]
Affiliation(s)
| | - Angelo Casà
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Sara Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Mauro Grova
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Macaluso FS, Papi C, Orlando A, Festa S, Pugliese D, Bonovas S, Pansieri C, Piovani D, Fiorino G, Fantini MC, Caprioli F, Daperno M, Armuzzi A. Use of biologics for the management of Crohn's disease: IG-IBD clinical guidelines based on the GRADE methodology. Dig Liver Dis 2023; 55:442-453. [PMID: 36792429 DOI: 10.1016/j.dld.2023.01.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/21/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023]
Abstract
A cure for Crohn's disease (CD), a chronic inflammatory disease of the gastrointestinal tract of unknown etiology, is not available, so patients require lifelong management to keep inflammation under control. The therapeutic armamentarium has expanded with approval of several biological drugs, including infliximab, adalimumab, vedolizumab and ustekinumab - monoclonal antibodies that target different inflammatory pathways - and darvadstrocel, a suspension of expanded human allogeneic, adipose-derived, mesenchymal stromal cells for the treatment of refractory complex perianal fistula. Notwithstanding existing practice guidelines on medical therapy for CD, the Italian Group for the Study of Inflammatory Bowel Disease felt the need to issue new guidelines focused on the use of biologics for managing the intestinal manifestations of CD and based on the GRADE methodology. This document presents recommendations regarding six clinical settings, from the induction to the maintenance of clinical remission, and from optimization and de-escalation of treatments to dealing with perianal CD and post-operative recurrence. The 19 evidence-based statements are supported by information on the quality of the evidence, agreement rate among panel members, and panel comments mainly based on evidence from real world studies.
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Affiliation(s)
| | - Claudio Papi
- IBD Unit, "San Filippo Neri" Hospital, Rome, Italy
| | | | | | - Daniela Pugliese
- CEMAD, IBD Unit, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Claudia Pansieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gionata Fiorino
- Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, Rome, Italy; Gastroenterology and Digestive Endoscopy, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Claudio Fantini
- Department of Medical Science and Public Health, University of Cagliari, University Hospital of Cagliari, Unit of Gastroenterology, Cagliari, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Marco Daperno
- Gastroenterology Unit, "Mauriziano" Hospital, Turin, Italy
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
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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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Macaluso FS, Grova M, Saladino M, Cappello M, Demarzo MG, Privitera AC, Giangreco E, Garufi S, Renna S, Casà A, Ventimiglia M, Fries W, Orlando A. The effectiveness of ustekinumab and vedolizumab as third-line biologic therapy in patients with Crohn's disease. Dig Liver Dis 2022; 55:471-477. [PMID: 36127230 DOI: 10.1016/j.dld.2022.08.028] [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: 06/21/2022] [Revised: 08/04/2022] [Accepted: 08/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The effectiveness of Ustekinumab (UST) and Vedolizumab (VDZ) in patients with Crohn's disease (CD) as third-line biologic therapies is unclear. AIMS We performed a multicentre, real-world assessment of the effectiveness of UST and VDZ among highly-refractory patients with CD. METHODS Data of consecutive patients with CD treated with UST and VDZ as third-line biologic therapy until December 2021 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease (SN-IBD). RESULTS 143 patients (UST: n = 113; VDZ: n = 30) were included. At the end of induction, the rates of clinical response (CR) were 61.9% for UST and 60.0% for VDZ (p = 1.00), with steroid-free clinical remission (SFCR) achieved in 38.1% of patients in the UST group and 43.3% of patients in the VDZ group (p = 0.75). After 52 weeks of observation, the rates of CR were 65.9% for UST and 71.4% for VDZ (p = 0.77), while the rates of SFCR were 51.8% for UST and 57.1% for VDZ (p = 0.78). At multiple Cox proportional hazard regression model, age (HR 0.98; p = 0.04) and need for systemic steroids at baseline (HR 3.29; p = 0.003) were found to be independent predictors of treatment discontinuation. CONCLUSIONS Both VDZ and UST showed high effectiveness as third-line biologic therapy in CD, without significant differences between them.
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Affiliation(s)
| | - Mauro Grova
- IBD Unit, "Villa Sofia-Cervello" Hospital, Viale Strasburgo 233, 90146 Palermo, Italy
| | - Marica Saladino
- Gastroenterology and Hepatology Section, PROMISE, University of Palermo, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, PROMISE, University of Palermo, Italy
| | | | | | | | - Serena Garufi
- Gastroenterology Unit, A.R.N.A.S. "Garibaldi", Catania, Italy
| | - Sara Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Viale Strasburgo 233, 90146 Palermo, Italy
| | - Angelo Casà
- IBD Unit, "Villa Sofia-Cervello" Hospital, Viale Strasburgo 233, 90146 Palermo, Italy
| | - Marco Ventimiglia
- Directorate General of Medical Device and Pharmaceutical Service, Italian Ministry of Health, Rome, Italy
| | - Walter Fries
- IBD Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Ambrogio Orlando
- IBD Unit, "Villa Sofia-Cervello" Hospital, Viale Strasburgo 233, 90146 Palermo, Italy
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Macaluso FS, Liguori G, Galli M. Reply to: "Multi-dermatomal herpes zoster in a young patient with Crohn's disease on thiopurine therapy: Need for reconsidering vaccine recommendations". Dig Liver Dis 2022; 54:1281. [PMID: 35614003 DOI: 10.1016/j.dld.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/29/2022]
Affiliation(s)
| | | | - Massimo Galli
- Department of Biomedical and Clinical Sciences, "L Sacco" University of Milan, Milan, Italy
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22
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Grova M, Crispino F, Maida M, Macaluso FS, Orlando A. Authors' reply to 'Use of restrictive iron transfusion strategy in IBD: one size does not fit all'. Eur J Gastroenterol Hepatol 2022; 34:808. [PMID: 35352695 DOI: 10.1097/meg.0000000000002373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Mauro Grova
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., 'Villa Sofia-Cervello' Hospital
| | - Federica Crispino
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., 'Villa Sofia-Cervello' Hospital
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology and Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo
| | - Marcello Maida
- Department of Gastroenterology and Digestive Endoscopy, Section of Gastroenterology, 'S. Elia-Raimondi' Hospital, Caltanissetta, Italy
| | - Fabio Salvatore Macaluso
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., 'Villa Sofia-Cervello' Hospital
| | - Ambrogio Orlando
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., 'Villa Sofia-Cervello' Hospital
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Grova M, Crispino F, Maida M, Renna S, Mannino M, Casà A, Rizzuto G, Macaluso FS, Orlando A. Effectiveness and safety of an on-demand ferric carboxymaltose infusion strategy in patients with inflammatory bowel disease: a real world experience. Eur J Gastroenterol Hepatol 2022; 34:607-612. [PMID: 35102111 DOI: 10.1097/meg.0000000000002348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/10/2022]
Abstract
BACKGROUND We evaluated an on-demand ferric carboxymaltose (FCM) infusion strategy in inflammatory bowel disease (IBD) patients with iron deficiency anemia (IDA). AIMS The primary outcome was the response rate to single or multiple FCM infusions after 12 months. Secondary outcomes were the response rate to a single FCM infusion after 3 months and the FCM safety profile. METHODS We retrospectively included 185 IBD patients who received at least one FCM infusion of 500 mg, between 2015 and 2018. FCM was administered to patients with Hb ≤10 g/dL and hypoferritinemia and repeated according to the physician's assessment. Complete response (CR) was defined as Hb ≥12 g/dL (≥13 g/dL for men) or Hb increase ≥2 g/dL. Partial response (PR) was defined as an Hb increase between 1 and 2 g/dL. A univariate analysis was performed at 3 and 12 months. RESULTS After 12 months, the response rate was 75.1% (CR, 48.6%; PR, 26.4%; mean number of FCM infusions, 1.7 ± 1.1). In total 169/185 patients received a single FCM infusion during the first 3 months and 79.2% achieved response (CR, 56.8%; PR, 22.4%). At univariate analysis, no variable was associated with response. No adverse events were reported. CONCLUSIONS An on-demand strategy was effective and well-tolerated in treating IDA in IBD patients.
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Affiliation(s)
- Mauro Grova
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology and Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Federica Crispino
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology and Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Marcello Maida
- Department of Gastroenterology and Digestive Endoscopy, Section of Gastroenterology, "S. Elia-Raimondi" Hospital, Caltanissetta, Italy
| | - Sara Renna
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Mariella Mannino
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Angelo Casà
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Giulia Rizzuto
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Fabio Salvatore Macaluso
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
| | - Ambrogio Orlando
- Department of Medicine, Inflammatory Bowel Disease Unit, A.O.O.R., "Villa Sofia-Cervello" Hospital, Palermo
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Macaluso FS, Cappello M, Crispino F, Grova M, Privitera AC, Piccillo G, Magnano A, Ferracane C, Belluardo N, Giangreco E, Fries W, Viola A, Di Mitri R, Mocciaro F, Camilleri S, Garufi S, Renna S, Casà A, Maida M, Orlando A. Vedolizumab may be an effective option for the treatment of postoperative recurrence of Crohn's disease. Dig Liver Dis 2022; 54:629-634. [PMID: 34924320 DOI: 10.1016/j.dld.2021.11.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 11/04/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The role of Vedolizumab (VDZ) as therapeutic option for the postoperative recurrence of Crohn's disease (CD) following ileocolonic resection is unknown. AIMS To assess the effectiveness of VDZ in this setting. METHODS All consecutive CD patients with a baseline colonoscopy at 6-12 months from the ileocolonic resection showing postoperative recurrence (Rutgeerts score ≥i2) and treated with VDZ after the baseline colonoscopy were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). The primary outcome was endoscopic success, assessed at the first colonoscopy following initiation of VDZ and defined as reduction of at least one point of Rutgeerts score. The secondary outcome was clinical failure, assessed at one year and at the end of follow-up. RESULTS Fifty-eight patients were included (mean follow-up: 24.8 ± 13.1 months). Endoscopic success was reported in 47.6% of patients. Clinical failure was reported in 19.0% of patients at one year, and in 32.8% of patients at the end of follow-up. A new resection was required in 7 patients (12.1%). CONCLUSIONS VDZ may be an effective option for the treatment of postoperative recurrence of CD.
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Affiliation(s)
| | - Maria Cappello
- Gastroenterology & Hepatology Section, Promise, University of Palermo, Italy
| | - Federica Crispino
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy; Gastroenterology & Hepatology Section, Promise, University of Palermo, Italy
| | - Mauro Grova
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy; Gastroenterology & Hepatology Section, Promise, University of Palermo, Italy
| | | | - Giovita Piccillo
- Inflammatory Bowel Disease Unit, "Cannizzaro" Hospital, Catania, Italy
| | - Antonio Magnano
- Gastroenterology Unit, "Vittorio Emanuele" Hospital, Catania, Italy
| | | | | | | | - Walter Fries
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Anna Viola
- Inflammatory bowel disease Unit, "G. Martino" Hospital, Messina, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, "ARNAS Civico - Di Cristina - Benfratelli" Hospital, Palermo, Italy
| | - Salvatore Camilleri
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Serena Garufi
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Sara Renna
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, "S. Elia- Raimondi" Hospital, Caltanissetta, Italy
| | - Ambrogio Orlando
- Inflammatory bowel disease Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Macaluso FS, Giuliano A, Fries, W, Viola A, Abbruzzese A, Cappello M, Giuffrida E, Carrozza L, Privitera AC, Magnano A, Ferracane C, Scalisi G, Minissale MG, Giangreco E, Garufi S, Bertolami C, Cucinotta U, Graziano F, Casà A, Renna S, Teresi G, Rizzuto G, Mannino M, Maida M, Orlando A. Severe Activity of Inflammatory Bowel Disease is a Risk Factor for Severe COVID-19. Inflamm Bowel Dis 2022; 29:217-221. [PMID: 35385102 PMCID: PMC9383704 DOI: 10.1093/ibd/izac064] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Data from the first wave of the coronavirus disease 2019 (COVID-19) pandemic suggested that patients with inflammatory bowel disease (IBD) are not at higher risk of being infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) than the general population and that a worse prognosis is not associated with immunomodulatory drugs, with the possible exception of systemic steroids. METHODS This retrospective, observational study included consecutive IBD patients from the Sicilian Network for Inflammatory Bowel Disease (SN-IBD) cohort who had a SARS-CoV-2 infection diagnosis (polymerase chain reaction-confirmed presence of the viral genome in a nasopharyngeal swab) during the second COVID-19 pandemic wave (September 2020 to December 2020). Data regarding demographics, IBD features and treatments, and comorbidities were analyzed in correlation with COVID-19 clinical outcomes. RESULTS Data on 122 patients (mean age, 43.9 ± 16.7 years; males, 50.0%; Crohn's disease, 62.3%; ulcerative colitis, 37.7%) were reported. Twelve patients developed COVID-19-related pneumonia (9.8%), 4 (3.3%) required respiratory assistance (nonmechanical ventilation or orotracheal intubation), and 4 died (case fatality rate, 3.3%). In a multivariable analysis, age (odds ratio [OR], 1.034; 95% CI, 1.006-1.147; P = .032) and severe IBD activity (OR, 13.465; 95% CI, 1.104-164.182; P = .042) were independent predictors of COVID-19-related pneumonia, while severe IBD activity (OR, 15.359; 95% CI, 1.320-178.677; P = .030) was the only independent predictor of severe COVID-19, a composite endpoint defined as the need for respiratory assistance or death. A trend towards a protective role of tumor necrosis factor α inhibitors on pneumonia development was reported (P = .076). CONCLUSIONS In this cohort of patients with IBD and SARS-CoV-2 infection, severe IBD activity was the only independent risk factor for severe COVID-19.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy,Address correspondence to: Fabio Salvatore Macaluso, MD, IBD Unit, “Villa Sofia-Cervello” Hospital, Viale Strasburgo 233, 90146 Palermo, Italy ()
| | - Alessandra Giuliano
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Walter Fries,
- Inflammatory Bowel Disease Unit, Policlinico “G. Martino,”Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, Policlinico “G. Martino,”Messina, Italy
| | - Alfredo Abbruzzese
- Inflammatory Bowel Disease Unit, Policlinico “G. Martino,”Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, Promise, University of Palermo, Palermo, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Section, Promise, University of Palermo, Palermo, Italy
| | - Lucio Carrozza
- Gastroenterology and Hepatology Section, Promise, University of Palermo, Palermo, Italy
| | | | - Antonio Magnano
- Gastroenterology Unit, Policlinico “Vittorio Emanuele,”Catania, Italy
| | | | | | - Maria Giovanna Minissale
- **Gastroenterology and Endoscopy Unit, “Buccheri La Ferla Fatebenefratelli” Hospital, Palermo, Italy
| | | | - Serena Garufi
- Gastroenterology Unit, “S. Elia- M. Raimondi” Hospital, Caltanissetta, Italy
| | | | - Ugo Cucinotta
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy
| | - Francesco Graziano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy,Pediatric Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Giulia Teresi
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Mariella Mannino
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Marcello Maida
- Gastroenterology Unit, “Papardo Piemonte” Hospital, Messina, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
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Bonovas S, Pansieri C, Piovani D, Macaluso FS, Orlando A, Festa S, Papi C, Pugliese D, Armuzzi A. Use of biologics and small molecule drugs for the management of moderate to severe ulcerative colitis: IG-IBD technical review based on the GRADE methodology. Dig Liver Dis 2022; 54:428-439. [PMID: 35183439 DOI: 10.1016/j.dld.2022.01.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 11/12/2021] [Revised: 12/28/2021] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
The increased knowledge on the biological mechanisms underlying ulcerative colitis (UC) has triggered an advance in drug development, drastically changing the therapeutic landscape. Several biologics and small-molecule drugs have been regulatory approved (i.e., infliximab, adalimumab, golimumab, vedolizumab, ustekinumab and tofacitinib), and frequently pose clinical dilemmas: physicians need to know how these therapies can be used to optimize patient-important outcomes. Adhering to the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) methodology, this technical review systematically searched and identified the evidence, synthesized it using rigorous meta-analytic methodology, appraised its quality, and concisely presented it in a transparent way, forming the basis for developing clinical recommendations on the use of biologics and small-molecule drugs in adult patients with UC.
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Affiliation(s)
- Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - Claudia Pansieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | | | | | - Claudio Papi
- IBD Unit, "San Filippo Neri" Hospital, Rome, Italy
| | - Daniela Pugliese
- CEMAD, IBD Unit, Unità Operativa Complessa di Medicina Interna e Gastroenterologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Orlando A, Macaluso FS. Epidemiological trends in pediatric inflammatory bowel disease: The precious contribution of the registries promoted by scientific societies. Dig Liver Dis 2022; 54:415-416. [PMID: 35131177 DOI: 10.1016/j.dld.2022.01.129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 12/11/2022]
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Macaluso FS, Orlando A, Papi C, Festa S, Pugliese D, Bonovas S, Pansieri C, Piovani D, Fiorino G, Fantini MC, Caprioli F, Daperno M, Armuzzi A. Use of biologics and small molecule drugs for the management of moderate to severe ulcerative colitis: IG-IBD clinical guidelines based on the GRADE methodology. Dig Liver Dis 2022; 54:440-451. [PMID: 35184989 DOI: 10.1016/j.dld.2022.01.127] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
The management of moderate to severe ulcerative colitis has undergone significant changes over the past 15 years due to the regulatory approval of several new drugs. In particular, following the approval of the first biological, i.e. infliximab, a number of further biological drugs, such as adalimumab, golimumab, vedolizumab and ustekinumab, and small molecules, such as tofacitinib, have been approved, thus enriching the therapeutic armamentarium for ulcerative colitis. Choice of therapy must take into consideration not only the need to induce and maintain disease remission according to the patient's profile, but also age, co-morbidities, and prior treatments. To guide these decisions, the Italian Group for the Study of Inflammatory Bowel Disease has developed clinical guidelines that supersede its earlier document from 2011. These new guidelines were developed following the GRADE methodology for rating the quality of the evidence and for determining the strength of the recommendations. This article presents the methodology and results, in the form of 20 statements with commentary on the use of the five biologics and tofacitinib for managing the intestinal manifestations of active ulcerative colitis and for maintaining remission. A separate technical review reports the analyses of the evidence upon which the present recommendations are based.
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Affiliation(s)
| | - Ambrogio Orlando
- IBD Unit, "Villa Sofia-Cervello" Hospital, Viale Strasburgo 233, Palermo 90146, Italy
| | - Claudio Papi
- IBD Unit, "San Filippo Neri" Hospital, Rome, Italy
| | | | - Daniela Pugliese
- CEMAD, IBD Unit, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Claudia Pansieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Massimo Claudio Fantini
- Department of Medical Science and Public Health, University of Cagliari, Italy; Unit of Gastroenterology, University Hospital of Cagliari, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico di Milano, Italy
| | - Marco Daperno
- Gastroenterology Unit, "Mauriziano" Hospital, Turin, Italy
| | - Alessandro Armuzzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; IBD Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Macaluso FS, Maida M, Ventimiglia M, Orlando A. Effectiveness and safety of tofacitinib for the treatment of ulcerative colitis: A single-arm meta-analysis of observational studies. Dig Liver Dis 2022; 54:183-191. [PMID: 34011482 DOI: 10.1016/j.dld.2021.04.018] [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: 03/02/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several observational studies on Tofacitinib (TOFA) in ulcerative colitis (UC) have been published over the last 2 years. AIMS To estimate effectiveness and safety of TOFA arising from real-world experience. METHODS PubMed Central/Medline and Embase were systematically searched for real-world observational studies on TOFA for the treatment of UC through November 2020. RESULTS Seven studies comprising 759 patients met the inclusion criteria. The pooled estimate rates were 49% for clinical response, 40% for clinical remission, and 34% for corticosteroid-free clinical remission at induction, while the rates of endoscopic response and endoscopic remission were 37% and 19%, respectively. At maintenance, the pooled estimate rates of clinical response, clinical remission, and corticosteroid-free clinical remission were 36%, 35%, and 24%, respectively. The pooled estimate of incidence rate of adverse events was 53.0 per 100 person-years (PY), while the pooled estimate of incidence rate of withdrawal of TOFA due to adverse events was 9.3 per 100 PY, with a pooled rate of infections of 17.6 per 100 PY. CONCLUSIONS Cumulative analysis of data from real-world studies confirmed the good efficacy of TOFA in UC shown by randomized controlled trials for both induction and maintenance, while the safety profile was consistent with previous reports.
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Affiliation(s)
| | - Marcello Maida
- Section of Gastroenterology, "S.Elia-Raimondi" Hospital, Caltanissetta, Italy
| | - Marco Ventimiglia
- IBD Unit, "Villa Sofia-Cervello" Hospital, Via Trabucco 180, Palermo 90146, Italy
| | - Ambrogio Orlando
- IBD Unit, "Villa Sofia-Cervello" Hospital, Via Trabucco 180, Palermo 90146, Italy
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Maida M, Macaluso FS, Orlando A. Upper gastrointestinal tract involvement in Crohn's disease: A relevant yet underestimated problem. Dig Liver Dis 2021; 53:1546-1547. [PMID: 34593347 DOI: 10.1016/j.dld.2021.09.006] [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] [Received: 08/24/2021] [Revised: 08/31/2021] [Accepted: 09/10/2021] [Indexed: 12/11/2022]
Affiliation(s)
- Marcello Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy.
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Abstract
Treatment of inflammatory bowel disease (IBD) frequently requires administration of immunosuppressive therapies, which increases susceptibility to a number of infectious pathogens. However, many infections can be prevented by correct and appropriate utilization of vaccinations. While several guidelines have been published on vaccination schedules in patients with IBD, vaccination rates remain suboptimal and even lower than those in the general population. This is due to many factors including poor awareness of the importance of vaccines by gastroenterologists and general practitioners as well as potential prejudices of patients regarding the safety and benefits of vaccines. With the aim of increasing awareness about the key role of immunization in the management of patients with IBD, the present review examines the existing literature relating to the main vaccinations and their application in these patients. We also summarize current evidence in order to provide clinicians with an easy source of reference for the principal recommendations for prevention of infectious diseases in patients with IBD. In addition, the recommendations about traveling for IBD patients are briefly explored. Lastly, since it is important for gastroenterologists to be aware of recommendations on vaccination, we recommend implementing educational programs to ensure compliance with current guidelines.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Department of Medicine, ''Villa Sofia-Cervello'' Hospital, Sicilian Network for Inflammatory Bowel Disease (SN-IBD), Palermo, Italy.
| | | | - Massimo Galli
- Department of Biomedical and Clinical Sciences, L Sacco" University of Milan, Via Giovan Battista Grassi 74, Milan 20157, Italy
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Macaluso FS, Cappello M, Busacca A, Fries W, Viola A, Costantino G, Magnano A, Vinci E, Ferracane C, Privitera AC, Piccillo G, Belluardo N, Giangreco E, Romano C, Citrano M, Graziano F, Garufi S, Bertolami C, Ventimiglia M, Scrivo B, Teresi G, Renna S, Rizzuto G, Casà A, Orlando A. SPOSAB ABP 501: A Sicilian Prospective Observational Study of Patients with Inflammatory Bowel Disease Treated with Adalimumab Biosimilar ABP 501. J Gastroenterol Hepatol 2021; 36:3041-3049. [PMID: 34152636 DOI: 10.1111/jgh.15590] [Citation(s) in RCA: 12] [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: 02/05/2021] [Revised: 05/16/2021] [Accepted: 06/16/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIM There are few clinical data on Adalimumab (ADA) biosimilars in inflammatory bowel disease. We aimed to perform a multicenter, observational, prospective study on safety and effectiveness of ADA biosimilar ABP 501 in patients with inflammatory bowel disease. METHODS All consecutive patients from the cohort of the Sicilian Network for Inflammatory Bowel Disease treated with ADA biosimilar ABP 501 from February 2019 to February 2020 were enrolled. Patients were divided into three groups: group A, naïve to ADA and naïve to anti-tumor necrosis factors; group B, naïve to ADA and previously exposed to anti-tumor necrosis factors; and group C: switched from ADA originator to ABP 501. RESULTS A total of 559 patients (median age 39 years; Crohn's disease 88.0%, ulcerative colitis 12.0%) were included, with a follow-up time of 403.4 patient-years. Thirty-six serious adverse events occurred in 36 patients (6.4%; incidence rate [IR]: 8.9 per 100 person-years [PY]). The IR of serious adverse events was higher among patients in group A compared with group C (17.4 vs 4.8 per 100 PY; IR ratio = 3.61; P < 0.001) and among patients in group B compared with group C (16.4 vs 4.8 per 100 PY; IR ratio = 3.42; P = 0.041). Among ADA-naïve patients (group A + B), 188 (85.8%) had a clinical response after 12 weeks, including 165 (75.3%) who achieved steroid-free remission. Higher treatment persistence estimates were reported for patients in group C compared with groups A and B (log-rank P < 0.001). CONCLUSIONS Safety and effectiveness of ABP 501 seem to be overall similar to those reported for ADA originator. Switching from originator to ABP 501 was safe and effective.
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Affiliation(s)
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Anita Busacca
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Giuseppe Costantino
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Elisa Vinci
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Concetta Ferracane
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | | | - Giovita Piccillo
- Inflammatory Bowel Disease Unit, A.O. "Cannizzaro", Catania, Italy
| | | | | | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood G. Barresi, University of Messina, Messina, Italy
| | - Michele Citrano
- Pediatric Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | | | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | | | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Barbara Scrivo
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giulia Teresi
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
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Maida M, Morreale GC, Sferrazza S, Sinagra E, Scalisi G, Vitello A, Vettori G, Rossi F, Catarella D, Di Bartolo CE, Schillaci D, Raimondo D, Camilleri S, Orlando A, Macaluso FS. Effectiveness and safety of 1L PEG-ASC preparation for colonoscopy in patients with inflammatory bowel diseases. Dig Liver Dis 2021; 53:1171-1177. [PMID: 33994129 DOI: 10.1016/j.dld.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/19/2021] [Accepted: 04/08/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The effectiveness of bowel cleansing is a key element for high-quality colonoscopy. Recently, a 1 L polyethylene glycol plus ascorbate (PEG-ASC) solution has been introduced, but effectiveness and safety of this preparation have not been assessed in IBD patients. This study aims to evaluate effectiveness and safety of 1 L PEG-ASC solution in patients with IBD compared to controls. METHODS We retrospectively analysed prospectively collected data on a cohort of 411 patients performing a colonoscopy after preparation with 1 L PEG-ASC, consecutively enrolled in 5 Italian centres. RESULTS Overall, 185/411 (45%) were patients with IBD and 226/411 (55%) served as controls. A significantly higher cleansing success was achieved in IBD patients (92.9% vs 85.4%, p = 0.02). The multiple regression model showed that presence of IBD (OR=2.514, 95%CI=1.165-5.426; P = 0.019), lower age (OR=0.981, 95%CI=0.967-0.996; P = 0.014), split preparation (OR=2.430, 95%CI=1.076-5.492; P = 0.033), absence of diabetes (OR=2.848, 95%CI=1.228-6.605; P = 0.015), and of chronic constipation (OR=3.350, 95%CI=1.429-7.852; P = 0.005), were independently associated with cleansing success. The number of treatment-emergent adverse events (TEAEs) (51 vs 62%, p = 0.821), and of patients with TEAEs (22.2% vs 21.2%, p = 0.821), were similar in IBD patients and in controls, respectively. CONCLUSIONS Results from this study support the effectiveness and safety of 1 L PEG-ASC solution in IBD patients, which may improve the definition of endoscopic outcomes both in Crohn's disease and ulcerative colitis.
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Affiliation(s)
- M Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy.
| | - G C Morreale
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | - S Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
| | - E Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Cefalù, Italy
| | - G Scalisi
- Gastroenterology Unit, ARNAS Garibaldi, Catania, Italy
| | - A Vitello
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | - G Vettori
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
| | - F Rossi
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Cefalù, Italy
| | - D Catarella
- Gastroenterology Unit, ARNAS Garibaldi, Catania, Italy
| | | | - D Schillaci
- Gastroenterology Unit, Basarocco Hospital, Niscemi, Italy
| | - D Raimondo
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Cefalù, Italy
| | - S Camilleri
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy
| | - A Orlando
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - F S Macaluso
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
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Graziano F, Macaluso FS, Cassata N, Citrano M, Orlando A. Pyoderma Gangrenosum in An Ulcerative Colitis Pediatric Patient During Vedolizumab Therapy Successfully Treated With Oral Cyclosporine. Inflamm Bowel Dis 2021; 27:e110-e111. [PMID: 34003258 DOI: 10.1093/ibd/izab106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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)
| | | | - Nicola Cassata
- Pediatric Unit, Villa Sofia Cervello Hospital, Palermo, Italy
| | - Michele Citrano
- Pediatric Unit, Villa Sofia Cervello Hospital, Palermo, Italy
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Macaluso FS, Cummings JF, Atreya R, Choi J, Orlando A. A Systematic Review on Infliximab Biosimilar SB2: From Pre-Clinical Data to Real-World Evidence. Expert Opin Biol Ther 2021; 22:203-223. [PMID: 34314284 DOI: 10.1080/14712598.2021.1958778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The infliximab biosimilar SB2 was approved in the EU (2016, Flixabi®) and the US (2017, Renflexis®) for the same indications as the reference product (Remicade®) based on a robust analytical and clinical data package. AREAS COVERED This systematic literature review summarizes available analytical and clinical data on SB2, including randomized controlled clinical trials and real-world evidence studies. Overall, 184 articles and congress abstracts were identified (excluding duplicates), whereof 5 reports on analytical data, four reports on two randomized controlled trials and 13 reports of real-world evidence studies were included. EXPERT OPINION The available analytical and clinical data support the equivalence of SB2 to the reference product across approved indications. This is further supported by emerging real-world evidence, particularly in extrapolated indications such as inflammatory bowel disease for both infliximab-naïve patients and patients already established on infliximab switching to SB2. Switching from originator or biosimilar infliximab to SB2 including both single and multiple switches was not associated with an increased risk of loss of treatment response or any safety or immunogenicity concerns. Overall, the approved infliximab biosimilar SB2 is safe and effective in clinical practice across licensed indications.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Gastroenterologist, Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Strasburgo 233, 90146 Palermo, Italy
| | - Jr Fraser Cummings
- Gastroenterologist, Department of Gastroenterology, University Hospital Southampton, and University of Southampton, Tremona Road, Southampton, Hampshire SO16 6YD, UK
| | - Raja Atreya
- Gastroenterologist, Department of Medicine, Medical Clinic 1, University Hospital Erlangen, University of Erlangen-Nürnberg Erlangen, Ulmenweg 18, 91054 Erlangen, Germany
| | - Jaeyun Choi
- Manager Medical Affairs Group, Samsung Bioepis, 76, Songdogyoyuk-ro, Yeonsu-gu, Incheon, Republic of Korea
| | - Ambrogio Orlando
- Gastroenterologist, Inflammatory Bowel Disease Unit, "Villa Sofia-Cervello" Hospital, Strasburgo 233, 90146 Palermo, 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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Crispino F, Grova M, Maida M, Renna S, Mocciaro F, Casà A, Rizzuto G, Tesè L, Scimeca D, Di Mitri R, Macaluso FS, Orlando A. Blood-based prognostic biomarkers in Crohn's Disease patients on biologics: a promising tool to predict endoscopic outcomes. Expert Opin Biol Ther 2021; 21:1133-1141. [PMID: 34042009 DOI: 10.1080/14712598.2021.1935857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE There is a growing need for biomarkers to predict therapeutic outcome in Crohn's disease (CD). MAIN OUTCOME MEASURES The aim was to evaluate whether NLR (neutrophil-to-lymphocyte ratio), PLR (platelet-to-lymphocyte ratio), ELR (eosinophil-to-lymphocyte ratio), and ENLR (eosinophil*neutrophil-to-lymphocyte ratio), could be prognostic biomarkers of endoscopic response (ER) when starting biologics. RESEARCH DESIGN AND METHODS Patients with CD who started biologics were enrolled. Multivariate analysis was used to evaluate whether NLR, PLR, ELR and ENLR at baseline and at w12 could predict ER (Simple Endoscopic Score for Crohn's disease [SES-CD] ≤2 or SES-CD≤2 and Rutgeerts i0-i1) after 52 weeks of treatment. Area under the curve (AUC) was calculated to find the cutoffs. RESULTS 107 patients were included. Patients who achieved ER had significantly lower baseline NLR (p = 0.025), ELR (p = 0.013), and ENLR (p = 0.020) compared with those without ER; results after 12 weeks of treatment for ELR (p = 0.006) and ENLR (p = 0.003). AUC was 0.64 (p = 0.003), 0.67 (p = 0.006) and 0.65 (p = 0.014) for NLR, ELR and ENLR. CONCLUSIONS Low NLR, ELR and ENLR can predict ER and could be used in clinical practice for a better management of CD patients.
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Affiliation(s)
- Federica Crispino
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology & Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Italy.,Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Mauro Grova
- Department of Health Promotion Sciences Maternal and Infant Care, Section of Gastroenterology & Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Italy.,Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Marcello Maida
- Section of Gastroenterology, "S.Elia-Raimondi" Hospital, Caltanissetta, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo,Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Lorenzo Tesè
- Radiology Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo,Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico - Di Cristina - Benfratelli Hospital, Palermo,Italy
| | | | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello Hospital, Palermo, Italy
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Macaluso FS, Maida M, Grova M, Crispino F, Teresi G, Orlando A, Orlando A. Head-to-head comparison of biological drugs for inflammatory bowel disease: from randomized controlled trials to real-world experience. Therap Adv Gastroenterol 2021; 14:17562848211010668. [PMID: 33995582 PMCID: PMC8111554 DOI: 10.1177/17562848211010668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/29/2021] [Indexed: 02/04/2023] Open
Abstract
During past years, the increasing knowledge of molecular mechanisms of inflammatory bowel disease (IBD) have led to the development of several targeted biological therapies. This great expansion of available medical options has prompted the need for comparative data between drugs. For years, given that most randomized controlled trials (RCTs) were performed only versus placebo, this demand has clashed with the absence of head-to-head trials comparing two or more treatments. The quality of evidence coming from real-world experience was low overall, so it was extremely difficult to clarify the correct positioning of the biologicals inside the therapeutic algorithms for IBD. Fortunately, times are changing: head-to-head comparative RCTs have been conducted or are ongoing, and the methodological quality of real-world studies is gradually increasing, mainly thanks to a higher rate of application of statistical methods capable of reducing the selection bias, such as the propensity score. In this evolving scenario, the increasing number of comparative RCTs is providing high-quality data for a correct drug positioning in IBD. In parallel, real-world observational studies are supporting the data coming from RCTs, and covering those comparisons not performed in the RCT setting. We believe that there is moderate evidence already available to support clinicians in the correct choice between different biologicals, and data will certainly be more robust in the near future.
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Affiliation(s)
| | - Marcello Maida
- Gastroenterology and Endoscopy Unit, “S. Elia-M. Raimondi” Hospital, Caltanissetta, Italy
| | - Mauro Grova
- Department of Medicine, IBD Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy,Department of Health Promotion, Sciences, Maternal and Infant Care, Section of Gastroenterology and Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Italy
| | - Federica Crispino
- Department of Medicine, IBD Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy,Department of Health Promotion, Sciences, Maternal and Infant Care, Section of Gastroenterology and Hepatology, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Italy
| | - Giulia Teresi
- Department of Medicine, IBD Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
| | - Adele Orlando
- Department of Medicine, IBD Unit, “Villa Sofia-Cervello” Hospital, Palermo, Italy
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Macaluso FS, Mazzola G, Ventimiglia M, Alvisi P, Renna S, Adamoli L, Galli M, Armuzzi A, Ardizzone S, Cascio A, Cottone M, Orlando A. Physicians' Knowledge and Application of Immunization Strategies in Patients with Inflammatory Bowel Disease: A Survey of the Italian Group for the Study of Inflammatory Bowel Disease. Digestion 2021; 101:433-440. [PMID: 31167191 DOI: 10.1159/000500798] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/16/2018] [Accepted: 05/04/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND No data on European countries about knowledge and application of immunization strategies in patients with inflammatory bowel disease (IBD) are available. OBJECTIVES We designed a questionnaire aimed at exploring these issues among Italian gastroenterologists dealing with adult and paediatric IBD. METHODS An anonymous, 24-item, questionnaire was sent via e-mail to all members of the Italian Group for the study of Inflammatory Bowel Disease. Three sets of questions were formulated: (1) Characteristics of respondents; (2) General opinions on the role of vaccines in IBD patients; (3) Immunizations of IBD patients in clinical practice. RESULTS Of the 455 total surveys sent, there were 198 respondents (response rate: 43.5%). The great majority of respondents (82.9%) reputed as "very important" to perform the vaccinations recommended by the guidelines in patients with IBD. The indication to immunization is given at the diagnosis of the disease by 55.6% of the respondents. The most frequently recommended vaccine in IBD patients is the annual flu vaccine, while the recommendation rate for the other vaccines is variable depending on the different pathogens. CONCLUSIONS Efforts carried out by the scientific societies are required to increase the awareness of this relevant topic among physicians.
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Affiliation(s)
| | - Giovanni Mazzola
- Department of Sciences for Health Promotion " G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Patrizia Alvisi
- Gastroenterology of Pediatric Unit, Maggiore Hospital, Bologna, Italy
| | - Sara Renna
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
| | - Lucia Adamoli
- Department of Sciences for Health Promotion " G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Massimo Galli
- Infectious Disease Unit, Department of Biomedical and Clinical Sciences, "Luigi Sacco" University Hospital, Milan, Italy
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sandro Ardizzone
- Department of Biochemical and Clinical Science "L. Sacco", University of Milan, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Antonio Cascio
- Department of Sciences for Health Promotion " G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Mario Cottone
- IBD Unit, "Villa Sofia-Cervello" Hospital, Palermo, Italy
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Mocciaro F, Di Mitri R, Macaluso FS, Renna S, Scimeca D, Orlando A. The key role of colonoscopy at 6 months from ileocolonic resection in Crohn's disease patients. Dig Liver Dis 2021; 53:517-518. [PMID: 33500236 DOI: 10.1016/j.dld.2020.12.122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy.
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
| | | | - Sara Renna
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Daniela Scimeca
- Gastroenterology and Endoscopy Unit, ARNAS Civico-Di Cristina-Benfratelli Hospital, Palermo, Italy
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Macaluso FS, Orlando A. Could Patients With Inflammatory Bowel Disease Treated With Immunomodulators or Biologics Be at Lower Risk for Severe Forms of COVID-19? Gastroenterology 2021; 160:1877-1878. [PMID: 32407807 PMCID: PMC7214317 DOI: 10.1053/j.gastro.2020.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Macaluso FS, Fries W, Viola A, Centritto A, Cappello M, Giuffrida E, Privitera AC, Piccillo G, Magnano A, Vinci E, Vassallo R, Trovatello A, Belluardo N, Giangreco E, Camilleri S, Garufi S, Bertolami C, Ventimiglia M, Renna S, Orlando R, Rizzuto G, Orlando A. The SPOSIB SB2 Sicilian Cohort: Safety and Effectiveness of Infliximab Biosimilar SB2 in Inflammatory Bowel Diseases, Including Multiple Switches. Inflamm Bowel Dis 2021; 27:182-189. [PMID: 32083291 DOI: 10.1093/ibd/izaa036] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND No data on the recently introduced infliximab (IFX) biosimilar SB2 in inflammatory bowel disease (IBD) are available. METHODS The Sicilian Prospective Observational Study of Patients With IBD Treated With Infliximab Biosimilar SB2 is a multicenter, observational, prospective study performed among the cohort of the Sicilian Network for Inflammatory Bowel Disease. All consecutive IBD patients starting the IFX biosimilar SB2 from its introduction in Sicily (March 2018) to September 2019 (18 months) were enrolled. RESULTS Two hundred seventy-six patients (Crohn disease: 49.3%, ulcerative colitis: 50.7%) were included: 127 (46.0%) were naïve to IFX and naïve to anti-tumor necrosis factor medications (anti-TNFs), 65 (23.5%) were naïve to IFX and previously exposed to anti-TNFs, 17 (6.2%) were switched from an IFX originator to SB2, 43 (15.6%) were switched from the biosimilar CT-P13 to SB2, and 24 (8.7%) were multiply switched (from IFX originator to CT-P13 to SB2). The cumulative number of infusions of SB2 was 1798, and the total follow-up time was 182.7 patient-years. Sixty-seven serious adverse events occurred in 57 patients (20.7%; incidence rate: 36.7 per 100 patient-year), and 31 of these events caused the withdrawal of the drug. The effectiveness after 8 weeks of treatment was evaluated in patients naïve to IFX (n = 192): 110 patients (57.3%) had steroid-free remission, while 56 patients had no response (29.2%). At the end of follow-up, 72 patients (26.1%) interrupted the treatment, without significant differences in treatment persistency estimations between the five groups (log-rank P = 0.15). CONCLUSIONS The safety and effectiveness of SB2 seem to be overall similar to those reported for the IFX originator and CT-P13.
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Affiliation(s)
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Andrea Centritto
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico G. Martino, Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico G. Giaccone, Palermo, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico G. Giaccone, Palermo, Italy
| | | | - Giovita Piccillo
- Inflammatory Bowel Disease Unit, A.O. Cannizzaro, Catania, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Elisa Vinci
- Gastroenterology Unit, A.O.U. Policlinico Vittorio Emanuele, Catania, Italy
| | - Roberto Vassallo
- Gastroenterology and Endoscopy Unit, A.O. Buccheri La Ferla Fatebenefratelli, Palermo, Italy
| | | | | | | | | | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. S. Elia- M. Raimondi, Caltanissetta, Italy
| | | | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Rosalba Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. Villa Sofia-Cervello, Palermo, Italy
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Macaluso FS, Ventimiglia M, Fries W, Viola A, Sitibondo A, Cappello M, Scrivo B, Busacca A, Privitera AC, Camilleri S, Garufi S, Di Mitri R, Mocciaro F, Belluardo N, Giangreco E, Bertolami C, Renna S, Orlando R, Rizzuto G, Cottone M, Orlando A. A propensity score weighted comparison of vedolizumab and adalimumab in Crohn's disease. J Gastroenterol Hepatol 2021; 36:105-111. [PMID: 32428981 DOI: 10.1111/jgh.15107] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 03/07/2020] [Revised: 04/23/2020] [Accepted: 05/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM There are no head-to-head randomized controlled trials between biologics in Crohn's disease (CD). We aimed to perform a multicenter, real-life comparison of the effectiveness of vedolizumab (VDZ) and adalimumab (ADA) in CD. METHODS Data of consecutive patients with CD treated with VDZ and ADA from January 2016 to April 2019 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease. The effectiveness was evaluated at 12, 52 weeks, and as failure-free survival at the end of follow up. Propensity score analysis was performed using the inverse probability of treatment weighting method. RESULTS Five hundred eighty-five treatments (VDZ: n = 277; ADA: n = 308) were included (median follow-up: 56.0 weeks). After 12 weeks, a clinical response was achieved in 64.3% patients treated with VDZ and in 83.1% patients treated with ADA (odds ratio [OR] 0.65, 95% confidence interval [CI] 0.38-1.10, P = 0.107), while at 52 weeks, a clinical response was observed in 54.0% patients treated with VDZ and in 69.1% patients treated with ADA (OR 0.77, 95% CI 0.45-1.31, P = 0.336). Cox survival analysis weighted for propensity score showed no significant difference in the probability of failure-free survival between the two drugs (hazard ratio = 1.20, 95% CI 0.83-1.74, P = 0.340). Post-treatment endoscopic response and mucosal healing rates were similar between the two groups (endoscopic response: 35.3% for VDZ and 25.5% for ADA, P = 0.15; mucosal healing: 31.8% for VDZ and 33.8% for ADA, P = 0.85). CONCLUSIONS In the first study comparing VDZ and ADA in CD via propensity score analysis, the drugs showed comparable effectiveness and a similar safety profile.
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Affiliation(s)
| | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Aldo Sitibondo
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Barbara Scrivo
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Anita Busacca
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | | | - Salvatore Camilleri
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli", Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli", Palermo, Italy
| | | | | | | | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Rosalba Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Mario Cottone
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
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Macaluso FS, Ventimiglia M, Fries W, Viola A, Cappello M, Scrivo B, Magnano A, Pluchino D, Camilleri S, Garufi S, Mitri RD, Mocciaro F, Magrì G, Ferracane C, Citrano M, Graziano F, Bertolami C, Renna S, Orlando R, Rizzuto G, Cottone M, Orlando A. A propensity score weighted comparison of Vedolizumab, Adalimumab, and Golimumab in patients with ulcerative colitis. Dig Liver Dis 2020; 52:1461-1466. [PMID: 32601033 DOI: 10.1016/j.dld.2020.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND No real-life study on the comparative effectiveness of Vedolizumab (VDZ), Adalimumab (ADA), and Golimumab (GOL) in ulcerative colitis (UC) is currently available. AIMS To compare the effectiveness of the three biologics in consecutive patients with UC. METHODS A three-arms propensity score-adjusted analysis was performed using the Inverse Probability of Treatment Weighting method. RESULTS 463 treatments (VDZ: n = 187; ADA: n = 168; GOL: n = 108) were included (median follow-up: 47.6 weeks). At 12 weeks (n = 463), a steroid-free remission was reported in 24.1% patients in the VDZ group, in 33.3% patients in the ADA group, and in 30.6% patients in the GOL group (p = n.s. for all comparisons). At 52 weeks (n = 377), a steroid-free remission was reported in 51.5% patients in the VDZ group, in 31.2% patients in the ADA group, and in 29.4% patients in the GOL group (p = 0.002 for VDZ vs. ADA, p = 0.001 for VDZ vs. GOL, p = n.s. for ADA vs. GOL). Cox survival analysis demonstrated that patients treated with VDZ had reduced probability of treatment discontinuation compared to those treated with ADA (HR: 0.42, 95% CI 0.28-0.64, p < 0.001) and GOL (HR: 0.30, 95% CI 0.19-0.46, p < 0.001), while patients treated with ADA had reduced risk of treatment discontinuation compared to those treated with GOL (HR: 0.71, 95% CI 0.50-1.00, p = 0.048). CONCLUSIONS VDZ was superior to ADA and GOL at 52 weeks and as treatment persistence, while ADA showed a superior treatment persistence compared to GOL.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy.
| | - Marco Ventimiglia
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
| | - Walter Fries
- Inflammatory bowel disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Anna Viola
- Inflammatory bowel disease Unit, A.O.U. Policlinico "G. Martino", Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Barbara Scrivo
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone", Palermo, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Dario Pluchino
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele", Catania, Italy
| | - Salvatore Camilleri
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi", Caltanissetta, Italy
| | - Roberto Di Mitri
- Gastroenterology and endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli", Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli", Palermo, Italy
| | - Giovanni Magrì
- Gastroenterology Unit, A.O. "Santa Marta e S. Venera", Acireale, Italy
| | | | - Michele Citrano
- Pediatrics Unit, A.O.O.R. "Villa Sofia-Cervello", Palermo, Italy
| | | | | | - Sara Renna
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
| | - Rosalba Orlando
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
| | - Mario Cottone
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory bowel disease Unit, A.O.O.R. "Villa Sofia-Cervello", Viale Strasburgo 233, 90146 Palermo, Italy
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Macaluso FS, Leone S, Previtali E, Ventimiglia M, Armuzzi A, Orlando A. Biosimilars: The viewpoint of Italian patients with inflammatory bowel disease. Dig Liver Dis 2020; 52:1304-1309. [PMID: 32807691 DOI: 10.1016/j.dld.2020.07.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/07/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The viewpoint on biosimilars among patients with inflammatory bowel diseases (IBD) is largely unknown. AIMS We aimed at exploring the confidence and opinion on biosimilars among Italian patients with IBD. METHODS An anonymous, 20-item, questionnaire was sent via e-mail to all members of the Italian IBD patients' association (AMICI Onlus). Three sets of questions were formulated: 1: Characteristics of respondents; 2: The use of biologics and biosimilars in clinical practice; 3: General opinions on biologics and biosimilars. RESULTS Of the 4,302 total surveys sent, there were 1,749 respondents (response rate: 40.6%). There was an equal distribution between males and females (48.3% and 51.7%, respectively), and between patients with Crohn's disease and ulcerative colitis (46.9% and 51.3%, respectively), while most of the patients were aged between 19 and 45 years and between 46 and 65 years (45.5% and 42.0%, respectively). Approximately 45% of the respondents declared to have never been informed about the existence of biosimilars. The great majority of patients (73.9%) did not know if originators and biosimilars could be considered equivalent, or if efficacy or safety of biosimilars could be lower than those of originators. Approximately half of the respondents (53.5%) had no idea that the use of low-cost biosimilars could be useful to increase the overall economic resources for the treatment of IBD. CONCLUSIONS An extensive lack of knowledge and confidence in biosimilars exists among Italian patients with IBD. Efforts carried out by scientific societies and IBD patients' associations are required to overcome this issue.
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Affiliation(s)
| | | | | | | | - Alessandro Armuzzi
- IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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Macaluso FS, Orlando A. COVID-19 in patients with inflammatory bowel disease: A systematic review of clinical data. Dig Liver Dis 2020; 52:1222-1227. [PMID: 32928672 PMCID: PMC7474894 DOI: 10.1016/j.dld.2020.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 07/27/2020] [Revised: 08/29/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Great efforts by the scientific community are rapidly expanding the evidence on the clinical interplay between Covid-19 and inflammatory bowel disease (IBD). AIMS We performed a systematic review of the literature on published Covid-19 cases occurring in patients with IBD. METHODS PubMed Central/Medline and Embase were systemically searched for records up to May 31, 2020. RESULTS 13 cohort studies and 5 single case reports were included in the qualitative synthesis. A cumulative number of approximately 800 patients with IBD and Covid-19 were identified. The case fatality rate ranged from 0% to 20.0%. Overall, immunomodulators and biologics were not associated with higher risk of Covid-19 or with negative outcomes, while the use of systemic corticosteroids was related to worse prognosis in some studies. CONCLUSIONS This systematic review highlighted two main points that may help clinicians dealing with IBD in reassuring their patients: (1) patients with IBD do not seem to be at higher risk of being infected by SARS-COV-2 than the general population; (2) in case of Covid-19, treatment with immunomodulators or biologics is not associated with worse prognosis, while systemic steroids are suspected to be potentially detrimental, even if more data are needed to confirm this point.
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Affiliation(s)
- Fabio Salvatore Macaluso
- Department of Medicine, ''Villa Sofia-Cervello'' Hospital, Viale Strasburgo 233, 90146 Palermo, Italy.
| | - Ambrogio Orlando
- IBD Unit, ‘‘Villa Sofia-Cervello’’ Hospital, Viale Strasburgo 233, 90146 Palermo, Italy
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Macaluso FS, Fries W, Viola A, Costantino G, Muscianisi M, Cappello M, Guida L, Giuffrida E, Magnano A, Pluchino D, Ferracane C, Magrì G, Di Mitri R, Mocciaro F, Privitera AC, Camilleri S, Garufi S, Renna S, Casà A, Scrivo B, Ventimiglia M, Orlando A. Effectiveness of Ustekinumab on Crohn's Disease Associated Spondyloarthropathy: Real-World Data from the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). Expert Opin Biol Ther 2020; 20:1381-1384. [PMID: 32981373 DOI: 10.1080/14712598.2020.1830057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The effectiveness of Ustekinumab (UST) on Crohn's disease (CD)-associated spondyloarthropathy (SpA) is currently unknown. RESEARCH DESIGN AND METHODS All consecutive CD patients with active SpA at the initiation of the treatment with UST were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Diseases (SN-IBD). The primary outcome was the articular response at 8 and 24 weeks, defined as the disappearance of objective signs of arthritis (swelling and/or articular stiffness) and resolution of pain. RESULTS Thirty CD patients with active SpA at the initiation of the treatment with UST were assessed. At 24 weeks, 13 patients (43.3%) had an articular response, including 10/18 patients (55.5%) with peripheral SpA and 3/9 patients (33.3%) with axial and peripheral SpA. No patient with axial SpA experienced an articular response. The drop of mean as Harvey-Bradshaw Index values from baseline to week 24 was higher in patients with articular response compared with non-responders (3.8 ± 2.4 vs. 1.3 ± 2.8, p = 0.02). CONCLUSIONS Our real-world, multicentre experience showed that UST was able to obtain a response on articular symptoms in nearly half of the patients with CD and active SpA after 24 weeks of treatment.
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Affiliation(s)
| | - Walter Fries
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino" , Messina, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino" , Messina, Italy
| | - Giuseppe Costantino
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino" , Messina, Italy
| | - Marco Muscianisi
- Inflammatory Bowel Disease Unit, A.O.U. Policlinico "G. Martino" , Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone" , Palermo, Italy
| | - Laura Guida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone" , Palermo, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico "G. Giaccone" , Palermo, Italy
| | - Antonio Magnano
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele" , Catania, Italy
| | - Dario Pluchino
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele" , Catania, Italy
| | - Concetta Ferracane
- Gastroenterology Unit, A.O.U. Policlinico "Vittorio Emanuele" , Catania, Italy
| | - Giovanni Magrì
- Gastroenterology Unit, A.O. "Santa Marta E S. Venera" , Acireale, Italy
| | - Roberto Di Mitri
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli" , Palermo, Italy
| | - Filippo Mocciaro
- Gastroenterology and Endoscopy Unit, A.R.N.A.S. "Civico Di Cristina Benfratelli" , Palermo, Italy
| | | | - Salvatore Camilleri
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi" , Caltanissetta, Italy
| | - Serena Garufi
- Gastroenterology Unit, A.O.O.R. "S. Elia- M. Raimondi" , Caltanissetta, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo, Italy
| | - Angelo Casà
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo, Italy
| | - Barbara Scrivo
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo, Italy
| | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, A.O.O.R. "Villa Sofia-Cervello" , Palermo, Italy
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Macaluso FS, Fries W, Renna S, Viola A, Muscianisi M, Cappello M, Guida L, Siringo S, Camilleri S, Garufi S, Privitera AC, Belluardo N, Giangreco E, Bertolami C, Vassallo R, Rizzuto G, Orlando R, Ventimiglia M, Orlando A. Effectiveness and safety of vedolizumab in biologically naïve patients: A real-world multi-centre study. United European Gastroenterol J 2020; 8:1045-1055. [PMID: 32772830 DOI: 10.1177/2050640620948802] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Biologically naïve patients with inflammatory bowel disease treated with vedolizumab (VDZ) are largely underrepresented in real-world cohorts. A multi-centre, observational cohort study was performed on the effectiveness and safety of VDZ in biologically naïve subjects with Crohn's disease (CD) and ulcerative colitis (UC). METHODS Data of consecutive biologically naïve patients with CD and UC treated with VDZ from July 2016 to December 2019 were extracted from the cohort of the Sicilian Network for Inflammatory Bowel Disease. RESULTS A total of 172 consecutive patients (CD: N = 88; UC: N = 84; median age 66.0 years) were included, with a median follow-up of 58.8 weeks. After 14 weeks, a clinical response was reported in 68.2% of patients with CD and 67.9% of patients with UC treated with VDZ, including 45.5% patients in the CD group and 46.4% patients in the UC group who achieved steroid-free remission. After 52 weeks, a clinical response was reported in 77.4% of CD and in 73.8% of UC patients treated with VDZ, including 59.7% patients in the CD group and 60.7% patients in the UC group who achieved steroid-free remission. CONCLUSIONS This study demonstrates the effectiveness and safety of VDZ as a first-line biological, particularly among elderly patients.
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Affiliation(s)
| | - Walter Fries
- Inflammatory Bowel Disease Unit, AOU Policlinico 'G. Martino', Messina, Italy
| | - Sara Renna
- Inflammatory Bowel Disease Unit, AOOR 'Villa Sofia-Cervello', Palermo, Italy
| | - Anna Viola
- Inflammatory Bowel Disease Unit, AOU Policlinico 'G. Martino', Messina, Italy
| | - Marco Muscianisi
- Inflammatory Bowel Disease Unit, AOU Policlinico 'G. Martino', Messina, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Unit, AOU Policlinico 'G. Giaccone', Palermo, Italy
| | - Laura Guida
- Gastroenterology and Hepatology Unit, AOU Policlinico 'G. Giaccone', Palermo, Italy
| | | | | | - Serena Garufi
- Gastroenterology Unit, AOOR 'S. Elia-M. Raimondi', Caltanissetta, Italy
| | | | | | | | | | - Roberto Vassallo
- Gastroenterology and Endoscopy Unit, AO 'Buccheri La Ferla Fatebenefratelli', Palermo, Italy
| | - Giulia Rizzuto
- Inflammatory Bowel Disease Unit, AOOR 'Villa Sofia-Cervello', Palermo, Italy
| | - Rosalba Orlando
- Inflammatory Bowel Disease Unit, AOOR 'Villa Sofia-Cervello', Palermo, Italy
| | - Marco Ventimiglia
- Inflammatory Bowel Disease Unit, AOOR 'Villa Sofia-Cervello', Palermo, Italy
| | - Ambrogio Orlando
- Inflammatory Bowel Disease Unit, AOOR 'Villa Sofia-Cervello', Palermo, Italy
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Maida M, Macaluso FS, Sferrazza S, Ventimiglia M, Sinagra E. Effectiveness and safety of NER1006 versus standard bowel preparations: A meta-analysis of randomized phase-3 clinical trials. Dig Liver Dis 2020; 52:833-839. [PMID: 32586765 DOI: 10.1016/j.dld.2020.05.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/14/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A 1 L PEG-based preparation for colonoscopy (NER1006) has been recently developed. AIMS We conducted a meta-analysis of randomized controlled trials (RCTs) to explore the effectiveness and safety of NER1006 versus traditional preparations. METHODS PubMed/Medline and Embase were systematically searched through January 2020 for phase-3 RCTs comparing NER1006 versus standard preparations. RESULTS Three RCTs (1879 participants) met the inclusion criteria and were included. The analysis showed a higher cleansing success for NER1006 compared standard preparations (OR=1.28; 95% CI 1.00-1.62; p = 0.047, I2=0%) as well as a greater high-quality cleansing of the right colon (OR=2.13; 95% CI 1.16-3.94; p = 0.015, I2=76.0%) when assessed by the Harefield Cleansing Scale (HCS). The pooled estimate of the NER1006 effect on ADR showed a higher, although not significant, ADR of the right colon (OR=1.19; 95% CI 0.73-1.92; p = 0.485, I2=53%). When considering the impact of NER1006 on mild to moderate treatment-emergent adverse events (TEAEs), we observed a significant pooled estimate of TEAEs (OR=2.31; 95% CI 1.82-2.94; p<0.001, I2=0%). CONCLUSIONS When compared to traditional preparations, NER1006 showed a better overall cleansing of the colon as well as a greater high-quality cleansing of the right colon, with comparable ADR. A higher incidence of mild to moderate TEAEs was observed for NER1006, in the absence of serious adverse events.
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Affiliation(s)
- M Maida
- Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy.
| | - F S Macaluso
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - S Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento, Italy
| | - M Ventimiglia
- IBD Unit, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - E Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto San Raffaele Giglio, Cefalù, Italy
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